Finding Your Ideal Diet

I've said it once. I've said it a thousand times. There is no one diet that fits everybody... otherwise we would all be eating it. Each and every one of us should be listening to our bodies every day to try to find our ideal diet. It is my personal philosophy and approach as a doctor that the way our bodies react to a food is the most important piece of information we can use when choosing our diets. An example of a group of people who commonly make dietary decisions based on external sources is vegetarians. Yes, it's nice to say that you are morally opposed to eating meat and won't eat it because of your love for the animals... But what about the love for yourself? If you don't like the taste or meat and/or feel better when you don't eat it then by all means, don't eat it. The point here is not to outrage my vegetarian readers, but to make a point. We as a species need to re-learn how to listen to our own bodies and treat our body's opinion with the utmost respect and consideration. When choosing a dietary pattern to follow there is no outside force that should hold more weight than your body. And yes, that includes me and my blog.


Here is a brief summary and my professional opinion about some of the most common diets.

Weight Watchers. I'm not a big fan of good ol' ww and I'll tell you why: too much math. Seriously, guys, food shouldn't involve this much long division. I like that they attempt to assign a hierarchy to food so you can get a lose grasp of how good or bad something is, but they make it too friggin hard. Yes, you might be able to keep this routine up for a few months, but once you start leaving the calculator at home it's all down hill. I have mixed feelings about the fact that you eat normal food (as opposed to mail-away programs). On the plus side, it teaches you a little bit more about how to eat normal food once you're off the diet. On the down side, the point system allows for so many loopholes one could easily eat a cookie or something bad each day and still be A-OK according to the point system. Skip the math lesson and find a different way to lose weight, guys.

Mail-away food and pre-made food programs (Jenny Craig, Nutrisystem, Lean Cuisine) are, in my opinion, are the scourge of the nutritional world. These programs lure you in with pictures of luscious chocolate cake in their infomercials, only to let you down when you see the size of the portions you get when you receive your order. I'm not a huge fan of calorie-restrictive diets anyway, but my main beef with this type of diet is the mail-ordered meals. These programs might work while you're on them, but leave the person hopeless and alone in a world full of super-sized meals when they are done. The result? Weight gain like you wouldn't believe. Don't become a mail-away food junkie. These programs teach you exactly zilch about how to eat in the real world.

Medifast has been around for a long time, and as far as I can tell it's basic premiss hasn't changed much. They operate by the 5-1 plan, five 100 calorie shakes throughout the day and 1 protein and vegetable meal. Aside from the fact that this one will totally leave you starving and hypoglycemic throughout the day, this program has some serious health concerns. I have heard numerous doctors say that patients who have done Medifast (especially more than once (yo-yo!)) tend to have gallstones. I don't know the mechanism, but apparently the program does a number on your gallbladder and liver. Doesn't that sound like something the FDA should have banned long ago? Yeesh. My other big issue with Medifast is, like the mail-away plans, it teaches you next to nothing about how to eat real food. Sure, you can lose weight when you starve yourself with their shakes, but the weight will go right back on as soon as you go back to eating "normal" food.

South Beach Diet has been gaining popularity in the last 10-20 years, and from what I can tell it seems pretty solid. They emphasize "good carbs" and "good fats" to replace the bad ones, and the whole diet sounds similar to the Mediterranean diet, which is a really good over-all pattern and starting point to model how you eat. I don't know much more about South Beach than that, but from what I have read this one sounds pretty decent.

Vegetarian... Ahhhhh they are an interesting group of people. Before I say more, I must admit that I was one for about 12 years, and have known and even lived with many others. The biggest issue with our veggie friends isn't the protein, but the fact that they often think they are far healthier than they actually are. It's like they all have vegetarian blinders on or something. When I was a vegetarian I think I survived on cereal, pasta, stir fry, pizza, frozen veggie burgers and baby carrots and you know what? I would have told you I was the healthiest eater I know. If you don't want to eat meat, you'll do great if you do it right, just don't become another self righteous junk food vegetarian. The vegetarian diet is great if you actually eat a lot of vegetables, but the way that I and so many others approach(ed) this diet is all wrong.

Vegan. Even though vegans take it only one or two steps past vegetarians in the foods they eliminate, they tend to be much healthier than their veggie friends. Maybe it's because virtually every processed food has milk or egg in it somewhere. Maybe it's because you have to be a special kind of health freak to go full-blown vegan. In either case, I think that the vegan diet is a good one, but not one that I personally choose to follow. One probably unintentional plus side to going vegan is the avoidance of two common, potent food allergens: Dairy and Eggs. Just avoiding those two will bring your inflammation down a few notches!

Raw food vegan (also simply called Raw) is yet one step further than simply going vegan- they don't eat anything that has been heated past 115 degrees. Another often unintentional plus of this diet? Raw almost always means no gluten (who eats plain flour? yuck.), which is the most serious and common allergen on the market today. I personally eat a lot of raw and minimally cooked veggies, but this has it's pros and cons. Raw eaters and critics go back and forth arguing which is best, cooked or uncooked, but I think this is a moot point. One is not inherently better or worse- they are simply different. Your body will react differently when you eat cooked vs raw broccoli. One will have more of vitamin X, one won't have broken down and released enzyme Y. Some foods are better cooked, such as tomatoes. Cooking tomatoes releases their lycopene and makes it more bioavailable. Garlic is best eaten raw, as the allicin in it is released when the raw, crushed garlic is exposed to oxygen. I think the best approach is to eat a wide variety of cooked and raw veggies every day to ensure you get a little of everything.

Juice fasting is what I believe to be the last step in the veggie diet spectrum, and has been getting a lot of attention lately. I think juice machines are a great way to make your own juices at home- I would love to not buy bottled carrot juice for my green smoothies and just make it from fresh carrots. I would say that I am a fan of juicing, but not long-term juice fasting. I could see juicing as part of a meal or even as one meal per day, but the idea of only consuming juice for weeks and months at a time doesn't sound healthy. The two big benefits of doing a juice fast are that you're avoiding all processed chemicals and junk (Have you ever found red dye #3 in a carrot? Didn't think so!), and the act of juicing is supposed to make vitamins and nutrients more available to the body. Keep in mind that one could also adopt a raw food diet to accomplish the first objective. Now here's why I'm still leery of the juice fasting idea. Taking out the insoluble fiber, the "meat" of the vegetables does two things to digestion. First, it allows for super fast absorption. This is a good thing when you're talking about the vitamins, but that also means that the sugar (which is abundant in a lot of veggies such as carrots) gets absorbed very quickly. This blood sugar spike and dump will leave you feeling "blah", at least until your body has gotten used to the roller coaster ride. Also, removing the bulk from the veggies takes most of the work load off the GI tract. Again, juicing advocates will say this is a good thing because you are resting your GI tract, but I also see it as a decrease in the stimulation to this group of organs, their muscles, and the nerves and parts of the brain that normally control them. Lastly, I will say that juice fasting is by far the healthiest version of the diets that don't teach you how to eat in the real world, but the reality is that it doesn't teach you anything about how to eat in the real world! Sure, it's better than medifast and Jenny, but once you ween yourself off the juicer what skills and practical knowledge have you gained? Not a lot. Good luck going from a juice fast back into navigating restaurants, busy schedules, and non-juiceable food. Now, I have to say this- there are a lot of people (including one friend of mine) who have done great things for their bodies by juice fasting for a few weeks or months, so I'm not writing this one off entirely. At this point, I am a fan of juicing (or better yet, green smoothies that let you keep some of the fiber), just not juice fasting.

Atkins/ Low Carbohydrate diets don't sound so fun, but they work. Unfortunately, we in this country are quick to label anyone who wants to take away our IHOP as a quack, and Dr. Atkin and his diet certainly earned that reputation. Atkin was a little extreme for even me- a little too much counting and math and, as I recall, the counting of carbs that are in vegetables, which I think is absurd. The modern Atkins diet is essentially the Paleo diet (see below), which tends to emphasize more veggies when done correctly. To learn more about why low-carb diets are great for losing weight, check out Gary Taubes [1].

Paleo, the so-called caveman diet operates on the premise that we should eat what our bodies were designed to eat. The idea is that our genes and our bodies haven't had a chance to evolve as quickly as our world. It takes hundreds of thousands of years to make even minor changes in our bodily structure and function, yet our world has changed drastically in the last 200 years. Paleo generally means the avoidance of all grains, legumes, beans, refined sugar, and processed foods. This diet has a heavy emphasis on healthy (humanly raised, grass-fed, cage free, organic, etc) meats and eggs, fresh fruits and vegetables. Think of it as the anti-junk food vegetarian diet (which tends to be high in grains, dairy and processed foods). I think that Paleo is the closest thing I've found to working for most body types and having the best philosophy behind them. That, and the food tastes great, so you'll literally never get bored doing this diet. Just be careful to not go too meat happy and this one gets the Nikki seal of approval. Bonus: aside from the eggs, this diet avoids many of the major food allergens that cause so many people grief and inflammation.

Gluten-Free (or other allergen-free) is great if done correctly. The gluten free market is booming in 2012 and it is now possible to find any food you ever wanted sans-gluten. Gluten free is only marginally healthier than the baseline Standard American Diet (SAD) if it consists of gluten free pastas, cereals, canned soups, and breads on a regular basis. However, there is something to be said for avoiding foods that irritate your gut and your immune system, and this diet should be a piece of everyone's diet... Just don't let it end there. No, gluten free is not a fad, and it's not going to go away- I think it is going to continue to grow for many years to come. See my previous posts about gluten and leaky gut for more information.

Dosha Dietary patterns are truly fascinating. The basic gist is that foods have certain properties (heavy, damp, heat, astringent, cool), and different body types exhibit different properties and characteristics. Vata tends to be more cool and airy, and will be aggrevated (become more prominant) if one eats foods that are similar in property (cool, astringent, airy). Pitta tends to be warm, damp and heavy, so this body type benefit from eating things that pacify (decrease) pitta and keep it in check. For example, dairy (phlegmy, thick) tends to not agree with pittas, but something dry and airy like popcorn would balance this dosha. Kapha is the cool, damp dosha, and should avoid foods such as dairy, which would exacerbate the kapha's already damp, phlegmy nature, but do well with warm, astringent foods such as warm tea or spices such as ginger and turmeric.[2]

Lastly, I leave you with the ultimate dietary strategy: Eat food. Not too much. Mostly plants. Michael Pollan sums it up beautifully [3,4]! Don't let your diet rule your life- Enjoy what you eat, don't do too much math, and just eat real, healthy food and you should be well on your way to a healthier tomorrow!

Learning every day,

Nikki Cyr, D.C.

Links
[1] http://www.youtube.com/watch?v=_6fgBj14Jdc&feature=related
[2] http://ayurveda-foryou.com/treat/doshadiet.html
[3] http://www.youtube.com/watch?v=c31cAdYUvT8
[4] http://www.amazon.com/Food-Rules-Eaters-Michael-Pollan/dp/014311638X

A New Year, A New You

It's almost that time of year again. January 1st marks the beginning of a new year, and for many, an opportunity for change. With the two biggest indulgent, food oriented holidays of the year behind us, the beginning of the new year is the perfect time to wipe the slate clean and make those new years resolutions. The most common new year's resolutions have to do with our health; weight loss goals, giving up smoking or drinking, exercising, and dieting. But as many of us know all too well, sometimes those goals are easier said (on New Year's) than done.

With over 1/3 of the US population considered obese [1] and even more overweight, probably all of us have been on a diet at one point or another. For most, the word diet evokes feelings of mental anguish and deprivation. When people think of diets they think of calorie restriction, eating salads, and making the switch to flavorless "diet" and low calorie products. To add insult to injury, while you eat your plain salad and aspartame ridden, cardboard-flavored "diet" food products, you must deal with the inner torment and yearning for the foods you once loved. For many, the thought of seeing someone else eating the food you really want is simply too painful to bear, and while on our diets we turn ourselves into reclusive hermits, counting the days until our captivity ends.

Which brings me to my second problem with the word diet- the implication that diets are temporary. Often times the diets people go on are so unbearable they don't last more than a few months. Feelings of relief that the diet has ended usually leads to a rebounding of poor choices that causes the person to eat especially unhealthy foods, and thus the stage is set for the weight to come back on hard and fast. This called yo-yo dieting; periods of diet and exercise induced weight loss followed by periods of falling off the wagon and weight gain. This fluctuation is not only counter-productive because it typically leads to weight gain over time, but it's downright unhealthy. The psychological and physical stress of yo-yo dieting may very well be more deleterious than being at a constantly unhealthy weight. That is why it is crucial to identify areas for improvement from past experiences, make a plan, and take the steps that will help you achieve your goals.

Dieting doesn't have to be torture, because torture is merely a state of mind. If we can all learn to feel empowered by our choices, rather than imprisoned by them, we can start on the road toward true health. Of course the first step toward changing how we diet is to change how we define the word diet. There are four primary definitions of the word diet on the merriam-webster dictionary website [2], only one of which fits the profile I just painted. I much prefer this definition:

Diet:
Habitual nourishment.

Two words. At first glance this definition is so simple, but in truth it represents so much more than those two little words ever hoped to convey. To fully understand and appreciate these two words we need to shift how we see our food as well as our relationship with that food.

Habitual. Many of us don't realize that our eating patterns are, in fact, quite habitual; something that is done with regularity and predictability. Yes, it's easier to look at that trip to Burger King in isolation ("one burger is no big deal"), but if you look back on the last few months can you pick up on a habit? Maybe it's not always BK. Maybe it's that popcorn every time you go to the movies, that desert when you went out to eat with friends, those sodas every time you gas up your car, or the constantly stocked stash of Betty Crocker in the pantry. Sure, no one thing is a big deal on it's own and hardly constitutes a habit, but make no mistake- this is still a habit and your body is still feeling the effects of this pattern.

Nourishment. All too often we forget that that which we consume has a greater purpose- to nourish us. Each and every day our cells replicate, get injured, heal themselves, live and breathe. Their busy lives require a multitude of different vitamins, minerals, amino acids, anti-oxidants and other nutrients... none of which can be found in it's usable state in the vast majority of the "food" on grocery store shelves. Putting unhealthy food into your body is like putting WD40 into your car's gasoline tank. Sure, it's still a petroleum-based liquid and given enough of it your car might even make it a few miles down the street, but you know it's not the proper fuel for your car. Just as using improper fuel in your car will cause it to age and breakdown prematurely, so the same will happen to your body if you don't give it the nourishment it needs.

So, as you consider your goals for the new year I hope that you re-think your definition of the word diet. Make the healthy changes in your life positive and long-lasting, not torturous and short-lived. Your 2013 self will thank you for it.

Looking forward to 2013.

Nikki Cyr, D.C.

References
[1] http://www.cdc.gov/obesity/data/adult.html
[2] http://www.merriam-webster.com/dictionary/diet
[3] http://www.urbandictionary.com/define.php?term=diet

A Practical Approach to the New Year

Okay, let's face it. New Year's resolutions don't usually have a great success rate [1]. Somewhere around half of Americans make a resolution each year, but few resolutions actually become permanent changes. The most bothersome thing about this is that the vast majority of those resolutions are health related. It breaks my heart to see people fail to follow through with health goals, so I sincerely hope that this post gives you the tools you need to succeed this year.

Nikki's Top Ten Tips to New Year's Success

1. Recall your previous resolutions and what hindered your success in the past. Learn from your mistakes. Did your fitness goals fizzle when you got board with that 24 hour fitness membership? Perhaps dance lessons or a membership to a rock climbing studio would hold your interest longer. Did your dietary goals get tossed aside when your valentine got you that Costco-sized box of chocolates? Plan on bringing in unplanned goodies into the office to share instead of leaving that melding, tempting box at home.

2. Do your homework- Learn from other people's mistakes. Blogs are a fabulous tool to use in this day and age. People post an endless amount of wisdom and numerous stories on blogs and forums that are just waiting to be found. Better yet, find someone who has succeeded at what you are trying to accomplish and ask as many questions as you can.

3. Set realistic goals. This one sounds simple enough, but it's really not. I can't tell you how many times I discussed goals with my clients when I was a personal trainer. Time and time again I would hear "I need to lose 20 lbs in one week for a wedding/reunion/bathing suit season." I explained to these people that their goal was most likely not realistic given the time frame they had given me, but I would do everything in my power to help them achieve that goal as quickly and smoothly as possible. In this case a realistic time frame to lose 20 lbs is 1-2 months with the proper work out and dietary choices. After that initial faster weight loss period (generally the first month or two after making changes), expect 1-2 lbs per week.

4. Write your goals down and tell people about them. The more you talk about your goals and see them the more real they will become. Added bonus: Telling all your friends you've started a fitness routine will keep you accountable and they may even be inspired to take up a similar goal!

5. Set several small goals that can be achieved en route to your ultimate goal. This will help keep you motivated until you reach that big goal. It may be hard to focus on that distant goal after a while, but if you give yourself check-points along the way it will remind you that you are making progress. For example, let's say you want to lose 60 lbs by next New Year's Eve. Perhaps good sub-goals would be to lose 20 lbs by March (keep in mind the initial faster weight loss phase), 30 (half way) by May, and an even 50 by October. Now when you fall off the wagon and have a few too many cookies in April you won't think man, I've only lost 25 lbs.. I'm still so far away from my goal and I've already cheated. Ah well, better luck next year. Instead you can say Yeah, I have a way to go, but I achieved my first goal and am on target to reach my next goal a few weeks early if I stick with it and don't let this derail me!

6. Plan your route to success. Try to anticipate bumps along the road, and what you will do when you encounter them. Maybe you know ahead of time that barbeque is your culinary weakness and you're going to splurge on the 4th of July. Instead of letting that ruin your day, tell yourself ahead of time that you will do at least two things to further your health on that day. Maybe meditating in the morning and a 5k in the afternoon? Or maybe that barbeque chicken wouldn't be such a bad thing if you planned ahead and brought a few healthy side dishes to your 4th of July party. It's all about planning and off-setting any bumps in the road.

7. Plan rewards for when you achieve your goals. No, I'm not saying that losing 5 lbs is reason enough to binge drink and eat an entire Cold Stone cake, but you should be proud of your accomplishments and you should celebrate them. Make yourself some paleo walnut fudge [2] or some coconut avacado chocolate pudding (trust me, it's delicious) [3] for a treat when you reach a benchmark!

8. Picture your life after you achieve your goals. World class athletes have long known the benefits of visualizing success. I am a firm believer that you tend to move toward your dominant thoughts... So why not take advantage of that and think about success? I know it's hard to turn off the worrying autopilot in our brains, but you should, you can, and you must start using your mind for your own good. Meditation is a great way to start practicing this, but not entirely necessary. Whenever you get 5 minutes of down time just close your eyes and picture yourself when your goals are achieved. Who knew day dreaming was so practical!

9. Know that falling off the wagon is not only common, it's part of the learning process. Rather than being consumed with guilt when you inevitably stray from your planned path (see tip 6), use that energy to re-assess what your goal really means to you and what you have learned from the detour. Nothing in life is (or has to be) 100% all the time, and nobody is perfect. Tell yourself ahead of time that it's okay to deviate from the plan from time to time, but it's important to always move forward. Most importantly, don't be tempted to throw in the towel all together when you get steered off course (Well, I had a piece of Cake at the office party. Guess my diet is ruined! Might as well buy those Oreo's I've been craving for the last month!)

10. Involve friends and make it fun! Don't just jog in place with that big frown on your face- invest in a few Zumba tapes with some friends and make a schedule to go over to each others houses to use them. Don't turn that diet of yours into a month of eating salads alone at home- find a few healthy recipes and organize a healthy foods potluck with your friends and family. We are social creatures by nature, and what better way to socialize than over common goals!

Looking forward to a healthier 2013,

Nikki Cyr, D.C.

[1] http://www.statisticbrain.com/new-years-resolution-statistics/
[2] http://www.thepaleomom.com/2012/04/recipe-chocolate-walnut-freezer-fudge.html
[3] http://mysanfranciscokitchen.com/coconut-chocolate-avocado-pudding/

Iron Deficiency Anemia

Anemia is a relatively common condition in which the blood's Oxygen carrying capacity has been compromised. This may be due to a loss of red blood cells, low Iron or hemoglobin, lack of B vitamins, or misshapen red blood cells as is seen in Sickle Cell Anemia.

The most common form of anemia both worldwide and in the United States is Iron deficiency anemia (IDA). Commonly seen in women, particularly those whom are pregnant, have a heavy menstrual period or are vegetarians, IDA is easily corrected by increasing your consumption of Iron. This is usually accomplished by taking a prescription Iron pill that I have nicknamed the Home Depot Special. I mean, have you ever cut one of those things open? It looks like someone took a chunk of Iron ore from the Home Depot, made it into a pill, and painted it red.

IDA seems like a simple enough condition with an even simpler cure: Take Iron. But after our last blog post where we discuss just how toxic inorganic Iron can be to the human body, it may leave our anemic readers a bit confused. On the one hand, you don't want to be anemic- without proper oxygenation of your tissues your body will be less able to build and repair itself and it will leave you feeling worn down. On the other hand, being the well-read, informed patient that you are, you probably don't want to take the Home Depot Special pills, either.

First we must ask the question, why is your Iron low in the first place? The many different causes of IDA require completely different treatments.

1. You lose a lot of blood. This is generally seen on a CBC as a high RDW value (above 15 on most labs). Perhaps you have a heavy menstral period because of a hormonal imbalance or PCOS, in which case addressing those conditions would correct the problem. Perhaps you have an internal bleed such as an ulcer, which would require a completely different work up and treatment than the above.

2. You don't eat enough Iron. Most people will tell you that this is seen in vegeterians, but I have found that vegan and vegeterian eaters can get along quite alright without extra protein and Iron. In my experience, this is more often due to just plain old unhealthy eating habits. There's not a whole lot of nutrients in Doritos last time I checked, guys. Stop fooling yourselves and eating that garbage.

3. You're not absorbing the Iron you are taking in. Honestly, I think this is by far the most common (perhaps in combination with number 2) reason people develop IDA. The big thing you need to know is that you need two things to digest and absorb Iron: Stomach acid (to break it down) and a healthy intestinal tract (to bring it into the body).

Low stomach acid, or hypochlorhydria, can be caused by a myriad of things including infection by a bacteria called H Pylori, or drugs that decrease stomach acid. For example, proton pump inhibitors (Prilosec, Omprezole) decrease the stomach cells' ability to make stomach acid. These drugs are used to treat ulcers, but all too often patients are left on these drugs for years after the ulcer has healed. Likewise, acid blockers such as Zantac and Pepsid have become increasingly popular and are often taken on a long term basis. These drugs are often advertised with the implication that you can now eat whatever you want without all those pesky unpleasant symptoms. I guess they forgot to mention the fact that those symptoms are just your body screaming please don't do this to me.. For Pete's sake put down the hot dog!!

Altering the state of the stomach's acidity not only leaves you vulnerable to nutrient deficiencies such as IDA, but it leaves the GI tract vulnerable to infection by opportunistic bugs like H Pylori. Because these drugs drastically alter your ability to digest your food properly (especially protein), food transit time through the stomach slows, allowing food to sit in the stomach for long periods of time and fester. This putrid food hanging out in the stomach longer than it's supposed to may produce symptoms of indigestion. Wait, wasn't that what we were trying to avoid in the first place?

Many, many things can cause malabsorption at the small intestine level. Celiac Disease, Crohn's Disease, Ulcerative Colitis, and Leaky Gut Syndrome have all been known to cause multiple nutrient deficiencies, and as you can imagine, their treatment involves far more than one little Iron pill. Another increasingly common reason for malabsorption in this country is due to malabsorptive surgery such as the gastric bypass. There are several various flavors of bariatric surgery, and they all have slightly different effects on the GI tract. For example, the gastric bypass mostly alters the stomach size, and therefore has the greatest impact on one's acid producing equipment. The Roux-en Y Gastric Bypass, on the other hand, is a procedure in which they actually bypass the first part of the small intestine all together. This sets the stage for great potential weight loss, but also for great potential nutritional consequences. Since about 90% of the vitamins and minerals in food are typically absorbed in that first, short portion of the small intestine, bypassing it severely handicaps that GI system for the rest of that persons life.

So what can we do to try to correct IDA without taking the Home Depot Special pills?

1. Stop to think, why am I anemic in the first place? Yes, getting to the root of the problem might be harder than simply popping a pill for the rest of your life, but it will be worth it. Really.

2. Stop with the acid blockers already! If this means going off a prescription medication communicate with your doctor, but be aware that they might think you've lost your mind. Your doctor should know that these medications were never meant for long term use, but if they give you a hard time just stick to your guns and explain why you are concerned.

3. Eat food that actually contains Iron. I know, it's a wild concept. And no, this does not mean that Iron fortified cereal is now a health food. I'm talking about real food that has real Iron- healthy meats, spinach, kale, chard and other green leafy veggies.

4. Even after all that if you are still Iron deficient (perhaps due to pregnancy), find a source of Iron supplementation that didn't come from a hardware store. I don't know of one off hand that is commercially available, but if you talk to someone in the supplement section of a Sprouts or a Whole Foods they should be able to help you. Functional medicine doctors such as myself often carry good quality Iron supplements in their office, but these products will only be available through the doctor's office.

Happy to be out of their box,

Nikki

Metals That Might Make You Mental

I've said it once. I've said it a million times. They haven't found a cure for Alzheimer's Disease because they don't know what causes Alzheimer's Disease. They don't know the cause of AD because there is no cause, per say. There are genes that make you more prone to the disease (such as ApoE), but there is no AD gene. There is no vitamin deficiency, toxicity, gene or one thing that causes AD. Instead, it appears that AD is a multifactorial disease that is caused by a different mix of things in each individual person. The only true cause that continues to have overwhelming evidence confirming it's role in causation of AD is inflammation... But that's where the multifactorial thing comes in. Weather it be a bad diet, head injury, drugs, infections, thoughts, toxins or autoimmunity, many things cause inflammation. Therefore, many things can contribute to one developing Alzheimer's Disease. The Alzhimer's Disease brain is a brain on fire, and research continually shows us that the fire starts many, many years before we see the smoke. There is no magic bullet to prevent Alzheimer's Disease; you just have to live a healthy life.

Everybody has heard of heavy metals. The bad guys of the periodic table, heavy metals such as mercury and lead have been associated with a wide range of diseases and disorders. But what about other metals? What about the metals we thought all along were good for us? In comes Iron (Fe) and Copper (Cu), two transition metals that may be new culprits in the AD puzzle and inflammation in general. But everybody knows we need iron to make hemoglobin, so having too much couldn't possibly be a bad thing, right? Wrong. The type of Iron or Copper dictates how it functions in the body, and having too much of the "bad" kind can wreak all sorts of havoc on the body.

Transition metals are unique because they exhibit two or more oxidant states (for example, Fe+2 and Fe+3). This is what makes able to participate in chemical reactions and makes them particularly useful in day to day bodily functions. This characteristic also makes them remarkably able to bind with stuff we don't want them to bind to and create free radicals. Free radicals like the hydroxyl ion are then able to scamper about the body binding to molecules and altering their function... This is the hallmark of inflammation- free radical damage that alters the body's normal molecules, and subsequently alters the function of those molecules.

For simplicity's sake, there are two basic types of metals: free metals (inorganic) and metals that are bound to other stuff (organic). Weather or not these metal ions are bound to a molecule (such as a protein) will affect how they are absorbed and processed by the body. Organic Copper and Iron compounds are absorbed a little slower by the intestinal tract, but more importantly they are processed differently than their inorganic brethren. Food Copper (and Iron) must go through additional processing in the liver before it is allowed into systemic circulation (the blood stream). Typically the body keeps most of it's Copper bound to proteins and keeps the more unstable, inflammatory free Copper to a minimum (5-15% total Cu in the blood). When inorganic Copper is absorbed it immediately contributes to the free Copper pool in the blood steam, bypassing the liver and increasing the risk of inorganic Copper induced oxidative stress [1]. Similar is true of Iron's story.

The proposed mechanisms of how inorganic Copper and Iron contribute to the inflammation in AD are numerous, but here are a few.

Copper has been shown to bind with homocysteine (an inflammatory molecule that is related to one's intake of B vitamins) and increase the oxidation of LDL- the so-called "bad" cholesterol [1, 2]. Cu, unlike Zinc, Nickel, Aluminum, or Cadmium, has been shown to compromise the stability of Ubiquitin. The Ubiquitin-Proteasome System (UPS.. haha) is the main pathway by which we eliminate misfolded proteins from our cells such as the notorious Beta Amyloid of Alzheimer's Disease and the Lewy bodies that are seen in Parkinson's Disease [5]. This may result in decreased clearance of these proteins in the brain, eventually leading to a build-up, cellular toxicity and death. Even the so-called AD gene may be related to Cu metabolism! The three different ApoE Alleles differ in the number of cysteine binding sites they posses- the part of the molecule that is able to bind to Copper. ApoE 2 has two binding sites, ApoE3 has one and ApoE 4 has none. This correlates with the risk of AD associated with each of those alleles (2 is protective against AD, 3 is neutral and 4 increases your risk). It has now been postulated that the risk associated with the ApoE alleles is due to ApoE 4's inability to bind and remove Copper from the brain [2].

Like Copper, Iron is necissary for human life, but an excess of inorganic Iron may be one of the inflammatory triggers in the AD cascade. Several studies have shown that Fe accumulates in Beta Amyloid plaques [3]. Not only that, but the presence of Iron during plaque formation not only increases the synthesis of Beta Amyloid by it's interaction with PACE, but it has been shown to favor the more toxic form of the plaques [4].

As in all things in life, your current inflammatory status will play a role in how you handle further stressors. Inflammation disrupts the blood brain barrier (BBB) and alters it's ability to regulate the transport of Fe to and from the brain [4]. HAMP, the gene that is responsible for the production of Hepcidin (THE Iron homeostasis hormone in our bodies) is directly influenced by inflammatory cytokines such as IL-1B and IL-6 [4]. Similarly, the mechanism I mentioned above of how Copper binds to homocysteine to produce inflammation would probably not be that big of a deal if you didn't have high homocysteine levels in the first place!

So what can we do to avoid the damage caused by inorganic Copper and Iron?

1. Decrease your inflammatory burden. I've said it once. I've said it a thousand times. This is highly individual, since no two of us have the same health problems. Weather it be being overweight, not exercising, a crappy diet, diabetes, gastrointestinal issues, an autoimmune disease, or whathaveyou, get healthier. If you're not inflamed it appears that these pesky metals won't hurt you as much.

2. Avoid inorganic Copper and Iron. Brewer et al [1] and several others have identified the two major sources of inorganic Copper and Iron as being Copper in our drinking water from Copper pluming and multivitamins (like Centrum). Interestingly, Brewer et al [2] points out in his paper that all of the industrialized countries are dealing with increased rates of AD- Except Japan. This is noteworthy, because Japan is the only industrialized country that does not use Copper pluming. In contrast, about 85% of US homes have Copper pluming [2]. Here's what you can do to minimize the amount of Copper that leaches into your water and avoid inorganic Copper and Iron:
     A. Filter your water. Brita.com does state that their filters filter Copper, but I can not say to what extent. Reverse osmosis is the best at
     filtering things like Cu and Fe, but is more expensive.
     B. Do not get hot water from the tap- Hot water will leach more Cu from the pipes than cold water- Warm the water after it comes out of the
     faucet.
     C. Check the acidity of your water. The more acidic your water, the more it will etch the Copper pipes.
     D. Avoid multivitamins like Centrum. They look like a big ol' piece of metal that they painted red anyway, so who are we fooling when we
     take those? There is no substitute for the vitamins and minerals you get from a healthy diet. Period.

 3. Zinc has been shown to lower levels of free Copper in the blood [2], so making sure you have adequate Zinc levels may be a good idea if you think you're at risk of ingesting too much Copper (perhaps people who have really acidic water at home and can not afford to install a reverse osmosis system).

Healthfully yours,

Nikki

References:
[1] Brewer, G. Risks of Copper and Iron Toxicity during Aging in Humans. Chem Res Toxicol 2010, 23, 319-326 (PMID 19968254)
[2] Brewer, G. Copper Toxicity in Alzheimer's Disease: Cognitive Loss from Ingestion of Inorganic Copper. J of trace elements in medicine and biology 26 (2012) 89-92. (PMID 22673823)
[3] Batista-Nascimento, L. et al. Iron and Neurodegeneration: From Cellular Homeostasis to Disease. Oxidative Medicine and Cellular Longevity, May 2012 (PMID 22701145)
[4] Mesquita, S. et al. Modulation of Iron Metabolism in Aging in Alzheimer's Disease: Relevance of the Choroid Plexus. Frontiers in Cellular Neurosci. May 2012 (PMID 22661928)
[5] Arnesano, F. et al. Copper-Triggered Addregation of Ubiquitin. PLoS ONE 2009 Sept 16; 4(9) e7052 (PMID 19756145)

When in Rome

.... DON'T eat what the Romans eat. Unless by Rome you mean Greece or another part of the world that still eats real food. But if by Rome you meant anywhere in the continental US, save yourself the inflammation and bring your own healthy food.

I always bring food with me when I travel. I can't afford to be stranded in the world without my food. What they eat scares me!

Case in point: gas stations. They always manage to have all the scariest edible food like substances *shiver*. Take Michael Pollan's advise: "don't fuel up at the same place your car does"!

In route to great things,

Nikki

Coping with the Inflammatory Aftermath of Halloween

Halloween has come and gone yet again, and once more I was left with a moral dilemma: How can I teach people to eat healthy and NOT eat candy and yet give out candy on Halloween? To me that's almost as bad as telling people to not do drugs and handing out little baggies of crack at my door once a year. I had to find a way to participate in the holiday without contributing to the inflammatory tradition.

I tried thinking of something else to give kids. Pennies? Stickers? Surely my house would be egged. Mike ended up getting us little baggies of trail mix and peanuts to give out, which made me feel a lot better. But despite our best efforts thousands of kids are going home tonight with a bag full of candy. So what can we do as health-conscious Americans to off-set some of that inflammation?

Dentists across the country buy Halloween candy from kids and send it to troops over-seas. What a great way to encourage your kids to give-up their precious candy stash! Granted, it's still not healthy for anyone to be eating that candy, but at least solders have a higher metabolic rate than most children. Sure, they'll have to worry about the inflammation now, but at least that candy won't contribute to the all too real threat of childhood obesity we now face. To find a participating dentist near you check out this site.

Wishing you a cavity-free Halloween,

Nikki

Reference:
http://www.halloweencandybuyback.com/

A Note on Choosing Supplements

I recently went to a health talk that my supervising doctor put on at Arizona State University, and one of the attendees brought up this great question. How do you find good quality supplements? I mean, if you walk into a Whole Foods or a Sprouts these days it's like the bread isle on crack. There's 8,000 companies offering 9,000 products, all the while claiming that theirs is the best. But how do you know you're getting what you paid for? Or more importantly, how do you know if you're paying for something you really didn't want?

Functional Medicine practitioners such as myself work with pharmaceutical grade supplements from many different companies. Such companies only sell their products to licensed healthcare professionals. To you out there in the world who just wants some vitamins this may be annoying, but believe me when I tell you it is for your own good. When they say pharmaceutical grade they really mean it... which means two things. On the one hand, you can have a great therapeutic (positive) effect with these supplements. On the other hand, you can do a lot of damage with them if you take them inappropriately... I know- I've made myself sick stimulating the wrong pathway a time or two and I've heard friends' stories after they've done the same. If these products got into the hands of the general public who doesn't know how to use them properly a lot of people would be in a whole world of hurt. I'm not saying that non-pharmaceutical grade supplements aren't effective... Just perhaps not as effective as what we in FM use. The other plus side to going to a doctor for your supplements is that they will run tests (blood, urine, saliva) to ensure that you are taking the right thing.

For those of you who don't want to go to a doctor, there is a more reasonable way to find good quality supplements. Consumer labs is a third party company that tests and reviews different supplements. There is a small subscription fee that goes toward funding the tests that they run, and it is well worth the fee. Not only do they test the supplements for what they claim to contain, but they test for contaminants. For example, their review of vitamin D supplements revealed two products that were contaminated with Lead [1]!

Stay healthy,

Nikki


References:
[1] https://www.consumerlab.com/reviews/vitamin-d-supplements-review/vitamin_d/

Healing the Gut

Yes, my dear followers, there is life after leaky gut syndrome. I recommend doing this protocol while doing an elimination diet. Oftentimes, people say "they went gluten free but didn't feel better", and often times it is because they either were not 100% gluten free OR their gut never got the opportunity to fully recover. In this blog post I am going to give you the tools you need to heal your gut, but I must preface this with a warning: 
                                                                                above all else listen to your body!

While these things work great for most of the cases I have encountered, no two people are alike. I have met people who made their gut problems temporarily worse doing one or more of these things. The key, as with anything in life, is to listen to your body. If something makes you feel worse stop doing it. Furthermore, if one of these things doesn't agree with your body it's a good indication that you should get checked out by a doctor and managed by them rather than a blog. Without proper testing you simply don't know for sure what is going on inside your body, but it has been my personal experience that these things work for most people. For example, some critters like candida actually use glutamine as a substrate for growth, and thus may be exacerbated with supplementation.

The trouble is that you can't walk into a normal doctors office and ask them to help you with your leaky gut. As with much of what I talk about on this blog, 95% of doctors won't know 95% of what you now know, so they will most likely tell you to go home and eat gluten because it's all in your head. Finding a doctor who knows what we know can be a little cumbersome, but it is absolutely crucial if you want to get results and feel better.

If you think your case merits individual management I recommend you do the following:
Go to http://carrickinstitute.org/ and contact them to find a Chiropractic Neurologist near you. This link used to provide a search feature, but the website is currently down. While on the phone, tell the person you specifically would like to find someone who is versed in Functional Medicine as well as neurology. If the people at the institute can not provide this additional information, do not be bashful about calling the individual offices and asking if they do functional medicine, too. You can also try a simple google map search of the phrases "functional medicine" or "functional neurology", but it will not be as effective. There are different flavors of doctors who practice functional medicine, and the flavor dictates the type of treatment they will use. Some doctors are really into heavy metal testing and chelation, which for reasons that will be made apparent in another blog post I do NOT recommend. MDs using functional medicine are good, but may tend toward the use of more pharmaceuticals than many would prefer. The nice thing about going to a DC who does this stuff is that they can not prescribe medications so that route generally is a last resort, in which case they will refer you to an MD. Call me old school, but I think drugs and surgery should be the last resort treatment. Not only that, but finding a DC through the neurology program ensures that the chiropractor will tailor your treatment to what is best for your brain as well as your spine.

Another point I have to make about going to see a doctor and being managed professionally is the quality of supplements you will get. Don't get me wrong, I have gone to Whole Paycheck many times when I am too impatient to wait for my regular supplements to come in... but often times they are not the same. Yes, vitamin D is available at every drug store, but is it a good quality product that you will be able to absorb and use? Many of the supplements doctors like me work with go to great lengths to test their products and ensure that they are optimally absorbed. For example, many of the Apex products I use have been emulsified with things that have been shown in the research to enhance absorption and effectiveness. These products are only available through licensed healthcare professionals, which is both a blessing and a curse. On the down side, it means that these products are not widely available to the public, and it requires people to work with (and pay) a doctor. The blessing side of the story is that these products are strong and not to be taken lightly. I have personally seen what pharmaceutical grade supplements are capable of when they are taken willy-nilly (by myself or other people who still have at least half a clue), so I would hate to see this stuff get into the hands of the general public who doesn't know exactly what they are doing.

Now, let's talk about what you can do today to get that leaky gut of yours back under control!

The "4 R Gut Program" is something that is easily googled, so I won't spend too much time on it... But here's the scoop: the four Rs are in order of importance and the order you should do them in.
Remove the stuff that's causing the problem. This may be a food, a critter, stress, alcohol, or a drug!
Replace the stuff your body should be making, at least for the time being. This may include digestive enzymes such as pancreatic enzymes or stomach acid in the form of Beatine HCl! You need all these things to properly break down your food.
Reinoculate, which is a fancy word for "recolonize your gut with good bugs"... i.e. take a probiotic!
Repair. Help speed up your gut's repair processes by taking supplements such as these and you'll be on your way to a healthy functioning gut in no time!

1. Vitamin D is not only great for your immune system, but it has been shown to increase the expression of tight junction proteins in the gut, which helps to repair the "leaks" between cells [1]
2. L-Glutamine is an amino acid that is preferentially used by the gut epithelial cells as fuel and may not only aid in repair, but prove to be protective to future epithelial damage [2]
3. Herbs that soothe and coat the gut such as licorice root, slippery elm and marshmallow root will help protect the gut while it heals.
4. Antioxidants such as omega-3s, curcumin and resveratrol will help get rid of any residual inflammation that the other Rs and supplements could not tackle.

Less leaky every day,

Nikki

References:
[1] Kong, J. Novel role of the vitamin D receptor in maintaining the integrity of the intestinal mucosal barrier. Am J Physiol Gastrointest Liver Physiol 2008 Jan; 294(1):G208 (PMID 17962355)
[2] Iizuka, Masahiro. Wound healing of intestinal epithelial cells. World J Gastroenterol 2011 May 7;17(17):2161-2171 (PMID 21633524)

A New Way to "Think Pink"

Ah, October. A month for trick or treating, crisp fall weather, carving pumpkins, apple cider, and pink. Yes, October is National Breast Cancer Awareness Month, and of all the months dedicated to a disease this one is the most prominent every year. You couldn't forget this one even if you tried, with all the pink-clad fundraisers and the wide array of pink products that hit the shelves this time of year.

I always thought the idea of having an "awareness month" for a disease such as breast cancer was a little weird. I'm fairly certain that we've all heard of breast cancer, so making us "aware" of the disease seems a bit redundant. Of course the month is really much less about actual awareness and more about fundraising, and therein lies the issue I take with this month.

If you look at the participating products in the "save lids to save lives" list [1] you'll notice that they're not the most healthy products. Actually, they are downright unhealthy. Yoplait yogurt, Totino's pizza rolls, Pillsbury cookies and cinnamon rolls, gummy snacks and cereal are just a few to grace the list... but this begs an important question: What's the point of raising awareness and money for cancer when the very products you buy to support the cause will (probably) give you the disease?? Clearly the people who approved these foods either don't understand human health or are more concerned with lining their pocketbooks than anything else. Call me a cynic, but I think the pink thing is yet another marketing ploy to encourage people to buy these unhealthy products. If you want to give money to cancer research go right ahead, but do yourself a favor and just write Susan Koman a check instead of buying this crap.

Furthermore, why are we raising money for a cure and not talking about prevention? I would be much more on-board with this whole "disease month" thing if they were about prevention. So instead of buying those cinnamon rolls and raising what is likely pennies for research to find a cure, go for a run and make sure you never need a cure.

When I get into practice (soon!) I plan on doing workshops and programs geared toward breast cancer prevention during the month of October, so stay tuned next year. Let's stop thinking in their box (big pharma and it's box of drugs) and create a new one, shall we?

Inspired by the need for change,

Nikki

References:
[1] https://savelidstosavelives.com/ParticipatingProducts

Who are we fooling?

The more I see out there in the world the more I realize the world is in need of a serious wake-up call. There are so many companies out there trying to make a buck off of you it's nauseating. I believe probably 90% of the people selling us "food" and nutrition products are not at all interested in our well-being, but just want to take advantage of the current nutrition culture. There is so much confusion surrounding food, supplements, and diets that it's easy to get confused, and that's exactly what companies are banking on.

As I sit in my living room happily eating my hummus and raw veggies for lunch, I am amazed at the commercials I see. When did we as a society decide that gummy vitamins was a good idea, for example? Surely I missed that memo. I would like to go on record as saying that candy is not good for you, not matter how many vitamins they force into those little sugary bear of doom.

Vitamin Water is a classic example of how companies just want to confuse consumers. They are just crossing their fingers we don't do our homework. People are out there thinking "well, water is good for you, so vitamin water must be really good for you!" But if you read the label on those things they are loaded to the brim with sugar... More sugar than a Dunkin Donut's glazed donut, as a matter a fact [1]. At 13 grams of sugar per serving and 2.5 servings per bottle, Vitamin Waters pack a mean 32.5 grams of sugar per bottle. I'm sure all that sugar doesn't interfere with the absorption of those vitamins....

Finally, my personal favorite is protein bars- Particularly the ones that are covered in chocolate. Really? These things are glorified candy bars we've added a little cheap protein powder to in a (successful) attempt to bamboozle consumers. I don't care if that candy bar you're eating has 100 grams of protein, it's still a candy bar.

Michael Pollan said it best when he said "don't buy foods that make health claims". Poor, shy broccoli will never outwardly boast about it's vitamins and fiber... mostly because there's no way to get rich off selling broccoli. If a product has to convince you that it's healthy chances are it's not that healthy. Stick with what we've known about nutrition all out lives: there is no substitute for fruits and vegtables. Learn to love them.

Nikki


References:
[1] http://www.dunkindonuts.com/content/dunkindonuts/en/menu/nutrition/nutrition_catalog.html?nutrition_catalog_hidden=0&nutrition_catalog_needType=Food&nutrition_catalog_selPage=2&nutrition_catalog_perPage=50

Why Gluten? Why now?

I admit it: I hunt for gluten sensitivity. My own friends have scoffed at me "not everybody is gluten sensitive, Nikki"... As if I am somehow insulting their diets by suggesting that others follow my lead into a gluten free life. I know I'm on the hunt for something that relatively few people care about, and I'm okay with that. Somebody has to tell the world about this issue. Maybe I'm just passionate about this topic because going gluten free has helped me so much. Maybe it's because I have trained and read so much about the topic. Or maybe it's because it's a very big issue and nobody else is tackling it. Gluten sensitivity is the elephant in the room.. Will you be one of the few who take notice?

Like Autism, scheptics like to debate weather or not gluten sensitivity (let's call it GS for short) and Celiac Disease (CD) are truly on the rise. It certainly seems like it's becoming more popular, but is it because of a true rise in incidence, or is "going G-free" the newest fad diet?

It's hard to provide real (research) proof that GS is on the rise because we've only started looking at non-celiac gluten sensitivity somewhat recently. However, it does appear that CD is on the rise, and not by a small margin. The most comprehensive study on this topic was done in 2009 [1]. The study compared blood samples from 9,133 healthy young adults from Warren air force base in the 1940s and 50s and compared them to the blood of 12,768 gender matched subjects in present day. The results of the study showed that in the last 50 years, incidence of CD has increased from 1 in every 700 to 1 in every 100 people. Furthermore, upon follow-up the researchers discovered that patients with undiagnosed CD had 4-fold increased risk of death. Since everything you can imagine that would kill you is related to inflammation (cancer, diabetes, heart disease, stroke, autoimmune disease, Alzheimers), it is of no surprise to see that an inflammatory bowel disease like CD can shave years off your life. Sure, it's a hassle to avoid gluten, but wouldn't it be better than setting yourself up for an inflammatory disease later in life?

So why are we reacting to gluten now more than ever before? Wheat isn't that new to us that we should react any differently than we did 50 years ago, right? As with most of the health problems we face today, there is no one cause of this phenomena.

I will discuss a few of the proposed mechanisms at play, but it all boils down to three main reasons:

1. Our environment has changed. Let's face it, folks. We're not in Kansas anymore. If you compare our world in 2012 to even twenty or thirty years ago you can tell that change is all around us. GMO food crops are causing immunological and inflammatory changes in our bodies without us even knowing it. We are exposed to numerous chemicals, fertilizers, pesticides, flame retardants, and cleaning chemicals before we even exit the womb. The animals we eat are being raised in CAFOs and dark, crowded chicken coups, fed hormones and antibiotics to the point of near death, and then brought to our dinner table. If that's not an unhealthy environment I don't know what is.

2. We have changed. Children are given more vaccines now than ever before. Our diets are not supplying us with the vitamins and minerals we need to keep us healthy. We don't go outside and play anymore. We've given so many antibiotics it's a wonder any of our gut flora are still alive. We probably all have had a leaky gut at some point in our lives, giving our immune system the perfect opportunity to launch an attack on unsuspecting proteins like gluten. We don't exercise enough. Our chronic stress is frying our brains and our guts. We're not physically as able to process the food we take in, including wheat.

3. The wheat has changed. Not only in the sense of genetically modified wheat, either. Even if the wheat in the field was the same wheat, we do so much stuff after we harvest it now that it's hardly recognizable to the naked eye, let alone the immune system. After being harvested it is not uncommon for crops such as corn and wheat to sit in silos for months or years. During that time, the grains begin to rot, leading to the formation of enterotoxins. Once we get it to the plant to be made into your PopTart it is further modified. Harsh acids and temperatures deaminade gluten so that it becomes more water soluble, making it easier to work with and add it to products. Sure, it's easier to work with in the factory, but do you think your body actually knows what to do with it once you ingest it? Deaminaded gluten can cause some of the most vigorous immune reactions to wheat, but guess what? That's not tested for in the classic celiac panel (but it IS in the Cyrex panel!)

Healthfully yours,

Nikki

[1] Rubio-Tapia, A. Increased prevalence of mortality in undiagnosed celiac disease. Gastroenterology 2009 Jul;137(1):88-93. (PubMed ID 19362553)

Gluten: What You Need to Know

It seems like everywhere you look there's a new gluten free item on the supermarket shelf, a restaurant with a gluten free menu, or a friend "going gluten free". But what's all the fuss over this one little molecule? And why is it becoming increasingly popular to avoid it?

Gluten is the protein found in wheat, barley and rye, and it is what gives many foods their form and texture. Think of it as the "glue" that holds bread products together. Gluten enteropathy, or Celiac Disease (CD), is an autoimmune disease in which the individual reacts to gluten and produce an autoimmune-mediated attack on their intestines. Currently it is estimated that CD affects 1 in every 133 people in the US, with a predilection for Caucasian people and women. More shockingly, it is estimated that 80% of people with Celiac Disease are unaware they have the disease [1]. Diagnosis of CD requires either a positive Anti-gliadin antibody test or Tissue Transglutaminase test, as well as a biopsy of the small intestines showing gross damage to the villi of the intestines. Often times a third test is used, a genetic test that looks for the "Celiac genotype" of either HLA-DQ2 or HLA-DQ8.

Okay, so it makes sense that if you have CD you shouldn't eat gluten. But then there's the real weirdos out there: the 1.6 million Americans who are on a gluten free diet but are not diagnosed with Celiac Disease. Why in the world would people without Celiac Disease go gluten-free?

Because you don't have to be Celiac to have an immunological, and very real reaction to gluten. As a matter of fact, scientists now believe that occult cases of CD account for an astonishingly low number of gluten sensitive individuals. As a matter of fact, research is now showing that those people with enteropathy (disease of the intestinal tract) represents only 1/3 of the patients with neurological manifestations of gluten sensitivity [3]! The vast majority of autoimmune patients are highly sensitive to gluten (and casein) and feel much better when they remove it from their diets. Remember, just because the intestinal tract itself isn't being attacked doesn't mean that the immune system isn't attacking another tissue. In CD it's the gut that gets chewed up, in RA it's the joints, in Hashimoto's it's the thyroid. In any case the immune system reacts to the foreign protein and stimulates an immune attack- it's just a matter of where they send the troops.

The problem is that most doctors have yet to acknowledge that non-celiacs can have a problem with gluten. To them, the "Celiac test" IS "the gluten test", but that is absolutely not true. I have heard countless stories from patients with the same experience: "my doctor said it was all in my head... They said I had no problem with gluten." It's so sad, because these people knew that their bodies did not tolerate gluten, but at the insistence of their ignorant doctors they continued to eat the foods that were contributing to their misery.

Here's what you need to know about gluten sensitivity testing and where you can go to get answers.

There are three main problems with traditional Celiac testing that cause gluten-sensitive folks to fall through the cracks.

1. The majority of testing uses the antibody IgA. However secretory IgA is commonly depleted in autoimmune patients, who make up a large percentage of gluten sensitive people. This means that the IgA test can come back low enough to fall into the "negative" range, when in actuality the patients' body was just not making any IgA, let alone IgA against gluten. To combat the risk of false negatives, look for tests that include either IgG or IgM in addition to IgA.

2. Celiac genotype testing is boarder-line useless, but many physicians will not consider you to have CD unless you have the HLA genotype. While 90+% of CD patients are HLA-DQ2 positive, approximately 30% of those of Caucasian decent have this genotype, too! This means that the genotype testing has pretty good sensitivity, but really lousy specificity. That and again, this test is looking for people with occult Celiac Disease, so those who are non-celiac gluten-sensitive would be passed by yet again.

3. The main problem with celiac and gluten testing is that the test only looks for sensitivity against one of the many components of wheat. The anti-gliadin antibody testing used do diagnose CD only tests for Alpha Gliadin- one of 12 or so components of wheat and gluten! Not only that, but most current testing does not test for reactions to wheat versus rye or barley- they assume that the structure is similar enough that they would all produce a positive test result to Alpha-Gliadin.

So what should you do if you believe you are one of the many who have an issue with gluten? The best advise I can give you is to listen to your body!

The cheapest way to find out if you have a food sensitivity is to do a good ol' fashioned food elimination test. That is, cut it out of your diet for a few months, then add it back in and see what happens. We need to re-learn as a species how to listen to our bodies. Back when we were in the bush we would simply know to avoid a food if it made us feel bad. Nobody needed blood tests and peer-reviewed, double blind, placebo controlled trials- it was common sense that your body knew what's best.

I recommend doing an elimination diet with the most common allergens: gluten, dairy, soy, eggs, and peanuts. Give your gut and your immune system a break from these inflammatory foods for a few months with absolutely no cheating. If you can do things to heal your gut (coming in a later post) during that time then all the better. After a few months have passed, slowly start re-introducing foods into your diet, about once every 3-4 days. Recall, it takes the epithelial cells in your gut approximately 3-5 days to regenerate, so it will take you that long to rebound from each new food. As you reintroduce foods, keep an eye out for any symptom: from restless leg syndrome, to gut problems, to pain or insomnia. Remember, the immune system lives in the entire body, so symptoms can pop up anywhere. If you have an autoimmune disease, specifically keep your eyes peeled for symptoms of your disease (ex. joint pain in RA, hypo or hyperthyroidism symptoms in hashimoto's or graves disease, etc). Of course, the entire point of the diet is to avoid the foods that produced any adverse reactions, so listen to your body and stay away from the stuff after that!

For those of you who like to see results that clearly tell you "you can eat this, you can't eat that", you are in luck. A few years ago a lab based out of Phoenix, AZ started running an amazing panel for gluten sensitivity and it is being implemented in functional medicine practices throughout the country. For more information about the lab visit http://www.cyrexlabs.com/. It has been my personal experience with this lab that they are very helpful, and if you ask them they will find you a doctor in your area who runs their tests.

Always in health,

Nikki


References:
[1] http://www.mayoclinic.org/news2012-rst/7008.html
[2] Chart recreated from Datis Kharrazian's seminar notes "Understanding the complexity of gluten sensitivity" 2011
[3] J neurol Neurosurg Psychiatry, 2007:72;560-563. Gluten sensitivity as a neurological illness.

Recommended videos:
[Tom O'Bryan] http://www.youtube.com/watch?v=DjvKrAvolMQ

Recommended websites:
http://www.theglutensyndrome.net/
http://www.glutenfreesociety.org/gluten-free-society-blog/grain-a-double-edged-sword/
[THE lab]  http://www.cyrexlabs.com/
[Great GFDF recipes!]  http://www.nourishingmeals.com/
[An example of how gluten attacks more than the gut]  http://www.livingwithout.com/issues/4_12/ataxia-2366-1.html

The Many Causes of Leaky Gut Syndrome

Last time we introduced the concept of leaky gut syndrome and discussed how the gut works. By now it should be clear that there are a lot of things that go on every minute of every day to ensure normal gut function- your microbes are talking to each other, your immune system is surveying the scene, and your intestinal lining is continually renewing itself. But what happens when one or more things interfere with normal gut function? Gut health is multifaceted it is no surprise that there are numerous things that can increase intestinal permeability (4). The easy way to explain this is that anything that causes inflammation of any kind is going to have an inflammatory effect on the gut... but let's explore a few mechanisms.

•  Anti-biotic drugs (and herbs) don't just kill the bugs you want to kill- they kill whoever is susceptible to them. Unfortunately, this often includes the "good" microbes that keep your gut healthy. While this may be the least of your concerns if you are on the brink of death from sepsis, it is something to consider when dealing with relatively common ailments such as UTIs, ear infections, and sinus infections. Before you walk out of your doctors office with that anti-biotic script ask yourself "would I be able to shake this bug without this drug?" and "what other effects will this drug have on me?" In my experience, ear infections are almost always viral and thus unresponsive to anti-biotics, UTIs can be killed very quickly with lots of water and some uva ursi, and sinus infections will go away good ol fashioned rest and neti-pot washes.
• NSAID drugs (non-steroidal anti-inflammatory drugs) such as ibuprofen and advil are notorious for causing stomach ulcers, so it's not a surprise that they damage the rest of the gut lining in the same way. There are multiple mechanisms at play here, including direct irritation of the GI lining by the drug when it is ingested, uncoupling of mitochondrial oxidative phosphorylation, and the inhibition of COX 1 and 2 (1). That last part is especially important. The Cyclooxygenase enzymes aka COX 1 and COX 2 are enzymes responsible for the formation of prostaglandins, or local cellular messengers. NSAIDs are said to be "non-selective COX inhibitors" because they block both enzymes. The sad news is that while blocking COX 2 gets rid of your pain and reduces inflammation, COX 1 is a good guy we really don't want to block. COX 1 is responsible for the formation of anti-inflammatory prostaglandins and actually helps maintain the gut lining. Whoops!
• Food intolerances are becoming all the more common, the two most common being to gluten and dairy. Exposure to gluten is one of the most potent triggers for zonulin release from the gut lining (which goes hand in hand with increased permeability) even in people without Celiac disease (2).
• Head injury has been shown to release zonulin, the same molecule that is released from the GI tract when it is injured. This tight junction protein not only closes the gap between epithelial cells in the GI tract, but it plays the same role in maintaining the blood-brain-barrier. When traumatic brain injury was applied to a rodent model in the laboratory setting Santos and colleagues found "significant damages to gut structure and impairment of barrier function" only three hours after injury (3). The authors believe that when zonulin is released from the injured blood-brain-barrier it makes its way to gut via the blood and signals the gut lining to become more permeable, too.
• Gastrointestinal infections
• Chronic stress
• Enviromental toxins
• Chemotherapy and radiation therapy
• Autoimmune disease
• Alcohol
• Corticosteroids
• Excessive sugar consumption

With so many things that cause leaky gut syndrome in the world it's a wonder why we don't all have leaky guts. Keep in mind that there are surely other things that cause the gut barrier to break down, but this is a good starter list. Also, people's reactions to the inflammatory stimuli can be much different. For some, stress may be what sends them into a diarrhea-ey downward spiral, for others it may be NSAID use. Everybody has different capacities to handle inflammation based on variations in dietary antioxidant consumption and their body's ability to make its own antioxidants. Either way, I look at this list and am reminded of why I have to eat as clean as humanly possible- you never know what inflammatory thing will try to take you down next!

In health,

Nikki


References:
(1) http://farncombe.mcmaster.ca/document/WallaceBestPractResClinGastroenterol2000141147-159.pdf

(2) Fasano Alessio, Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer, Physiol Rev 2011; 91: 151–175.

(3) Santos Alejandro, Intestinal Permeability to Glucose after Experimental Traumatic Brain Injury: Effect of Gadopentetate Dimeglumine Administration, Nordic Pharmacological Society Basic & Clinical Pharmacology & Toxicology 2008, 103, 247–254.

(4) The Textbook of Functional Medicine 2010 pg 192

(5) Lipski, Elizabeth, Leaky Gut Syndrome 2010 pg 17