Is Vitamin D the "Missing Link" of Flu Prevention?

Vitamin D and Flu Prevention: Part 1

Influenza (the flu) is the poster-child of seasonal variability in an infectious disease. During "flu season" rates of influenza skyrocket, but in the warm, summer months the virus is seemingly dormant. I think that last bit does a particularly good job of beginning to elude to the commonly held beliefs surrounding the flu. Public officials tell us every year that this is going to be a bad year for the flu- perhaps the worst one yet. I think that most people conjure up an image of a virus that "attacks" every year, is defeated (fails to infect everyone), goes into hiding for the summer and makes itself bigger and better, and mounts an attack again the following year. It seems simple enough why people get sick- if you come into contact with enough germy people and if the virus is "bad" enough the virus will get you; it's only a matter of time. But what if the virus isn't the biggest variable in this equation- what if it's us?

There is a number of theories for what makes us more susceptible to infection in the winter. The start and end of the school year, the fall of absolute humidity in the winter months which dries out mucous membranes, seasonal patterns of behavior, temperature fluctuations, changes in viral transferability, and changes in host (human) immune function throughout the year all almost certainly play some role in influenza transmission [2]. Out of all of those reasons, however, one theory has risen above the rest in terms of answering unanswered questions (below) and promising research trials (to be discussed in Part 2).

Host (human) immune function is dependent on Vitamin D

Vitamin D is considered to be a hormone- a chemical that is made in one cell or gland (skin cells), released into the blood stream, and affects other cells in the body. Vitamin D is known to regulate at least 913 genes [3], including many that regulate immune function. Vitamin D is the major regulator of several antimicrobial peptides (AMPs) (you're body's in-house, broad spectrum antibiotics), namely cathelicidin and beta-defensin [3,4]. Among other functions, AMPs are known to protect the body's barrier surfaces (lungs, mouth and throat, gut) by creating a hostile antimicrobial shield [5]. This alone has tremendous implications in disease transferability! If the virus can not get past these barriers and get into the body it makes it tremendously difficult for it to make you sick. Vitamin D is also a key player in the innate immune system [3,5], which is the body's first, non-specific line of defense against pathogens. One way it does this is by enhancing TH3 cell function- T Helper cells that keep the rest of the immune system running smoothly. Fascinatingly, new research has shown that cells of the immune system and epithelium (barriers) are able to convert the non-active form of vitamin D into it's active metabolite [6]. This mechanism may further demonstrate the immune system's dependance on this modest little hormone.

Vitamin D as the "seasonal stimulus" answers many otherwise unanswerable questions about Influenza's odd behavior [5]

1. Why is Influenza both seasonal and ubiquitous (everywhere) and where is the virus between epidemics?
It is unlikely that the virus hides each summer and magically comes out in the winter. What's more likely is that the virus is around us (and in us) all year-round, but during times of enhanced immunity (sun exposure) we are able to fight it and remain asymptomatic.

2. Why are the epidemics so explosive?
As vitamin D levels begin to drop in the fall and winter months, so does our ability to fight infections. After a prolonged amount of time without sun exposure people's vitamin D levels will begin to fall, resulting in more and more people becoming increasingly more prone to infection. Once people's vitamin D levels drop below their tolerable threshold (which is most likely different from person to person), a subset of the population would find themselves suddenly susceptible to infection.

3. Why do epidemics end so abruptly?
It is likely that there is a sub-population of "good transmitters" within each population, which may be associated with each person's degree of Vitamin D deficiency. The depletion of this limited supply of good hosts most likely plays a large role in flu season's speedy resolution.

4. What explains the frequent coincidental timing of epidemics in countries with similar latitudes [5]? Why is the seasonal pattern of Influenza so weak or non-existent in equatorial regions [1]?
The peak of the last 25 epidemics in France and the USA occurred within a mean of four days of each other [5]. Similar latitudes likely follow a similar pattern (in both severity and seasonality) of impairments in innate immunity. This would also explain why regions closest to the equator experience fewer cases of influenza and seem to exhibit no pattern of seasonality [1].

5. Why is the serial interval so obscure?
The "serial interval" refers to the amount of time it takes for an infected person to make a well person sick. The serial interval has been shown for a number of other respiratory diseases, but has yet to be established for Influenza [5]. It appears that the presence of "good transmitters" among a population, who's infectious period is limited, makes this incredibly hard to measure for Influenza. The variation in Vitamin D status from one individual to another is likely one of many factors that seperates the "good transmitters" from the poor transmitters.

6. Why is the secondary attack rate so low?
For a  (supposedly) "highly contagious" virus such as Influenza, it's secondary attack rate is surprisingly low- about 15-20% at most, compared to 70% for measles and 58% for rhinovirus [5]. This is inconsistent with the idea that the virus sustains itself via regular sick-to-well transmission. The presence of a limited number of "good transmitters" as a result of vitamin D variation likely plays a role. Surely we've all known a person who always gets sick when there's a bug going around? It would be interesting to measure that person's vitamin D levels!

7. Why did epidemics in previous ages spread so rapidly, despite the lack of modern transportation?
"If Influenza were embedded in the population, only to erupt when impairments in innate immunity create a susceptible subpopulation, the disease would only give the appearance of spreading. Instead, it would appear in large segments of the population seasonally, and almost simultaneously, as long as good transmitters were available" [5].

8. Why are so few sickened by direct aerosol inoculation of influenza virus?
If the virus is highly infectious, one would expect most, if not all, people to fall ill when exposed to the virus. However, this is not the case. Even if the virus is sprayed directly into patient's eyes, nose and throat (I swear they really did this in 1918 and 1919) none of the volunteers became ill in any way. Other studies found similar results, where none or relatively few of the volunteers became sick after direct exposure to the virus. Once again, we must ask ourselves what makes one person susceptible and one person all but impervious to infection?

9. Why have influenza-related mortality and hospitalization rates significantly increased in the last three decades, despite profound increases in the rate of influenza vaccination?
Simply said, because vaccine manufacturers and researchers grossly overestimate the effectiveness of the flu vaccine every year. The flu vaccine lowers the incidence of the flu by 1.55%. If you want to know why I am so certain in saying so, please check out my previous blog posts on the flu vaccine here.

Check back soon for Part 2 of this series- I will be going over the current research on vitamin D as a means of preventing the flu.


Stay healthy out there, folks!

References:
[1] Juzeniene, Asta et al "The seasonality of pandemic and non-pandemic influenzas: the role of solar radiation and vitamin D" 2010 [PMID 21036090]
[2] Shaman, Jeffrey et al "Shortcomings of vitamin D-based model simulations of seasonal influenza" 2011 [PMID 3108988]
[3] Lang, PO "How important is vitamin D in preventing infections?" 2012 [PMID 23160915]
[4] Aranow, Cynthia et al "Vitamin D and the immune system" 2011 [PMID 3166406]
[5] Cannell, John et al "On the epidemiology of influenza" 2008 [PMID 2279112]
[6] Sundaram, Maria et al "Vitamin D and influenza" 2012 [PMID 3649720]

Why I'm Grateful for Smartphones

I fully admit to being a technology addict. I've had a love affair with Facebook for many years and am now starting to get really into Twitter, Google Plus, YouTube and (obviously) Blogging. I've had conversations with people who "don't get it" and have never been on Facebook before, and I'm sure I sound just as much like a martian to them as they do to me. I have also been a smartphone addict for a number of years and have had similar conversations with non-believers.

But beyond my love of all that has a microchip in it, I recently became exceptionally grateful for smartphones. Yes, those "unnecessary" phones that think they're computers. The very gadgets that make many in my parent's generation cringe when they see a 4 year old mindlessly thumbing her way through Facebook or Angry Birds when she should be paying attention to something else. Dear readers, these little gadgets have an important place in my heart.

My husband and I recently lost our beloved beagle Ralphy to cancer. We took him in to the vet because he started acting funny last week- he wasn't eating good for us and was a little more lethargic than usual. He had just recovered from a herniated disc in his neck, so we thought perhaps the steroids he had been on caused an ulcer. Five hours and a lot of testing later, the vet told us that the mass they saw on the X-ray was most likely a very malignant form of cancer and they had to remove his spleen. When they opened him up and removed the spleen they found several other masses on his liver and pancreas that they could not remove. When we got the phone call late that night we agreed with the vet- if we closed him up and let him wake up he would only be waking up to a very painful couple of weeks. Our baby didn't deserve that. We gave them the go-ahead to let him go that night. We had had him for one year and ten days and he was only six years old. Within a span of eleven hours we went from "just a quick run up to the vet" to "we think it's cancer" to "the humane thing to do is to let him go tonight".

Life is SO short, but the problem (and the blessing) is we don't really remember that until we lose someone close to us. It's probably a good thing that we're not fully aware of how short our time was here on Earth (go to 20:10). Maybe this is another case where ignorance is bliss. On the one hand, it makes these times in life tremendously painful. I feel like someone just came up and punched me in the face, heart and stomach all at once. But what about the alternative? If we had known that Ralphy's time with us was growing short what would we have done? The only thing we can hope to do is appreciate everyone and everything we have every single day and lead a life that brings ourselves and others joy.

Smartphones made this difficult time in our lives a little bit easier because they allowed (nay- encouraged) us to document every single thing that dog did this last year. In the old days if you saw something you wanted a picture of you'd have to run and find your camera, but not anymore. Why risk losing the photo op to go get your "real camera" when you can bust out your iPhone on the spot? We have hundreds of pictures of Ralphy doing absolutely nothing because we were constantly sending each other picture and video text messages of "our son". When I wasn't texting a picture to Mike I was posting pictures of Ralphy to Facebook and Twitter. Facebook is the new wallet full of awkward family photos- you don't need to have hard copy prints of every photo and then try to show them to everyone you know. Instead, upload them to Facebook or text them in real time. I can't tell you how many times I've talked to my mom on the phone and said "You wouldn't believe how cute Ralphy is being... Check your texts for pictures!"

If it wasn't for cameras, texting and social media on smartphones I guarantee we wouldn't have even 1/10th the number of pictures and videos of that precious dog as we do today. So yes, smartphones are unnecessary. But like so many things in life, sometimes you'd be surprised how one's definition of the word "necessary" can change in a matter of minutes.

In health,

The Pain Game Part 1: The Basics of Pain

As a chiropractor, it is not uncommon for people to come to my office in pain. We are a profession that has become well known for our non-surgical treatment of back and neck pain, and with good reason- chiropractic works marvelously for such problems. My mom has experienced this at least three different times when I've gotten rid of migraines on the spot with a cervical adjustment. But what about the cases that don't respond quite so quickly? What about chronic pain?

First, let's cover the basics of pain.

1. Pain is all in your head. Really.

Pain is not a sensory event, but a conscious one. There are receptors throughout the body that detect light, taste, smell, vibration, temperature, blood pressure, mechanical stress, muscle stretch, and tissue damage (nociception), but none actually sense pain. The nerves in our body can sense tissue damage and relay the information to our brain, but our perception and reaction to that information is what we have come to know as pain.

The easiest way to explain this concept is to use examples of pain and nociception that are independent of one another. A classic example of pain without nociception is phantom limb pain. We can't blame this type of pain on tissue damage since the nerves that would normally sense that tissue damage were removed along with the limb! Phantom pain is thought to be "learned pain"- a concept we will revisit later. Another example is pain that starts after a stroke. The body part that is perceived as being painful was never injured, but the neurons that represent that body part were damaged, resulting in the experience of pain. The key here is that the presence of pain does not necessarily indicate that the painful tissue is actually damaged- it simply means that the neurons in the brain that perceive/create the conscious event that we call pain have come to threshold. That doesn't make the pain any less real, but is a concept that will be important in a later blog post.

An example of nociception without (or with minimal) pain is when an athlete gets injured on the field but continues to play despite obvious injury. Other stimuli at that time (endorphins, distractions from the other team, teammates, coaches, and the roaring crowd, preconceived ideas of how much the injury should hurt) affected how the brain dealt with the nociceptive information it was receiving, and changed the pain it ultimately felt. This leads me to my next point...

2. A LOT of different things affect our perception of pain.

Pain is a lot more complex than we often give it credit for, undoubtedly because of how many different areas of the nervous system are involved. There are many, many levels of the nervous system where pain signals can start or the signals can become scrambled. Take the above scenario as an example. An athlete may not recognize the extent of the tissue damage and feel as much pain as we would expect for a number of reasons. The endorphins that bathe the athlete's nervous system during the game work on the brain stem in much the same way as morphine. An area of the brain stem called the periaqueductal gray then sends signals down to the spinal cord to inhibit nociceptive neurons. The sheer act of moving, which stimulates sensory nerves called mechanoreceptors, also inhibits nociceptive neurons in the spinal cord. Distractions from the crowd and teammates affect the frontal lobe's ability to focus enough to generate the perception of pain. The athlete's state of mind and mood affect the limbic system- the part of the brain that generates the emotional side of the pain experience. There are surely a multitude of other things that can influence such a scenario, but by now you get the idea.

3. There are two different types of pain- acute and chronic.

The mechanism behind acute pain is what people usually think causes all pain: tissue damage. Bodily damage can be caused by a number of things; a cut or a bruise, an invasive tumor, muscle soreness from a hard work out, sprain or strain, a burn, gangrene, or other physical injury. And while pain is never a pleasant experience, acute pain is incredibly useful- it serves as a warning. Without pain we wouldn't know when we are damaging our bodies and would surely wear them out very quickly. People with congenital insensitivity to pain typically lead short, injury-ridden lives for this reason. We need acute pain. It teaches us valuable lessons.

Generally, pain is said to be chronic when it has persisted for at least three months. Most often the initiating event is acute (injury), but the fact that the pain lingers for so long makes chronic pain completely different in it's pathology and therefore, treatment approach. Often chronic pain persists long after the tissues have healed and the body has otherwise recovered. This indicates that there is some level of neurological involvement- whether it be at the level of the brain, brianstem, spinal cord, peripheral nerves, or somewhere in between. Now, that's not to say that some cases of chronic pain are not directly due to downstream peripheral effects of old injuries. Perhaps an old ankle sprain just never really healed properly- the ligaments are now unstable or the muscle firing pattern has been altered. However, I would be one to argue that even in those cases there is some degree of neurological involvement that should not be (but often is) ignored. Sure, altered biomechanics sounds like a purely musculoskeletal problem, but the brain, cerebellum, and brain stem are always well aware and in control of everything that goes on in the body including what your muscles and tendons do.

4. There is no way to accurately measure pain.

Sure, we like to give the illusion that we can measure pain, but because pain is incredibly subjective it is also incredibly hard to quantify. In medical offices we like to use the visual analog (0-10) scale (VAS) which is an alright means of assessing someone's pain, but I think it's much more useful for tracking individual progress than anything else. As much as I may try, I have no way of knowing what a 9/10 pain feels like to you. I can, however, safely assume that I've made a pretty profound change in your symptoms if I figure out a way to bring that 9/10 down to a 3/10. The VAS is a game of comparing apples and oranges. If you compare apples to apples and oranges to oranges it has it's uses, but it still doesn't come close to telling you what the other person is going through.

5. Medications and Surgery don't fix the underlying problem*

Not only do medications not fix the problem, many of them do more harm than good. Morphine, hydrocodone, tramadol, vicodin and codeine are all opioids and work much like heroin or endorphins in the brain and brain stem. They work largely in the brain stem, firing pathways like the ones discussed before that inhibit nociceptive neurons. The problem is that while they are effective at getting rid of pain in the short term (or at least making you so sleepy you don't remember you have pain), they do nothing for the long term health of the brain- actually, quite the opposite! All of these drugs are highly addictive and often require more and more of the medication to produce the same effect because the body builds up a tolerance to them over time. Meanwhile, these drugs do nothing to improve the overall health of the brain, nor do they encourage the brain to relearn how to inhibit those pain pathways on it's own. The other major class of pain medications is COX inhibitor drugs such as celebrex and aspirin, which decrease inflammation. There is certainly theraputic value in decreasing inflammation, but there are many other ways to decrease inflammation in the body without drugs.

Surgery for chronic pain often involves cutting nerves that go to the painful body part. The problems with this approach are numerous, but the most important is that it's often not the body part causing the pain in chronic pain conditions- it's the brain and brain stem. Not only that, but such surgery usually has to be repeated every few months because the nerves grow back! And we wonder why healthcare is so expensive?

*This statement, as with most things in healthcare, is not absolute. If pain is caused by tissue damage- a broken bone, meniscus tear, tumor, etc then surgery will most likely fix the problem. In this case, I am referring to chronic pain, which is more often neurological in nature.

Stay tuned for my next post, Chronic pain- Why it's there and what you can do about it!

 In health,

Want to learn more about pain? Check out these videos:
Understand pain in less than 5 minutes
An excellent lecture about pain
A pretty good Ted Talk about pain (although I have a different treatment approach than he does)

The Moment We've All Been Waiting For!

It gives me great pleasure to announce the opening of my practice in Tempe, AZ earlier this month!

In my practice I will be focusing on  Functional Medicine [1] and Functional Neurology [2], the two topics I talk about here on the blog. If you or a loved one in the greater Phoenix area are unnecessarily suffering from a neurological or metabolic disorder such as those listed below, feel free to call my office at (480) 280-3943 to schedule a free ten minute consultation.

To check out my new website and learn more about my office, click here.

Conditions that often respond well to a Functional Medicine and Functional Neurology based approach include:

• Headaches
• Chronic constipation
• Chronic diarrhea
• Fibromyalgia
• Autism, ADD and ADHD
• Diabetes
• Thyroid problems
• Autoimmune diseases
• Chronic Pain

I evaluate the body through the use of  various lab testing- including blood, saliva and stool testing, as well as a neurological and full body exam. Only then, after I have a better understanding of the physiology at play, I am able to make recommendations about diet, lifestyle, supplements, neurological exercises, or medical referral.

That which get's measured gets understood. That which is understood gets effective care and monitoring.
That is the simplest possible way to explain how I practice.


Dr. DiNezza

[1] http://createanewbox.blogspot.com/2012/06/functional-medicine-new-box.html
[2] http://createanewbox.blogspot.com/2012/08/functional-neurology.html

http://www.drnicoledinezza.com/

Beware of Junk Science

The more I learn about health, the more I realize being healthy should be a no-brainer. Eat more vegetables. Move more. Laugh more. Put down that PopTart. But what about all the scads of conflicting information out there? Low fat, low carb, or low cal? Which of the thousands of antioxidants available should we be taking? Fish oils, resvertrol, goji berries, green tea? Is sunlight good because of the vitamin D, or bad because it increases our odds of skin cancer? Should we eat that egg yolk?

In many cases false information is propagated by one thing- money. I'm not saying that everyone with something to sell is trying to dupe you out of your money... I'm just saying they have something to sell you. As long as we remain objective and never stop asking questions, we will get along just fine in this free market economy, but it's always nice to have a little help to weed through information. Junk science is science (or something that seems scientific) that is produced or interpreted by those with special interests. For example, articles investigating the safety or efficacy of a drug that are being funded by the company that makes said drug. Can you say "conflict of interest"?

But I digress.

There is one particular experiment I have seen recently in the media and on the internet that I just couldn't resist debunking. On websites such as this one, authors say that you can test your vitamins by seeing whether or not they dissolve in water. While I will be the first to admit that most multivitamins sold in the stores are not only junk, but might actually be harming you [1], this is not a valid test by any means.

My favorite example of this lately is this popular commercial for a CoQ10 supplement, Qunol. The makers of this supplement boast that their product dissolves better in water than other CoQ10 supplements... but when did we decide that this was a good thing? Beyond the issues I outline below, CoQ10 is a fat soluble antioxidant, which means it should NOT be able to dissolve in water. The makers of this product are bragging about a quality in their product that is actually undesirable! That's marketing for you.

There is SO much more going on inside your body than in a cup of water it's exhausting to imagine listing them all, but for the sake of the article I will talk about just a few.

1. Stomach acid is extremely acidic- ranging in pH from 1.5 to 3.0 [2]. As we all know, acidic is extremely corrosive- apparently enough so to dissolve razor blades [4]! I should hope such a strong acid would be able to dissolve a pesky pill or two. While the above article did state that vinegar better mimics the stomach's acidic environment than water, vinegar is only moderately acidic with a pH of 4.25-5.0 [3]. Compared to the stomach's pH of about 2, even at it's strongest (we'll say 4.0) vinegar is 100 times weaker than stomach acid.

2. There's more stuff in the stomach than just acid. Even if you did dunk those pills in a vat of acid that is the same strength of stomach acid, you still couldn't hope to make up for all the other stuff in our guts. Digestive enzymes such as salivary amylase start working on your food the moment it enters your mouth and continually get added throughout the digestive process. Amylases, proteases, lipases, pepsinogen, intrinsic factor, mucous, bile salts, bicarbonate, and a plethora of gastric hormones are among the many, many things that get secreted as food moves through the digestive tract.

3. The digestive tract is a muscular tube. The juices that digest our food only make up a part of the whole digestive picture. The stomach is a big muscular bag and the rest of the digestive tract is one long muscular tube that is constantly pulling, pushing, squishing and mashing the ever-loving heck out of the food we eat. Last I checked, cups of water weren't capable of such things... even with the most vigorous of stirring.


The question we should be asking ourselves is not weather our pills can dissolve in a cup of water. Rather, once the pill (or food) is broken down will it be absorbed from the digestive tract and properly used in our body? If there is a leaky gut or inflammation afoot I would say the answer to both of those questions is a "no".

Take care and beware of junk science, dear readers


Nikki Cyr, D.C.


Resources
[1] http://createanewbox.blogspot.com/2012/11/metals-that-might-make-you-mental.html
[2] http://en.wikipedia.org/wiki/Gastric_acid
[3] http://en.wikipedia.org/wiki/Vinegar
[4] http://www.mnn.com/health/fitness-well-being/stories/infographic-28-odd-facts-about-the-human-body
[5] http://www.ehow.com/how_5641704_test-vitamins-home-dissolving-water.html

To Be or Not To Be "Sugar Free"

"Sugar free" seems like an easy enough thing to figure out. Sugar free foods are foods with no sugar in them, zero sugar, sugarless, if you will. But is that actually the case? In many instances, the answer is no.

For starters, let's look at how the USDA defines "sugar free". Technically, food manufacturers can say that their product has zero sugar if it contains 0.5 grams of sugar per serving or less [1]. The same is true of labels that boast claims of "cholesterol free", "calorie free", and "fat free". Certainly this is a negligible amount if you eat one serving, but what if you eat more than one serving? This tactic is commonly used when labeling junk food, foods which people are far more likely to consume more than one serving. Sure, two grams of sugar still isn't much if you eat four or more servings, but it's not what I would call "sugar free", either.

The other problem with processed foods that boast the sugar free label is that they are usually riddled with artificial sweeteners that are even worse for you than sugar. Aspartame consumption, for example, has been linked to numerous types of tumors. Add to that the fact that the ingestion of artificial sweeteners has been shown to increase sugar cravings, the exact opposite of what the average diet Coke drinker wants to do, and it just doesn't make sense to consume this stuff. On the other hand, low glycemic index (read: low glucose, high fructose) sweeteners such as high fructose corn syrup and agave nectar are technically low in the sugar that raises your blood sugar (glucose), but are preferentially stored as fat making them even worse for diabetics and people trying to lose weight than regular sugar. For more on these topics, please see my previous posts here.

 I don't think the Pillsbury dough boy will ever advertise something that is truly healthy...

However, my most recent pet-peeve has been the use of the term "sugar free" in various health food recipes such as this one. This recipe calls for bananas and honey, both of which have a pretty hefty amount of sugar in them [2].I see this type of thing all too often in paleo and vegan recipes- the use of maple syrup, honey, coconut crystals, dates, raisins, bananas, etc and yet they still call the recipe sugar free. I think what the author meant to say is that this fudge is refined sugar-free. Now, don't get me wrong, I make these types of recipes more frequently than I'd like to admit... I just think it's incorrect to call them sugar free. Actually, I made that fudge recipe this weekend and highly recommend it! Just don't go crazy and eat a lot of it because you think it's sugar free ; )


So where do we go from here? I think the best way to tackle this once and for all is to take a moment to define sugar. Hopefully if we know what sugar is we will know how to best avoid it.

Sugar
1. Table sugar, the white crystalline form of the disaccharide sucralose*.
2. The simplest form of carbohydrate, consisting of one, two or three carbon-based rings. Examples include glucose, fructose, and galactose (monosaccharides), as well as combinations of the three such as lactose (one glucose and one galactose) and sucrose* (one glucose and one fructose).

I hope this post has made you think of something you hadn't ever thought about before. Don't take anything at face value- even something as seeminly simple as the term "sugar free".



Nikki Cyr, D.C.



References
[1] http://www.fsis.usda.gov/pdf/labeling_requirements_guide.pdf
[2] http://nutritiondata.self.com/facts/fruits-and-fruit-juices/1846/2

Live and Lent Live

Ah, Lent. A season for sacrifice, for discipline. Each year thousands of Christians choose something to give up for forty days as they prepare for Easter. But have you ever noticed how many of these happen to be unhealthy habits? Chocolate, ice cream, soda, fast food and alcohol are among the things I have seen people give up for Lent.

In a weird way Lent is like New Years part two for Christians- with each holiday thousands of people give up an unhealthy habit each year. There are several key differences, however. New Years resolutions are intended to be permanent (although, sadly, many of them do not turn out that way). On the other hand, Lent is known to be a only temporary inconvenience. I think this creates a predictable, yearly yo-yo diet. Every year people give up something for Lent only to over-indulge and go back to their old, bad habits after the Easter finish line has come and gone. Yes, this almost always happens with New Year's resolutions, too, but at least the initial intention is for some degree of permanency.

Additionally, the motivation for Lent (sacrificing for something bigger than oneself, i.e. religion) is completely different than the motivation that drives New Year's resolutions. But that brings up an important question- why is it that we are able to buckle down and make a healthy choice for our religion, but not for our own health? I do not mean this to belittle the meaning of Lent, but I do think that there is nothing more important than taking care of our bodies. Arguably, without our bodies none of us would be able to worship the deities of our choosing, so shouldn't we regard our health with at least the same degree of importance as our religions?

My challenge to you, dear readers, is to not let Lent be yet another yo-yo diet. They say it takes 30 days to form a habit. So, since Lent is 40 days that means that if you can successfully make it through Lent you've already made it through the hardest part of kicking a bad habit! This year use Lent as a spring board into your new, healthy lifestyle, not just another fad diet.

Yours in health,

Nikki Cyr, D.C.

"Drug Free Solutions" Podcasts!

For those of you for whom this blog just simply isn't enough.. have no fear! I am proud to announce that I have started co-hosting weekly podcasts with my colleague Dr. Aaron Newman, D.C. Dr. Newman runs a functional medicine based chiropractic office in Seal Beach, California and has been a mentor of mine for several years. Check out our latest podcast all about the thyroid!

Drug Free Solutions Podcasts: Thyroid Health

The Untold Story of Fat

Let's face it, fat. Nobody likes you. You give us muffin tops, cellulite, heart disease, and sadness. But what if there was more to fat than we've given fat credit for? What if, benieth that simple yellow exterior, there was something deeper?

Gluttony and sloth are commonly thought of as the cause of obesity. In healthcare we often talk about energy balance as a simple math equation. That is, if you eat more calories than you burn in a day, the rest will be stored as fat. Common logic is that if you over-indulge (gluttony) and don't move enough (sloth), you get fat. Not only do we think of fat people in these terms, but I believe we have come to see fat tissue in much the same way. We see fat as "extra" tissue, just weighing us down and getting a free ride while muscles and other organ systems do all the work. In personal training we like to show clients models of 1lb of fat and 1lb of muscle and repeatedly remind them that muscle is more metabolically active than fat. It is true that muscle cells burn more energy than fat cells, but it doesn't mean that fat cells aren't active.

Adipose tissue (fat tissue) serves several important functions beside the obvious storage of fat. Vitamins, like any other chemical, can either be fat soluble or water soluble. Water soluble vitamins such as B vitamins get to hang out in the blood, which is mostly water. Such vitamins need to be consumed regularly because there is little to no storage in the body- any extra you might have will get filtered by the kidneys and excreted in the urine daily. Fat soluble vitamins such as A, D, E and K, however, can be stashed away in the liver and adipose tissue. Fat soluble toxins such as DDT, PCBs and hexachlorobenzenes are stored in adipose tissue, liver and reproductive tissue in a similar manner [1]. It is thought that the release of toxins back into the bloodstream with fat loss may be part of the reason many people hit a weight loss plateau [2]. As you lose weight (fat) from adipose tissue you are also releasing whatever is stored in that tissue. If this includes high levels of toxic substances your body may not be able to cope with the inflammatory load, resulting in slowed mitochondria function and metabolism. In a way, your body may thwart it's own attempts at weight loss because it simply can't keep up with the toxins [2].

Adipose tissue is not the benign, inactive beast we often think it is. Fat has a half-life in the blood stream of only about 2-3 minutes. Similarly, the fat in each adipose cell is renewed every two to three weeks [3]. Adipose tissue even makes it's own hormone called Leptin. While we are only just starting to learn about leptin, it is understood that this hormone signals satiety (fullness) to the brain. Leptin levels increase in direct proportion to the amount of fat tissue, which brings us to an interesting point. If obese people have more leptin than skinny people, shouldn't they feel more full and therefore not be as obese? I believe that this catch-22 of physiology is due to leptin resistance at the neurological level, but that topic deserves it's own blog post. In any case you can now see that adipose tissue isn't just chillin' out in our thighs. Fat is a dynamic creature that is participating in our daily lives more than we ever gave it credit for!

Now that we've talked a little bit about the inner workings of fat, perhaps we should shift focus and think about what outside forces act on adipose tissue. After all, adipose tissue is just as connected to your body as any other organ system, so there must be some body-adipose cross-talk happening.

Several hormones are known to have a direct effect on adipose tissue and fat metabolism and storage. Namely, insulin is the chief hormone that acts on adipose tissue. Insulin (and glucose itself) activate Lipoprotein Lipase, the enzyme that promotes the storage of fat in adipose tissue [4]. At the same time, insulin inhibits enzymes that stimulate fat breakdown (lipolysis and beta-oxidation), ensuring that metabolism moves in an anabolic (storage) direction. Insulin also promotes the intracellular enzymes that facilitate the storage of excess glucose and amino acids into fat [5]. On the other side of the spectrum are catecholamines like epinephrine (adrenalin) and norepinephrine, and hormones such as thyroid hormone and growth hormone. These hormones oppose insulin and promote fat release from adipose cells and fat breakdown via beta-oxidation, as well as inhibit the enzymes that would normally store fat (lipogenesis) [3,4]. Epinephrine and norepinephrine are chiefly responsible for the increase in fat mobilization seen with strenuous exercise. These two catecholamines stimulate Hormone-Sensitive Lipase, the enzyme that promotes the release of fat from adipose tissue.

So, what is the take-away from all of this? It's not necessarily the calories that you consume that make you gain weight- it's how those calories affect your body through your hormones. Low sugar, low carbohydrate diets such as the paleo diet and the Atkins diet work by decreasing insulin and glucose surges. My advise to anyone who is trying to lose weight is simple. Don't stress over calories. Rather, eat a diet and behave in a way that will positively influence your hormones. Reducing insulin surges is like removing your foot from the brake pedal of your weight loss efforts. Stop hindering your own ability to lose weight and let your hormones do the rest.

In health,

Nikki


References
[1] The Textbook of Functional Medicine, 2010
[2] Mark Hyman "Systems Biology, Toxins, Obesity, and Functional Medicine"
[3] Guyton and Hall. Textbook of Medical Physiology 11th edition.
[4] Burton, Cerny. Exercise Physiology for Healthcare Professionals.
[5] Silverthorn. Human Physiology and Integrated Approach.

The Flu Vaccine: A Recap

I admit that last post was kind of intense, all be it a little controversial. A few readers didn't much care for the way I re-evaluated the numbers, even going as far as to say that I was lying. I am aware that not everybody is ready to be un-plugged from the matrix of mainstream medicine, but I certainly don't want anybody to walk away from this blog with a bad taste in their mouth. My goal is to empower you to take control of your health, stimulate thought and discussion, and open your eyes, ears and hearts to different opinions other than your own- not doop you into not getting a vaccine because of what I personally believe. Luckily a little syntax can go a long way, so lets see if I can't clarify and break that last post into bullet points.

• Looking at the results from the 2012 meta-analysis, the flu vaccine is about 56% effective. In other words, about half as many people get the flu when vaccinated according to the cited studies (4). However, this number does not take into account the numerous confounding variables that likely also contribute to so-called "vaccine effectiveness".

• However, the flu vaccine decreases incidence of the flu by 1.55%. That is, it lowers the odds of someone getting the flu from 2.73 to 1.18% (4).

• Researchers estimate that for every 100 people who get the vaccine, ONE case of influenza like illness (ILI) is prevented (10). Keep in mind, ILI may or may not be the actual flu, it simply means that someone feels like the flu.

• Other research estimates that for every 4,000 elderly people who receive the vaccine, ONE case of influenza related death is prevented (5). It is worth noting that it is the elderly who are most likely to get the flu and also account for approximately 90% of all influenza-related deaths.

• This is all assuming that confounding variables are not responsible for the benefit seen. However, there is ample evidence that indicates that part or ALL of the benefit seen in vaccination studies is due to variables other than vaccine effectiveness (1,2,4). For more on this, please see my previous article.

• It has been shown that the flu vaccine doesn't do anything to prevent community acquired pneumonia (9). This is important, because community acquired pneumonia causes approximately 34,000 of the 36,000 yearly deaths associated with the flu.

 

I would also like to point out that the flu vaccine is not benign. It, like anything else, can do harm. When you get a flu shot you are getting injected with things like mercury, formaldehyde, and aluminum salts (11). Just like we should look at the label for the foods we eat, so should we at least look at the ingredients of the vaccines we inject into our bodies. If you saw a food with formaldehyde in it would you still eat it? Would you feed it to your child?

Lastly, have you ever noticed the frequency with which the flu vaccine seems to make people sick? I'm not saying that it gives you the flu, but it seems like a lot of people just don't feel good after they get the flu shot. I know that word of mouth hardly has the street-cred of a meta-analysis, but its still something. After all, it was only simple hearsay that warned our ancestors to not eat the poisonous "death cap" mushroom a few thousand years ago... Imagine what would have happened if nobody had listened back then! If only Piers Morgan had listened to theflu vaccine nay-sayers..... (12)

I'm not saying we shouldn't try to prevent the flu. Nobody wants to get the flu, and it can be a serious illness. I just don't think that the flu shot is the safest, most effective or most logical way to do it. Instead of taking a disease-centered approach to care, I think that we'd have a better shot at preventing diseases if we focused on our health. For that matter, even if you do choose to get the flu shot I encourage you to still take an active roll in your health. Don't simply rely on the supposed passive immunity from the vaccine to save you, but take every step you can to ensure your whole-body health this flu season.


In health,

Nikki


References:
(1-10) Please see references from my previous post
(11) http://www.cdc.gov/vaccines/parents/vaccine-decision/ingredients.html
(12) http://2012thebigpicture.wordpress.com/2013/01/27/piers-morgan-falls-ill-days-after-public-flu-shot-with-dr-oz/

The Flu Vaccine: Your Best Shot at Preventing the Flu?

Once again, the flu season is well underway and there is no shortage of commercials, posters, billboards, and doctors telling us to get our flu shot. But is the flu shot really your best shot at preventing the flu? In part 1 of this series on flu prevention I hope to prove to you that the flu vaccine isn't as impressive as we have been led to believe. In the next post(s) I will discuss what has been proven in the research to naturally prevent the flu.

I know you're not all scientists, but a quick overview of the different forms of scientific research is necessary to fully appreciate the second half of this article. There are many types of research articles out there, and they all have varying degrees of abundance and credibility in the scientific community. For a more detailed description and explanation please see this website. For now all you need to know is that not all research is created equal. The most credible is the meta-analysis, followed by systemic reviews, randomized double-blind placebo studies, then cohort studies. Most of the research on the flu vaccine tends to be cohort studies, which are decent, but can still have a lot of flaws. Randomized control trials eliminate a lot of bias, but may still have issues as we will discuss below. Meta-analyses are considered to be the best because of their rigorous inclusion criteria. These studies compile information from many different articles, and more importantly, only the best articles make it into a meta-analysis.

As you will soon see, there are many different issues surrounding the debate of Influenza Vaccine Effectiveness. Issues like cohort (study group) selection bias, non-specific end points, and proper diagnosis of the flu can all stand in the way of an otherwise decent study, and will undoubtedly alter the reported numbers. Because it seems to be the most commonly recognized confounding variable in cohort studies, I will focus briefly on selection bias.

The term "selection bias" is a little bit of a misnomer in this case, because it is seen in cohort studies where the groups are not actually "selected" by the scientists. Rather, these studies follow two groups of people (those who got the vaccine and those who did not) and use the information to estimate how effective the vaccine is. The problem is that it's nearly impossible to account for other differences between the two groups of people. Factors such as health status, belief or disbelief in vaccine effectiveness, vaccine availability and possibly other unknown variables may all lead to the difference in behavior studied (i.e. the behavior to get the vaccine or to choose to not be vaccinated).

A great deal of skeptisism comes from what scientists are calling the "healthy user" effect, which means that the people who are getting vaccinated tend to be healthier, and therefore less likely to get the flu or die from it, than those who do not get the vaccine. This is the image of the ideal patient- someone who listens to their doctors advice; weather it be to eat more fiber, exercise, or get a vaccine [4]. One study examined this more in depth and compared several variables between the two groups: age, sex, the log of the insurance risk score, self-assessed health status, and presence of chronic diseases such as diabetes and heart disease. This study found a strong correlation between insurance risk score and self-assessed health status with risk of death, but more importantly they found a strong negative correlation between risk of death (poorer health prior to the flu season) and vaccine coverage. In other words, the more frail people, those who were the most likely to die with or without the flu, were among the least likely to get the flu shot, which undoubtedly skews the results of cohort studies in favor of higher vaccine effectiveness [5].

Aside from the patient's conscious choice there are also other factors that may create this effect. For example, vaccination is generally not recommended for the extremely frail or immuno-comprimised, a group that would be expected to have naturally higher hospitalization and death rates, who then get lumped into the "unvaccinated" group in a simple cohort study [4]. This is called a "frailty selection" [1]. In placebo controlled studies, it is considered unethical to include high-risk patients in such studies (it's not nice to give someone a placebo when there is a higher likelihood that the vaccine can save their life), so there is absolutely no high-quality (double blind, placebo controlled) data on the group that is theorized to benefit from vaccination the most [2].

In their paper, Simonsen et al [1] outlined criteria that can be used to detect such bias. The authors note, however, that it is easier to detect bias than to account for it and calculate exactly how much of the results are due to bias.

Seasonality. Think about it, the vaccine's ability to prevent death should be seasonal- only during the flu season when the virus is actually circulating. If there is a benefit outside of the flu season when the virus is not circulating, this is a strong indicator of a difference between the two groups. Several studies have identified a similar effect on all-cause mortality and hospitalization both during flu season and the off season, indicating an intrinsic difference between the ultimately immunized and non-immunized cohorts [1,6,7]. In 2008 Eurich et al demonstrated a 51% reduction in all cause mortality in pneumonia patients outside the flu season in those who would eventually get the flu shot- a number that is strikingly similar to what other groups report during the flu season [6]. The authors go on to say that this indicates that some or all of the benefit in mortality that is seen in cohort studies is likely due to confounding variables such as the healthy user effect [1].

Vaccine match. Each year the flu virus mutates, creating the supposed need to get the updated yearly flu shot. Each summer and fall, scientists have to try to predict which flu virus will be the predominant strain to make a vaccine against it. Some seasons end up being better matches than others. Such information can be found on the CDC website [8]. Logically, the effectiveness of the vaccine should fluctuate with how well the vaccine is matched to the circulating strain. However, this does not appear to be the case [1,4]. Below is a chart from a 2012 meta-analysis (remember, this means that the studies they use should be the best of the best) that shows how well the vaccine is matched and effectiveness [1]. As you can see, most of the studies from the years that were reported as being mismatched were reported to have the same or better effectiveness than other years. How can that possibly be?

The use of specific end points is important for obtaining accurate, clean results in a study. The more specific your end point (the thing you're measuring), the better the data you can obtain. Three things that are commonly used to describe flu vaccine effectiveness are all cause mortality, Influenza-like illness (someone says they have the flu), and laboratory confirmed influenza. Since people die from a lot of different things, even during the flu season, we would expect the vaccine's effectiveness at preventing all cause mortality to be relatively low. On the flip side, since the specific goal of the vaccine is to prevent the real flu (as opposed to ILI which may be the flu virus or something else), we would expect the vaccine's effectiveness here to be highest. On the contrary, current cohort evidence shows vaccine effectiveness estimates are highest (and implausibly large) for all cause mortality and lowest for laboratory confirmed influenza [1].

Cohort studies are most prone to bias because of the healthy-user effect, but even placebo controlled trials have their problems. Not only is the specificity of the end point being measured a concern, but the way those results are obtained may be an issue even in placebo controlled studies. Serology confirmed or laboratory confirmed influenza has been reported to skew results in favor of exaggerating vaccine effectiveness [2,4]. Culture confirmed influenza or better, vaccine-matched culture confirmed influenza seem to be the best in this regard, but the research in this area is sparse. Most studies look at all cause mortality, and many of the others look at laboratory confirmed infection, neither of which will give entirely accurate results.

Several authors have noted that the repeatedly reported 50% effectiveness against all cause mortality is simply not realistic. The flu only accounts for about 5% of all deaths in the winter, so "that the influenza vaccine can prevent ten times as many deaths as the disease itself causes is not plausible"[1]. Because influenza only contributes a small percentage to all cause mortality, it cannot be reasonably expected to do more than eliminate this excess. As I will show below, the real flaw lies in how that number, 50% is used, but there is another point to be made here. Several studies in the United States have tried to evaluate weather there has been a decrease in all cause mortality with increasing vaccination rates. In the last twenty years, since the flu vaccination rate among the elderly has soared from 15% to 65% there has not been a single study to has documented any change in hospital admission rates nor all cause mortality [6]. Similarly, studies failed to show an increase in mortality during the 1997-98 season, during which the vaccine was completely mismatched with the circulating strain [1].

Okay, here comes the really crazy part of this whole mess. For the time being, let's put aside all the stuff I just talked about and focus on the numbers- we'll assume that the data the studies are getting is actually reflective of what the vaccine is doing and that none of it is from confounding variables. We're not all statisticians here, but I think we can all do some basic 8th grade math. Let's solve this word problem:

100 people get the flu vaccine. Two of them get the flu. 100 other people do not get the vaccine. Four of them get the flu. How effective is the vaccine?

Okay, pencils down. Most of us would think through this problem like so, "We need to compare what percentage of each group got the flu. 2 percent versus 4 percent of each group got the flu. The vaccine was therefore 2% effective at preventing the flu. In other words, for every 100 people who got the flu vaccine, two less got the flu." What we just did was we calculated the absolute difference between the two groups- the percent difference. This is how people generally perceive percentages- we like to think of the number of people who's life would have been changed with the intervention. However, this is not how vaccine effectiveness is calculated. These studies calculate (and then report to us, the lay people) the relative difference between the two numbers. This is what it would be like for the example above, "We need to compare what percentage of each group got the flu. 2 percent versus 4 percent got the flu. 4 is twice as big as 2. The vaccine is therefore 50% effective."  Let that logic soak in for a minute or so. Yes, this is a perfectly legitimate way to compare these two numbers, two and four, but exactly what that percentage is comparing is rarely, if ever explained on flu vaccine posters. No wonder they're (and we) all are getting so confused! I think this is incredibly misleading. Let's look at the numbers from the studies cited by that 2012 meta-analysis again and compare the absolute values to their inflated relative values:

The way I see it, there has been an unintentional miscommunication between the science (research) world and the consumer world. We tend to see things how they relate to ourselves and we like to apply numbers to real life. I think when people see that the flu vaccine is 50% effective, they imagine it as "if I was 100% at risk, now that risk is only 50% which is pretty good". The reality is that most people's odds of getting the flu are already pretty low (2.73% odds without the vaccine if we use the numbers cited above), especially if you take care of yourself. What the vaccine does is it lowers your risk of getting the flu from 2.73% to 1.18%- which to you is only an overall difference in risk of 1.55%. Another way of looking at it is that you need to vaccinate 100 people to prevent ONE set of influenza symptoms [10]. As if that's not impressive enough, Fireman et al estimated that you would need to vaccinate 4,000 people to prevent one death from the flu in their elderly Kaiser Permanente cohort [5]. Again, this is the group of people theorized to need the vaccine the most and whom make up approximately 90% of influenza related deaths. Oh, and let's not forget that this doesn't even take into consideration the numerous confounding variables we talked about in the first half of the article, some of which have been shown to either partially or completely explain any benefit the vaccine has been shown to have. Call me crazy, but that doesn't sound nearly as impressive as the 50-70% effectiveness rates we typically hear about...

Not only is this misleading to the lay person, but researchers seem to be confused by their own statistics. Recall if you will, the authors who said that the 50% reduction in all cause mortality reported with the vaccine was unrealistic because the flu itself only accounts for about 5% of all winter deaths. They are trying to compare apples to oranges- you would have to back track and look at the absolute differences in order to compare these results to all cause mortality. Perhaps if they used the numbers from the Fireman et al study, 1 death prevented for every 4,000 vaccinated, that would make more sense. The kicker is that this wording was only used once toward the end of the article. If you read their abstract or their conclusion, however, even this group reported the vaccine effectiveness rate as 47% [5]!

It is worth noting that numerous studies have demonstrated that the vaccine is least effective in the two groups that are presumed to need it the most- children and the elderly [1,4].  In one trial the researchers estimate that the vaccine effectiveness drops from 75% to 23% between the ages of 65 and 70- a huge and important drop considering that 90% of all influenza deaths are in folks over the age of 65. There were no randomized clinical control trials that were good enough to meet inclusion criteria for the 2012 meta-analysis that showed TIV (trivalent influenza vaccine) effectiveness in people aged 2-17 or over 65 [4]. Only the live attenuated vaccine (LAIV) was shown to have any effect in the 65 years old plus crowd, but that vaccine is not approved for use in adults over 50 in the United States [4]. Perhaps most importantly for seniors, the influenza vaccine has been shown to do nothing to prevent community acquired pneumonia. Pneumonia is responsible for the vast majority of influenza-related deaths (approximately 34,000 of the 36,000 deaths) each year [9], so this certainly doesn't lend much credibility to those estimates on decreasing all cause mortality.


I think it's safe to say at this point that there are a LOT of things to consider when it comes to this body of research. There are numerous confounding variables that may either partially or completely account for the reported effectiveness of the vaccine, "effectiveness" can mean anything from preventing death to preventing the flu, there is a lack of solid evidence that the vaccine works at all in the populations that supposedly need it the most, and the method of reporting the vaccine effectiveness is misleading at best. There are other issues that simply could not make it into this post such as the ingredients in the vaccine, side effects, politics, marketing, and conflicts of interest with funding sources. But all things said, I can not legally tell you whether or not you should get the flu shot. Whether you choose to get the vaccine or not is your personal choice, and I understand that there are a lot of factors that do, and should, go into this decision. All I can hope to do is educate you so that you can make the best decision for you and your family. I personally think I have a better shot (pun!) at preventing the flu if I keep myself healthy... especially when you take the unimpressive results from the research into consideration.

Even after all that, we still haven't gotten to talk about what actually causes the flu! I know what you're thinking, the influenza virus causes the flu. But the reality is that it is predominantly your health as host that determines weather or not a virus will successfully make you sick. Surely we have all lived with someone who has gotten sick, yet did not get sick ourselves. There had to have been a reason why you didn't get sick, and it surely wasn't from lack of exposure. Next blog post we're going to talk about what actually causes the flu, as well as what natural things you can do to prevent it. Spoiler alert- there is a vitamin out there that kicks flu vaccine butt at preventing the flu!

Stay healthy,

Nikki Cyr


References:
[1] Simonsen, L. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy. Lancet Infectious Dis 2007;7:658-66
[2] Jackson, L. Safety, efficacy and immunogenicity of an inactivated influenza vaccine in healthy adults: a randomized, placebo-controlled trial over two influenza seasons. British Medical Journal Infectious Diseases 2010, 10:71
[3] Lang, P. Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence. Clinical Interventions in Aging 2012:7; 55-64
[4] Osterholm, M. Efficacy and effectiveness of influenza vaccines: a systemic review and meta-analysis. Lancet Infectious Disease 2012; 12: 36-44
[5] Fireman, B. Influenza vaccination and mortality: Differentiating vaccine effects from bias. American Journal of Epidemiology 2009;170:650-656
[6] Eurich D. Mortality reduction with influenza vaccine in patients with pneumonia outside "flu" season. American Journal of Respiratory Care Medicine 2008;178:527-533
[7] Hottes, T. Influenza vaccine effectiveness in the elderly based on administrative databases: change in immunization habit as a marker for bias. PLoS ONE 6970: e22618
[8] http://www.cdc.gov/flu/pastseasons/1112season.htm
[9]  Jackson. Influenza vaccination and risk of community acquired pneumonia in immunocompetent elderly people: a population-based nested case-control study. 2008;372:398-405
[10] Jefferson, T. Vaccination for preventing influenza in healthy adults. Cochrane database of systemic reviews; 8 article CDOO4879

Fructose, a not-so-sweet surprise?

Fructose has earned itself a special spot in the lime-light in the last ten years, and with good reason. One minute you hear fructose is bad, the next you see a commercial saying it's the same as sugar. One day you go to your alternative medicine doctor and they say stay away from the stuff, the next day you do to your medical doctor and they tell you to use agave nectar because it's low glycemic. It's all very confusing! Well, I'm here to help you sort out the facts, the myths, and most importantly, the marketing.

First of all, let's compare fructose to it's cousins, glucose and galactose. Each of these are monosaccharides (one-unit sugars) that contain 6 carbons. These are bound together to form disaccharides (two-unit sugars). Sucrose, table sugar, is a glucose bound to a galactose. Lactose is a glucose bound to a galactose. These are both so called "simple sugars" because only one bond needs to be broken to get back to sugar building blocks, monosaccharides. Starch, like the glycogen in muscle and liver cells, is made up of long strands of glucose molecules bound together for easy storage. Each of these bonds requires slightly different enzymes for digestion, but the end product that makes its way to your cells for energy is going to be one of these three basic sugars.

Fructose is naturally found in fruit, and is by no means an evil sugar all by itself. However, the invention of high fructose corn syrup (HFCS) in the 1970s has made fructose an all too common occurrence in the American diet today. While the Corn Refiners of America may try to bamboozle us into thinking that HFCS is "a natural sugar that comes from corn" and "like sugar, is fine in moderation", I'm here to tell you that these statements could not be further from the truth.

In terms of their caloric value fructose and glucose are practically the same, but there are several things that make fructose a completely different beast in regards to its effects on the human body.

1. The metabolism of fructose is quite different than glucose.  For you biochemistry nerds out there, in his YouTube video "Sugar: The Bitter Truth" Dr. Lustig details the differences between glucose and fructose metabolism [1]. The two main differences (aside from the hormonal interactions) is that almost all of the metabolic burden of fructose falls onto the liver, and that calorie-for-calorie fructose is more readily converted to fat.

2. Fructose affects the body, and it's hormones differently than glucose. Glucose requires the hormone insulin to get into cells, which triggers adipose (fat) cells to release a hormone called leptin. Leptin tells the brain "I've had enough", thus serving as a negative feedback mechanism to prevent over-consumption of sugar. These hormones also suppress the release of another hormone, ghrelin. Ghrelin is a hunger stimulating hormone that is produced in the stomach. Suppressing ghrelin while increasing leptin secretion gives you the feeling of satiety. However, fructose does none of these things, leaving you yearning for more sugar.

3. Perhaps most importantly, marketing for HFCS and fructose containing products such as agave nectar have lead people to believe that they are actually healthy. The Corn Refiners "sweet surprise" commercials [2] and print ads surely paint a convincing picture. By portraying the HFCS skeptic as a uninformed scare-mongers, who after being questioned by what can only be called the HFCS enthusiast can only shrug and mumble, the Corn Refiners have made it quite clear that you should feel silly for simply questioning their product [2]. I much prefer this spoof commercial [3].

Agave nectar is unique in that many well intentioned doctors are now recommending it as a sugar alternative to their diabetic patients. Touting it's shiny low glycemic index label proudly, agave has managed to find itself a nice little niche among those who have diabetes and a desire to follow a low sugar diet, but still crave sugar. The problem is that agave is NOT low sugar- it is low(er) in glucose. According to my searches, agave ranges anywhere from 70-85% fructose, as opposed to HFCS that is typically 55% fructose, or table sugar that is 50% fructose. The reason agave is low glycemic is that fructose does nothing to raise your blood sugar, because "blood sugar" actually means "blood glucose". When blood glucose raises, diabetics have to take insulin (see number 2). Since fructose does not interact with these hormones it is considered better for diabetics, but that could not be further from the truth. The problem is that they fail to tell you on that nice, shiny label that high fructose sweeteners such as agave will leave you wanting more sugar, is more readily converted by fat, places undue burden on the liver, and is, calorie for calorie, still a sugar.

The moral of the story yet again is that you can't trick the body. We should all be on a low sugar diet-  but this means all sugars and all sweeteners. Don't fool yourself any longer- there is no such thing as a healthy sweetener. I'm not saying don't enjoy your sweets every now and then, but sugar is truly something to be consumed in MODEST moderation.

In a previous post we talked about how artificial sweeteners like aspartame create a feeling of disconnect between the stomach and the brain which leaves you craving more sugar, in addition to the very real possibility of causing cancer [4]. Now we have learned that low glycemic sweeteners (aka high-fructose sweeteners) such as agave and HFCS not only leave you craving more sugar, but will make you more fat and stress your liver. I hope you use this information to make the healthiest possible choices in the future.


Too legit to quit,

Nikki Cyr, D.C.


Referenced links:
[1] https://www.youtube.com/watch?v=dBnniua6-oM  <-- More on the metabolism of fructose
[2] https://www.youtube.com/watch?v=lQ-ByUx552s  <--- Commercial funded by the Corn Refiners
[3] https://www.youtube.com/watch?v=hYiEFu54o1E  <--- The real deal!
[4] http://createanewbox.blogspot.com/2012/08/artificially-sweet-part-1-truth-about.html

Other good reads:
[5] http://www.foodrenegade.com/agave-nectar-good-or-bad/
[6] http://articles.mercola.com/sites/articles/archive/2010/01/02/highfructose-corn-syrup-alters-human-metabolism.aspx
[7] http://www.sciencedaily.com/releases/2008/12/081209221742.htm

My 2013 Goals

In an attempt to follow my own advise, I decided to post my goals for 2013 here for all to see. Some are bigger or smaller than others. Some I already do anyway but I want to make a mental note to keep doing them. Some will be challenging.

One (the work out routine) is an old friend whom I have yet to conquer, but I believe I have identified the reasons why I have failed in the past and have tailored a plan to work around that. I know it's the oldest one in the book, but I have often found myself using the old excuse of not having time to work out. Solution: Work out at home (mostly) and fit mini-work outs in when I walk Ralphy in the morning (something I already do anyway). The other issue I have run into since I stopped rowing is boredom. I was a personal trainer for a year, I have a bachelors in Exercise Science, I am a chiropractor, and I still get bored working out. I know more about the movement I do than any one human being needed to know about movement, and yet, I mentally yawn just thinking about going to the gym. I rowed in college and ran and lifted weights for cross training, but that extra stuff was all because of my love for rowing. I just wanted to be a good rower. Well, that and I knew I had to go to the boathouse every morning or Rudy would probably find me and hurt me. I think I need a workout that 1. Keeps me interested 2. keeps me accountable or 3. Is rowing. Here are my ideas so far.

1. Groupons are a fabulous way to explore what is available in your area AND keep your workout boredom at bay! I bought three workout related groupons right before the new year, which will give me a great sample-platter of workouts to keep me interested. I really enjoyed the first class I went to and will most likely continue to work out there after the groupon runs out : )

2. As of last night, I have officially recruited a workout buddy! Involving friends is a great way to make working out fun AND keep you accountable. I make a really good workout buddy (I have a lot of toys and experiance putting together workout plans), but I make a lousy solo-work outer.

3. My ultimate goal is to join the boat house here in Tempe so I can get back on the water again. I think if I can get myself in decent shape and start rowing again, it will help me keep my eyes on the prize when I do non-rowing workouts.

Practicing what she preaches writes about,

Nikki Cyr, D.C.