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/