Tuesday, January 22, 2013

Paleo and your microbiome

My guess is that most of you reading this blog realize how dramatically your life can change by switching to a Paleo Diet.  Having worked in the fitness industry for 17 years I have not seen anything quite like it.  Not only do people tend to lose a boatload of weight doing the diet, but many of the minor health maladies/aches and pains they have attributed to just getting old tend to fade away as well.  What most people fail to realize is that these 2 improvements are not separate issues.  They are also not mechanical in nature, you don't ache less because you have less weight to lug around.  The reason for both are tied to the inner ecosystem known as your gut microbiome.

This past year has been a gigantic leap forward in human health.  Epigenetics is picking up steam and being realized as one of the most important discoveries in human health ever while potentially revolutionizing the way we look at evolution.  However, if this past year has had an MVP for health research, it is the gut microbiome hands down.  From autism to autoimmunity to obesity to insulin resistance, changes in the gut seem to be dramatically affecting the way the human organism works.  Whether we are talking about the gut environment itself or the bacterial species that inhabit it, having a healthy gut is crucial to human health.  In fact, the gut is where most of your immune system lies and those bacterial species ferment the food you eat in order to provide your body with nutrients.  So, what is the gut microbiome?

The gut microbiome refers to the make up of the bacteria in your gut.  What most people don't realize is that you are more bacteria than human, about 10 times more bacteria than human.  If you look at the number of genes a human has in relation to the number of genes contained in the bacteria that inhabit one, the microbiome contains 100x more.  Given that the genes are what actually accomplish biological functions, the microbiome is pretty important stuff.

As we find out more about the way our bodies work, the way we approach certain things changes.  New research as well as research that has been around for decades indicates that weight gain/loss isn't solely regulated by calories in vs calories out, also known as energy balance.  For one, the magnitude of both calories in and calories out is highly variable based on what you eat, what you do, your genetic make up and you microbiome.  Another issue is that in the absence of Lipopolysaccharide (LPS) induced sepsis, animals fed high fat or high calories diets don't tend to gain weight.  Ironically enough, what you eat seems to be the most important factor here, both in terms of maintaining the integrity of the intestinal barrier as well as providing the bacterial diversity that is necessary for optimal health.  In my opinion, the gut microbiome will help explain a lot of the things we don't currently understand in human health.  Chief among them is weight loss.

When someone comes to me because they are having trouble losing weight on a Paleo diet, the first thing I look for is nutrients that may be compromising the gut lining either directly by causing inflammation or indirectly by changing the gut microbiome.  Obviously I need to find out if this person is work week Paleo or 7 days a week Paleo.  The problem with being work week Paleo is that every Friday after 5 through Sunday night they undo most of the healing they had done to their gut over the course of the previous 4.5 days.  It would basically be like popping the stitches on a wound every 5 days, certainly not a winning strategy for wound treatment.

The next step is to look at the composition of their diet, specifically what veggies they are eating.  One group of people that I red flag are those people who are Atkins circa 2002 Paleo.  These people eat nothing but meat and often neglect both bone broth and organ meats, both necessary components of doing it that way.  This is a problem because high fat diets tend to cause significant amounts of gut inflammation by changing the gut microbiome, something we are trying to avoid.  However, it appears that it is not the high fat diet per se, but an absence of plant matter in the diet.  Here is a rundown of that topic...

Human Food Project: An eater's guide to a healthy microbiome

Before we get in to how this may happen we should go over how bacteria spread in an environment such as your gut.  If I have 2 petri dishes full of the same ratio of a diverse array of bacteria and introduce different fuel sources in to each they will quickly become drastically different from one another.  This is because the bacterial species that consume the fuel source I introduce will multiply while the others will die off and be replaced with bacteria that can use that fuel.  So, if I put a plant in one and meat in the other, we would eventually have completely different bacterial communities.  Your gut operates in the same way.  When you eat a purely meat diet, some of the beneficial bacteria that ferments plant material and heals your gut lining reduce in numbers, making it difficult to heal an already damaged gut.  In addition, eating a diet devoid of plant material slows down the transit time of what you are consuming, allowing it to fester in your intestines long enough to cause some serious inflammation.  The prescription...More plants in the diet.

Now that I have gone through all of that, I would like to announce that my Synergy Wellness Paleo Challenge Group will be participating in a challenge within the challenge.  That's right, I plan on making next week Microbiome Diversity week with the ultimate goal of eating a minimum of 40 different vegetables during the week.  If you are interested in getting involved, let me know.  You don't have to do the challenge to be in the group, most people just use it as a way to get recipes and tricks to help them follow the diet.

Monday, January 14, 2013

Magnesium Part 3: The wrath of histamine

In the first 2 parts of this blog series we went over the importance of magnesium to the metabolic syndrome and lifestyle factors that contribute to magnesium wasting.  If you haven't read those two blogs they can be found here and here.  If you remember from part 1, one of the important functions of magnesium is to help create the histamine metabolizing enzyme Diamine Oxidase (DAO).  In magnesium deficient rats, DAO activity is decreased to 50% after 8 days of magnesium deficiency and it returns to baseline once magnesium is reintroduced back in to the diet(1).  In addition, histidine decarboxylase (HDC) activity is increased in some of the tissues of the magnesium deficient rats, particularly the spleen and peritoneum but not the skin(2).  HDC is an enzyme that makes histamine from histidine, an amino acid.  It is this conversion as well as certain foods that contain and/or liberate histamine that can be potentially problematic for someone with an existing magnesium deficiency.

Histamine intolerance is a condition where histamine accumulates in the body as a result of defective histamine metabolism(3).  This occurs as a result of reduced DAO activity, something that is made worse by a magnesium deficiency as referenced in the above study.  In addition, HDC activity increases which increases the conversion of histidine to histamine in the gut and circulation.  Histidine can be found in most high protein foods and is an essential amino acid.  As histamine accumulates in the body, numerous symptoms related to allergic reactions can occur including rash, GI symptoms, headache, hypotension, heart arrythmia, and a host of other symptoms.  Below is a flow chart of symptoms taken from reference #(3).

It becomes important for a person experiencing these symptoms to do a good job of managing histamine levels.  To do this, one should avoid foods that contain histamine, foods that liberate histamine from mast cells, and foods that block DAO activity.  Foods that contain histamine include alcohol, any food that has undergone microbial fermentation including cheeses, meats, pickled foods/sauerkraut, beans, pulses,  nuts, chocolate, wheat based products, shellfish, canned foods, and smoked meats(4).  Leftovers should be strictly avoided as bacteria act on the histidine in foods quickly, converting it in to histamine even in the refrigerator.  Foods that are known to liberate histamine from mast cells include citrus fruits, chocolate, nuts, papaya, beans/pulses, tomatoes, strawberries, pork, spinach,wheat germ, undercooked egg whites, and food additives(3,4).  Finally, foods that are known to block DAO activity include alcohol, green/black/mate teas, and energy drinks(4).

In addition to minimizing foods that can increase histamine levels in the body, it is a good idea to increase magnesium levels to help support DAO levels and reduce HDC levels.  Another nutrient that appears to be important in supporting DAO levels is Vitamin B6(5,6).  There is also evidence that vitamin B6 may help transport magnesium in to cells, possibly by forming a complex between the two(7).  As far as foods to support DAO activity, one interesting finding is that fat is the only macronutrient that increases DAO levels in the lymphatic system, protein appears to only increase DAO levels in the intestinal lumen while carbohydrate seems to have no effect on DAO levels(8).  Therefore, DAO only enters the circulation in the presence of fat.  If you are experiencing systemic symptoms of histamine intolerance, increasing fat intake may be something you want to look at.  Just make sure you take any oral magnesium supplement away from high fat meals as there is evidence that fat negatively impacts magnesium absorption(9).  However, if the reduction of magnesium absorption is due to utilizing more magnesium for DAO production, this may be a positive effect.

Most of you who have been "enjoying" the paleo autoimmune protocol are probably jumping for joy that you get to eliminate a bunch of other foods.  Ironically enough, some of the foods that are known to negatively impact histamine levels are also FODMAPS.  The point here is that if you are experiencing autoimmune symptoms you should be keeping a strict food journal to identify foods that are triggering responses so that you can compare those foods to foods that are known to cause negative reactions in the body to establish mechanism.  If these foods seem to match up to foods known to negatively impact histamine levels, try that route.  If it's FODMAPS that tend to be causing the problems, remove those foods.  If there doesn't seem to be any rhyme or reason to the reactions and you eat a lot of leftovers, something people who eat a paleo diet do often, try eating only fresh food.  If you want to find out if histamine is a problem, try antihistamines for a couple of days to find out if that ameliorates some of the symptoms.  I wouldn't use that as your solution since it's not a solution, it's a band-aid, but improvement from antihistamines infers that histamine may be a problem.

If you do identify histamine as being the culprit, it is probably a dose/response issue.  What I mean by that is you should find your tolerable dose of histamine and attempt to limit exposure to foods that increase histamine to below that dose.  The absolute fastest way to remedy the situation would be to eliminate those foods altogether, but that doesn't really leave much left if you are already on a paleo diet.  In any case, you may also want to increase magnesium and Vitamin B6 intake to both increase DAO production and reduce HDC production.  It seems fairly apparent that one of the underlying issues in the whole situation is a magnesium deficiency.  My best guess is that correcting the magnesium deficiency corrects the histamine intolerance.  In this situation I would recommend both oral and topical magnesium supplementation to make sure both the gut and your cells are getting their fair share of magnesium.

Wednesday, January 9, 2013

Hardwired for failure...



The articles above illustrate something I try to get clients to understand every day.  While they are busy concerning themselves with how many calories they consume and trying to burn as many as possible, something I tell them not to do, they ignore the fact that what they choose to eat is actually changing their operating system.  The reason I recommend a paleo diet is that the paleo diet actually repairs this operating system.  It's not only the software our systems have run on forever, it's the software our systems are optimized for.

When you choose to follow the diet for a couple of days and then go off the rails and eat something you shouldn't, you undo a significant amount of the progress you made because you begin to re-feed the bacteria you have been trying to do away with for the last couple of days.  Think of it as sending supplies to the enemies you are at war with, why would you do that?  Obviously if you are further along on the diet and have re-established your operating system you have a lot more leeway than someone who has been on the diet for a little while.

One of the hardest things to do is to get someone to change their diet.  I can't tell you how many clients who I've told to eliminate grains, legumes, and dairy who tell me they have done just that only to find out they are eating greek yogurt and granola for breakfast.  Granola has grain in the first 4 letters and who doesn't understand yogurt is dairy?  It's not that they are stupid people, it's that in a metabolically deranged individual they will always look for workarounds, it's what their body tells them to do.  Given the multiple body systems, and non-body systems in the instance of gut bugs, involved in driving them towards what they eventually end up eating, stupid isn't the proper term. I prefer the term hardwired for failure, and until they fix this issue that's what they'll continue to be.  While they may be able to lose a little weight here and there and maintain it for a few months, they will always go back to the status quo because they never fix the problem.  Eating the way a standard American eats changes the operating system, changes appetite, and drives people to make poor food choices.  It is also one of the primary drivers of the obesity and heart disease epidemics.

Monday, January 7, 2013

Factors in improving magnesium status

In my last blog found here I went over the importance of magnesium in the metabolic syndrome.  In this blog I will go over some of the things I feel are important in maintaining an adequate magnesium status.  While digging through the research I found a lot more than what I originally bargained for so it appears we may have a part 3, but more on that later.

To recap, when your intestine becomes permeable, an endotoxin known as LPS enters your blood circulation. This sepsis leads to your cells not responding to insulin, leading to high blood glucose levels which cause an even greater secretion of insulin which leads to conversion of glucose to fat and storage in your fat tissue.  In addition, the release of histamine in response to this sepsis increases your need for DAO, an enzyme used to decrease histamine levels.  Since all of the above require magnesium in order to perform these processes, magnesium deficiency appears to be a central player in the metabolic syndrome.  The question now becomes how can we manage our magnesium levels to prevent these issues?

Judging by the way this country operates, my guess is that most of the people who read part 1 came to the conclusion that they need to start supplementing with magnesium.  While magnesium supplementation is a good idea given the mineral depleted status of our soil and de-mineralized status of most water sources, just shoving magnesium supplements in to your mouth is probably not sufficient.  We need to pay attention to multiple factors here including whether or not the magnesium we ingest makes it's way in to cells, if it stays there, as well as how much magnesium we use on a daily basis.

The RDA for magnesium is set at 320mg for women and 420mg for men while actual intake in North America is 228mg and 323mg, respectively(1).  According to Carolyn Dean, MD, author of The Magnesium Miracle, research over the past 20 years shows that 300mg is required per day just to offset daily losses under ideal conditions(2).  When you add in stress, lack of sleep, a high sugar diet, diuretics such as caffeine and alcohol, and other things known to affect magnesium status, this number increases dramatically.  Let's take a look at each one and see what the research shows.

Stress and sleep deprivation are so intertwined that it is difficult to separate the two.  If there is any relationship that underscores the fact that you cannot separate the mental state from the physical it's the relationship between sleep and stress.  Magnesium appears to be a huge player here.  In a study performed on students during finals week, students who were under stress and had 80% of the sleep they were accustomed to saw a decrease in erythrocyte magnesium levels(3).  This study confirmed the results of a previous study by the same principal investigator that showed 4 weeks of sleep deprivation increased catecholamine levels (Stress hormones) and decreased intracellular magnesium levels and heart rate variability (HRV)(4).  Heart rate variability is a measure of autonomic function/stress where lower heart rate variability indicates increased stress load.

One of the problems one experiences with magnesium deficiency and sleep is that reduction in the quality and quantity of sleep increases magnesium wasting while a magnesium deficiency reduces the quality and quantity of sleep, making the problem worse.  One of the primary roles of magnesium in the body is to calm down the nervous system.  In a small study with people who experience restless leg syndrome, 10 subjects were given an oral magnesium supplement in the evenings.  The number of arousals per hour experienced by the subjects due to leg movements was reduced from 17 to 7, sleep efficiency improved from 75% to 85%, and 7 of the subjects stated that their sleep had improved on oral magnesium supplementation(5).  In another study on rats, 9 weeks of a magnesium restricted diet increased wakefulness by 50%, with a reduction of slow wave sleep by week 7.  When magnesium was reintroduced back in to the diet, the rats' sleep patterns returned to baseline(6).  Because of it's ability to improve sleep quality, it is probably a good idea to dose any magnesium supplementation just prior to bed in people who have poor sleep quality that may be caused by magnesium deficiency.  This will help end the vicious cycle of low magnesium decreasing sleep quality which in turn decreases magnesium levels.

One form of stress that people expect to see positive benefits from is exercise.  The results of exercise on magnesium balance have been mixed with most studies showing a shift from the plasma to erythrocytes (intracellular space) with an increase in urinary output on the same day based on the intensity of the exercise(7,8).  In 1 study, the amount of magnesium lost in the urine was positively correlated to post-exercise blood lactate levels and oxygen consumption indicating that exercise modalities that rely more on the anaerobic energy pathways are likely to induce greater losses of magnesium than aerobic activities(7).  This information should be of practical use to people pounding themselves in to the ground with 5 times a week crossfit and p90x style workouts as well as overweight people who begin with exercise that is too intense for their needs on January 1st.

As stated in part 1, magnesium is required to not only secrete insulin but also for cells to take in glucose once insulin has attached to the receptor on the cell membrane.  It makes sense that as you increase the amount of carbohydrate you eat you would also need to increase the amount of magnesium you get in order to process the higher amount of glucose being manufactured from that carbohydrate.  It would seem that this is a problem of relying on insulin as the primary modality of increasing glucose transport in to cells.  While a person who uses physical activity as their primary method of transporting glucose in to cells may not need to worry about magnesium needs via insulin action, the fact that ATP must be bound to magnesium in order to be active shows that there is really no way of getting around the greater need for magnesium in a higher carbohydrate diet, whether you exercise or sit on your keister.

As far as diuretics go, caffeine and alcohol are by far the most frequently used diuretics given their ease of availability.  Since both increase water loss, they can both have an impact on magnesium status.  Alcoholics tend to have lower levels of magnesium and some of the clinical symptoms of alcoholism such as hypertension, sleep problems, and the withdrawal symptoms after ceasing alcohol use appear to be from low magnesium levels(9,10).  Alcohol negatively impacts magnesium by drastically increasing urinary losses(9).  Interestingly enough, this appears to be dose dependent as a study looking at the effects of light beer consumption (330mL/day for 30 days)showed an increase in plasma magnesium status with the ingestion of beer when compared to a control drink containing mineral water with similar mineral content(11).  (Mmmm, beer)  However, we do not know if this is a shift out of cells and in to the plasma or a result of a response to the alcohol and magnesium combination.

Caffeine appears to have the same effect on magnesium as alcohol in that it increases urinary loss of magnesium.  The urinary loss of magnesium appears to be dose related and tends to occur around the time of caffeine consumption, tapering off as time from ingestion increases(12,13,14).  The average intake of magnesium is nowhere near sufficient in people who drink alcohol or coffee/caffeinated beverages, get poor sleep, are chronically stressed, exercise intensely, and eat high sugar diets.  I would even make the argument that the RDA is insufficient for people who do more than one of these things on a regular basis. 

Up until this point we have discussed lifestyle factors that increase the need for magnesium.  The next logical step is to increase magnesium intake via supplementation or foods high in magnesium.  The problem is, this simplistic way of looking at it can be problematic.  Many gastrointestinal issues can prevent magnesium from being absorbed.  Since magnesium requires stomach acid to separate the elemental magnesium from whatever it is bound to, people with low stomach acid tend to have a problem absorbing magnesium(2).  In addition, those with a leaky gut will also have a problem absorbing magnesium because some of the magnesium channels are located in the tight junctions between enterocytes.  In fact, 80-90% of the magnesium absorbed from the intestine uses these tight junction channels, illustrating why a healthy gut is critical in making sure magnesium is getting in to the blood so it can make it's way to cells(15).

In 2 studies performed on rats, animals that were induced with intestinal permeability to either 5 or 10 fold greater than baseline levels saw permeability return to baseline upon rinsing the lumen with magnesium or calcium at lower permeability and only magnesium at higher permeability(16,17).  In this instance ingesting oral magnesium may prove beneficial to healing your leaky gut, but if you continue to enjoy weekly gluten and alcohol bombs on Friday through Sunday very little magnesium will ever make it in to your cells so you wouldn't really be fixing the problem.  It would be like trying to heal a cut on your hand that has 5 stitches by popping the stitches every few days, it's never going to heal that way.  Take a couple of months to fix the problem and then return to enjoying your life, it will be worth it in the end.  Obviously a couple of rat studies proves nothing but they certainly make you think, especially with so much other evidence pointing to a positive effect of magnesium on health.

Let's say you are doing everything you can to heal your leaky gut and you would like to speed up the process.  You like the idea of taking oral magnesium and you are doing everything in your power to avoid things that may perforate your intestinal lining.  Is there something we can do to also get magnesium directly to cells?  In his book transdermal magnesium therapy, Dr. Mark Sircus goes over, in detail, the benefits of transdermal magnesium therapy.  There appears to be multiple ways to use magnesium transdermally, and while there is not a lot of studies supporting the use of it that way, there are thousands of anecdotal reports of success on the internet.  In my opinion, the best way would be to enjoy dips in sea water as often as possible, but since a lot of us are landlocked, I will go over the other routes of administration.

Magnesium sulfate (Epsom salt) baths-Putting magnesium sulfate in to a bath or a foot soak is one potential way of getting magnesium transdermally.  I find this way to be less than ideal from a cost perspective because you have to use a ton of epsom salts.  However, I've done the baths with just 2 cups of epsom salts and when you are finished I cannot think of ever being in a more relaxed state.  I also add in an equal amount of baking soda as a sort of detox bath.  Foot baths are also a good option and require less epsom salts.

Magnesium chloride oil-A few companies make a magnesium preparation from sea brine that can be effective for delivering magnesium while bypassing the gut.  It's not really an oil, but it kind of feels that way.  This was how I did it when I was having problems sleeping and oral magnesium glycinate didn't seem to help.  I was out like a light on the first night and my wife commented I was not my normal tossing and turning self.  Obviously I cannot rule out placebo effect but when you can't sleep any effect is welcome.

Personally, I use magnesium oil transdermally and it was initially my preferred modality because even high oral doses of magnesium glycinate did nothing.  It turns out this was because I had a leaky gut and the magnesium wasn't making it's way in to my cells.  As the leaky gut improved I no longer needed to take it in this manner so now I just take periodic baths and a small oral dose.  It took a while for me to fix the issue because I initially went at it alone and didn't completely fix my diet.  I eventually contacted a functional medicine doctor to help address the issue, something I will be discussing in an upcoming blog series.  I do continue to use the oil  as a deodorant/anti-perspirant because it works better than anything else I have ever tried.  I will not go over how much I took to resolve my issue because it is higher than the RDA and I'm not a doctor, I will only say that I did a lot of digging on this site and followed his instructions:


FYI, at high doses the oil burns.  As far as oral magnesium goes, I like dimagnesium malate and magnesium oxide.  If you search around the internet enough you will find plenty of evidence that magnesium oxide isn't absorbed well from the intestine.  This may not be a bad thing if you have significant issues in your gut and are taking transdermal magnesium with it.  The functional medicine doctor I use told me that in his clinical experience the magnesium oxide he prescribes seems to work better than anything else.  My guess is that since it doesn't get absorbed well from the gut it probably works better for fixing issues in the gut.  As for dosage, this will be specific to the individual and requires a bit of tinkering.  You'll know if you take too much orally because your stools will become loose. As an example, I took about 4x times the RDA and still didn't experience diarrhea.  As long as you have properly functioning kidneys you don't really need to worry about overdoing it, but consult your doctor just to make sure.

So where do we go from here?  In researching for this second part I actually came upon something very interesting with regard to the histamine part of the magnesium picture but it would have made this blog too long.  In the final part of this blog series on magnesium I will explore the interplay between histamine and magnesium and how you may be unknowingly botching your efforts to improve magnesium status by eating those leftovers.

If you have any questions about magnesium feel free to post them in the comments.