Monday, July 29, 2013

4 stress reduction tips to balance your stress account

I discuss balancing your stress account often on this blog because it's one of the things that anyone can do that will have a fairly dramatic impact on their health.  The first step in balancing your stress account is identifying that you have one.  Anyone can see that as they accumulate more stress the need to unwind or get away becomes greater.  For some reason, most people only take the chance to unwind when they go on vacation or have a special event such as a wedding or birthday that allows them to get together with friends and just relax.  While good times such as these are always great to have, incorporating stress reduction strategies on a daily basis can help improve health and well being.  Below are four strategies to help add funds to your stress account.

Daily commute?  Try laughing.

Most people begin their work day with a commute to work.  Whether your commute is 15 minutes or an hour, a good strategy to reduce the stress of being in traffic, or just get your day started off on the right foot is to laugh.  A great way to add humor to your car, bus or train ride to work is to listen to some comedy on your iphone, ipod, or radio.  There are many apps that will allow you to listen to stand up comedy or even funny podcasts that will take the stress out of your commute and get your day started right.  Pandora and Spotify are 2 free apps that have multiple options for comedy stations.

Get to bed early

We live in a very sleep deprived society.  We have tons of things going on during the day and those things don't just go away at night.  Whether you set yourself up for failure by not getting to bed early enough or you have a problem clearing your head once you get to bed, poor sleep can take a toll on your health and negatively impact your ability to handle stress.  Spend a week trying to build better sleeping habits by getting to bed with the lights out and all electronics off by 10pm.  If you have trouble falling asleep because your mind races, try focusing on your breath as you fall asleep.  If your mind begins to wander, don't get upset, just slowly bring your focus back to your breath.

Practice mindfulness

Many people are familiar with mindfulness as it pertains to mindfulness meditation.  While meditation is a great way to begin practicing mindfulness, it is not the end all be all for mindfulness.  Being mindful is about being in the present and not focusing on the past or future.  By focusing on the now, the stresses of what has happened and/or what will happen won't have as detrimental of an effect on your ability to deal with stress.  In addition, one of the added benefits of mindfulness is that it teaches you how to process information without generating an emotional response.  Brain imaging studies show practicing mindfulness decreases brain activity in the amygdala, the emotional center of the brain.  The amygdala has a direct connection to the hypothalamus which is the part of the brain that initiates the stress response. 

Foam roll/stretch

Many people realize the importance in maintaining their flexibility with a regular stretching program.  Whether you end every workout with a good full body stretching routine or participate in a yoga class, you may not be getting the full benefit from your program if you fail to address your fascia.  Fascia is a network of connective tissue that runs throughout the body.  It contains many mechanoreceptors and allows muscles to transmit forces more efficiently as well as glide over one another without friction.  During times of chronic stress, the fascia begins to tighten which does a couple of things.  First, it can lead to pain and fatigue as blood vessels and nerves run through it and can become entangled.  Second, while stress causes the fascia to tighten, tight fascia increases stress which can lead to an endless cycle.  Compounding the problem is that fascia doesn't respond to stretching, it responds to pressure, so merely stretching the muscle isn't enough.  In fact, the muscle is 300x more extensible than fascia so most of the restrictions people have in their range of motion have to do with tight or restricted fascia, not tight muscles.  Massage is a good way to address the fascia, but you can also address the fascia by using a foam roller and then stretching afterward.  This allows you to free up restrictions and break up adhesions in the fascia with foam rolling and then restore length to the muscle with stretch.  This is a killer combination for relieving stress and reducing or eliminating pain. 

Foam rolling the IT band
Taken from


There are many ways to help manage your stress account.  By digging deep in to the physiology of stress, you can identify many tools you can use to help balance your stress account.  Laughing, getting 8 hours of quality sleep, practicing mindfulness, and performing a foam rolling/stretching routine regularly are all helpful tools you can use to manage your stress account.  Each of these tools works through a different mechanism so combining all of these methods should have an additive or synergistic effect on helping you manage stress.

Thursday, July 25, 2013

Healthy mitochondria: The key to optimal health and wellbeing

While most people tend to look at human beings as an individual unit composed of organs and tissues with regard to health, it is important to realize that the health of individual cells will dictate how healthy your organs and tissues, and thus you, are.  Of course all parts of the cell serve a vital purpose to our survival, but one organelle appears to be particularly important for your health: The mitochondria.  Your mitochondria serve many roles in your cells that are critical to proper function including generating the bulk of ATP(Energy), cell specialization, apoptosis, control of the cell cycle, and cell growth.  The role of the mitochondria is so important to health that mitochondrial dysfunction is found in many of the chronic diseases people experience today including Cancer, Diabetes, Alzheimer's, Parkinson's and a host of others.  Let's take a look at the mitochondria and their impact on health.

A look at a single mitochondrion through a microscope

An interesting tidbit on the mitochondria

The mitochondria are interesting little organelles found within our cells.  Organelles are little structures within our cells that carry out tasks.  Each cell within in an organ has organelles that perform the function of that organ.  For example, one of the functions of your liver is detoxification and many of the cells within the liver contain organelles that do just that.  The mitochondria, which along with energy generation have many functions critical to survival, can be found in just about any cell within a multicellular organism.  The predominant theory on how mitochondria came to be in our cells is referred to as endosymbiosis.

Endosymbiosis is the theory that many of the organelles within our cells came to be there due to a mutually beneficial relationship with the host cell.  In the case of the mitochondria, the theory goes that the mitochondria were bacteria that were engulfed by a separate single celled organism.  There is plenty of evidence for this, and the fact that mitochondria contain their own DNA in the shape of a circle, something primarily found in viruses and bacteria, lends support to this theory.  Over time, the mitochondria became organelles within the cell and lost some of their DNA to the nucleus.  However, to this day, the mitochondria still contain some DNA that cannot be found in the nucleus of the cell.  This DNA primarily codes for proteins found in the electron transport chain, something we will discuss a little later.

What do the mitochondria do?

While the mitochondria within your cells do quite a few things, the role they are most famous for is generating most of the ATP.  ATP, or adenosine triphosphate, is the form of energy your cells use to accomplish the many tasks they perform.  Some cells create hormones, some cells create movement, some cells transmit nerve impulses, and some cells relay information within the body.  Any cell that requires energy to power it's processes uses ATP to do so.  Most cells have many mitochondria, and the number of mitochondria within the cell is in proportion to the energy needs of the cell.  In addition to generating energy for cells, mitochondria also have a prominent role in apoptosis, or cell suicide.

While the concept of cell suicide may sound bleak, apoptosis is a critical process that begins when you are developing as a fetus.  The formation of fingers and toes is accomplished by apoptosis of the cells between the fingers and the toes.  In people with webbed feet or hands, this process did not operate efficiently when they were in the womb.  Apoptosis helps remove unwanted or unhealthy cells before they become a problem.  When apoptosis doesn't occur, bad things happen.  Cancerous cells somehow override apoptosis which is how they proliferate and become tumors.  As long as apoptosis is working properly, irregular cells are terminated.  In fact, thousands of cancer cells develop and go through apoptosis ever day.  It's when apoptosis doesn't work smoothly that cancerous cells proliferate and become tumorous.

As you can see, healthy mitochondria are important for health.  By eating the proper foods and getting regular physical activity, you can keep your mitochondria working smoothly.  Let's take a look at the foods you should be eating and things you should be doing to maintain healthy mitochondria.

Foods for healthy mitochondria

Many foods are beneficial to healthy mitochondria, chief among them are vegetables high in sulforaphane.  Sulforaphane is a molecule found in cruciferous vegetables that helps to increase intracellular glutathione levels.  Glutathione is your body's master antioxidant.  One of the ways your mitochondria makes ATP is the electron transport chain(ETC).  The ETC generates energy by passing electrons between molecules in the mitochondria which creates an electrochemical gradient.  It's not important to understand the specifics of this energy generating process, but it is important to understand that this process generates free radicals as a natural byproduct of making ATP.

Free radicals are unstable substances with an unpaired electron in their outer shell that react with healthy components of your cells.  It is important to limit free radicals because they can interfere with proper functioning of the cell.  Antioxidants donate electrons to free radicals but become weaker free radicals in the process.  Glutathione, being the master antioxidant, donates electrons to free radicals as well as antioxidants that have become free radicals.  Having high glutathione levels, then, can allow you to limit free radical production and limit the amount of damage free radicals can do to your mitochondria.  This is important because most of the antioxidants you eat cannot enter the mitochondria and since the mitochondria has DNA that codes for the proteins in the ETC, damage to that DNA can accelerate free radical production.

Eating cruciferous vegetables such as broccoli, cauliflower, cabbage, asparagus, and kale is important to help keep your glutathione levels high.  Studies have shown the sulforaphane found in these vegetables helps induce cell apoptosis in cancer cells(1).  However, since these vegetables are also goitrogenic meaning they can interfere with thyroid function, you want to limit consumption of these foods to five or six servings a week.  Cruciferous vegetables are not the only foods found to increase glutathione levels, whey protein(2) and blueberries(3) both contain compounds that increase glutathione levels as well.

Supplements for healthy mitochondria

While keeping glutathione levels high should be one of your goals, supplemental glutathione won't work because it is destroyed by stomach acid.  N-Acetylcysteine does appear to work very well at keeping glutathione levels high(4).  However, when looking at maintaining good mitochondrial health and a healthy number of mitochondria in your cells, there is more to it than just increasing glutathione levels.

Magnesium deficiency has been shown to lead to fewer mitochondria in cells(5), so getting sufficient levels of magnesium is important to generating many mitochondria.  Iodine is another important nutrient to make sure you are getting enough of to support healthy mitochondria.  In addition to it's role as a component of thyroid hormone which regulates metabolism throughout the body, iodine also has an important role to play in cell apoptosis(6) which it apparently mediates through mitochondrial mechanisms(7, 8).  In one study, iodine was shown to induce apoptosis in human breast cancer cells but not in healthy cells that surround the cancerous cells(7).  In another, iodine helped induce apoptosis in 4 out of 5 breast cancer cell lines.  For the most part, people tend to be deficient in iodine unless they consume large amounts of fish or low to moderate amounts of seaweed.  Table salt is iodized but few people use iodized salt and the iodine tends to evaporate out of the salt over time.

Lifestyle factors for healthy mitochondria

Given what we've discussed thus far about mitochondria, you may be able to figure out the things you should be doing to have many, healthy mitochondria.  Calorie restriction has been shown to boost the health of mitochondria which makes sense.  Fewer calories going through the mitochondria means fewer free radicals that can potentially react with healthy parts of the cell.  Ketogneic diets tend to lead to healthy mitochondria, potentially via an increase in glutathione levels(9).  It is important to note that one should not randomly undertake a long term ketogenic diet as these types of diets require modulating the intake of other nutrients for safe implementation.

Another thing people can do to maintain healthy mitochondria is exercise.  Daily physical activity is important to signal cells to keep many mitochondria on hand.  There is probably a sweet spot you should shoot for as excessive exercise should, in theory, lead to greater free radicals via increased mitochondrial free radical production.  If I were to ballpark it I would say running for 3-5 miles per day is probably ok but anything above that would provide no added benefit with potential negative consequences, but there are no studies to back up this assertion.  As far as strength training, a normal strength training program is probably fine but bootcamp or circuit style training could potentially cause problems in excess.  Regardless, any situation where you are calling on your body to produce lots of energy will create lots of free radicals that you should attempt to keep in check by keeping glutathione levels high and eating foods high in antioxidants(fruits and veggies).


Keeping healthy cells is important to maintaining your health.  While all components of your cells are important, the mitochondria are crucial for energy generation and proper cell functioning.  There are many things you can do to keep many, healthy mitochondria.  Eating foods that boost glutathione levels as well as making sure you are getting enough magnesium and iodine are nutritional strategies everyone should utilize.  In addition, regular physical activity that is not excessive can signal your cells to increase production of mitochondria without the netative side effect of creating too many free radicals.

Monday, July 22, 2013

4 ways to mitigate the damage from alcohol

Let's face it, most of us like to throw caution to the wind and have some drinks on the weekends.  Whether you are going out with friends, attending a special event, or just sitting on your deck or porch and throwing a few back, there are a few things you can do to help your body process the alcohol.  Let's take a look at 4 strategies to help mitigate the negative effects of alcohol.

4)Plan your more intense workouts accordingly

Alcohol and exercise are both stressors to the body.  Since they both will cause damage that the body must repair, it's a good idea to space them apart.  A good rule of thumb is to plan more intense sessions away from your drinking days.  If you plan on drinking on Friday evening, your last intense session should be no later than Thursday morning.  If you drink on Saturday night, your next intense session shouldn't be until Tuesday morning.  If you decide to exercise on Friday or Monday you should perform low intensity work like light weightlifting, walking, or a leisurely bike ride.  As I've discussed before about your stress account, you always want to make sure you balance debits with credits.  Alcohol has the added problem of negatively affecting sleep which will increase the amount of the debit.   In this instance you can benefit from the stress reducing effects of meditation or yoga.  In fact, doing one or the other after a day of drinking can help you recover faster.

3)Use liver support

When you drink alcohol, your liver has to work overtime to process it.  Supporting your liver with the nutrients it needs to do this is a good idea.  Milk thistle tends to be the go to supplement for liver damage control, but most of the studies are in people with damaged livers from disease.  It appears as though milk thistle is beneficial to people with cirrhosis of the liver or liver damage from diseases such as hepatitis C, but whether nor not this translates in to being beneficial to someone with a healthy liver who is looking to prevent damage remains to be seen.  Regardless, it's cheap and non-toxic so it is probably a good option.  Another supplement that is of value is Pantethine.  Pantethine is the biologically active form of Vitamin B5.  When the liver processes alcohol, it turns it in to acetaldehyde which is then turned in to acetic acid where it can be excreted via the urine.  The problem in this process is that acetaldehyde is more toxic than alcohol and a potential contributor to the hangover you feel the next day.  Pantethine is used by the liver to help detoxify both alcohol and acetaldehyde so supplementing with it may help the body process alcohol better, or at the very least it can prevent a B5 deficiency after alcohol intake.  Molybdenum is a trace mineral that also helps convert acetaldehyde in to acetic acid and, therefore, may be of benefit as well.  In addition to this role, molybdenum is also used to metabolize the sulfites found in wine.  People deficient in molybdenum are prone to negative reactions to sulfites so making sure you are at least getting the RDA is a good idea.  With molybdenum, it's important to not take too much as high doses can interfere with copper absorption.

2)Use gut support

Alcohol causes significant gut inflammation.  To help repair this damage and prevent the bugs in your gut from getting out of whack, it's a good idea to make sure you get plenty of soluble fiber to feed healthy bacteria that will in turn help heal the gut damage.  The best way to do this is to eat plenty of fruits and vegetables before, during, and after consuming alcohol.  Another good thing to do is add a little resistant starch to the mix.  While resistant starch isn't classified as fiber, it acts like fiber in the body.  We cannot digest resistant starch so it makes it's way to the colon where it can feed the good gut bugs.  There are resistant starch supplements available, but the best, cheapest, and easiest way to get resistant starch is to go to your local grocery store and purchase Bob's Red Mill Unmodified Potato Starch.  Each tbsp contains 8g of resistant starch, just make sure you don't heat it up or the starch will break down and become non-resistant.  Just mix it in water or add it to a vegetable smoothie to get a good dose of soluble fiber, resistant starch, and antioxidants to help repair the free radical damage caused by alcohol.

1)Get those electrolytes

Since alcohol is a diuretic, it will cause you to flush out water as well as electrolytes which can contribute to may of the symptoms of a hangover including headaches, dizziness, and thirst.  The 3 primary electrolytes you are concerned with replenishing are magnesium, potassium, and sodium.  I recommend most people supplement with magnesium as it is very important for human health and our soil tends to be deficient in it.  When consuming alcohol, it is probably a good idea to up your dosage of magnesium to offset the loss caused by the diuretic effect of alcohol.  Potassium is found in high levels in fruits and vegetables such as bananas, tomatoes, potatoes, carrots, as well as many others.  As long as you are keeping the veggies coming while drinking you should be fine.  Coconut water is high in potassium but also high in sugar so if you are worried about body composition it is probably best to stick with the veggies.  The best way to get sodium is to salt your food liberally or add a small amount of salt to the water you drink throughout the day.  Obviously you should drink plenty of water, but neglecting your electrolytes will definitely lead to an electrolyte imbalance you are not going to enjoy the next day.

Thursday, July 18, 2013

5 mistakes most people make in their exercise program

Let's face it, when it comes to exercise, there are a million ways to skin a cat.  In fact, the best thing about exercise is that there are no hard rules as to what constitutes it.  You can run, you can swim, you can dance, you can ride a horse, there are literally hundreds of possibilities.  However, just because there are so many options doesn't mean that you should go about exercise haphazardly.  In fact, most people do just that and it ends up doing the exact opposite of their intent, it makes them less healthy and causes them to gain weight.  When I get a new client, the assessment doesn't begin by looking at the state they are in now, it begins by looking at what they have been doing and identifying things that may be working against them.  More often than not, a lot of the problems they are having can be fixed by changing their approach to fitness.  Below are the top five problems I see with the exercise program of new clients.

5)Their exercise time is spent in the same position as the rest of their day...On their ass

There is probably nothing worse for a humans than prolonged sitting.  Most of us spend the vast majority of our day in a seated position. Our exercise program should do the opposite, you should be on your feet as much as possible.  This is a problem that runs the gambit, too.  I know some people who spin 4 days a week as their primary mode of exercise.  I also know people who warm up for their workout for 5 minutes on a bike and then go sit on different benches for 10 minutes at a time with 15 second intervals of bench press or leg curls interspersed between their sitting time. I'm not saying the bench press is not a good exercise, I'm saying that when 95% of your time is spent sitting and 5% of your time is spent bench pressing, why would you call that sets of bench pressing and not sets of sitting.  Get up and move around, explore the space.

4)Focusing on quantity and not quality

This is a big one.  When people think of exercise, they tend to think of quantity and not quality.  This can mean a couple of things.  This can mean they are using terrible form to get a high number of reps which is a stupid thing to do.  If you need momentum to move a weight for a prescribed number of reps you need to decrease the weight so your muscles can do the job.  This can also mean they are using a partial range of motion.  If you can't move a weight through the entire range of motion, lower the weight and use the full range so you can recruit all of your muscle fibers.  Finally, this can mean that they are just training too much.  If you beat yourself up in the gym day in and day out and your technique suffers you are only asking for trouble.  This scenario typically leads to injury which leads to prolonged breaks from exercise.

3)Sticking to one activity

Most of the time, people pick one exercise modality and just stick with it and ignore the others.  Endurance athletes stick to endurance exercise, meatheads stick to meathead exercises, people who do yoga just stick with yoga, pilates people only do pilates, and the aerobics crowd sticks with aerobic exercise.  This typically leads to burn out as people get bored, and it also tend to lead to overuse injurie.  Specializing in one form of exercise will typically build up some attributes of fitness while neglecting others.  To become a better rounded person as well as a more fit and healthy person, it's important to improve all facets of your body.  This includes getting some conditioning in to work your heart, some flexibility training to maintain range of motion, some strength training to maintain bone and muscle health, some yoga and meditation to give your brain a break, and some balance and core work to help maintain good movement.  When I first meet with clients, we come up with a plan to address all of these things either directly in our workouts or over the course of the week in a combination of workouts with myself and other fitness professionals.

2)Overdoing it

Oddly enough, most of the people I assess need to dial back the number of workouts they do in a week.  Unless you are an athlete, most people only need to lift weights twice a week.  I often get clients who come in already exercising 4-5 times a week with no real rhyme or reason behind what they are doing.  We have been programmed to believe that with something like exercise, more is better.  This is not really the case.  Most people need to exercise less and move more in their everyday life.  The most common lifestyle I find coming to me frustrated for lack of results is a lifestyle that is spent sitting behind a desk for 8 hours and that exercises for 5 or more hours a week.  These people need to get up and move more throughout the day while exercising 2-3 hours a week.  There is a lot that goes on with sitting for long periods of time from a genetic expression level that cannot be reversed with any amount of exercise.  Moving more throughout your day and exercising 2x per week is more than enough for people to drastically improve their health and drop excess pounds.

1)Not balancing your stress account

Most people don't realize the benefit of balancing stress.  More importantly, if you don't balance stress you can negatively impact your health as well as your ability to lose weight.  This is ironic to me because I've heard many people talk about a mythical stress mode their body enters when they don't eat every 3 hours.  While that stress mode is a figment of people's imagination, beating yourself in to the ground 5 days a week with exercise and then getting drunk on the weekends leading to poor sleep will certainly put your body in to stress mode.  When this happens, many things can go wrong.  You will not properly digest your food so you will not absorb the nutrients you eat which will lead to increased appetite.  Your sleep will become negatively impacted which will cause your blood sugars to run high.  Your immunity will be negatively impacted because your body will always be in fight or flight mode and will become incapable of both resting and digesting.  As a result, you will not adequately recover from your overexercising and will push yourself further push your self in to stress mode until you break.

It's best to look at your exercise program like a bank account.  On the one hand you have stress debits such as strength training, conditioning, boot camps, crossfit, and aerobics classes and on the other hand you have stress credits such as yoga, meditation, tai chi, foam rolling/stretching, recovery days, and solid sleep.  If you don't balance all of your debits with credits you will be on the fast track to stress bankruptcy, and that is certainly not a good state to be in.  One of the best ways to monitor this is with heart rate variability.  Heart rate variability can tell you if you are overdoing it and need to dial it back, or if you are underdoing it and need to dial it up.  Fortunately for the technically savvy, there are many apps for that.  The best idiot proof apps are Bioforce HRV and Ithlete, but there are free apps you can tinker with that require a learning curve.

Monday, July 15, 2013

Client questions: Supplement edition

This blgo will be regularly updated with questions clients as well as readers ask me.  If you have a specific question you would like answered about nutrition, supplements, exercise, or anything related to health and fitness send me an email, post a question on facebook, or ask one in the comments section.

Do you recommend any probiotics and if so what kind and how many CFU?
This is a question I get asked a lot and there is actually a simple answer: It depends.  For the most part, I think most people put way too much stock in probiotics.  For one, if you use probiotics that need to be refrigerated, it seems odd that they are so fragile that they cannot survive outside of the refrigerator but not so sensitive that they can survive 8 hours immersed in your digestive juices and a 98 degree environment before settling down safely in the large intestine.  I think more focus, and the research bares this, should be placed on eating foods high in prebiotic fibers such as fruits and vegetables.  Prebiotics are substrates that probiotics ferment, so they are basically food for the bacteria.  My personal strategy is to eat fermented foods and tons of fruits and vegetables and I don't take probiotics in supplement form.  They may have some utility if you need to take a course of antibiotics.  In this instance I would take a high CFU probiotic(10-15 billion) that contains prebiotics as well or I would take a prebiotic supplement as well.

Do you recommend taking any antioxidants?
I don't see anything wrong with taking antioxidants, and you obviously need antioxidants such as vitamins C and E which are necessary for good health.  When making your decision on whether or not you should take antioxidants, it makes sense to understand how they work.  Free radicals are atoms, molecules, or ions that have an unpaired electron.   Since this makes them unstable, they react with nearby atoms, molecules, or ions and steal an electron.  This makes the object they reacted with a free radical and, thus, unstable.  Antioxidants donate an electron to free radicals, but this makes the antioxidant a weaker free radical.  The free radicals you get from food work in this manner, but you have an endogenous(it's made inside the body) antioxidant called glutathione that acts as a super-antioxidant.  Not only does glutathione donate electrons to free radicals, it donates electrons to antioxidants that have donated their electrons.  This essentially recharges the antioxidants you eat and allows them to get back to work.  Certain foods increase glutathione production in the body including the omega 3 fatty acid DHA found in fish, curcumin from turmeric, blueberries, and the cruciferous vegetables.  One thing of note: since the cruciferous vegetables are goitrogenic, it's a good idea to limit their consumption.  The good thing is, the effects from the cruciferous vegetables appears to last for 3 days so daily consumption is unnecessary.  N-Acetyl Cysteine and undenatured whey are supplemental ways to improve glutathione status.  Ingesting glutathione itself won't work because it is destroyed by stomach acid.

What type of protein supplement do you recommend?
For the most part I recommend people get their protein from animal flesh.  The only type of protein powder I recommend outside of that is Mercola Pure Power Protein.  I recommend this protein because it comes from grass-fed cows and contains prebiotics.  Since it is whey, it can be completely digested(Casein is the problematic protein in milk) and will help improve glutathione status.  It's also 99% lactose free so it is tolerated by most people.  Supposedly, since it's undenatured(Not heat processed) it's better at improving glutathione status but I have seen studies showing regular whey to work perfectly fine for improving glutathione status. 

Thursday, July 11, 2013

Top 6 reasons people fail on the Paleo diet

I've worked with quite a few clients to help them change from a Standard American Diet to the Paleo Diet.  While the change is often difficult at first, many get the hang of it within a month or two.  This does not mean that everyone attains their goals and part of the reason is how blurry the lines are as to what a Paleo Diet is composed of.  I know I don't speak for everyone, and how anyone chooses to apply their diet to their lifestyle is totally up to them, but in this blog I will go over the top 6 reasons people fail on the Paleo Diet.  I am not simply defining "fail" as having anything to do with weight, I am including failure to attain health goals as well.  So here they are in order.

6)Not tracking data
However you choose to go Paleo, whether you go 2 months strict Paleo or just 80/20, it's important to pay attention to how food affects you.  It is unlikely that you will find foods that you are sensitive to if you don't go strict for at least 4 weeks, but you can still identify trends.  By paying attention to things such as energy levels, GI discomfort, how you sleep, and mental clarity you can tinker with your diet to identify what's optimal for you.  While the basic template of what we should eat is the same, there will certainly be a significant amount of individual variability based on genetic differences.  Most people feel that if something doesn't give them a stomachache then it's fine for them to eat.  This is certainly not the case.

5)Avoiding supplements
When Robb Wolf and Chris Kresser came out with their line of supplements for the Paleo Diet several months back, they were eviscerated by people on the web and on Facebook.  For some reason, people equate the Paleo diet with meaning that the need for supplemental nutrition doesn't exist.  News flash...people in the Paleolithic Era often died of malnutrition/nutritional deficiency.  The only reason we know anything about the RDA for vitamins and minerals is because people were contracting diseases of nutritional deficiency such as rickets and scurvy.  The healing potential of food has been around forever but that doesn't mean that eating an all natural diet such as the Paleo Diet won't lead to a nutritional deficiency.  Furthermore, the RDAs for most of the nutrients we know about were determined during a different environment with regard to the soil the food was grown in as well as the environment we live in.  I take krill oil, iodine, magnesium, and vitamin D3 all for different reasons.

1)I take krill oil because it 's a good source of DHA that isn't tainted heavily with mercury.
2)I take iodine because both the environment and our food supply have a lot of goitrogenic compounds and I have no way of sourcing seaweed in a way that would guarantee that it hasn't been tainted with radioactive iodine.
3)I take magnesium because I believe the soil our food is grown in is deficient in it and I drink alcohol and coffee which increase magnesium loss via the urine.
4)I take vitamin D3 during the winter months because where I live doesn't get D3 from the sun during that time of year.

Face the facts, our environment is not optimal and some supplemental nutrition is probably necessary for everyone unless they grow their own food and live in a bubble.

4)Not getting enough physical activity
I've discussed the negative effects of being sedentary on genetic expression in detail here, so I won't rehash all of the science.  What everyone needs to know is that both limiting daily sitting time as well as getting 10,000 steps a day are bare minimum physical activity requirements that cannot be replaced by exercising 6 hours a week.  In fact, getting those requirements in drastically reduces the amount of exercise you need to do at the gym to about 60-90 minutes per week.  Even if follow the Paleo Diet 100% of the time you need to move your butt!

3)Avoiding carbs
I like the ketogenic(low carb) version of the Paleo Diet and often do it for a couple of weeks at a time to lean out.  Going low carb is not a bad idea in and of itself if you are going to stay that way and you know everything you need to do to successfully implement a ketogenic diet.  The problem is, if you do it improperly you can hammer your thyroid and adrenals pretty badly.  In addition, if you are going low carb you need to stay low carb for an entire stretch for it to be beneficial to you.  No binging on the weekends, no higher carb day, no beer, no wine, no 80/20.  The problem with looking at carbs as the enemy is that people will have zero carbs for a stretch which will induce physiological insulin resistance and then binge on carbs in this state which is terrible for you.  Carb-phobia is a bad thing; don't focus on macronutrients, just focus on the food source.

2)Still eating processed foods
It seems that this would be common sense but it's not.  One of the primary tenets of the Paleo Diet is that processed foods are bad for you, at least in their current incarnation.  Somewhere along the line, people decided this processed food avoidance only pertained to processed foods high in carbs so processed foods high in fat such as nut butters, nut milks, and nut flours were perfectly fine.  This is an offshoot of the anti-carb paranoia I guess, but it is a bastardization of the concept of processed food avoidance.  The reasons you should avoid processed foods are because they are hyper-palatable which will cause you to overeat them and they are uber-doses of things you shouldn't be uber-dosing.  I wouldn't say you need to completely avoid these things, just count them as your 20 and not your 80.

I feel that this one is merely the pendulum swinging too far to the opposite side.  While being bombarded with propaganda to avoid fat for the past 40 years has certainly contributed to our current spate of health problems, we need to be careful not to overcorrect.  Most of us eating a Paleo Diet do so to avoid the gut inflammation caused by eating grains.  For some reason, to some people, this means that we should bombard ourselves with lots of fat.  You obviously have to replace some of the energy you lose from carbohydrates by eliminating processed foods with fat, but this doesn't mean you should be eating fat ad libitum.  There is plenty of evidence that eating a high fat diet will lead to gut microbiota changes that will increase intestinal and systemic inflammation (1, 2, 3).  While some of this can be reversed by eating foods high in prebiotics(aka fruits and vegetables), just eating fat for the sake of eating fat is a bad idea.  In addition to the inflammatory factor, calories do matter.  Just because counting calories isn't an effective way to be healthy or lose fat doesn't mean that eating a ton of calories won't pack on the pounds.  So if your breakfast is a cup of bulletproof coffee you may want to reconsider.

Monday, July 8, 2013

Carb cycling: Good for fat loss or a bad idea?

I was recently asked whether or not I thought carb cycling was a safe, effective way of dropping body fat.  While I think carb cycling can be very effective at dropping excess fat, I think carb cycling as practiced by most people who are practicing it is potentially a bad idea without covering all of your bases.  Let's science...

Carb cycling 101

Carb cycling is exactly what it sounds like, you cycle the amount of carbohydrates you eat each day, normally by eating high carb on workout days and low carb on rest days.  While individual programs vary, most follow a structure similar to the one below:

Taken from:

My primary issue with carb cycling safety is the level of carbohydrates on the low carb days for women, and to a lesser extent men.  Let's take a look at the numbers for a 150lbs woman.  On high carb days, this woman will consume 210g of carbohydrates and on low carb days she will consume 90g of carbohydrates.  This may not seem like a big deal, but when you consider the brain uses 120g of glucose just to keep you operational everyday you can see a woman could easily put herself in to a brain glucose deficit.

A woman who is not ketoadapted(It's impossible to become ketoadapted when you consume a carb level higher than 50g/day in a 1 week period) will burn approximately 1500 calories just to stay alive with 150g coming from carbohydrate.  This is merely to keep her alive, this does not include physical activity which will increase this number considerably unles she is ketoadapted.  So if she stays in bed and doesn't move she is in a 30g glucose deficit.  To make up for that deficit, she will have to call upon cortisol to make glucose from non-carbohydrate sources.  If she does any sort of physical activity, even walking, she will use some of the glucose she made from carbohydrates and the glucose her brain would use later in the day would be used up.  Cortisol could be called in to action to make more glucose, more than likely later on in the day or at night as the brain runs out of energy, especially if intense exercise is part of your weekly plan.  Having cortisol secreted late in the evening or even in the middle of the night is bad for your circadian rhythms and will disrupt sleep.  It would even be possible to go in to a glucose deficit on training days if you train intensely enough and a 200lbs male would be able to achieve a considerable glucose deficit at 180g on low carb days.

So avoid carb cycling?

Since carb cycling is both popular and very effective, throwing it out completely is only a valid option if there is no way around the issue of providing energy to the brain.  Fortunately, the brain can use an alternate fuel source called ketones as energy and can replace up to 90g of it's glucose needs with ketones.  The problem is, the body won't make this amount of ketones unless you maintain a low carbohydrate intake (<50g/day) for at least 4 consecutive days.  However, your liver will make ketones out of medium chain triglycerides(MCTs) or coconut oil regardless of how many grams of carbs you have been eating.  As such, carb cycling is a valid and safe option for fat loss provided you are replacing the glucose your brain needs with ketones from coconut or MCT oil.  And since MCTs are instantly metabolize for energy, you don't need to worry about storing them as fat.  Assuming the brains energy needs are met at the same number of calories from carbohydrates and ketones, 3 tbsp of coconut or MCT oil would be suficient.


Many people have seen the benefits of carb cycling for fat loss.  While carb cycling is certainly an effective way to drop some fat, one must be careful not starve the brain of energy or rely on cortisol to help provide the brain with energy.  By consuming 3 tbsp of coconut or MCT oil on low carb days, you can provide the brain with energy and avoid the primary pitfall of relying on cortisol to produce glucose for the brain with carb cycling.

Monday, July 1, 2013

Should people with adrenal fatigue be tested for iodine deficiency and bromide toxicity?

Adrenal fatigue and iodine deficiency share a lot more in common than the fact that most physicians don't believe they exist or that they are not a significant problem in the United States.  These conditions share treatments, symptoms, and a host of other interesting commonalities.  In this blog article I will discuss these commonalities as well as provide evidence that people with adrenal fatigue should be tested for iodine deficiency and bromide toxicity.

Adrenal Fatigue

Adrenal fatigue is a syndrome where the adrenal glands produce insufficient levels of the adrenal hormones cortisol and aldosterone or an altered circadian rhythm of cortisol release.  Adrenal fatigue is thought to be the product of excessive stress, poor stress management, and nutritional deficiency.  In addition to these factors that are thought to be at the root of adrenal fatigue, the reliance on energy drinks and caffeine to provide energy are also thought to be relevant.

Iodine deficiency and bromide toxicity

Iodine deficiency and bromide toxicity go hand in hand.  Iodine and bromide are known as halides, a group of elements that can substitute for one another in specific tissues in the body.  Fluoride, chloride, iodide and bromide are the primary halides with astatide being a less commonly seen halide in biology.  Iodide and chloride have biological value to humans while fluoride and bromide do not and can potentially be toxic.  In a person with sufficient iodine/iodide there tends to be no issue, but when a person is not getting sufficient levels of this nutrient or the other halide chloride, bromide can accumulate in the body tissues that store them, including the thyroid and stomach.

Bromide is thought to be a neurotoxin and it's use as a sedative provides support for this notion as overdose of sodium bromide can lead to neurological issues.  The use of bromide in prescription and OTC medicines was ceased in the 1970s because bromide's half-life(12 days in humans) made it difficult to dose.  Bromide is ubiquitous in modern society.  It is found in some citrus drinks and bread and bakery products but it is primarily an environmental toxin.  Bromide is used as a flame retardent in mattresses, carpets, and upholstered furniture and can also be found in plastics, car upholstery, pool and hot tub chemicals, pesticides, and certain medications including atrovent.  Since bromide toxicity is unlikely to occur in someone sufficient in iodine that isn't taking large doses of bromide-based medications, we will consider the two more or less the same for this discussion.  While it is possible that someone could be deficient in iodine and not have bromide toxicity, it is unlikely given our current environment.

Bromide competes with iodide in the thyroid and the goitrogenic effect of bromide is enhanced under conditions of iodine deficiency(1, 2).  Under iodine deficient conditions, up to 40% of the iodide in the thyroid can be replaced by bromide.  With sufficient iodide supply, a constant iodide to bromide ratio is established in the thyroid(2).  Very high bromide intake shortens the half-life of iodine in the thyroid of both iodine sufficient and iodine deficient rats to about 1/3rd of the value in controls and increases whole body loss of iodine via the kidneys(2).  This is a problem because bromide's serum half-life in humans is 12 days compared to iodine's which is approximately 10 hours in iodine sufficient people and significantly lower in those with iodine deficiency(3).  This is the primary reason it takes high doses and long periods of time to improve an iodine deficiency and bromide toxicity.  In addition, bromide's half-life is increased significantly in salt deficient diets and can be shortened with increased salt consumption(2).

The interesting thing about iodine deficiency and bromide toxicity is that increasing iodine intake increases bromide excretion in the urine.  This is more than likely initiated first by iodine replacing bromide on receptors of cells in target tissues.  This will lead to an increase in serum bromide until the kidneys filter bromide out of the blood and into the urine.  This is an important process and one I believe to be the primary link between iodine deficiency/bromide toxicity and adrenal fatigue as bromide has a long half-life in serum and the kidneys can only filter out so much bromide at a time.  Once kicked off of receptors and in to the blood, bromide can mess with electrolyte balance and cause a host of other problems.  On the surface, it doesn't appear that these conditions are related in anyway.  When you take a look at some of the common symptoms between the two, a potential relationship begins to emerge.  Below is a list of the common symptoms of adrenal fatigue and iodine deficiency/bromide toxicity:

Common symptoms include:
Electrolyte imbalance
Hormonal imbalance
Frequent urination
Brain fog
Skin problems/dermatitis
Dream changes
Sleep problems

As you can see, that is quite a laundry list of symptoms.  It is important to realize that a person who experiences either adrenal fatigue or iodine deficiency/bromide toxicity may not have all of those symptoms and may have separate symptoms that are not listed.  These are just the common symptoms that tend to be reported in people with adrenal fatigue and/or iodine deficiency/bromide toxicity.  In addition to these symptoms, both adrenal fatigue and bromide toxicity have similar treatments as well.  These treatments include high doses of salt, vitamin C, and magnesium.  As you can see, a relationship begins to emerge just by looking at common symptoms and treatments.  Let's take a look at some of the science to identify how these seemingly unrelated conditions can have such a strong relationship.

Adrenal fatigue, iodine deficiency, bromide toxicity, and electrolyte imbalance

In his book Adrenal fatigue: The 21st century stress syndrome, Dr. James Wilson points out that many of the symptoms of adrenal fatigue are related to an electrolyte imbalance(4).  This is primarily due to low levels of the mineralocorticoid aldosterone.  When sodium levels in the body become too low, aldosterone is secreted by the adrenal glands and acts on the kidneys to reabsorb sodium and water and excrete potassium in the urine.  Aldosterone can be stimulated in multiple ways including via adrenocorticotropin hormone, the renin-angiotensin system, or simply by high potassium levels.  Since adrenocorticotropin hormone is also responsible for secretion of cortisol, it appears to be the link between cortisol and aldosterone in adrenal fatigue.  However, the link between aldosterone and the renin-angiotensin system appears to be the link between iodine deficiency/bromide toxicity and adrenal fatigue.

The renin-angiotensin system helps regulate blood pressure via fluid and electrolyte balance.  When blood pressure is low, the kidneys secrete renin which converts angiotensinogen in to angiotensin I.  Angiotensin I is then converted to angiotensin II which acts on blood pressure by constricting blood vessels as well as signalling the adrenal glands to secrete aldosterone.  Aldosterone then signals the kidneys to recycle sodium and water in to the blood to bring blood pressure back up.  In situations where aldosterone is low, sodium is wasted and blood pressure drops further.  Needless to say, low levels of renin will have the same effect since renin helps to stimulate aldosterone release.  In adrenal fatigue, aldosterone levels are typically low which causes salt wasting in the urine which then leads to an imbalance in the ratio of sodium to potassium.  In adrenal fatigue, licorice root is given to allow cortisol to attach to mineralocorticoid receptors and mimic the effects of aldosterone on the kidneys by recycling sodium and dumping potassium via the urine.

Increasing sodium consumption will help with any symptoms associated with a low sodium to potassium ratio; however, administration of sodium chloride in the form of salt decreases renin activity.  It seems logical that this is mediated by an effect of high sodium levels causing decreased plasma renin activity(PRA) in response to an increased sodium to potassium ratio.  This does not appear to be the case, however.  In humans, PRA is suppressed by sodium chloride but not sodium bicarbonate(5).  The effect of salt intake on PRA appears to hold true for bromide as well.  PRA decreased by nearly 50% with the administration of sodium chloride and sodium bromide but not with sodium bicarbonate or nitrate.  In addition, lysine monohydrochloride but not lysine glutamate had a similar effect, indicating a renal effect of bromide and chloride on renin activity rather than of sodium(6).  Whether this holds true for all of the halides has not been elucidated.  Regardless, high serum levels of bromide appear to have a very strong effect on sodium wasting via a reduction in PRA.

The intake of salt in the form of sodium chloride is a very powerful therapy in both adrenal fatigue and bromide toxicity.  In the treatment of adrenal fatigue, salt is used to relieve the symptoms caused by electrolyte imbalance as well as to nourish the adrenals.  In bromide toxicity, salt is used to increase the excretion of bromide.  One of the primary ways of removing bromide from the body is with the use of sodium chloride.  Increased sodium chloride intake increases bromide loss via the urine in dogs and humans and improves bromide induced dermatitis in humans(7).  Increased intake of sodium chloride in rats considerably reduces the half-life of bromide.  In 2 studies by the same authors, administering sodium in the form of 5 different salts, including sodium chloride and bicarbonate, had the same effect on the rate of bromide excretion which was proportional to sodium excretion in all 5 cases under the same sodium intake.  The authors concluded that the excretion of bromide is dependent on sodium intake rather than chloride(8, 9, 4). In addition, the proportion of bromide and sodium excretion are constant at a given sodium intake and increase with the amount of sodium ingested.

This does not mean that chloride does not also have an effect on bromide excretion.  In addition to being a halide and competing with bromide on receptors in target tissues, the sum of chloride and bromide in extracellular fluid remains constant at 110mmol/l(2).  Increasing one will cause a concomitant drop in the other as it is excreted via the urine.  In addition, bromide half-life in rats varied with chloride intake from 2.5 days with high chloride intake to 25 days under low chloride intake(10).  There doesn't appear to be a synergistic effect of sodium and chloride on bromide excretion nor does it make sense to use a different form of sodium such as sodium bicarbonate in terms of increasing bromide excretion.  However, there may be benefit to using sodium bicarbonate for bromide excretion to avoid the negative effect of reducing PRA.  As you will see shortly, PRA has a very strong impact on sleep quality.

Decreased PRA is associated with increased wakefulness and a decrease in sleep efficiency index.  PRA activity is higher during non-REM sleep, but PRA had no relationship with cortisol levels(11).  Multiple studies have established a strong link between PRA and sleep stage.  Specifically, PRA drops as someone enters REM sleep and increases during non-REM sleep(12, 13, 14, 15), with entering REM sleep leading to a near complete cessation of renin release(13).  In addition, peak levels of renin occurred during the transition from deep sleep to light sleep and the initiation of rises in PRA occurred in the transition from REM to stage 2.  All sleep disturbances and irregularities were reflected in deviations from the normal PRA curve.  Finally, both provoked and spontaneous awakenings blunted the rise of PRA found in deep sleep(14). Given the fact that sleep disturbances are both a strong contributor to and a primary symptom of adrenal fatigue, these relationships provide strong evidence that adrenal fatigue and iodine deficiency/bromide toxicity are related by changes in sleep quality.

Another interesting relationship worth exploring is that of magnesium with PRA.  High plasma magnesium levels have a strongly positive relationship with the release of renin by the kidney of dogs(16) as well as rats(17, 18) and humans(19).  However, this relationship seems to be flipped in people with hypertenson(19, 20) and may be a result of a decreased pool of intracellular magnesium due to abnormal intracellular magnesium metabolism(21).  Interestingly enough, while magnesium has an effect on renin release, it appears to decrease aldosterone release in rats(17) and humans(19).  In addition, magnesium deficient rats have higher levels of aldosterone secretion than magnesium sufficient rats(17).  One thing most users of supplemental magnesium notice, particularly those with adrenal fatigue, is an improvement in sleep quality.  Magnesium is also used in the treatment of iodine deficiency and bromide toxicity, further strengthening their relationship to adrenal fatigue.


All of the evidence described above points to a strong relationship between adrenal fatigue, iodine deficiency, and bromide toxicity.  It is difficult to draw hard conclusions with this evidence since a lot of it is not done in humans, but there is certainly enough evidence to support the notion that people with adrenal fatigue should be tested for iodine deficiency and bromide toxicity.  While there is strong evidence that they are related, we do not know whether one causes the other or they share a separate variable; whether they are related in a large number of cases or only a few; and how iodine deficiency and bromide toxicity relate to low or altered cortisol levels.  In addition to the effects of bromide on sodium loss, iodine is found in significant concentrations in the adrenals and there is the potential for there to be a direct effect of iodine deficiency on adrenal function, but this has not been studied.  A few other questions emerge as well.  One question worth answering is if bromide and sodium excretion levels are constant at a given sodium intake, does this mean being in a low sodium state increases the likelihood of bromide accumulation in the blood and, in a state of iodine deficiency, in the cells as well?  Could the natriuresis of fasting associated with low carb diets exacerbate this effect with inadequate sodium intake?  Are the negative effects of very low carb diets on sleep and thyroid function caused by iodine deficiency and/or bromide toxicity and can this be avoided with adequate iodine and salt intake?

There are other avenues worth exploring with the relationship between adrenal fatigue, iodine deficiency, and bromide toxicity.  Digestive problems are associated with both adrenal fatigue and bromide toxicity.  Since bromide concentrates in the gastric mucosa, is secreted into the stomach, and is known to replace chloride in other tissues, there is the potential that hydrobromic acid could be produced rather than hydrochloric acid and interfere with digestion.(1).  In addition, given that the sodium calcium exchanger is highly expressed in the smooth muscle cells of the intestinal wall, could a drop in sodium levels caused by increased exposure to bromide slow peristalsis and impact digestion by increasing the amount of time food spends in the digestive tract?  Is a reduction in the sodium to potassium ratio a contributor to poor digestion in adrenal fatigue?  As you can see, there are many unanswered questions in this relationship.  At this point it seems prudent to begin testing people with adrenal fatigue for iodine deficiency and bromide toxicity in integrative/functional medicine clinics to help provide some of the answers clinical research is unlikely to answer.

For more information on adrenal fatigue, consult Adrenal fatigue: The 21st century stress syndrome by Dr. James Wilson.

For more information on iodine deficiency, consult Iodine: Why you need it, why you can't live without it by Dr. David Brownstein.

For more information on properly supplementing with iodine consult this blog.