Thursday, August 29, 2013

Effects of a gluten free diet on blood lipids: A case study


A client with no history of sensitivity to gluten or abnormal blood cholesterol levels suddenly developed significant gastrointestinal pains and discomfort.  Upon testing from her doctor, her blood lipids were fond to be abnormal.  Removing gluten from her diet lead to an improvement in her symptoms and her blood lipids improved dramatically within 2 months.  The mechanisms behind these changes are also discussed.

Client History

Client is a 62 year old female who has begun to experience gastrointestinal distress over the last few months.  Prior to this she has had no problems with the foods she eats.  She explains that all of a sudden she started experiencing gut wrenching pain whenever she would eat.

Her doctor initially put her on low dose Prilosec(20mg/day) but had to increase the dose to 60mg/day as it lost effectiveness.  She was then put on Nexium with no relief,  This is not surprising since Nexium converts to the same drug as Prilosec in the acidic environment of the stomach and thus has the same effect.

Other relevant history

Blood lipids were drawn and she had the following values:

  • Total Cholesterol: 259 mg/dL
  • LDL Cholesterol: 151 mg/dL
  • HDL Cholesterol: 58 mg/dL
  • TC: HDL ratio: 4.5
  • Triglycerides: 251 mg/dL

Client was asked which foods gave her the most trouble.  She stated that beer would give her the most stomach pain followed by broccoli, pork, and anything fried.  I recommended the Paleo diet to cut back on the amount of problematic proteins in her digestive tract.  If she tolerated dairy she could continue eating dairy.

Client removed all grains, basically going on a gluten free diet.  Her legume consumption was pretty low to begin with so she continued to keep it low.  Five days after starting the diet she began to feel much better and reported not being "gassy" or having that "sick" feeling in her stomach.  She ended up losing a total of 24lbs even though she didn't want to lose any weight and the arthritis in her hands improved significantly.

She has been off Nexium and Prilosec for a couple of weeks.  Two months after being on the diet she had her blood lipids tested again, a total of 6 months from the previous testing.  Her values are listed below.

  • Total Cholesterol: 213 mg/dL
  • LDL Cholesterol: 132 mg/dL
  • HDL Cholesterol: 53 mg/dL
  • TC: HDL ratio: 4.0
  • Triglycerides: 142 mg/dL


This client's great improvement in her blood lipid results is fairly common for people switching to this diet, and she was elated to see these improvements.  While there is still more progress to be made, she has made huge strides in improving her digestion and general health.  Cholesterol is a part of the immune system and when the body gets attacked, these numbers typically go up as the immune system initiates a response.  Outside of this instance, the LDL numbers in a standard cholesterol panel are worthless and tend to be inaccurate since they are estimates and not directly measures.

In the case of gluten, gluten causes the tight junctions between cells of the intestinal wall to dissolve, allowing undigested food particles to enter the blood circulation.  This causes the immune response and could be the cause of her higher LDL numbers.  Going on a gluten free diet typically improves blood cholesterol numbers in the vast majority of people, probably even better than is seen with statin drugs.

Many people believe that gluten only causes a problem for people with gluten sensitivity or celiac disease.  The fact is, gluten causes the tight junctions between intestinal cells to dissolve in everybody.  The difference between people with celiac disease and people without celiac disease is that the tight junctions get repaired much more quickly in people without celiac disease, but this would be dependent on teh dosage ingested and the immune system of the person.  As we age our ability to deal with this becomes impaired as our immune system weakens.  Digestive enzymes also decrease with age and can make things that were not previously problematic an issue.  In addition, being sedentary causes food to stay in the intestines longer.  Since gluten cannot be broken down by humans, the likelihood of a problem arising increases with dosage, age, and sedentary behavior.  This could perhaps be the link between both age and sedentary behavior with Type 2 Diabetes and/or heart disease. 

While most physicians recommend against a gluten free diet for who knows what reason, it would be in the best interests of most people to avoid or limit gluten as well as all grains and legumes.  While we are most familiar with gluten, there are other storage proteins in grains and legumes that are both difficult for humans to digest and that cause an immune response.  This client's improvement in the arthritis in her hands is more than likely attributed to a dampening of the immune response caused by gluten in her diet.  It is interesting to point out that in her younger years she had no problems with gluten.  While age and the increased sedentary time that comes with it could certainly be the causative factor, it could also be that the dosage of problematic proteins she is exposed to on a daily basis has been increased as processed foods have become more commonplace.

Monday, August 26, 2013

Thiamin deficiency, altered circadian rhythm, and adrenal fatigue

Have you been diagnosed with adrenal fatigue?  Have you recently removed processed foods from your diet and had a tough go of it?  Have you been diagnosed with a magnesium deficiency?  Do you:
  • Drink coffee or tea
  • Drink alcohol
  • Binge on sugar or carbohydrates
  • Exercise excessively (Crossfit or endurance)
  • Have poor sleep
  • Have an altered cortisol rhythm
  • Have candida overgrowth
If you said yes to a number of these things you may be at risk for a thiamin deficiency.  What's worse, if you have cut out processed foods or grains you are probably not ingesting enough thiamin through diet and making your problem worse.  Let's take a look at this rarely discussed nutrient and how it may be contributing to your adrenal fatigue.

Thiamin 101
Thiamin(Also called thiamine or vitamin B-1) is an essential water-soluble B vitamin that humans cannot synthesize, they must get it from their diet.  Thiamin is involved in carbohydrate and amino acid metabolism and is used in the biosynthesis of the neurotransmitters acetylcholine and GABA(1).  The RDA for thiamin is set at 1.5mg per day and food sources of thiamin include cereal grains, yeast, pork, organ meats, beans, and nuts(2).  The problem is that other than cereal grains and yeast, most food sources only contain small amounts of thiamin.  Since thiamin is used in carbohydrate metabolism, eating high amounts of carbohydrates or performing physical activities that rely on the glycolytic energy pathway such as crossfit or longer distance sprinting activities increase a person's need for thiamin(2).  Other nutrients that are thought to impact thiamin status are magnesium and calcium, a deficiency in either may make a thiamin deficiency worse(1) 

Other lifestyle factors that are prevalent in modern society also negatively impact thiamin status.  Coffee and tea contain tannins that render thiamin useless in the body(3) in addition to the diuretic effect that caffeine has that increases the loss of B vitamins.  Alcohol also has a negative effect on thiamin levels both by preventing absorption as well as it's diuretic effect(4).  Wernicke-Kosakoff Syndrome(WKS), a disease of thiamin deficiency, is most often seen in alcoholics(1).  In addition to it's alcohol content, wine contains sulfites that destroy thiamin.

Diseases of thiamin deficiency including WKS and beriberi often present with neurological symptoms, but can include the circulatory system as in the case of wet beriberi.  Candida overgrowth can also lead to thiamin deficiency as yeast use thiamin in the first step of alcohol fermentation.  In addition, 3 strains of bacteria known to reside in the human small intestine and colon are known to produce enzymes that degrade thiamin in the digestive tract(1) which could become problematic if they overgrow.

Diabetes and high blood sugar can also induce thiamine deficiency and diabetics have been found to be deficient in thiamin(4, 5).  This is due, in part, to hyperglycemia causing increased loss of thiamin in the urine.  Since it is believed that this effect is due specifically to high blood glucose, whether insulin resistance is pathological due to diabetes or physiological due to low carbohydrate intake would be irrelevant.  In addition, low thiamin has been shown to impair pancreatic function leading to hyperglycemia(4) and thiamin therapy has been shown to improve hyperglycemia in diabetics(5, 6, 7).

Research on thiamin deficiency, the adrenals, and circadian rhythm

Thiamin and adrenal function

In rats, thiamin deficiency has been shown to have a fairly dramatic effect on adrenal function.  In a study looking at rats induced with thiamin deficiency, the rats experienced an exaggerated cortisol response to stress within 2 weeks, with a complete exhaustion of the adrenals within 4 weeks(8).  The adrenals increased in size throughout the study and the mitochondria within the area of the adrenals responsible for cortisol secretion became swollen.

In addition to the changes in the adrenals, liver glycogen levels became extremely low and the thymus of the rats shrank in size, indicating a compromised adaptive immune system.  This could be a potential mechanism by which candida can gain access to the body as the adaptive immune system is responsible for making T helper cells that would be in charge of removing candida, or any infection, from the body in the event the intestinal barrier becomes compromised.  Ironically, a thiamin deficiency may negatively impact intestinal permeability by thinning the microvilli and decreasing enzymatic secretions in the gut that digest protein and carbohydrate, including lactase(9).

Cortisol is not the only adrenal hormone affected by low thiamin status.  In a study also done in rats, rats with thiamin deficiency had a decreased aldosterone response to low sodium levels(10).  Aldosterone is the chief mineralocorticoid responsible for regulating electrolyte balance in the body.  When sodium levels become low, aldosterone is secreted to recycle sodium back in to the blood and dump potassium out via the urine.

Many of the symptoms associated with adrenal fatigue are due to an electrolyte imbalance, an issue I discussed here.  Having a decreased ability to regulate electrolyte balance will lead to a worsening of symptoms associated with adrenal fatigue.

Thiamin and circadian rhythm

Many studies have shown thiamin deficiency to disrupt circadian rhythm in mammals(11, 12, 13) and the change in circadian rhythm precedes the neurological damage associated with thiamin deficiency(11).  GABA is an inhibitory neurotransmitter in the central nervous system, meaning it is a calming substance.  GABA is considered an essential player in regulation of the circadian clock(14), and given thiamin's role in the biosynthesis of GABA, it makes sense that a thiamin deficiency would disrupt circadian rhythm.  In addition, the thiamin deficiency disease beriberi primarily affects the autonomic nervous system which is a central regulator of the circadian clock(14).

Anecdotally, many people who have undertaken a low carbohydrate diet have noticed a change for the worse in sleeping habits.  Since lowering carbohydrate intake always includes lowering grain consumption and thus thiamin consumption, this is a potential mechanism by which low carbohydrate diets may negatively impact sleep.  The problem may not be in the low carbohydrate status so much as low GABA caused by a lack of thiamin intake.  In people who periodically binge on sugar, overexercise, or drink coffee or alcohol the problem will be worse.  Carbohydrate intake could come in to play once adrenal insufficency sets in because in the absence of carbohydrate, cortisol is used to increase glucose output by the liver.  Also, since low thiamin has been shown to reduce liver glycogen storage, this would impact your ability to meet the brain's glucose needs when asleep.

Thiamin form and dosage

While I am a firm believer in getting your nutrients from food, several instances may prevent someone from being able to establish healthy thiamin levels through diet.  People who are using diet therapeutically to identify food sensitivities or improve digestive disorders with grain and nut/seed-free diets will most certainly not be able to get adequate thiamin from their diet.  A lot of these people also have mild to severe adrenal dysfunction so supplementation may be necessary to get them back on the right track.

Most forms of thiamin are water soluble and poorly absorbed from the digestive tract when compared to disulfide derivatives of thiamin.  Allithiamine(TTFD) is one of these derivatives, is found in garlic, and has been shown in studies to increase blood thiamin levels almost 10 fold(15).  This would be the equivalent to intravenous injection of the standard water soluble forms of thiamin.  This makes allithiamine the preferred oral form of thiamin for reversing deficiency.  There are no studies on a recommended dosage for allithiamine, but most recommendations indicate that there is no upper limit to intake and therapeutic dosages range from 50mg a day up to 300mg. 


Thiamin deficiency appears to be a pretty strong player in adrenal fatigue and altered circadian rhythm.  The RDA for thiamin is set at 1.5mg per day by the USDA, something most people eating a grain restricted diet such as the Paleo diet, specific carbohydrate diet(SCD), or GAPS diet will not be able to attain from food.  Of the three, it is possible to get enough thiamin on a Paleo diet as it allows the consumption of nuts and seeds.  While the Perfect Health Diet does allow white rice consumption, white rice has been stripped of it's thiamin which is why it is recommended to supplement with thiamin.  In fact, beriberi was prevalent in Japan for just that reason(1) as it was found that the disease was caused by an imbalance between energy ingested from carbohydrates and one of the micronutrients(thiamin) required for their oxidation(14).  This was discovered in birds as white rice and/or starch consumption in the presence of inadequate thiamin consumption led to neurological damage similar to beriberi(1) and was reversed with thiamin intake.

All of this is not to say that I believe the RDA for thiamin is accurate for everyone.  I still hold to my statement in my last blog that there is unlikely any way our paleolithic ancestors got 1.5mg of thiamin in their diet.  However, their carbohydrate consumption was likely quite low, they didn't regularly consume alcohol or coffee, and they were under far less chronic stress than we are.  It is also possible that their gut flora contained a strain of bacteria that manufactured thiamin for them, and as we relied more heavily on grain consumption that strain disappeared or was significantly reduced in our gut and replaced with bacteria that we required or inadvertently overfed with our dietary choices.  In fact, research has found that there tend to be 3 different enterotypes of the human microbiome that produce different levels of enzymes capable of producing varying levels of different vitamins.  The microbiome of enterotype 2, which is high in the bacterial species Prevotella, shows higher activity of enzymes responsible for the production of thiamin(15).

This is one way in which you cannot really say that our genes are not different from those of our paleolithic ancestors.  While it may be true that the genes within our bodies haven't changed, our gut flora has.  This is an effective change in our genome as we may no longer possess the ability to extract a particular nutrient from our food, or we become too good at extracting nutrients that can be detrimental.  In this way, the choices we make now can have serious ramifications on the way we function down the road as well as the diseases we experience as a species.

I do not want people to read this as saying a grain free diet is not the way to go.  It is still my belief that the Paleo diet is the best diet for people to consume.  One takeaway I hope people eating the SCD or GAPS diets will get from this is that they should be supplementing with thiamin until their condition gets better and they can move on to eating nuts and seeds.  Many of these people have adrenal dysfunction and a thiamin deficiency will only make their condition worse. 

I enjoyed this little diversion from my no deficiency diet research, but now it's back to work.

Thursday, August 22, 2013

100 of 100:The no deficiency diet.

In my last blog post, I discussed an experiment I planned to begin on next Monday and run for 2 weeks.  The plan is to make a diet that provides 100% of the RDA of all nutrients deemed essential by the USDA.  I still intend to run the experiment, but since the following weekend is Labor Day weekend and I'll be away, I am going to push it back a week.  I have, however, begun devising the diet and a few red flags have popped up regarding my current diet.  I currently stick to a Paleo diet during the week and stray a bit on the weekends.  Some of the red flags are:
  • There are several water soluble nutrients I am not getting enough of
  • I am not getting anywhere near enough magnesium through diet
  • I am more than likely under-eating during the week
  • I will have to add organ meats, nuts, and bone broth back in for this experiment
 In addition to these red flags, some other interesting points have popped up:
  • Nuts or seeds must have been a huge part of the diet if these RDAs are correct
  • The need for calcium has to be way overstated
  • I wonder if some of these RDAs are truly necessary
One thing you need to keep in mind is that vitamins were discovered because it was determined that many of the diseases that were prevalent prior to 80 years ago were due to deficiencies in these vitamins.  In other words, while looking for what caused scurvy, rickets, or any of the other diseases that were prevalent at the time, researchers identified foods that would help with these conditions.  For example, scientists as far back as the 1700s knew that citrus fruits helped scurvy.  It wasn't until 1932 that vitamin C was identified and eventually fingered as the culprit.  Therefore, in some disease, a lack of certain components found within food was determined to be the causative factor.  These components are called vitamins and now most people try to make sure they are getting enough either through diet or supplementation.

Are pills enough?

This has, in my opinion, given people the erroneous notion that all they need to do to be healthy is to eat whatever the hell they want and chase that down with some supplemental vitamins.  The problem is, just because some diseases are born out of vitamin deficiency doesn't mean vitamins are the only components of food that you need to consume to be healthy.  Most people know of the anti-cancer effects of broccoli.  It is completely possible that cancer could be due, at least in part, to a deficiency in sulfur containing vegetables in the diet.  We know that the sulforaphane found in cruciferous vegetables activates a genetic pathway that mops up oxidative damage to cells and that oxidative damage is a hallmark of cancer as well as many chronic diseases.  Given the length of time it takes cancer and other chronic diseases to progress, we are unlikely to figure out anything definite any time soon.  There is, however, another possible explanation.

Vitamin deficiency combined with modern diet? 

One of the things repeated time and time again in the Paleosphere is that traditional hunter gatherer tribes who eat a traditional diet are free of cancer, diabetes, and heart disease.  When these people are fed a more modern, westernized diet, they begin to experience cancer, diabetes, and heart disease.  In addition, it seems to be common knowledge in anthropology that with the advent of agriculture humans lost bone density and experienced an increase in dental cavities.  In researching for this experiment, it has become blatantly obvious to me that there is no way any hunter gatherer from the past or present has or ever will be able to meet the RDA for the mineral calcium.  Despite this, they tend to have better bone density, go figure.

A vitamin that they would not be able to reach the RDA for is thiamin, or vitamin B-1.  Thiamin is found in cereal grains, pork, yeast, and in minute quantities in some vegetables.  Beriberi is one of the diseases caused by thiamin deficiency and can effect the cardiovascular or nervous systems.  Symptoms include difficulty walking, loss of muscle function/paralysis, mental confusion, strange eye movements, and a host of other symptoms that would make it very difficult to find food.  In addition, most cultures that lived in a latitude with a prolonged winter would have had no chance of getting adequate thiamin during those months. How could these people have survived without adequate thiamin?

If it hasn't become blatantly obvious by now, my point is that these RDAs may only be valid for people consuming a modern diet.  In my example above, perhaps cancer is the result of a sulfur containing vegetable deficiency in someone eating an agricultural diet.  Since any of the recorded data and/or scientific studies done to determine the RDA for vitamins and minerals was more than likely done on people consuming an agricultural diet, extrapolating this data to someone who doesn't consume an agricultural diet is wrong.  It could be that 1.4mg of thiamin is necessary to prevent Beriberi, but it could also be that only people eating an agricultural diet require that much thiamin to prevent Beriberi.

Does it seem accurate to say that a thiamin deficiency causes Beriberi when you can get less than the RDA of thiamin and still not get Beriberi?  That's the problem with being a part of something that is not part of the dogma of scientific society.  They ask for scientific evidence that what you are saying is true while at th same time extrapolating their results beyond what is scientifically valid.  In fact, there have been no randomized placebo-controlled experiments looking at any of the RDAs for someone consuming a paleo diet.  I cannot tell you how many people have told me that the Paleo diet will lead to nutritional deficiencies.  It could very well be that their entire set of nutritional recommendations is only necessary if you are eating the foods they tell you to eat.


This is one of the reasons I plan on doing this little experiment.  My first step is to establish a diet that provides 100% of the RDA of all nutrients deemed essential by the USDA.  I may, in the future, tinker with lower amounts of some vitamins and minerals to see how lower levels of each effect me.  While it could certainly be the case that eating a Paleo diet lowers your requirement for certain vitamins and minerals, it could also be the case that a nutrient deficiency in a Paleo diet will lead to a different set of symptoms than the same nutritional deficiency in a modern diet.  I definitely plan to make a seasonal diet for each of the seasons once I establish one that I like.  I look forward to this long term project.

Monday, August 19, 2013

Upcoming blog experiment: 100 of 100

Starting next Monday, my wife and I will be undertaking an experiment that I will be blogging about for a couple of weeks.  The basics of the experiment are simple, I want to devise a diet that gives me 100% of the RDA of 100% of the micronutrients deemed essential by the USDA.  If you don't know the difference between micronutrients and macronutrients, micronutrients are vitamins and minerals while macronutrients are fats, carbs and protein.  Here are the constraints I am putting on this diet:

  1. All foods must be strict Paleo(No grains, legumes, or dairy)
  2. No processed food of any type(Nut butters, flours, etc.)
  3. Coconut and olive oil are allowed
  4. Micronutrient values will be based off of a 2000 calorie diet
  5. I will get at least 120g of carbohydrate per day, hopefully more
  6. I will get at least 30g of fiber, but strive for much more
  7. Any alcohol will follow Paleo constraints and be 2 servings or less
The impetus for this experiment is simple.  I have had several discussions with people over the last few months that ultimately end in them stating that you cannot eat a Paleo diet without needing to have some sort of vitamin support.  To be honest, I do not agree with some of the RDA values, particularly the calcium requirement.  For one, the RDA values are based off of research in people who eat a Standard American Diet.  In my opinion, your micronutrient needs are probably partially determined by what you eat as well as your lifestyle.  However, if I set the experiment up to be based off of the RDA, there can be no argument as to whether the diet is nutritionally sound or not.

The reason I am not restricting or setting macronutrient levels is because it has been hypothesized that appetite is dictated not only by a need for energy but also a need for micronutrients.  In the case of obesity, while obese people tend to appear to be well nourished, oftentimes they have one or multiple nutritional deficiencies.  I generally have a very hearty appetite, it will be interesting to see what happens with that appetite when eating around 2000 calories and getting 100% of the of the RDA of all of the essential micronutrients.  I won't be a stickler for hitting that 2000 calorie number, I may eat a little more or a little less but the micronutrient numbers will be 100% based on a 2000 calorie diet.  It will be interesting to see what happens to my physique over that time.

For physical activity, I will stick to my general recommendations and get at least 10,000 steps per day and strength train for 30-45 minutes, 3 times per week.  Most of this training is glycolytic in nature which is why I will try to get at least 120g of carbohydrate per day.  I will take before and after pictures as well as follow my sleep pattern with my fitbit.  I will also post general feelings about appetite/energy levels and potentially changes in blood glucose levels.  While I am not trying to change body composition or weight, I know people care about that stuff so I will post bodyfat and change in weight along with the pictures.

I look forward to this experiment.  My intention is to do this first one for 2 weeks to see what can be accomplished in a short period of time.  If things go well, I may run it again after a short wash out period and have a blood lipid panel/particle size test done before and after a 4 week run of the diet.  While I won't be posting the meal plans, I will most likely post some of the recipes along with the micro- and macronutrient values of those meals.  This all begins in one week, it should be interesting.

Thursday, August 15, 2013

Using your Fitbit One data: Sleep

In this blog, we will go over the many ways to use the Fitbit One sleep data.  In a previous blog post found here, I went over the benefits of the Fitbit One Activity Tracker.  Compared to the older Fitbit Ultra, I find the Fitbit One to be a big upgrade.  However, there is also a lower end version of the Fitbit called the Fitbit Zip.

The primary differences between the two are that the One measures flights climbed as well as sleep.  While the flights climbed is a pretty good data point considering the work is more vertical than walking on flat ground, the biggest benefit of the Fitbit One is the sleep data.  This data is useful to help identify issues you may be having with:

  • Identifying lifestyle factors that can impact sleep
  • Identifying food sensitivities you may have 
  • Not getting enough physical activity
  • Getting too much physical activity
  • How your sleep changes over time
  • How your sleep changes over the week
Below is a picture of the data the Fitbit One collects on sleep.  This is from the Fitbit App for the Iphone 4S, the data on the dashboard found at contains more information.

As you can see, the app gives you data on how long you were asleep, when you went to bed and when you woke up, and when you were restless or awake throughout the night. All of this is good data to have and can illustrate things that you may be doing that aren't particularly good for your health.  However, one of the knocks on the sleep data the Fitbit collects is that it isn't really measuring if you are asleep.  Since it is merely worn on your wrist, all it is measuring is whether or not you are moving.  In other words, you can just lie still and it will measure you as asleep.  This is really isn't a problem if you look at the data.

Anyone can see the difference between these two sleep patterns.  Whether you are attempting to stay as still as possible or not, there is something going on in night 1 that isn't in night 2.  Keep in mind that these are both Thursday's sleep which means they were recorded on Wednesday night in to Thursday morning.  First, we can see that while the first Thursday's sleep was almost 45 minutes longer, it was of much poorer quality.  There was more than likely something going on either on this day or leading up to this day that led to poor sleep.  There are several reasons why this may happen when comparing the same day of the week over time.

1) Hidden food sensitivities

It is possible that something or some things were eaten on the first Thursday that weren't on the second Thursday that negatively impacted sleep.  A common symptom of a food sensitivity is poor sleep, and not all food sensitivities will have overt GI symptoms.  Since the best way to identify a food sensitivity is to make a food journal, you can compare the two.  Luckily, the Fitbit allows you to log all of your food so you can easily enter it in the App or Dashboard and access it from either.  Over time you can narrow down foods you are sensitive to by eliminating foods one at a time and watching how they affect your sleep cycle.


Too much stress can also negatively impact sleep.  Maybe you were approaching a deadline at the end of the week of the first night but not the second.  Obviously you can look at this and see the effect stress has on sleep quality, even if you get to sleep in.  You can also record subjective info like this on your Fitbit Dashboard or in the App.  The benefit in this situation is that you can see that you should take active steps to manage stress or your sleep will suffer.

3)Too little physical activity or too much

You can compare the sleep data from both days to the step data on both days and see if you may have slacked on getting your steps in.  Too little physical activity during the day can lead to a surplus of energy at night and difficulty sleeping.  On the flip side, you could be entering a state of overtraining by overexercising.  This will cause your body to shift in to fight or flight mode which will make it more difficult for you to get in to rest and digest mode.  In this instance you will want to cut back on your exercise for a while until your sleep improves.

4)Whether an intervention is working over time

Most people associate the word intervention with a drug or alcohol problem.  What I am referring to here is a health intervention you apply to a health condition.  If you are having problems and try to remedy the situation, looking at how the intervention affects your sleep can be a huge benefit.  In this instance you wouldn't use just two data points, but if all of the other data points trend in the right direction you know you are on the right path.

You can also look at the data over the course of a week to find trends.


As you can see, it appears that this person sleeps better later on in the week.  I've looked at all of the other data throughout the year and this is a pretty standard trend for this person.  In this instance we can identify things that the person may be doing on a weekly basis that negatively impacts sleep.

1)Coffee consumption

Maybe this person drinks more coffee on the weekends.  You would expect coffee consumption to be greater during the work week, but this person could work weekends and have Tuesdays and Wednesdays off.  If they avoid coffee on these days but not the other days that could certainly be an issue as coffee is a stimulant that could potentially impact sleep on days it is consumed.

2)Alcohol consumption

This is actually what is happening in this picture.  This person drinks alcohol on the weekends but abstains during the week.  As a result, not only is their sleep disrupted on Friday and Saturday nights, it carries through in to Sunday night's sleep.  In this instance, the person actually consumed a small amount of alcohol at a celebration on Sunday during the day.  However, this disturbance in the sleep cycle is similar whether they confine alcohol consumption to Friday and Saturday or they allow a little consumption on Sunday as well.

3)Any significant changes that impact sleep

It could also be some other change you make during the weekend that negatively impacts sleep.  Going back to a lack of physical activity, most people don't exercise on the weekends or reduce general physical activity such as walking.  Binging on junk food during the weekends could also negatively impact your sleep.  Tweaking these things and then looking at your sleep data can give you tremendous insight in to what may be causing your sleep to change over the course of a week.


As you can see, the sleep data that the Fitbit One collects is pretty cool and useful.  Whether you are just looking to live a healthy lifestyle or you are working on improving a health condition, using the Fitbit One can give you a little more information that can help you make the right decisions.  You simply wear the Fitbit One in the wrist strap that is provided with it and hold the button until the counter starts when you are ready to go to bed.  When you wake up in the morning, you simply hold the button again until the counter stops.  If you forget to start and/or stop it but wear it anyway, you can enter the time you went to bed and/or the time you woke up in the App or the Dashboard the next day.  The data was collected as long as you wore it.  The best part...the silent alarm doesn't jolt you out of bed.

Monday, August 12, 2013

Proper management of Type 2 Diabetes: Don't focus on calories and exercise

Type 2 diabetes is extremely prevalent in modern society.  Despite spending decades trying to get people to exercise more and eat less, the problem has only gotten worse.  Thirty years ago Type 2 diabetes was called adult-onset diabetes because people only developed it when they became adults.  The theory behind this is that people would go from an active lifestyle of playing with friends, playing sports, partaking in gym class, and walking from class to class when they were in school to jockeying a desk for forty hours a week once they started work.  In an effort to combat the problem, more people began counting calories and going to the gym to ward off to the disease.  It hasn't worked.

When you look at how Type 2 diabetes has changed, it is most certainly for the worse.  Not only are more people getting it, even children are being diagnosed with it.  Currently, proper management of Type 2 diabetes involves eating fewer calories and burning more calories through exercise. While most people would certainly be better off doing both, they shouldn't be where most of your attention is focused.  Most people would be better served taking the following advice first:

  • Eat more fruits and vegetables
  • Limit or eliminate all processed foods
  • Spend as little time as possible sitting
  • Get 10,000 steps per day
  • Get 8 hours of quality sleep every night

Eat more fruits and vegetables

Eating more fruits and vegetables helps on a few levels.  First, both are more nutrient dense than they are energy dense which means they have fewer calories per unit of volume.  By eating more fruits and vegetables, you will feel fuller on less food because they take up more room in the stomach.  Both are also good sources of fiber which will cause food to move more quickly through the digestive tract.  Soluble fiber also helps feed the beneficial bacteria in your gut that helps heal damage to your intestinal lining.  People with Type 2 Diabetes tend to consume fewer fruits and vegetables as well as fiber.

Limit processed food

Limiting or eliminating processed foods is important because processed foods tend to be more energy dense. This means you have to eat more to feel full because they tend to carry more calories per unit volume.  Most processed foods also tend to be very inflammatory to your intestinal lining.  Obesity and Type 2 diabetes are often referred to as inflammatory conditions so lowering the amount of inflammation you experience is a good idea.  Gluten, which is found in most processed foods, is bad because it can cause an immune reaction that causes blood glucose to run high because glucose gets conserved for the immune system.  This causes your body to increase insulin production and can damage the pancreas, a hallmark of Type 2 Diabetes.  For more of the science on this process, click here.

Reduce sitting time

Spending as little time siting as possible helps on a couple of fronts with Type 2 Diabetes management.  First, it helps you burn off some of the carbohydrates you eat and lowers your blood glucose.  Secondly, for as long as we have been studying the effects of sedentary behavior(hundreds of years), scientists have noted that sedentary behavior slows down the movement of food from your gastorintestinal tract.  The longer food stays in your GI tract, the more calories you will be able to extract from it.  In addition, being in a seated position for long periods of time causes poor genetic expression that increases the risk for Type 2 Diabetes as well as other poor health outcomes. For more of the science on this check out this blog.

Get 10,000 steps

Getting 10,000 steps a day is a general recommendation for good health put out by many health organizations including the American Heart Association as well as the American Medical Association.  It helps in basically the same way that reducing sitting time works.  I recommend people spread out their steps through the day and a recent study showed taking a 15 minute walk after very meal helped people with Type 2 Diabetes manage their blood glucose better than a single 45 minute walk.

Get 8 hours of quality sleep

Getting 8 hours of quality sleep per night is also a very important habit to have to manage Type 2 Diabetes.    Poor sleep can lead to poor blood glucose control and disturb many hormonal systems by disrupting circadian rhythms.  Even just a week of getting 6 hours or less of sleep per night can disrupt these rhythms, which is common for many people.  This article does a pretty good job of discussing the science behind this.


The purpose of this article is not to give you the impression that calories are not important or that you shouldn't exercise.  Calories are significant, but that doesn't mean counting them is an effective tool for managing Type 2 diabetes.  Exercise is an important component of any comprehensive health program, but you have to realize that your priorities should lie with the other 6 factors first.  Once you have successfully implemented those strategies, you can add exercise in to boost your results.  As for calorie counting...You can count calories if you choose, but if you are following the other 6 factors listed above, you probably won't have to.

Thursday, August 8, 2013

The popular media. misinformation, and heart disease.

During a routine physical, former President George W. Bush discovered he had a blocked artery in his heart earlier this week.  The following day, he had a stent placed in the artery to open the blockage.  Watching the NBC Nightly News' description of the event, I found myself to be dumbfounded.  Below is a list of key points from the news broadcast.

  • President Bush is an avid exerciser
  • He exercises 5 times a week for at least 30 minutes
  • His cholesterol is normal
  • Eating a low fat, "heart healthy" diet is your best protection


 What you believe about nutrition could be wrong

The medical correspondent, Nancy Snyderman, MD, as well as host Lester Holt bantered about how even someone living a seemingly healthy lifestyle is not immune to the ravages of heart disease.  What struck me as strange is that the notion that the recommendations for heart health are pretty much bogus never entered anybody's mind.  Of course there is a huge genetic factor involved here as well as the stress involved with leading the free world for 8 years.  After all, his father has heart disease and held the same job for 4 years.  I have no problem with this fact.  However, I do take issue with the recommendations being untouchable, especially if someone can pretty much follow them word by word and still get a blockage.

Exercise-Not the cat's meow

For one, exercise is great and is something everyone should do for a multitude of reasons.  As for reducing your risk for heart disease, reducing the amount of time spent being sedentary is far more important than exercising.  This should be common sense, but to put some numbers behind it, 30 minutes of exercise performed 5 days a week is 2.5 hours out of a total of 168 hours in the week.  That's 1.4% of the week, it doesn't even seem plausible that this amount of time could counteract being a slouch on the couch for the other 98.6%.

High cholesterol is an overrated risk factor

The fact that his cholesterol is normal is also interesting for most people, but isn't very surprising.  Approximately 50% of heart attacks occur in people with normal or low cholesterol.  That didn't prevent Dr. Snyderman from referring to the blockage as a cholesterol blockage.  I wonder why they don't refer to them as calcifications since the plaques that form the blockages are 50% calcium and only 3% cholesterol.

This certainly adds to the confusion I get when I tell people they don't really need to concern themselves with the amount of cholesterol they eat unless they have a genetic condition called familial hypercholesterolemia.  Familial hypercholesterolemia is found in 1 out of every 500 people so it is certainly not a common condition.  It will also be interesting to see whether or not the former President is put on statins, despite having normal cholesterol levels.  People with familial hypercholesterolemia and people with a previous heart attack are the only people I would recommend take a statin, but that's just what the research shows and I'm not a doctor.  That makes the point moot.


Low fat does not mean low risk

The notion that the low fat heart healthy diet isn't actually healthy to the heart has been unraveling over the course of the last 5 years.  Not only has it been determined that saturated fat and cholesterol are not that bad for you, replacing these foods with processed, low fat foods high in carbohydrate is worse.  This has been the de facto dietary advice for a healthy heart for more than 40 years.  Talk about digging yourself deeper in to a hole.

Science works best when done properly

All of this brings up an excellent point that most people need to understand about science.  Science doesn't make truths, it identifies them.  When funding for science primarily comes from companies with financial interests in the outcomes of that science, you cannot expect to get unbiased results.  A recent article looked at the likelihood of finding positive outcomes in both industry funded and government funded studies, specifically with the pharmaceutical industry.  Oddly enough, government funded studies tend to get positive outcomes around 50% of the time while industry funded studies tend to find positive results around 85% of the time.  Part of this problem is certainly due to the fact that industry is not required to report results from all of their studies, so they just don't report the negative ones.  This is more of a pharmaceutical industry problem, but who do you think is pushing the low fat, low cholesterol BS?  I'd go with the folks making the anti-cholesterol drugs.

A more common problem with dietary research isn't with how the research is conducted so much as the way it is reported.  The popular media loves to report results from epidemiological research as fact.  These types of studies cannot prove cause and effect, they can only identify relationships that can be further studied with better research.  The primary problem lies within the fact that most people get their information from the popular news media and not from peer reviewed journals.  When the media reports this stuff, it sticks because everyone has heard it and it becomes established fact even though it has never been proven scientifically.  Then, physicians get on television and keep the BS rolling.  Is it any wonder how we are so misinformed on diet?

Monday, August 5, 2013

Product Revew: Fitbit One

What: Fitbit One Activity Tracker

 How much: $99.95

Where: Best Buy or online at

Overview: A major upgrade to the Fitbit Ultra at the same price point.  The silent alarm and new dashboard are also much improved.  They've also fixed the bluetooth syncing for the Iphone 4S and 5.

Features: Directly tracks steps, flights of stairs, calories, sleep, and functions as a vibrating alarm.  You can also track much more data including blood pressure, blood glucose, workouts, diet and a lot of other variables on the dashboard at or on your iphone 4S or 5, or Ipad 3. 

Review: I was a big fan of the Fitbit Ultra when it fist came out so I was excited when the Fitbit One became available at the beginning of the year.  Not only is the new design sleeker, but the whole user experience has been improved with the Fitbit One.  For those of you not familiar with activity trackers, they are far more sophisticated than a pedometer.  While the device itself is really cool and worth the price, the greatest benefit of the Fitbit One is the dashboard located at, but more on that later.

The Fitbit One is very easy to set up and get started.  You simply download the Dashboard software from the website and plug the wireless dongle in to a USB port on your computer.  Syncing the One is as easy as being motionless within 15ft of the computer you have the dongle plugged in to.  The One also has an onboard battery so you need to remember to charge it every 7-10 days.  The Fitbit Ultra definitely had a longer battery life but it also had a more archaic display and the bluetooth syncing didn't work as well.

Another new feature on the Fitbit One is the device itself.  The Ultra came with a belt clip but could attach directly to your belt without a clip.  The Fitbit One must be used in the rubberized clip if you want to attach it to a belt or bra and is water resistant, but not really waterproof.  I dropped the One in a glass of water (On accident of course) and it worked perfectly fine, and I don't see sweat being an issue as it could be with the Utra.  The sleep function appears to be exactly the same as the Ultra, but the One sports a silent alarm that is so much better than waking up to a blaring radio or annoying buzzing sound.

As mentioned above, the dashboard is where the Fitbit One shines.  There are many features and extra data points you can put in through the dashboard.  I see many ways that you can use the One and dashboard to help with a variety of problems.  In particular, people with food sensitivities or allergies who are keeping a food journal can follow the effects certain foods have on their sleep, energy levels, blood pressure, blood glucose, subjective feelings, and even more.  Below is a screen grab of the Fitbit Dashboard.

Scrolling over and clicking on each variable allows you to see that variable in more depth.  There is so much information that you can use from the dashboard that I will devote a future blog post on how you can use some of this specific data to help improve your personal wellness program and make positive lifestyle changes. In addition to the data, you can also form groups and compete in challenges with one another.  We have a Synergy Wellness Paleo Challenge Group where we compete in different challenges to motivate one another.  Starting this fall we will begin an 8 week challenge that anybody is welcome to join provided they have a Fitbit device.

So what are the problems with the Fitbit One?  I have yet to find something glaringly wrong with the product and feel that it is worth the extra $40 to go with the One over the lower end model Zip.  Obviously the sleep function cannot determine whether you are in deep sleep or just being still, but I still think that data can be useful.  As is the problem with most of the Fitbit products, it takes a while to get used to taking it off of your clothing.  This can lead to problems with losing the device or throwing it in to the wash on accident.  I have had clients who have accidentally thrown their Fitbit in to the wash and customer service has been good about replacing them. 

The Bottom Line: I highly recommend the Fitbit One to anyone trying to live a healthy lifestyle.  I also highly recommend that trainers and people running corporate wellness programs get their clients in on the action.  It not only provides a level of accountability that people can't slip out of, it also provides motivation through challenges and allows people to identify lifestyle factors than can work against achieving their goals.

Thursday, August 1, 2013

A lesson in what we truly know...

I find it humorous when people tell me something is a scientific fact, particularly when it pertains to diet.  If you have been paying attention to the popular news media as of late, you may have noticed that cholesterol and saturated fat have been given a mea culpa.  After spending more than 30 years being demonized as the cause of heart disease and atherosclerotic plaques, it turns out that cholesterol and saturated fat really aren't that bad for you.  Of course, 30 years ago, we knew cholesterol and saturated fat were as bad for society as Keeping up with the Kardashians would eventually become.  The problem is that what we knew 30 and even 60 years ago turned out to be wrong, and foolish people continue to pass it around as gospel.  Here are some snippets from a paper from 1953 found here.

1) "Atherosclerosis may be readily produced in the rabbit and in the chicken by feeding a diet containing large amounts of cholesterol...while feeding cholesterol to man, or the monkey, has very little effect on the blood even when enormous doses of cholesterol are given."

2) "The cholesterol-fortified diet commonly used to produce hypercholesterolemia and subsequent atherosclerosis in the rabbit...corresponds to about 15 gm of cholesterol in a 3000 calorie diet for a man...Even when concentrating on foods of naturally high cholesterol content, it is difficult to devise a diet to provide, experimentally, as much as 2gm of cholesterol in the daily diet."

3) "That dietary cholesterol is not important for man would be predicted from the fact that the biliary output of cholesterol from the human liver is from 10 to 20 times as much as the daily amount of cholesterol in any diet of natural foods."

4) "Controlled experiments on men clearly show that serum cholesterol changes in direct relation to a change in the total amount of fat in the diet.  Both animal and vegetable fats show this effect and the addition or removal of cholesterol from the diet does not change the result. The cholesterol level may fall, however, if the diet is almost exclusively pure fat and is free of carbohydrate."

5) "In the classification of the U.S. Department of Agriculture, by far the largest proportion of the total fats, from 45 to 50 percent in recent years, is "fats and oils as such, excluding butter."  This means cooking and salad fats and oils- lard, corn oil, cottonseed oil, hydrogenated vegetable oil shortening, margarine, mayonnaise, etc."

All of this evidence more or less exonerates cholesterol yet it was ignored.  In 1977 the government began a decades long attack on cholesterol and saturated fat.  The government and AMA recommended that we limit our cholesterol intake and saturated fat intake despite the evidence listed above.  Could there be anything worse than that?  Actually there can, the person who wrote the above paper was Ancel Keys, the physician whose work was used to form the very recommendations put out in 1977.  Despite the fact that there was no evidence that cholesterol was bad the government still recommended limiting cholesterol consumption along with saturated fat.  In addition, despite the evidence that most of the fats people were eating in this 1953 study were vegetable in origin, we were told to avoid saturated animal fats and replace them with...wait for it...vegetable oils.

Regardless, Keys still came to the conclusion that we should limit fat consumption as a whole which turned out to be wrong.  One of his assertions in this paper that sticks out to me is that controlled studies show a direct relationship between serum cholesterol and fat consumption, but when carbohydrates are kept low, aka fat is upwards of 80% or more of total energy intake, serum cholesterol drops.  I wouldn't consider myself a genius or anything, but I find it hard to call something a direct relationship when putting one of the variables at it's highest causes the other one to drop like a rock.  Ironically, in this same paper, Keys brushed off a low carb high fat diet as not rooted in reality.  Well, in reality, a high fat/low carbohydrate diet is more than likely the diet we subsisted on for millions of years.  As an illustration of this concept, I would like you to go home and devise a suitable diet calorie-wise and do so without bread, pasta, cereal or any other processed foods.  It's nearly impossible to come up with a 2000-3000 calorie diet that doesn't involve a large number of processed foods OR a lot of animal fats.  Since processed foods weren't around a few thousand years ago, I'll let you guess as to whether or not animal fats were a significant part of our ancestor's diet considering Cocoa Puffs certainly wasn't.  This is what is so interesting about using an evolutionary template, it not only looks at current data, it looks at whether the current data jives with what the reality was prior to recent history.  You know, the type of history that started more than fifty years ago.

So whatever became of Ancel Keys?  In 1955 President Dwight Eisenhower survived his first heart attack and decided to begin following the recommendation of Keys.  Six more heart attacks later and he finally succumbed to the last one in 1969, how did that advice serve him?  As for Keys, he got his picture on the cover of Time magazine in 1961 and Americans soon started snapping in line and following his advice.  Fifty-two years later and heart disease is still the leading cause of death in the United States.  Whether or not you agree with Keys' conclusions, you have to wonder how long you have to follow advice before you realize it's bad.  The truth of the matter is, we obviously don't know exactly what is causing heart disease and diet appears to only be one of many factors involved in it's progression.  In addition, the notion that high serum cholesterol is a major causative factors, at least what we consider high, is probably also false.  It's simply based on the notion that cholesterol is part of the plaques that form on blood vessel walls.  If only someone would have brought that up years ago...Oh yeah, Keys brought it up in the paper cited at the beginning of this blog post.  That's the problem, people read something in it's entirety and ignore the parts that don't fit their narrative.  Interestingly enough, calcium is also found in the plaques on blood vessel walls yet we were told to supplement to make sure we were getting enough.  Recent studies are showing that people who supplement with calcium are more likely to have cardiovascular disease than people who don't.  It shouldn't come as any surprise that we seem to be wrong on so many levels, the Earth was flat once upon a time too.