Monday, March 31, 2014

The Human's guide to being human: Physical inactivity and prolonged sitting

People often take a couple of hours out of every week to get in some form of exercise.  The recommendation by most health authorities is that people should perform at least 150 minutes of moderate to vigorous physical activity (exercise) per week to maintain a healthy body.  When you look at the literature, this seems like pretty good advice.  However, there is a problem that isn't typically addressed by these recommendations that is equally, if not more, important.  Does exercising for 2.5 hours per week adequately address the needs of a person who sits for 8-12 hours per day.  When you take a look at the literature, it appears that this is not the case.

Are inactivity and exercise points on a continuum?

Over the last couple of decades, researchers have been trying to identify whether being inactive and exercising are merely points on a continuum.  If you are inactive for most of the day, can adding in some moderate to vigorous physical activity average out that inactivity and improve the negative effect you get from sitting all day long?  Most of the epidemiological data shows that exercising is healthy and reducing sedentary time is healthy, but are they both just manipulation of the same physiological response?

The problem with using epidemiological data to determine something like this is that when someone engages in one form of health promotion such as exercise, they are more likely to engage in other activities that are health promoting and avoid activities that are health compromising.  In other words, someone who exercises is more likely to also pay attention to their diet and avoid smoking when compared to someone who doesn't exercise at all.  This causes the data to be corrupt because you really can't determine from a questionnaire whether or not the healthy person is seeing an effect from a single healthy activity or from their many healthy activities.  This is why you typically see conflicting data from study to study.

It becomes very difficult to figure out what is healthy when you get so much conflicting data, such is the inherent risk of relying on epidemiological data.  A great case in point is that this study shows that sedentary time is associated with the metabolic syndrome independent of exercise, this study shows that exercise but not sedentary time increases the risk of Type 2 diabetes in at risk people, and this study shows that sedentary time is a better predictor for Type 2 diabetes than exercise time.  If that doesn't make your head spin, those last 2 articles were published a month apart in the exact same journal and essentially say the polar opposite of one another.

Current research suggests a difference between inactivity physiology and exercise physiology

While there is conflict in the epidemiological data, the bulk of epidemiological evidence coming out now point to exercise and reducing sedentary time both being important for health, but for different reasons(1).  In other words, moderate to vigorous exercise does not offset sitting down all day because they work through different channels.  This has directed researchers to observe the effects of sitting time and exercise on how genes are expressed in animals, which has confirmed that there is a difference between exercising and reducing sedentary time, particularly with the way fats are metabolized in the body(1, 2, 3, 4).  Further research in humans has confirmed these results and identified a few other potentially important cellular responses to high levels of sedentary time.

The amount of time people spend being sedentary has been associated with poor health and obesity, primarily through higher levels of inflammation(5, 6).  As mentioned in Evidence against the Western Lifestyle, three conditions that are associated with every chronic disease are chronically high levels of inflammation, high blood glucose levels, and high levels of oxidative stress.  Since the epidemiological data is conflicting but animal studies have shown that inactivity physiology and exercise physiology are different, studies in humans have been conducted to determine what happens when humans sit for prolonged periods of time.

Inactivity and changes in gene expression

One of these studies found that sitting for prolonged periods of time without getting up induced changes in gene expression that negatively impacted glucose regulation as well as antioxidant and anti-inflammatory pathways(7).  When people broke up these periods of inactivity by getting up and walking around, a positive response in gene expression was seen.  Another study looking at the effect of loading one leg while causing the other leg to be unloaded showed that the expression of genes in each leg was different, with the unloaded leg showing the less desirable pattern of gene expression(8).  This poor pattern of gene expression persisted even once the unloaded leg was reloaded again.

Since these studies are not comparing people who exercise but are mainly sedentary to those who don't exercise but are on their feet most of the day, they cannot be used to say that there is a significant difference between the two conditions.  At this point there is no perfect study such as that to prove one way or another whether exercise makes up for being seated all day long.  However, there is evidence that reducing sedentary behavior and performing exercise lead to different physiological outcomes.

Lipoproteins in inactivity and exercise

A study looking at blood lipids found that reducing sedentary time improved VLDL-P, LDL-P, and triglycerides while exercise had no effect.  Exercise had an effect on HDL-P, HDL size, Apo A1, and total HDL-C while reducing sedentary time had no effect(9) on these variables.  All of these variables are related to how fat and cholesterol are carried in the blood and metabolized, and this evidence points to there being distinct benefits from reducing sedentary behavior and performing exercise that do not overlap with one another.  Another study backed up this evidence by showing that 1 hour of exercise did not compensate for the negative changes in glucose handling and blood lipids caused by sitting the rest of the day despite both groups burning the same total number of calories(10).

Another study that compared the effects of sedentary time to exercise found that levels of interleukin 6(IL-6) were affected by reducing sedentary time independent of whether the person exercised or not(11).  This is an interesting finding because high levels of IL-6 are a very strong risk marker for the diseases associated with chronic levels of inflammation(12).


These studies point to there being a difference between inactivity physiology and exercise physiology.  On top of their effect on overall health, high levels of inflammation and altered lipid metabolism will also negatively impact your ability to burn fat.  Many people like to push exercise as the end all be all in fat loss, but these studies suggest otherwise.  There is also a fundamental flaw in the logic that 1-2 hours of exercise 5-6 days per week can make up for being sedentary all of the time.  Sitting down all day long and running or strength training for a couple of hours should not be considered the default condition because it is not the condition we evolved in and were selected for.  The condition we evolved in would have included very little sitting time, walking 5-7 miles per day, and intermittent bouts of intense to moderately intense exercise when necessary.  While just a couple of years ago it was believed that sitting down all day long and exercising were merely a continuum, the bulk of the evidence out today points to reducing sedentary time and exercising being physiologically different from one another.  This does not mean one is more important than the other, but if you are doing one or the other and not seeing the results you would like to see from your wellness plan, start working on the other variable.

Previous: The Problem with gluten

Thursday, March 27, 2014

4 Steps for a diverse microbiome

What constitutes a healthy microbiome?  If you are looking for a specific answer to this question you are not in luck.  Not only do we not know what a healthy microbiome looks like, it's likely different for every one of us.  In addition, we've only classified about 10% of the microbes found in the gut so it would be hard to tell you one way or another which ones are beneficial and which ones are potentially harmful when we've studied so few.  We do know that certain strains of bacteria are associated with certain beneficial effects and others can become problematic if not held in check.  We also know that hunter gatherer cultures who don't typically see the same sorts of chronic diseases and digestive problems that we see tend to have a much more diverse microbiome than us.  So how do we develop a more diverse microbiome?  Let's take a look at 4 tips you can use to develop a diverse microbiome.

1)Ditch the probiotics and eat fermented food

Probiotics are very popular these days as some have shown some clinical benefit in studies.  I do not discount what these studies say, but it's hard to believe that taking a pill that simply contains the organism is the most effective way to increase the amount in your colon.  For one, they have to make it through your acidic stomach and the rest of your digestive tract to set up shop in the colon.  While some bacteria can be found in the small intestine, it is far fewer than the number found in the colon and may not be something you want in large numbers in your small intestine, as is the case with small intestinal bacterial overgrowth.  Eating probiotic foods, however, makes a lot more sense.  For one, since these organisms are found in the food, the food contains nutrients(Called prebiotics) that the bacteria can use to make the byproducts of fermentation that are beneficial to us.  These effects appear to be directed through the vagus nerve which can be found all throughout our digestive tract, so you may get some benefit even though the bacteria don't make it to the colon where they can set up shop.  Secondly, if the organisms themselves don't make it to the colon, the prebiotics they are packaged with may and feed any organisms that you already have residing there.

2)Eat a lot of fiber...a lot!

In order for beneficial bacteria to colonize the colon, they need to have food.  They get food from you, but they tend to only get the food you don't completely digest.  This makes it important to get a lot of fiber from your diet.  Since we don't digest fiber, it makes it's way through our digestive tract in tact and bacteria in the colon can act upon it to produce nutrients that we can't and provide other forms of beneficial behavior such as crowding out bad bacteria and aiding in mineral absorption.  It is estimated that ancestral hunter gatherers consumed 100-150g of fiber today and this evidence is supported by what Jeff Leach of the Human Gut Project has seen in modern day hunter gatherers.  Beneficial bacteria in our gut ferment fiber in to short-chain fatty acids such as butyric acid which promote a healthy digestive tract and a healthy digestive process as a whole.

3)Eat a diverse diet, and not just the most edible parts of plants

Not only is the American diet the polar opposite of diverse, most people dispose of the parts of the few vegetables they eat that contain the most fiber.  While it is common to see some people eating broccoli, most of them eat just the crowns and trash the stems.  Root vegetables such as turnips and beets also contain greens that are high in fiber and polyphenols that are often delicious when sauteed in ghee or coconut oil.  You should shoot for 30 or more different plant foods per week and attempt to eat as much of the plant as possible.  In addition, striving for 5 different colors of fruits and vegetables per day will give you many different polyphenols that will also help promote a diverse microbiome.

4)Limit hard to digest proteins

Hard to digest proteins such as gluten, dairy, and legumes should be limited to reduce the amount of substrate available to amino acid fermenting bacteria in the colon such as Candida Albicans. C. Albicans and other amino acid fermenting organisms can generate ammonia as a byproduct of fermentation that can negatively impact digestion when they overgrow.  How hard these proteins are to digest is likely specific to the individual and some people may have no problems with them at one point in time but develop sensitivities to them later as certain strains of bacteria overgrow.  If they overgrow to the point they impact digestion, other forms of protein can become problematic as protein digestion becomes compromised.

While we try to untangle the specific strains of bacteria that make up a healthy microbiome, as well as the ones that are less than ideal, the best we have at this point is to try to have as diverse of a collection of bacteria in your gut as possible,  While this certainly doesn't guarantee you lifelong health, you are imitating the patterns of cultures that don't have the chronic diseases and digestive problems that we have today.  Most of these diseases, particularly autoimmune diseases and digestive issues, are related to specific changes in the gut microbiome that are likely, at least in some way, related to your diet.  Other chronic issues we see today, including obesity and Type 2 diabetes, are also related to changes in the microbiome.  You can't help but think that the Western diet has something to do with this.  The tips contained within this blog identify a few of the likely factors that contribute to a less than ideal microbiome, and eliminating these common dietary faux pas' should take you a long way in improving the landscape of your inner ecosystem.

Monday, March 24, 2014

Prolonged sitting may actually cause your fat cells to expand...mechanically

We all know that people need to sit down less and move around more.  When most people think about the reason why sitting all day will cause their butt to get bigger, they break it down to burning too few calories and taking in too many.  There are actually quite a few reasons why this happens, many that have to do with genes.  Researchers just found a new one that may seem a little cooky.

By analyzing the way cells respond to forces applied to them, researchers were able to determine that when fat cells are exposed to chronic pressure, they begin to accumulate lipid droplets at an accelerated rate.  In layman's terms, this means that sitting on your butt all day long will cause the fat cells located there to grow bigger due the weight you are putting on them, not just because you are eating more calories than you are burning.  This is in direct contrast to the effect sitting has on muscle and bone cells, which causes a reduction in those cells.

Other environmental factors are at play here. In this blog I discuss how prolonged periods of sedentary behavior create environmental changes within the body that cause your cells to change in a way that promotes higher blood glucose, triglycerides, inflammation, and other changes that are associated with obesity.  As you can see, people become obese for many reasons, not just because they eat more calories than they burn.  They are promoting an environment that causes their cells to respond in a way that makes that person obese.  Energy balance certainly has a place at the table in this discussion, but it doesn't have the only place.  Looks like we can add a place for prolonged physical loading at the table now too.

Thursday, March 20, 2014

Developing a plan for lifestyle change: A case study

Last week I went over the 5 things that a person should have when beginning to implement a Paleo diet. One of those things, and likely one of the most important, is a solid plan.  In this blog I will go over how I helped a client develop one of these plans and some strategies we used to get her on her way to living a healthier.  Below the steps of our plan, I'll use italics to define the thought process I used to come up with them.  I have changed her name to protect her anonymity.

Vicky is 38 year old stay at home mom with a very busy lifestyle.  She drives all of her kids to school and since the schools all start and end at different times and they are all in sports, she is constantly picking someone up or dropping them off.  Her diet is a Standard American Diet based on convenience and snacks all day long, but she doesn't mind spending a little time cooking meals.  She doesn't, however, like eating vegetables, especially cooked ones.  Other than that she will eat pretty much anything.  She states that she feels she gets enough physical activity rushing around taking the kids everywhere, she is just looking for an exercise program to help her burn off the 20 lbs she has put on over the past 2 years.  She has done P90x, Insanity, and T25 and has a history of mild shoulder issues.  She has Type 2 diabetes and gets IBS occasionally when she eats raw or undercooked vegetables.  She is completely cleared for exercise, but her movement assessment showed her to have insufficient flexibility and poorly working glutes.

1)Eat at least 1.5 cups of vegetables at every meal

After further discussing her distaste for vegetables, I learned that she doesn't like the texture of cooked vegetables.  She was instructed to begin making her 1st and 2nd meals the day before and place them in the fridge.  While she didn't like the texture of cooked vegetables, refrigerated ones were fine.  Since we started, she has begun eating more vegetables and the diversity in her diet is growing.


2)Remove grains, legumes, and dairy from the diet

Vicky's IBS and Type 2 diabetes lead me to believe she has a problem in her gut.  Grains, legumes, and dairy all contain proteins that humans don't digest very well, leaving protein to interact with the bacteria in the gut and potentially cause GI distress(I discussed this here).  I instructed her to remove these things from her diet for at least a month to see if that would help with either condition.  After 4 weeks both issues had improved greatly and she decided to limit her exposure to these foods.


3)Begin tracking your activity

I had Vicky purchase a Fitbit activity tracker and wear it for 3 days to get an idea of how much physical activity she was getting.  I told her not to worry about trying to get as many steps as possible because I wanted to see how active she was previously, which turned out to be about 60% of what she should be doing.  I told her to begin working to get more steps and to track her progress with the Fitbit.  She should increase her daily average by 1000 steps each week until she averages 10,000 per day.


4)Begin foam rolling and stretching 3 times per week

While Vicky wanted to jump right in on an intense training program, I informed her that this would be a bad idea.  Her lack of mobility and proper glute firing indicate that the activity she wanted to engage in would be detrimental to her goals at this time.  To get her ready for more intense exercise, we are working to restore proper movement mechanics by increasing her mobility and strength in the areas where she needs it.  While she wanted to dive right in, I made her realize how this would negatively impact her progress.  She was happy to hear that she could still see substantial progress towards her goal by simply being on her feet more and getting 10,000 steps per day in addition to changing her diet.  I informed her that this would be better for her goals down the road because when she plateaus we can add in more intense activity when it is safer.


Vicky's problems are very similar to those I see often, but it isn't the solution to the problems that is important.  The fact that she is addressing them and has a solid plan of attack to tackle her own personal hang ups when they come up is what is important.  Having general guidelines isn't helpful because they allow wiggle room which leads to making decisions that compromise attaining your goals.  While Vicky didn't all of a sudden begin following all of these letters to a T, she knew when she was doing something that would compromise her goals and that gave her a level of satisfaction, even if she did cheat from time to time.  There were other issues we had to address but the specific issues don't matter, we identified her strengths and weaknesses and developed a plan that used her strengths to help overcome her weaknesses.  Even if you can't completely solve the issues, realizing that they are there can allow you to avoid situation where they come up.

Monday, March 17, 2014

Health Research Recap (Gut bugs edition)

Well, I was going to stop doing a Health Research Recap and then a ton of gut bug studies popped up this week.  Moving forward I will only do these recaps periodically so I can focus on other stuff, but here's what we have this week.

The microbiome, the collection of bacteria that colonizes your entire digestive tract is incredibly complex.  There are so many things to consider when trying to build a healthy, diverse microbiome, but why build a diverse microbiome?  A diverse microbiome is clearly associated with health, and a disturbed microbiome is found in many health conditions such as inflammatory bowel diseases, autism, Type 2 diabetes, and depression.  At this point it is clear as to how to build a healthy microbiome.  In a presentation at the Gut Microbiota for Health World Summit, experts presented what we currently know.  A diet high in fruit and vegetables provides ample substrate to build a diverse microbiome while antibiotic use, being delivered by C-sections, frequent use of NSAIDS, and not being breastfed are all factors that can lead to a less diverse microbiome.

The effects of antibiotics on the microbiome were also discussed in relation to weight gain as there is a clear association between antibiotic use in childhood and weight gain later on in lifeA study looking at Crohn's disease identified the specific strains of bacteria that are affected in the disease, and as the abundance of specific strains of beneficial bacteria becomes reduced, the abundance of pathogenic strains begins to increase.  While antibiotics are frequently used to help combat Crohn's, they may be contraindicated because they are not selective in which bacteria they effect, and reducing the number of beneficial bacteria may have the same effect as increasing pathogenic bacteria by removing competition.  Since this study indicates a clear pattern in the microbes that are affected, it seems obvious that these strains compete with one another for resources and a dual approach of reducing the bad guys while increasing the good guys is the best course of treatment.

Good or bad, there will always be competition between bacteria that require the same resources.  Co-infections of parasitic organism is very common because some share common food sources, and treating one without treating the other can lead to problems as they may have been keeping each other at bay until you removed the competition for resources.  Both are simply trying to survive so competition may prevent one from taking a stronger hold in the body.  Beneficial strains of bacteria are known to crowd out pathogenic strains via this competition.  Candida albicans is typically a benign strain of yeast found throughout the digestive tract and may even exert some beneficial effects.  People with HIV tend to have higher levels of C. albicans and lower levels of a different strain called Pichia while the reverse is seen in healthy people.  Candida overgrowth is common in those with HIV, and it turns out that Pichia and C. albicans compete for resources in a petri dish.  This indicates that Pichia may help keep C. albicans levels in check by limiting the amount of resources it has to grow.

In addition to competing, parasitic organisms can also team up against you.  The fungal form of Candida albicans cannot colonize teeth effectively, but is often found in the oral cavity.  On it's own C. albicans won't adhere to teeth, but in the presence of Streptococcus mutans it develops the ability to adhere to teeth as the enzyme that S. mutans uses to metabolize sugar also causes C. albicans to produce a glue-like substance that causes it to bind to S. mutans and adhere to teeth to form plaque.  In the presence of both organism, the risk for cavities doubles and the severity of cavities increases seven-fold.

The microbiome is a critical factor in the development of the immune system.  Mice raised to be microbiome free have a reduced ability to fight infection as they have a poorly developed immune system with fewer immune cells.  This effect is not only seen in the gut where the microbiome exists, but throughout the body as well.  Since these are areas where bacteria don't typically exist, it appears that the organisms that make up the microbiome are exerting their effects from the gut on the entire body.  The vagus nerve is believed to be the "string" these bacteria are pulling to exert these body-wide effects because when you cut the vagus nerve the beneficial effects of probiotics disappears.  When you look at the vagus nerve and where it connects, it makes perfect sense as the vagus nerve connects the brain and gut together.  This could also explain why brain and gut health are so closely linked.

It is clear that our understanding of the microbiome is in it's infancy.  We are just starting to unravel the effects of specific strains of bacteria on gut and overall health.  Lactobacillus rhamnosus is a probiotic strain that has been studied at length and shown to help support those with poorly developed microbiota.  It exerts some of it's effects via the production of a protein called p40 that, when attached to receptors of intestinal cells, exerts an anti-inflammatory effect and prevents cell death.  While it would be nice to be able to simply take a few probiotic strains to heal many of the conditions that a disturbed microbiota is associated with, it's not that easy.

It's not just which bugs you have, it's how they interact with one another as well.  In a study looking at gut bugs and autoantibodies in Type 1 diabetes, researchers found that the microbiome of children who would eventually develop diabetes autoantibodies was similar to that of children who would not, but the bacterial populations within their microbiome interacted differently with one another.  This adds yet another layer of complexity in the way the microbiome influences health and shows us that further study is certainly needed.

Overall it looks like the next major step in health and medicine will look at gut health as central to optimal health.  The gut is a major interface between the environment and our internal environment, so it makes sense to make sure this barrier does what it's supposed to.  One of the keys to optimal gut health is a healthy and diverse microbiome.  At this point we have yet to determine exactly what a healthy microbiome is.  At this point the best advice is to eat a diverse diet rich in plant material, use antibiotics only when necessary and with probiotics to support your microbiome, and reduce the use of non-steroidal anti-inflammatory drugs.  For the health of your children, it is probably best to make every effort to give birth naturally and breast-feed them if at all possible.  Eating probiotic foods such as kimchi, sauerkraut, and raw yogurt or kefir if you tolerate dairy may also be beneficial.

Thursday, March 13, 2014

5 important resources for undertaking a Paleo diet

I've helped many people shift from a conventional diet to a Paleo-based diet.  More often than not, the information is easy to understand and you can get substantial buy-in by providing a little science, but the problems begin when you get to implementation.  In this blog I will go over 5 resources that people should use to help implement a Paleo diet.

1)A thorough plan

Before you take any step, do yourself a favor and get together a solid, detailed plan.  If you were going to drive to Florida or plan a vacation anywhere, you wouldn't just wing it because winging it is likely to lead to failure or at least a less than optimal experience.  Look at shifting from your standard diet to the Paleo diet as a journey.  Where are you going?  How are you going to get there?  Are there any potential pitfalls along the way?  Do I need anything to make this an enjoyable journey?  Fortunately, enough people have undertaken this path before you that you likely don't have to pay someone to help you.  You can buy a book, or just pop online and read other peoples' experiences.  There are a few standard issues that people run in to while implementing a Paleo diet, and most of these issues are due to poor planning.  What do you do if you're out eating with friends?  What should you have in the house to snack on in case you get hungry?  Are there any strategies you can use to reduce the amount of time you spend in the kitchen.  Fortunately, these problem have been encountered by other people and can be answered pretty simply if you sit down and develop a detailed plan rather than just say you're going to do a Paleo diet for 30 days and wing it.  In my next blog I will discuss how to come up with a detailed plan and provide a sample one I made for a client.


One of the biggest pitfalls people encounter when "going Paleo" is that they end up neglecting certain nutrients that are contained in a group of foods they may not particularly enjoy. is a good way to identify the nutrients you may not be getting and determine which foods you should add in to your diet to get them.  Once you sign up, you can enter the foods you eat every day and look at an analysis of which nutrients you are getting and which you may be missing out on with your food choices.  From there, you can use the tools section and search for foods high in the nutrients you are deficient in to help make a more healthful diet.  I find indispensable when developing a diet for someone and a great value, especially since it's free.  It's also a good way to develop a diet for clients while using their existing diet as a template, that way the change is not as severe.

3) Good food storage containers

One thing we can never have enough of in my house is food storage containers.  Whether we are cutting up vegetables for the next few days, packing lunch, or making extra chili for the following week; we always seem to run out of food storage containers in short order.  One of the biggest changes when switching to a Paleo diet is that it is not very convenient from a food prep standpoint.  Rather than spend more than an hour every day preparing food, we tend to spend an hour 2 times a week cutting and prepping food and then storing leftovers from each nights dinner in the freezer for the following week so that we are always prepared.  A ton of food storage containers in multiple sizes is crucial for cutting back on prep time.

4)An activity tracker

Activity trackers are very useful places to store and look at data that may be of interest to you.  I've used a Fitbit One on a daily basis for the past 2 years.  While I am using it to motivate and compete with my clients, I initially used it to look at how my lifestyle affected my health.  I found a few things including coffee and dairy that I eventually removed from my diet since both seemed to be effecting my sleep in a negative way that also caused my morning fasting blood glucose to be a little high.  I removed them and saw a fairly substantial improvement after a couple of weeks so I kept them out and make sure not to do other things that may negatively affect my sleep if I do partake in either.  Another benefit I find from the Fitbit is that clients who tell me they are doing everything they can to lose weight are often sitting around for hours at a time or only getting 6000 steps per day.  If they wonder why the diet isn't working for weight loss and they are getting 6000 steps per day, I can tell them the problem isn't the diet, it's the couch.  I go over a bunch of the ways you can use your Fitbit One sleep data in this blog.


In terms of nutrient density, nothing beats spices.  Ounce for ounce, spices are a far greater source of many essential nutrients than any other foodstuff on the planet.  They also contain a ton of phytonutrients that provide many benefits outside of those found in the essential nutrients.  For example, turmeric, a spice used frequently in middle eastern cuisine, has a potent anti-inflammatory effect and activates stage 2 cell detoxification.  Also, garlic contains a special form of vitamin B-1 called allithiamine that is 50x more bioavailable than the thiamine version of B-1 found in nearly every other food.  B-1 is crucial for carbohydrate metabolism, adrenal health, and is a nutrient likely lacking in any Paleo diet that doesn't utilize copious amounts of sesame seeds or tahini.  You can check out why B-1 is important and signs you may be deficient here.  While fresh spices are best, dried ones should be added to oil first to help release the essential oils.  You really can't go wrong with any spices, I like to rotate mine daily so that I get a myriad of benefits that I didn't get when my diet was fairly plain from a spice standpoint.  Another added benefit to using spices is that they can be a way to get plant matter in to your diet if you react to FODMAPS because they are consumed in far lower doses than whole plants and vegetables.

Monday, March 10, 2014

Health Research Recap (Week of March 3, 2014)

Researchers believe Alzheimer's disease may be a more common cause of death than reported.  The CDC estimates that 83,494 deaths are caused by Alzheimer's per year.  Researchers looked at a group of 2,566 people aged 65 or over who routinely underwent testing for dementia.  The cause of death in 1/3 of the 1,090 who died could be attributed to Alzheimer's disease.  This translates to roughly 503,400 deaths per year from Alzheimer's, almost as much as heart disease and cancer.  The risk of death increased by 400% in those between the ages of 75-84 and 300% in those over 85 who were diagnosed with Alzheimer's disease.  The average time from diagnosis to death was approximately 4 years.  This problem is likely to get worse as baby boomers get older.

A study looking at children with parents that were smokers found that children who had 2 parents that smoked developed thicker artery walls than children whose parents didn't smoker or who only had 1 parent who smoked.  The increased thickness is likely not an issue for an otherwise healthy person, but it does increase their risk of heart disease and likely exacerbates other risk factors that they may experience such as a bad diet, excessive stress, or becoming smokers themselves.

Hops, one of the most beautiful and glorious plants on the planet, contain polyphenols that help fight cavities and gum disease by preventing bacteria from being able to adhere to surfaces in the mouth as well as the release of bacterial toxins.  Unfortunately for beer drinkers, these polyphenols remain with the spent hop plant, they do not make their way in to delicious, life-giving beer.

It's nice to see scientists band against idiocy.  A group of researchers recently penned a paper warning about taking the results of single studies that often look at single factors and drawing large scale nutritional recommendations from them.  This paper was primarily directed at the many anti-meat articles coming out in the press lately.  Many of these studies are done in mice who are fed meat without any other food types that protect against cancer such as fruits and vegetables and therefore can't really be applied to humans eating a mixed diet.  The most recent one that has taken the interwebz by storm which showed increased animal protein consumption increased the risk of death was epidemiological, so it's basically garbage with regard to drawing any conclusions.  It would be like saying practicing yoga causes meat consumption to go down.  While people who do yoga may eat less meat, the act of practicing yoga doesn't cause meat consumption to go down, there is merely a relationship between the 2.

Children with higher levels of the omega-3 fatty acid DHA tend to sleep better than children with lower levels.  Children who were supplemented with  DHA levels tended to get 1 more hour of sleep and awoke 7 fewer times per night than children given corn or soybean oil.  Unfortunately corn and soybean oil are inflammatory so I wouldn't consider them suitable placebo oils, therefore we can't tell with 100% certainty that the effect was from a positive effect from the DHA or a negative effect of the other oils.  Since most people likely consume many times more soybean or corn oil per day from processed foods and little to no DHA, it's safe to say that the effect is likely from a beneficial effect from the DHA.

The slow turn away from the bad advice to avoid saturated fat and replace them with polyunsatuated fats and carbohydrates gained some momentum this week as a British MD wrote an editorial in the journal Open Heart condemning the crappy science that those recommendations are based on. 

Consuming a diet high in fruits and vegetables is associated with a decreased risk for preterm delivery in pregnant women.  The authors point out that since the study was epidemiological, all you can really say is that a pregnant mother's diet will have an effect on whether or not she delivers early, not that avoiding fruits and vegetables causes preterm delivery.

Looks like Type 2 diabetes may be as epigenetic as it is genetic.  Researchers looking at the disease found epigenetic changes to over 800 genes in people who have the disease.  To assess whether the changes cause diabetes or diabetes causes the changes, they looked at healthy people and found that those with risk factors for the disease such as BMI or higher blood glucose were already developing these changes before the disease developed.  While people are awaiting a drug that will allow them to be able to sit on a beach, sip coronas, and eat ice cream cones ad libitum without getting Type 2 diabetes, they can improve their epigenetic risk factors by avoiding processed foods, reducing the amount of time per day they sit, and getting regular physical activity.

Taking antiobiotics appears to be a pretty significant risk factor for C. Difficile infection in kids.  No news here, other than doctors are still prescribing antibiotics that children don't need and this has unwanted consequences.  71% of C. Difficile infections in US children aged 1 to 17 occurred shortly after taking antibiotics, which wipes out your gut microbiome and doesn't differentiate between good guys or bad guys.  Unfortunately, many of the cases were in children whose initial problem would not be fixed with antibiotics.  Shame.

There's a new program for children with autism in North Carolina and 5 other states.  The program hopes to improve the lives of children who are graduating high school through development of social skills.  Info on the program can be found here.

Thursday, March 6, 2014

Why your Paleo diet may not be so healthy

I love the logic behind the Paleo diet and the many health problems that people have reversed by undertaking it.  People have reversed autoimmune diseases and Type 2 diabetes, lost tons of weight, and drastically improved their overall health in many ways from fatigue and pain relief to just being happier.  While there is a lot going for the Paleo diet, I feel many may be making errors in logic when formulating their own personal Paleo diet.  In this blog I'll take a look at the primary logical fallacy I see in Paleo world.

Start the story from the beginning

When we think of our ancestors, we tend to think of our immediate ones that looked like us, talked like us, and ate diets very similar to ours.  The problem with thinking this way is that it starts the narrative halfway through the story.  The story doesn't begin with a somewhat modern human with an ape face chasing down game, it begins with a primarily herbivorous primate that was likely incapable of hunting or attaining any meat outside of scavenging dead carcasses.  Ok, you got me, it actually begins much further back with a single celled organism, but since their diets didn't consist of food as we look at it today, what they ate doesn't really provide us with concrete evidence as to what we should eat...or does it?  More on that later.

So here we have an herbivore who is competing for food against other herbivores in a constantly changing climate that is ultimately responsible for all of the mass extinctions save for the dinosaurs.  Being able to eat different foods is not a novelty of an animal living in this world, it's a survival necessity.  When competition was tough or the climate changed the foods that were available, having fallback foods that are not typically parts of the native diet can be crucial to survival.  While scavenging the remains of dead carcasses may be the first thing that comes to the mind in Paleo world, another one is the consumption of underground storage organisms, also known as roots and tubers.

To get at roots and tubers, you need a couple of traits that these early primates likely didn't have.  First, they would have needed the intelligence to be able to identify them as potential food sources, despite the food portion being located underground.  Second and more importantly, it would require the use of tools to dig them out.  Using a stick to dig a tuber out of the ground was likely one of the first steps in the use of tools, even if it's not it certainly predated the making of hunting tools such as spears, atlatls, and bows.  So here we likely have a point in time where a small offshoot of the primates started consuming these fallback foods when the components of their primary diet were not available.  However, being fallback foods, they still weren't the bulk of the diet when all food was available.

Fallback foods and evolution

Over time our diet likely changed immensely as our ancestors evolved in to something more human-like, but we started as an herbivore and that is likely what our diet should be made mostly out of...plants.  When you look at fallback foods, most of them have some sort of importance in to what we evolved in to because those that didn't eat these fallback foods likely evolved in to something else or disappeared altogether.  This doesn't mean that a fallback food that helped get us to where we are should become the staple portion of the diet.  In fact, if you are arguing for Paleo you really can't do that.  Grains and legumes began as a fallback food and were likely necessary to get us where we are now.  This doesn't mean that ad libitum grain consumption should be your goal, and in the same way it doesn't mean ad libitum meat or protein consumption should be either.

To clarify what I mean, I have to go in to the microbiome, teh collection of bacteria located in your GI tract.  When a person switches from an entirely plant matter diet to an entirely animal matter diet, as would happen when the dry season or winter comes, the microbiome changes drastically and very quickly(1).  As this happens, your microbiome is adapting to the foods that are available and changing what is happening in your body by changing it's inputs, and changing inputs changes outputs  What we tend to see in this scenario is a change from mostly carbohydrate/fiber fermenting bacteria to mostly protein/amino acid fermenting bacteria.  This change, in theory, will lead to increased intestinal permeability as the butyric acid used to seal up and repair tight junctions between cells in your digestive tract won't be produced as it is a byproduct of bacterial fermentation of fiber in your colon.  This, in turn will increase systemic inflammation which sounds like a bad thing, but in the context of low food availability it is actually a beneficial trait.

With increased systemic inflammation, comes insulin resistance.  In today's world this is bad because we have unfettered access to all types of foods, but several thousand years ago it probably activated the thrifty genotype that is associated with more efficient fat storage and more energy extraction which is beneficial when food is low.  This process is described by Jeff Leach in a blog on his website discussing the effect of a low carb diet on the microbiome and another one where he discusses the Paleo diet and obesity located here.  In the grand scheme of things this got us to where we are today, but that doesn't mean that it doesn't contribute to the problems we see in a completely different food environment.

If we flash forward many moons, grains and legumes likely had the same impact on farmers.  Here we have an easily storable source of nutrients that can last through even the longest winter, and it just so happens that they have proteins that humans have difficulty breaking down.  The result, a steady flow of substrate to bacteria in the colon that ferment amino acids and increase insulin resistance in a time where it is beneficial.  Again, beneficial when food is scarce, not so beneficial when food is plentiful. 

Fighting microbes with microbes

Here we have some compelling evidence that a Paleo diet that is 90% meat with a few veggies may not be the best in terms of health.  Further support for this notion comes from another blog by Jeff Leach that identifies that it may not be high levels of protein so much as it is low fiber consumption that is the problem with a typical high meat Paleo diet(2).  Fermentable fibers, since we can't digest them, provide substrate to the colon that will increase the amount of bacteria that ferment fiber there,  This will also crowd out some of the amino acid fermenters, and also creates an acidic environment that amino acid fermenters can't survive in.  This is not to say that you cannot eat high levels of protein, only that the smart way to do it is to make sure you are getting enough fiber to support the microbes in your gut.  Something I find interesting is that people who undertake ketogenic diets typically don't achieve success unless they limit protein.  The assumption is that the excess protein gets converted to glucose in the body, but this doesn't necessarily have to be the only thing at work, your microbes could play a significant role here as well.

Would you like some partially digested plant matter with your steak?

I know it sounds like I'm beating the Jeff Leach horse to death, but he is studying the effect of many variables on the microbiome, and since he's hanging around with hunter gatherers, he provides other evidence that the microbiome is critically important and ad libitum meat consumption may not be the best idea.  Jeff's experience with a group of Hadza hunters is very eye opening.  When these hunter gatherers killed and field dressed an impala, they did something that would make most of us cringe; they tore open the stomach, washed their hands with the partially digested contents, and cut up parts of the raw stomach and ate them(3).  While this may seem a little kooky to you and I, maybe they know something that we don't.  Maybe there is some undesired consequence to unfettered protein consumption just as there is some undesired consequence to grain and legume consumption.  Perhaps "innoculating" themselves with the fiber fermenting bacteria of an herbivore provides some level of protection against large shifts in the microbial composition of the gut.  Who knows, but I can't imagine they do this just for the fun of it.


Creating a diet based on evolution requires applying the same type of logic throughout the entire story.  Grains and legumes as fallback foods were likely beneficial when they were needed, but in a completely different food environment I think there is strong evidence that they are not so good.  Of the two, legumes contain fiber as well as hard to digest proteins, so they are likely less problematic than grains.  I think it is 100% true that our ancestors ate these foods, just as I am 100% sure that seasonal food availability likely led to times where animal flesh was the primary source of nourishment in the diet.  This doesn't mean that it is optimal from a health perspective, only that it was necessary to get us to where we are.  Mass consumption of grains and legumes as well as an uber-high protein diet may not be in your best interest if health is your primary concern and you have unlimited availability of fruits and vegetables.  This isn't to say that protein isn't necessary, it is.  It's merely to point out that eating pounds of bacon, sausage, and steak every day coupled with mass consumption of nut butters and flours likely isn't healthy, especially if fiber in the diet is low.  While people like to point out that correlation doesn't equal causation when looking at protein consumption and health, that doesn't mean there is no causation there, simply that we can't imply it from the data.  I guess you could just eat the partially digested contents of the cow who made up your hamburger, I'll just hammer some veggies and resistant starch.

Sunday, March 2, 2014

Health Research Recap (Week of February 24, 2014)

A study on the effect of BPA on pregnant primates found that very low levels of BPA, levels similar to those found in human fetuses, can negatively impact the fetus of the pregnant mother.  BPA had an adverse effect on the develop on the lungs, heart, ovaries, and brain of developing fetus and indicate that chronic, low dose exposure to BPA may have a more detrimental impact than previously thought.

If you think you are only exposed to BPA through plastic drinking containers, think again.  A source of BPA that most people don't know about is found in receipts you get from the store.  Researchers wanted to find out if exposure from receipts had a significant impact on those handling receipts for 2 hours a day(Such as cashiers)  They found that handling receipts without gloves for 2 hours caused the level of BPA found in the urine to increase while handling them with gloves led to no significant increase in BPA in the urine.  Of particular note is that traceable BPA levels were found in 83% of the people before the no-gloves condition and in 100% after.

There's good reason not to throw away that sprouted garlic in your refrigerator.  Researchers found that when garlic was sprouted for 5 days, it contained many new chemicals that protected the young plant that may also be of benefit to humans.  Of particular interest is that the antioxidant activity of sprouted garlic was higher than unsprouted garlic and there were more potentially beneficial metabolites that require further study. one of which protected cells from different types of damage.

It seems the number of psychological side effects related to the use of anti-depressants may be worse than thought.  In a study of people aged 18-25, researchers found that in some cases, a majority of people using these drugs experienced psychological side effects.  The side effects most reported in included sexual difficulties(62%), feeling emotionally numb (60%), and withdrawal effects.  Despite experiencing these issues, 82% stated that they felt the drugs were helping their depression.

It appears as though you can die of a broken heart.  Researchers looking at the likelihood of death within the 30 days after a loved one passed found that the risk of stroke or heart attack doubles for those who have lost a loved one.  Apparently the increased stress associated with bereavement may be too much for some people to take.  In addition, some of the bereaved also neglected to keep up with taking their medications post-bereavement.

Those born by C-section are 26% more likely to become overweight adults according to a new study.  While birthing method probably has some effect on genetic expression due to many factors, this study must be taken with a grain of salt as there are many factors that could contribute to this process.  If these results hold up, it is likely that the effect would be mediated by a change in gut bacteria as those born by C-section are not inoculated with their mother's vaginal flora as they do not pass through the birth canal.

In good obesity news, the rate of obesity in those aged 2-5 has declined significantly by 43%.  While this is certainly terrific news, the obesity rate as a whole has remained the same and women aged 60 and older saw an uptick by almost 20%.  While the news about youngsters is certainly encouraging, the news about older women will likely have a large impact on healthcare costs that are already too high.

In monkey see monkey do news, it has been long known that people in lower socioeconomic areas are more likely to become obese or have type 2 diabetes.  In a study looking at people within these areas, the researchers found that the individual socioeconomic status of people in these areas didn't matter, even people who are better off that live in this area are more likely to be obese or have type 2 diabetes.

Research has shown a link between low vitamin D3 levels and autism, and now new research indicates why this may be.  Researchers found that vasopressin, oxytocin, and serotonin, 3 brain hormones associated with social behavior, appear to be activated by vitamin D3.  The researchers believe that supplementation with D3, serotonin, and omega 3 oils could help relieve some of the symptoms associated with autism.  Daily sun exposure, eating foods with tryptophan, and eating fish or grass fed beef are likely better alternatives to get these nutrients.