Is Your Liver Happy

Here we are a month into 2019 and what we knew about health last year remains pretty much the same.  For the large majority of people we find a “health lane” and stick to it. For one person that may look like high-activity levels 5-6 days of “training” per week, a Whole 30 eating protocol, 5-day work week at the office, and the occasional cocktail outing with friends. On the other end of the spectrum person “x” eats mostly vegetarian, engages in yoga once a week, prefers snuggling with their cat, and enjoys church activities.  

People tend to find their comfort zone and begin habit building from a young age. In many cases adopting practices and ideas from their parents and peer groups. Cue the “my mom and dad had this or that issue, must be my genetic cards,”

However we choose to behave it is altering our bodies and physiology at a cellular level. In some ways, and much like our current healthcare system, these behaviors feel uncoupled from our health trajectories. This is because while some activities (injuries, sleep, caloric consumption, food choice, activity levels etc.) have short-term effects the long-term patterns result in ramifications that trickle out over 5 -20 years before we realize their full effect. Often times it’s very difficult to rule out early stage pathology or disease barring an invasive diagnostic test.

Overtime the body gives back, adapts, based on what has been required of it. As a student of the musculoskeletal system the research is quite clear when it comes to how quickly the neuromuscular complex can refashion itself. The Center for Healthy Aging and the Department of Biomedical Sciences at the University of Copenhagen concluded that it takes two weeks for a young person not using a leg to lose 1/3 of their muscle strength and mass leaving them on par with a person who is 40-50 years their senior.  

Inactivity does not discriminate and affects both young and old. What is more interesting is that after 2 weeks of immobilization participants cycle trained 3-4 times per week for six weeks. This was not enough for them to regain their muscle strength unless they included weight training.

This example demonstrates how quickly the body adapts to inactivity and results in rapid muscle loss.  The real kicker is that it will take you three times the amount of time to regain the lost muscle mass.

 Let’s look at a few examples of disease that require a period of 10-20 years before the disease has fully developed and spill over into other organ systems.  Most people don’t realize that cirrhosis of the liver and the deposition of connective tissue (scarring and fibrosis) requires about 80 grams of ethanol daily for 10- 20 years.  For those wondering what’s 80 grams - there is roughly 14 grams of ethanol in a 12 oz beer.  

More importantly, non-alcoholic fatty liver disease or NAFLD parallels that of obesity and has steadily risen over the last 30 years. NAFLD is projected to become the leading cause of liver related morbidity and mortality within 20 years and a leading indication for liver transplantation in the next few years.

Some researchers are calling diabetes a disease of the liver first. The liver is an important organ especially for energy metabolism and storage. The development of Type 2 Diabetes takes around 5-10 years in adults and can take much less time in children. These are 2 examples of long-term metabolic disorders. Atherosclerosis (think plaque and eventual heart attack) would be another example of inter-related long term metabolic stress that leads to maladaptive changes to an individual’s physiology.

Nutrition in the broader context of caloric intake

If you overload the system with continued doses of  “fuel” whether alcoholic beverages, sugar, or fat/protein for that matter, eventually the body will be unable to effectively process, detoxify and utilize these energy sources. A fatty liver is a signal that it is unable to burn fuel appropriately. A healthy liver ranges from 1-3 % fat and once it is at 5% normal function is on the line.

Judging by the statistics, if you’re an American, chances are you may stand to shed a few pounds. This tradeoff, excessive pounds for improved function, will increase your overall health and longevity. I’ve heard firsthand from patients, friends and family how difficult it can be to shed some weight and how to track progress when the scale seems to stall. Even exercise has its limits if your liver is struggling. Exercise is not a game changer for healthy weight loss as much as it is for maintaining a healthy weight. 

Most of us aren’t having routine blood work that looks at our liver enzymes, and even if you are by the time they are elevated your liver has been under insult for a while. The only way to rule out fatty liver is with a biopsy. Dr. Alan Christianson shares an interesting statistic: in situations where healthy individuals are undergoing testing to provide liver tissue donation 40.2% were found to have fatty liver disease. These are individuals with otherwise healthy blood markers.

Height to waist ratio

How do I know if my liver is strained or how it is handling the cumulative energy load? One of the most important metrics is your waist circumference. Your waist should be less than ½ your height. If it’s larger you may be more likely to have higher triglycerides, lower HDL cholesterol, higher LDL particle size, elevated inflammatory markers, elevated blood pressure, and higher fasting glucose.

If you want to quantify your risk of fatty liver disease Dr. Christianson has a built a calculator (because, as we know, short of a biopsy every other marker is inherently imperfect).

Fatty Liver Index

All you need are some results and some measurements:

The measurements you need:

• Weight in pounds

• Height in inches

• Waist circumference in inches

The blood test results you will need:

• Fasting triglycerides

• Fasting GGT

Unlike your car, your liver doesn’t want to be “topped off” at every meal.  Whenever we eat above and beyond our basal fuel requirements metabolic processes result in elevated free radicals and inflammatory compounds. Energy production is a “dirty process” metabolically speaking and requires the liver to run it’s detoxification pathways.

 Trust me, the body is not trying to carry trapped fat around our midsection. If you give the liver no choice and subject it to fuel overload this will result in high density fat storage, high blood glucose aka pre-diabetes/diabetes type 2, suppressed metabolism, and increased levels of pro-inflammatory adipokines.

In addition to eating nutrient dense meats, dairy, fruits and vegetables, do I take any evidence-based supplements for liver health?

Liver specific support

• N- Acetyl-L - Cysteine: can raise the liver’s protective glutathione

• Milk thistle: shown to protect liver cells and safeguard it from cell death

•  Alpha lipoic acid, Taurine, and Betaine Anhydrous  

• Dandelion tea to enhance bowel secretion and liver function

Health care solutions when you have decided to stop chasing symptoms.

As a Functional Medicine nutritionist, I think like a detective to help my clients understand the "why" behind their "what" (the diagnosis). Sometimes, the "why" can be revealed in a simple conversation; more often, more investigation is needed (various types of functional testing and lab work).

The following is an example of one hunt for the root cause of a client's problem. It was a simple conversation over dinner. Amy showed me the dry itchy patches on her hands, which I recognized as eczema, the "what" or diagnosis. To really help Amy and keep her away from the stereo typical treatment with cortisone cream, I now needed to know the "why."

Me: How long have you had the itchy dry spots?

Amy: A couple of months

Me: Are you prone to UTI’s or yeast infections?

Amy: I had my first yeast infection a month ago.

My thoughts are that two things are happening within a month of each other, both possibly stemming from gut imbalances.

Me: Have you had a round of antibiotics within the last 6 months?

Amy: No

Me: Are you taking birth control pills?

Amy: Yes

Me: For how long?

Amy: 3 months

BINGO! Birth control pills are notorious for altering gut bacteria. We’d found the smoking gun, the "why."

I already knew that Amy had a history of chronic constipation as well as acne. Before starting the pill, she likely had bacterial imbalances and the BC pills triggered the eczema, which always has its origin in the gut.

Since she wasn’t ready to stop the birth control pills, the best path was to find ways to support her gut flora so that together, her acne, constipation, yeast and eczema would subside.

I recommended cutting out all dairy and adding probiotics and non-dairy fermented foods. For further support, I suggested 50 mg B6, in the absorbable form of pyridoxal -5- phosphate as BC pills deplete B6 (a vitamin that influences energy, metabolism and the formation of neurotransmitters, influencing sleep, anxiety and depression). Lastly, I recommended vitamin D to help modulate the immune system.

If these steps do not give us the results we expect to see within a couple months, I’ll recommend a stool test to determine the function of her digestion and to rule out any parasites or pathogenic bacteria.

Instead of giving Amy steroids indefinitely to control her eczema, the conventional method of treating eczema, we’re taking steps to heal her by identifying and treating the root cause.

To read more about gut health and bacteria click here. https://alivingbalance.net/2015/05/invitation-to-a-digestion-party/

Written by: Cindy Dupuie, CN

Edited by: Vicki Ronaldson

www.alivingbalance.net

Emotional Vulnerability: Take care of your body to take care of your mind

Unmitigated stress can hurt your health

Our mind, body, and soul are all interconnected. How we treat our bodies has a major impact on our minds and our soul, and vice versa. It’s important to know how we are contributing to our emotional vulnerability. Life is hard. Emotions are raw and real. It’s important to understand how you may be contributing to your emotional vulnerability.

What is vulnerability?

Vulnerability is the quality or state of being exposed to the possibility of being attacked or harmed, either physically or emotionally. In other words, when we leave a vulnerability unattended, we are opening the door to being physically and emotionally harmed.

Often when we feel emotionally vulnerable, we are in a state of mind called “Emotion Mind”. Emotion Mind is when our emotions run rampant, we engage in mood-dependent behavior and our “emotions get the best of us.” Emotional distress can be reduced by decreasing factors that make us more vulnerable to negative emotions and moods.

To increase your emotional resilience to negative or undesired emotions, think PLEASE.

PL: Treat PhysicaL Illness- Being sick lowers your resistance to negative emotions. The healthier you are, the more likely you’ll be able to regulate your emotions. When you are injured, observe the urge to “just wait it out.” Often times we may think, “I should be able to power through this,” or “it’ll get better on it’s own.” See a doctor, chiropractor, dermatologist, or a specialist when needed. Reflect on what interferes with you attending to your physical illness and work toward problem solving the barriers.

E: Balanced Eating- Focus on eating balanced meals that make you feel good and avoid eating foods that upset your stomach or make you feel lethargic. Be mindful about urges to engage in emotional eating or eating out of boredom. Both eating too much and excessive dieting can increase your vulnerability to Emotion Mind. Research indicates that “self-imposed diets” show negative effects of eating too little. In other words, the more you restrict your food intake, the more likely you are to binge eat or having psychological problems (preoccupation with food/eating, increased emotionality and dysphoria, and distractibility). When you eat balanced and nutritional foods, you are less likely to have emotional control.

A: Avoid Mood Altering Substances: Alcohol and other substances, like certain foods, can lower resistance to negative emotions. Stay off illicit drugs and use alcohol in moderation. All substances, including caffeine and nicotine, increases our emotional vulnerability. Some of us may not feel an increase in emotional vulnerability while under the influence, rather experience Emotion Mind the days after.

S: Balanced Sleep: An increasing amount of research indicates that lack of sleep is related to a wide variety of emotional difficulties. Sleep is often undervalued in our culture. As a society, we are busy and constantly getting things done that we tend to slack on getting to bed at a decent hour. For people who work long hours, are single parents, are taking care of their loved ones, we tend to put sleep on the backburner. Maybe 11pm at night is the only “me” time you have, and you really want to catch up on the show. The thing about sleep is, we can’t “catch up” on it. There is no “making up for lost sleep.” Making sure you get the amount of sleep that feels right for you and your body is one of the most important variables to overall emotional well-being. Some people need 7 hours and other people know 10 hours. It’s also important to maintain a sleep routine, especially if you have difficulty sleeping. How much sleep do you need?

E: Get Exercise: Aerobic exercise, done consistently, is an antidepressant. Not only is exercise great for our our physical health, it’s great for our emotional well-being. Try and get some type of exercise every day. 20-30 minutes of cardio a day can increase emotional resilience. When your body is strong and healthy, you are less likely to slip into Emotion Mind and will feel less vulnerability overall. If you are new to exercising, build mastery. Start with 10 minutes and slowly increase the amount of time. Find a workout that is FUN that you WANT to get up and attend. You are more likely going to engage in physical activity if you are doing something that you look forward to. For some of us, that won’t be going to the gym for 1 hour. It may be running outdoors, spin class, yoga, dance classes, and other group classes (group classes are great for meeting people!)

Today’s guest blogger is Marissa Colangelo. Marissa Colangelo is a Licensed Clinical Social Worker (LCSW) with Compass Behavioral Health, specializing in treating adolescents and adults with emotion dysregulation, primarily personality disorders, anger, depression, impulsivity, substance abuse, and anxiety.

Putting Your House in Order: Food Reigns Supreme

Wouldn’t it be nice if managing one’s health was like maintaining a clean home? Make the bed, empty the dishwasher, swiffer the floors, cleanse the sinks and tubs, tidy the countertops, use some floor mats and don't forget your annual window washing. Only green cleaners, right? Barring any catastrophic natural disasters, a two-minute shower while your four year-old is unsupervised, or an ant infestation (anyone else in OC relate to this?) the formula is rather simple.

On the other hand, obtaining a clean bill of health from your doctor can feel complex and downright overwhelming. Perhaps you are not feeling well, but your doctor(s) can’t seem to find anything wrong. You might be wondering if you have taken the right tests and had a thorough work-up. Conversely, maybe you are pre-diabetic, struggling with hypothyroid, joint pain, skin rashes, bouts of anxiety and depression, and migraines. You have been prescribed a host of medications and you’re expected to remain on those meds into perpetuity. You may be searching for a sustainable solution, one with fewer side effects, and one that allows your body to heal from the inside out. By and large, we underestimate the potential of food, sleep, and stress management.

Setting yourself up for a life free of disease and vigor in today’s society may feel like a pipe dream for a growing majority. I’d argue that there are a handful of reasons this is such a common dilemma.

• Mismatch between diet and activity levels.

• Change is hard, reinforced patterns are easy

• The “attention economy” does not provide valuable education

• Repetitive insults to the gut, immune system and metabolism go unchecked

• A one size fits all healthcare approach

• Conventional medicine is designed for disease management and not prevention

• Most medical paradigms do not “aim at the origin” and/or discount the body’s interconnectedness

• Lifestyle interventions are time-intensive and difficult to align with insurance- based care

• Diagnostic testing is looking downstream

• Poor diagnosis and treatment plans do not educate or empower the patient

Let’s focus on the elephant in the room: diet. It’s time for a gut check; by definition a gut check is an honest reflective appraisal of one’s true feelings regarding a matter of concern. How and what we eat is either optimizing our health or initiating new underlying pathology and eventually disease. For example, patients struggling with supporting thyroid function may need to address gut function to fully combat symptoms of hypothyroidism.

Risk factors for developing Digestive Pathology.

Chronic Stress

Sleep Deprivation

Physical inactivity

Hypothyroidism

HPA Axis dysfunction

Excess Alcohol

Environmental toxins.

Family History

Cesarean Birth

Formula fed

Standard American diet

Food poisoning

Antibiotics

Medications

The evolving role of diet has altered the way we understand disease. In fact, digestive health has a wide array of implications. Intuitively, this should not be a surprise. The gut is one of our main interfaces with our external environment, it houses trillions of bacteria, has its own nervous system and gut-associated lymphoid tissue (GALT).

The digestive system is both resilient and dynamic. This is a double-edged sword because it is really good at masking the effects of a poor diet. What happens in the gut is so powerful that it has long-distance effects on the brain, skin, skeleton, muscles, metabolism, cardiovascular system, endocrine system, and immune system. It’s not like the “what happens in Vegas stays in Vegas.” Take a look at figure 3. These examples of reactivity may be the result of something called molecular mimicry. Due to the similarity in molecular structure with food we eat and our own tissue, the immune system can be fooled into attacking look-a-like molecules that make up our own tissue leading to autoimmune disease.

Educational resource from Cyrex Laboratories.

Below is my own list of the top 10 effects of a poor diet:

6 Joint pains

7 Neurodegenerative syndromes

8 IBS and GERD

9 Dermatitis and eczema

10 Constipation

1 Diabetes

2 Obesity

3 Cardiovascular disease

4 Autoimmune disorders

5 Anxiety and Depression

So how do we detect, avoid these problems and remedy our diet. Some patients have symptoms like gas, bloating, constipation, abdominal pain and cramps, skin rashes, diarrheas, excess gas, brain fog, heartburn, excessive hunger, and other complaints. However, there are patients that do not have symptoms or have symptoms that seem unrelated. For example of those diagnosed with Celiac Disease, autoimmunity to gluten, only 50% have GI symptoms.

With advances in research we have a better understanding about gut pathologies such as intestinal permeability aka “leaky gut,” food intolerances (tend to be undiagnosed), celiac disease and non-celiac gluten sensitivity, hypochlorydia, gut dysbiosis, small intestinal bacterial overgrowth (SIBO) and infections.

A functional medicine approach is a great way for patients to understand what is at the root of their health challenges. What that looks like for most patients is an extensive history, some form of altered diet (in some case removing gluten, wheat and dairy) and tests or screens for:

• Wheat/Gluten reactivity

• gluten-associated cross-reactivity

• pathogen screens

• intestinal permeability

• SIBO

• and other tests depending on a working diagnosis.

Treatment protocols are designed for each patient and tend to employ a mixture of dietary restriction, antimicrobials, pro/prebiotics, and other temporary supplementation meant to heal the gut

Researchers and clinicians continue to unravel the different mechanisms behind health pathology. There is some controversy regarding food intolerances, dysbiosis, leaky gut, autoimmunity, and hormone dysfunction. However, novel screening tools and continued research help shed light on how to treat the source of the problem and return your overall health.

If you have questions please email them to nick@spineandjointoc.com

Is Carnivore your Dietary Magnum Opus

Is Carnivore your Dietary Magnus Opus: Craving the truth
 

Mid December amidst discussion about ketosis, paleo and plant-based rhetoric the carnivore approach piqued my interest. It was not the first time I was driven to self experimentation with diet, but in this case I felt an acute sense pulling on the threads of curiosity. I figured it might pair well with my intermittent fasting and sauna protocols. Frankly, I wanted an experiment to spark positive physical and cognitive change.

Around this time I started to uncover some research theories related to diet on autophagy, physiological reserve and endogenous plant pesticides that had me wondering if perhaps I was over-dabbling in the vegetable department. I can say with certainty that I fare better without grains (headache triggers) and most legumes (GI dysfunction). I still have love for my cruciferous veggies. Gone but not forgotten.

The carnivore diet is essentially ZC (zero carb) therefore men (depending on activity/performance levels) are eating around 2.5-4lbs per day and women 1.5-2lbs per day (Beef, turkey, chicken, fish with marginal amounts of butter, eggs and cheese). As you read this please note that this is by no means "Medical Advice." I am sharing information as it pertains to my self experimentation.

This sort of restriction can be a tough pill to swallow for some. Who does not want a panko-crusted chicken thigh with a side of roasted potatoes and broccolini. Personally, I have eaten in what one would describe as a “healthy manner” for nearly a decade. These last 3 years I have gravitated more towards a plant-based diet (most recent conventional thinking) with low to moderate animal proteins. I’m physically active/training 5-6 days per week, and while I have noticed mild changes in biostatic measurements, my strength began to wane, I was fighting off cravings, noticed dermatological changes, gut irritation and a host of other not so exciting phenomenon.

Two weeks before Christmas and I took the plunge.  From day 1 I felt well. Some people talk about the keto-flu and negative side effects to the metabolic transition. I never experienced any of these negative effects with the exception of one isolated headache (may have been related to electrolyte imbalance). The longer I went the better I felt. It put the kabosh on any holiday-related carbohydrate binge. However, the thought of an avocado or chocolate stout crossed my mind a few times. Otherwise I felt a deeper detachment from flours and grains then ever before. I was full and content. My blood pressure and heart rate improved, perceived ability to focus skyrocketed, aches, pains and training soreness diminished and strength increased.

Tradeoffs when attempting this culinary lifestyle!

Now the question is do I continue for 2 months or pepper in cyclic ketogenic phases? I know my wife’s answer to this question.

Okay, so let’s just say what you’re thinking (or not).

All that fat can’t be good, right?

Well in an environment free of processed foods and high volumes of sugar the body appears to do quite well becoming fat-adapted and using fat as an energy source.

That’s really got to stress your kidneys?

Sorry, this is a perpetuated myth and several prominent nephrologists have done research to say otherwise, unless you have failing kidneys to begin with or other extenuating circumstances. Dr. Jason Fung’s studies

What biomarkers will you rely on?

This time around zilch. Perhaps next time around I will utilize pre and post NMR lipid profile, C-Reactive protein, ESR, micronutrient levels along with a urinalysis. Understand that many biomarkers are poorly understood and poor predictors of the benefits and or problems with high volumes of meat consumption

Will you be able to use the loo?

People may experience an adaptation period with change in frequency a/o quantity but go on to have regular and improved bowel movements.

In addition, there is a bevy of researchers asking interesting questions and potentially changing old thought processes around diet:

A bit nuanced and some science-based links (If you enjoy health related research subscribe to Dr. Rhonda Patrick’s podcast

Dietary fat and cholesterol/lipoprotein inversion patterns (this is huge for people taking statins) Dave Feldman and Jeffrey Gerber

Insulin metabolism (connection btw diabetes and cardiovascular disease) Dr. kraft ( 5- hour insulin assay)

Does Saturated Fat Cause Heart Disease? Dr. Rhonda Patrick

LDL Cholesterol and Cardiovascular Disease Risk with Dr. Krauss

IF and time restricted eating Dr. Satchin Panda

Health benefits of sauna use Dr. Jari Laukkanen

Thats a wrap.