Behavior Change - Rocket Powered Healing

We live in a fast-paced demanding world. It’s not unusual for us to create habits and even routines that help with the decision fatigue and a constant barrage of responsibilities. Some of these habits are by design and others just a default pattern. In some ways we are in “self preservation” mode.

Let me ask you – How many minutes per year do you spend on “habit change,” or “decision making.” It’s not really something we ponder, but maybe we should. Why? I’d argue that if we don’t we are more likely to go on cruise control and allow subconscious programming to guide our current behaviors. That inner pilot light that’s helping us close the gap on our goals, assess our progress, and change our behaviors grows silent.

So what do we have to do to enhance that inner voice and position ourselves to choose better behaviors? Dan Ariely, is a psychologist that uses a rocket analogy. It’s simple yet profound. Dan’s point is that we must change our environment in a way that reduces friction to make a desired behavior more attainable. Just as a rocket is designed with aerodynamics in mind people can minimize different types of resistance. Once friction has been reduced the rocket needs as much fuel as possible. Fuel in behavioral change is the motivation/energy or incentivizing factors.

Discover & share this Toy Story 4 GIF with everyone you know. GIPHY is how you search, share, discover, and create GIFs.

How do we apply this analogy to actually making better choices. Providing information alone or education is not a good recipe to change a behavioral or a pattern. Changing a person’s mind with information is tough whereas changing someone’s behavior with information is a true test.

Instead we need to take it a step further and reduce friction by changing our internal environment and external environment. If that's true we already have a leg up on the rocket because we have more control over our external environment. Last I checked gravity does not fluctuate therefore it's a constant variable for the rocket scientists to overcome.

However, we have control over the people we choose to be with, the food that we eat, the relationships we foster, our attitudes, the dreams we pursue, and how we respond to our circumstances. And because our behaviors are often irrational it’s imperative we attempt to harness health related irrationality.

Similar to the mind our physical body responds to friction and fuel (here fuel is food, sleep, stress, social determinants, and mental attitudes).

Let’s look at 3 conditions people struggle with and then engineer ways to reduce the friction and fuel a sustained change.

LEAKY GUT

What creates friction?

• Processed foods

• Industrial seed oils

• Multiple courses of antibiotics

• Extended use of Antacids, histamine blockers and PPI’s

• Unknown food intolerances

• Bacterial overgrowth

• Overtraining

• Lack of sleep

How to reduce friction?

• Create weekly meal plans

• Allocate time to create a recipe list

• Limit eating out

• Test your gut

• Look to natural remedies

• Try an elimination diet

• Intermittent fasting

• Utilize a prebiotics and probiotic

Fatty Liver

What creates friction?

• Overeating Leaky gut

• Food intolerance

• Poor bile production

• Poor food choice

• Endotoxins from GI tract

• Alcohol in excess

• Nutrient deficiencies

• High blood sugar Medications

• Bad Oils (seeds oils)

How to reduce friction?

• Portion control

• Eat for gut health

• Liver support

• Eat protein fats and some carbs

• Liver blood work

• Use time-restricted eating Intermittent fasting

• Check thyroid health

Blood sugar and cholesterol problems

What creates friction?

• Processed food consumption

• Calorie surplus and high carb diet

• Excess body weight

• Insulin resistance

• Elevated inflammatory markers

• Genetic predisposition

• Lack of activity

• Emotional eating

• Nutrient deficiencies

How to reduce friction?

• Increase insulin sensitivity

• Liver support

• Eat protein fats and some carbs (Nutritional balance)

• Use time-restricted eating

• Check blood glucose with a glucometer after food (1hr & 2hr)

• Check thyroid health

• Get adequate sleep

What fuels these examples of friction?

• Eating out (especially fast food)

• Lack basic cooking skills

• Poor time management

• Not enough social connection

• Poor sleep hygiene

• Inability to cope with stress

• Inadequate amount of downtime

Fuel to minimize friction?

• An unhealthy gut creates problems elsewhere in the body

• Gut problems may weaken your immune tolerance (autoimmune)

• Gut problems may shift hormonal balance (i.e. PCOS, Cancer)

• A dysfunctional gut suppresses our detox pathways

• Leaky gut may interfere with your metabolism

What fuels these example of friction?

• Disconnection from food choice and disease

• Hyper-palatable foods (i.e. potato chips, pizza)

• Ignoring constipation

• Alcohol addiction

• Not enough social connection

• Lack of plants and animal products

• Pill for every ill mentality

• Oblivious to your lipid levels

Fuel to minimize friction?

• We tend underestimate our dietary calories

• Comprised liver leads to inflammation in the joints as well as the brain

• Inflammation is linked to poor liver function

• Liver health is directly connected to disease risk

• A dysfunctional liver impairs our detox pathways

• Liver can be compromised by 90% without a warning signs

What fuels these examples of friction?

• Hyper-palatable foods (i.e. potato chips, pizza)

• Giving in to cravings

• Disregarding weight gain

• Sugary drinks

• Excessive snacking

• Limited information from your doctor

• Relying on basic lipid panels and subpar labs from a annual physical
  
  Fuel to minimize friction?

• Diseases associated with insulin resistance includes obesity, cardiovascular disease, nonalcoholic fatty liver disease, metabolic syndrome, and polycystic ovary syndrome(PCOS)

• Gradual increase of physical activity and energy expenditure

• Liver can be compromised by 90% without a warning signs

• A dysfunctional liver impairs our detox pathways.

• Sleep is necessary appropriate metabolic function

You may have noticed some of the overlap and redundancies, but that’s because there is an interplay going on in all these conditions. What’s going on in the gut directly affects the liver and both organs affect the cardiovascular system all the way down to each individual cell.

Leaky gut, fatty liver and blood sugar/cholesterol problems put a tremendous burden on the healthcare system and can subtract years of good health from just about anyone. Don’t fret because lifestyle modification should be the primary focus for treating any of these conditions.

The body is interconnected, complex, but also self healing. For example the The Diabetes Prevention Program and its Outcomes Study (DPP & DPPOS) demonstrated A 7% weight loss reduced the onset of type 2 diabetes (T2DM) by 58%. The best treatment for non-alcoholic fatty liver is weight reduction and correcting leaky gut and restoring immune tolerance can be done through shifts in diet, diagnostic testing, and targeted supplement protocols.

Given the importance of patient participation in healthcare decisions you deserve sufficient time and treatment solutions that require some self-management other than guzzling down a pill. It’s time to move away from the old “ diagnose and adiós” mentality. Never underestimate the changes you can make by learning about your health and assessing your habits. This exciting shift puts you in the driver’s seat of your life.

I’ll leave you with this, we don’t always do what’s in our own best long-term interest. With that in mind what will you do differently? Can you identify areas of friction and find your source of fuel?

“Broken & Unaccountable:” American Healthcare – What to do instead?

Many health professionals, especially early in their careers, would tell you healthcare is a calling. I’m not sure that there is a better job in the world than taking care of a patient. There are many doctors that are trying to fix the problems, but are facing some very strong headwinds. We’ve inherited a system that makes it difficult to prioritize the patient without neglecting the business’s bottom line.

As a chiropractor using functional medicine I have seen first hand that appropriate care is not being delivered to treat the root cause of illness. Drugs and surgeries are prescribed in way that forestalls the resolution of underlying pathology. If you have high blood pressure does it make sense to artificially lower it, or treat the cause of elevated blood pressure.

We all deserve healthcare that is patient-endorsed and that gets results.

What is driving healthcare problems?

1. Consumers have waited for politicians to ride to the rescue

2. There is a cost crisis and total lack of price transparency

3. Preventative care is rarely covered

4. Delivery of care is not designed to treat the root cause

5. Medicine is overprescribed (in 1997 2.4 billion prescriptions were written. By 2016 that number doubled to 4.5 billion)

We’ve all been taught that if you are going to criticize something that you should supply an alternate solution. Numbers 1 and 2 open up Pandora’s box. Therefore I’ll share a few observations and opinions, but spend the majority of this article on numbers 3,4, and 5. I’ll provide a case study that should help the reader relate to how this applies to you.

The media and politicians have polarized public opinions on healthcare and will continue to perpetuate this two-sided affair. You’re either pro affordable care act (ACA) or anti-ACA. You support a one-payer system or you believe in free market and competition. In reality it’s much more involved and we have yet to establish a meritocratic approach that reins in the cost, optimizes the delivery of valuable care, and ensures all Americans access to care.

This is especially important when speaking broadly about chronic disease (diabetes, obesity, heart disease, hypertension, fatty liver disease, etc) because it’s responsible for approximately 80 % of healthcare expenditures in the US ($3.5 trillion in 2017)

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Did the affordable care act accomplish some things? Not denying people insurance with pre-existing conditions and keeping kids on their parent’s plans until 26 is embraced by the large majority. Did the ACA lower the price of health insurance in the United States by $2,500 per year? No! Will getting rid of it fix healthcare? I would argue that it would not, because in order for healthcare to be fixed we need a total re-haul. Does conventional medicine excel at preventing or reversing chronic disease?

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The US healthcare system runs on a fee-for-service model where doctors get paid for the pills and surgeries they prescribe. This rewards quantity over quality. Doctors don’t get reimbursed for spending time with patients counseling them on the benefits of healthy eating and other lifestyle modifications. Until that reimbursement model changes medical care and education will continue on unchanged.

We need to be aware of what’s happening in the medical system.

• A national study found that 21% of medical care was deemed unnecessary by physicians

• A new study out of John Hopkins details how 48% of all Federal spending goes to healthcare

• 1 in 5 Americans have medical debt in collections

There is zero transparency when it comes to healthcare costs. Predatory billing and price gouging are hard to detect, but are commonplace.

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The current system plays a game of inflating prices for insurance companies and making exorbitant amounts of money on the backs of patients. The days of plans with great benefits are gone.

Outside of your monthly premium it’s nearly impossible to know how much you will pay out of pocket, what the hospital or doctor will bill the insurance, and the degree to which what you paid for was medically appropriate.

People are getting crushed by their premiums and our health continues to deteriorate. If you’re interested in learning more about cost crisis and how to navigate within conventional medicine see the link Dr. Marty Makary new book, The Price We Pay.

Most doctors want to provide meaningful care to their patients.

What this means to me is keeping patients out of disease and empowering them to take health into their own hands.

If we look at the statistics around chronic disease it demonstrates that the current approach to healthcare is failing. Until patients have the right platform we will continue to go in the wrong direction.

Why don’t expensive insurance plans pay for the tests and therapy we need to prevent and fix disease at its core?

In the 1960’s the AMA [American Medical Association] agreed to drop its opposition to Medicare and Medicaid. They demanded that the new laws would back usual, customary and reasonable fees.

This was the beginning of ‘corporatized” care that lead to disproportionate fees for hospital visits, surgery, and technologic procedures for treating acute illness. Where reimbursement waned -- office visits for maintenance, treatment of chronic illnesses and/or for prevention. It’s important to note that during the time these fee structures were developed much of what we know about preventative evidence-based care has changed dramatically.

When creating a treatment plan or in doctor speak an “interventional therapy”, you should aim for a plan with a “curative effect.” Sounds simple but conventional medicine is not designed to provide us a cure. It’s meant as a way to manage disease.

Here is a very simple example. Patient goes to primary care doctor. Blood tests are run and results show high LDL cholesterol and triglycerides. Doctor then prescribes a statin drug to decrease cholesterol production and runs a basic lipid panel every year for 20-30 years while re-filling the prescription.

You should know that statins have not been shown to extend the lifespan in men under the age of 80 without heart disease, in women of any age, and in men over the age of 80 with heart disease. Moreover, statin side effects are often underreported!

If you have read any of my articles on heart disease you know that what’s important are the LDL particle numbers (lipoproteins) as well as markers for diabetes and inflammation.

How should you approach medical care?

Start with P4 medicine.

• Personalized

• Predictive

• Preventative

• Participatory

Healthcare practitioners want to spend our time on things that matter. So what matters to the patient?

• Getting answers

• Piece of mind

• Understanding the treatment

• The total perceived value of the care

• Personalized care

• Getting them back to what’s important in their life

• Being included in the decision making process

• Integrated care based on patient priorities

At this point in time if you are looking to stay healthy, reverse chronic disease, or even obtain a diagnosis you will have to do some work. This might mean working with an integrated team. For example I assist patients that are working with an endocrinologist, an obstetrician, personal trainer, and a psychiatrist. It’s key to find providers that can spend enough time with you. You will have to pay more up-front, but you will save beyond your wildest imagination long term.

Case Study: Functional medicine approach

Let’s talk about Karen. She is a 41-year-old, 5’4” woman who weighs 165 pounds and is premenopausal. Her goal weight is 135 lbs which was her weight before becoming pregnant with her second child.

She goes to the gym 3 times per week and performs some type of cardio i.e. elliptical or gentle yoga. She drinks red wine a few nights a week and has a self-confessed sweet tooth. She was recently diagnosed as pre-diabetic. Five years ago she was diagnosed with thyroiditis, but was told last year that her thyroid is “okay.”

She doesn’t sleep well and stays up late watching tv sometimes. She suffers from bloating and stomach upset. Conventional doctors have been unable to diagnose her with any gastrointestinal issues. She has tried Weight Watchers and paleo, but regains whatever weight she loses. Based on her 24-hour food diary her total calorie intake is about 2,400.

What are some of the things we did?

Recommend a “simple” Paleo diet template that provides around 1,900 calories per day, 25 percent protein (about 110 g), 25 percent carbs (about 110 g), and 50 percent fat (100 g). What the heck does that look like?

• 10 to 12 ounces of meat/chicken/fish/eggs

• 1.5 to two cups of starchy plants

• one serving fruit

• six tablespoons of added fats

We gave the patient the option of intermittent fasting with an eight-to-10-hour feeding window and suggested that she consume the recommended amount of food within that window.

We recommended that the patient get the following testing: SIBO breath test, Cyrex testing (as finances allow), and stool testing if needed. In her case we performed the stool test as her TSH levels were elevated as were her Anti-TPOs and it’s important to see if microbial imbalances may be promoting autoimmunity.

We ran a cardiometabolic panel and a full thyroid panel.

After 3 months of treatment (targeted supplementation, dietary and lifestyle modifications) Karen was able to loose 20 lbs. Her SIBO retest came back negative, and her blood sugar improved (HgA1C, fasting blood glucose and insulin). She has had 1 or 2 episodes of bloating, but her stomach pain has resolved.

What these results mean

• Karen feels like she has control over her diet and weight

• She won’t need to be on insulin or metformin in the future

• She’s decreased her cardiovascular risk profile

• She won’t need to take thyroid medication (at least not in the near future)

• She has improved energy and anxiety has decreased since her stomach pain resolved.

This was a bit longer than I intended so I’ll wrap it up.

The best part about taking a comprehensive approach is the opportunity to “upgrade” a patient’s overall paradigm of health to one of prevention and empowerment as opposed to passive and reactive therapies.

Keep advocating for your health. Map ouT your health risk(s) sooner than later .Try to find resolution to health concerns now so that you can avoid the future pills, surgeries, and medical bills.

Spanx and dad bods - what do they have in common?

The picture above is the Spanx warehouse circa 2019 (popped up on linkedIn and if I’m being honest served as the muse for this post)

If these terms are foreign to you. Spanx is a huge company that manufactures shapewear to help men and women appear thinner. The term “Dad bod” (as defined by the Urban dictionary) is a male body type that is best described as "softly round."  It's built upon the theory that once a man has found a mate and fathered a child, he doesn't need to worry about maintaining a sculpted physique.

These products and this language are symptoms of large health issues.

If you are wondering, here are three common threads: a damaged liver, metabolism dysfunction and weight loss resistance.

If you have read some of my other posts then the term fatty liver syndrome is not all that new. When the liver is overburdened by excess sugar it will store fat, become insulin resistant and spark an inflammatory response.

Think about the combination of overly stressful lives and modern diets high in refined carbohydrates and excess calories. This is no walk in the park for the body. On the contrary, it's extremely taxing. If we are carrying excess weight over extended periods, the pancreas and the liver are taking a hit. Depending on how well your metabolism works people’s bodies respond across a broad spectrum.

Have you heard of the TCA cycle, also known as the Krebb’s or citric acid cycle? This cycle allows the body to burn food for energy by converting glucose into ATP. The more glucose burned, the less glucose in the bloodstream. Too much glucose in the bloodstream can have a damaging effect. It’s one reason why we check the biomarker hemoglobin A1C. It’s measuring the approximate damage to the red blood cells over the course of 90 days. Out of control glucose levels damage body proteins in the bloodstream, which in turn has damaging effects on the eyes, brain, kidney, etc. If high fructose is repeatedly making its way into your diet excessive fructose consumption can lead to excessive glycation of proteins (up to 16 times faster) than glucose.

Every day is a chance to right the ship a little bit at a time. The body is very dynamic and desperately prefers to be in an energy balanced state. Your DNA holds the blue print to a well functioning metabolism, but it needs a diet with the right type and amount of fuel.

If we can construct a daily routine that normalizes glucose, leptin, and insulin metabolism the benefits are Vast (with a capital V):

• reduced risk of diabetes-related complications

  • (neuropathy, kidney or vision damage),

• lower cardiovascular risk (lower blood pressure, triglycerides, increased HDL, better

endothelial function)

• reduced cell proliferation (tumors), less water retention, less fat storage and easier fat release from the adipose cells.

In my experience when patients regain their metabolic flexibility they will see their blood pressure and high cholesterol normalize. And in the case of autoimmunity these markers improve as well. When I use the term metabolic flexibility I’m referring to humans ability to use, properly store, and breakdown different food sources.

Sayonara Spanx expenditures and dad stereotypes

When you are trying to repair your metabolism you need to layer in 4, possibly 5 things.

1. Better Sleep

2. Mitigate stress

3. Activity level

4. Food

5. Supplements in therapeutic doses.

Research shows that sleep deprivation can have profound metabolic and cardiovascular implications. Sleep deprivation, sleep disordered breathing, and circadian misalignment are believed to cause metabolic dysregulation through myriad pathways involving sympathetic overstimulation, hormonal imbalance, and subclinical inflammation (1). Some studies have shown that recurrent partial sleep restriction can create dysfunction of both glucose and lipid metabolism. Lastly, epidemiological data is suggestive of weight gain with sleep deprivation, although a few studies have also noted weight gain with prolonged sleep.

We know that perceived stress can have a similar impact as physical stress. Stress can be a thought or even the perception of a threat. If we loop back to stress and metabolism what we find is a cluster of disorders: Obesity, lipid disorders, type 2 diabetes, high blood pressure and coronary heart disease. When you are stressed your nervous system, specifically the sympathetic nervous system, activates a stress response. It does this through epinephrine and cortisol release. Over the long term these hormones decrease your body’s sensitivity to insulin.  It hypothesized that cortisol may favor the development of central obesity. Hello flat tire and muffin tops.

Today we are faced with repeated professional or social stress and a small portion turn to exercise to help curb the stress and maintain weight. If your metabolism is broken it probably makes more sense to fix your nutrition, sleep and stress before you overhaul your workout routine. I’m not saying don’t exercise but it’s better to incrementally build up to more challenging training. As someone who works out 5-6 times per week, it's very important. If you are someone with the signs and symptoms of metabolic syndrome walking, occasional stretching (yoga) and micro workouts might be the better way to start.

For example check out this quick circuit that Dr. Mark Hyman shared on social media.

This 7 minute workout has been shown to: decrease body fat, lower insulin resistance, and  improve VO2 max and muscular fitness.

When you are struggling with weight loss resistance, diabetes, heart disease, or fatty liver, food can seem like an enigma. Let me be clear - sifting through all the information can be overwhelming and in some ways feel defeating. How you plan, package and execute will determine the degree of transformation. I’m going to avoid the gritty details and share a few patterns. If what to eat is the bane of your existence I would suggest two options. Start reading some of the new books on nutrition or work with a functional nutritionist until you feel you are ready for some autonomy. It’s never a bad idea to have functional medicine practitioner run a comprehensive blood panel to understand your baseline markers.

Let me preface these statements with:

Eat the standard American diet, get the standard American diseases.

No 1. When it comes to food “focus on taking the role of an impartial observer”. The food we eat is tied to our emotions and woven into our habits.

No. 2 Make sure you are eating to meet your energy needs.

No. 3 Say goodbye to bagels, cereal and flour (at least during the dietary intervention). Chances are you will be able to reincorporate down the line.

No. 4 Do not fall prey to overly restrictive fad “all or nothing” diets (there are exceptions). Give your body the vitamins nutrients and minerals by eating some meat and plants. Avoid foods with labels and if they have them read them!

The last I read the dietary supplements industry was at 122 billion a few years ago.  It’s expected to grow another 100 billion. What can I say? We’re getting sicker and are open to magic pills. The reality is that some supplements have a place in nutritional care plans and therapeutic protocols. Once you find the right supplements they can be beneficial.  For non-practitioners I’m not sure if it’s really possible to stay up to date on the best products. Moreover, understanding when and how to incorporate and test a supplements efficacy take some education. Along with diet and lifestyle changes supplements can be extremely powerful tools for treating and in many cases overcoming symptoms that present with metabolic disorders.

As always please email your health questions to nick@spineandjointoc.com

Is your metabolism sick: 9 ways you may be hurting your metabolism

1.Weight

Let’s start with the low hanging fruit. Research in the 90’s determined that the overwhelming majority of women— 89%—want to lose weight and 3% wanted to gain weight. In contrast, 22% of the men who were dissatisfied with their weight wanted to gain weight. Today Americans are eating more calories than we ever did in the past. More importantly refined sugars and flour make up the larger part of the pie when compared to whole foods i.e. vegetables, fruits, meat, poultry, seafood.

The average woman in the US today weighs 168 pounds. This is approximately the same as an average man in the 1960’s (CDC). Men are up 30 pounds and 20% of children are obese.

As a nation we are addicted to convenient, hyper-palatable large portioned options and it is taking its toll in more ways than one. The prevalence of non-alcoholic fatty liver, diabetes, obesity and cancer move in lockstep with a dysfunctional metabolism. It would be an understatement to say Americans are confused about food choices. Most are perplexed and making personal choices that provide the knockout punch to a struggling metabolism.

2.Overeating

Yes, food choice matters! Deciding to have repeat bagels or cereal instead of eggs and avocado or a shake with healthy fats and protein for breakfast negatively affects your liver and blood sugar. The effects may be less dramatic for some (those with a healthy weight and insulin sensitivity) and accelerate the negative effects for those that are overweight or prediabetic. A perpetual cycle of overeating chokes the liver and creates the perfect environment for systemic inflammation, high triglycerides (TAGs), elevated LDL- particle number, leptin resistance, dyslipidemia, and insulin resistance.

Having a clogged liver is serious business. The liver is responsible for detoxifying the body. In today’s world it is under constant assault from toxicants. In addition to the liver’s detox duties it plays a large role in the conversion of fuel to energy. An overloaded liver creates a slow metabolism. Even worse it fails to recognize insulin signaling and continues to unload sugar into the blood stream. When your liver is struggling and you consume a high carb meal it is estimated that 80% of the sugar in the blood stream has its origin in the liver and not a spike from recently consumed food.

If your liver is clogged it may continue down four stages of disease progression:

NAFL - nonalcoholic fatty liver

NASH - nonalcoholic steatohepatitis

Fibrosis - inflammation causes scar tissue

Cirrhosis - function impaired and can be life threatening

Eat the standard American diet for 5 years and chances are you may fit the criteria for Metabolic syndrome (MetS). MetS comes with a host of risk factors including cardiovascular risk. Click here to read more about the risk of cardiovascular disease.

Abusing stimulants such as caffeine can disconnect you from your natural circadian rhythm and disrupt cortisol patterns. Some people are better at metabolizing caffeine than others. Alcohol in excess can hijack restorative sleep and boost cortisol as well. Everyone is different and women typically produce less alcohol dehydrogenase that breaks down ethanol into acetaldehyde. If you have heard of alcohol flush this is due to accumulation of acetaldehyde and deficiency in aldehyde dehydrogenase 2. The point is you are taxing your metabolic resources.

3.Gut problems

If you are having gut issues, with intestinal symptoms or not, your metabolism and hormonal health may suffer. The renewed interest in our microbiome is a breath of fresh air. The microbes that inhabit the human GI tract play a role in human health and disease. For a tube whose contents are actually outside the body it plays a role in nutrition, digestion, immune processes, the central nervous system and energy homeostasis.

The disruption of the microbiome-gut-brain axis has a wide array of implications. You may be familiar with the term “leaky gut”, irritable bowel syndrome, metabolic endotoxemia or small intestinal bacterial overgrowth (SIBO). Those that have intestinal permeability or a leaky gut may develop food intolerance and fat loss resistance. Give the book Wheat Belly or The Plant Paradox a read if you want to learn more. For those that want the deep dive check out The Mind-Gut Connection.

When the microbiome is restored to a healthy set-point it trains and regulates our immune system. It keeps gut inflammation at manageable levels, limits pathogenic growth, helps prevent allergies, reduces gas and has anti-tumor properties. You may not be aware that 20-25% of T4 is converted to T3 (active thyroid hormone) in the gut.

What can disrupt the gut:

Medications (PPI’s, antibiotics, Birth control, corticosteroids)

Wheat/gluten/lectins

Alcohol and high sugar intake

Parasites and infection

Low stomach acid

Poor intestinal motility

Sleep and Stress

4.Stress and sleep debt

When we are stressed our brain knows. Specifically the HPA axis (hypothalamus, pituitary and adrenals) is busy preparing the body to adapt to the four types of stress:

• Perceived stress e.g.mental/emotional and anxiety and depression)

• Inflammatory signals e.g. GI, allergies or cardiovascular signals

• Glycemic dysregulation e.g.insulin resistance and obesity

• Circadian disruption e.g sleep issues (pain/apnea) or light dark disruption

When we experience stress that lasts for weeks and months chronic levels of high cortisol are stuck in the redline position. There is evidence that chronic stress changes food preferences and leads to insulin resistance. Some researchers have found that people with sleep disturbances, high stress, depressed mood and anxiety are strong predictors of low back pain.

A good night’s sleep will improve glucose metabolism, boost growth hormone secretion, and help normalize and help regulate cortisol levels. Because cortisol is released in a rhythmic fashion it’s not uncommon to see dysfunctional 24 hour cortisol patterns. This can contribute to fatigue throughout the day and difficulty sleeping in the evening. For example if a person has a disrupted cortisol rhythm but otherwise normal cortisol production symptoms may include fatigue, sleep disturbances, and higher perceived stress.

5.Excess Inflammation

Inflammation is a normal response to injury. We rely on inflammation to signal the immune system for cell injury and repair or defend us against bacterial or viral infections. When inflammation becomes chronic - metabolic disease begins to take hold.

Inflammation may be the most important mechanism driving “diabesity” (the one-two punch of diabetes and obesity). Elevated inflammatory markers are predictive of weight gain and insulin resistance. Those with higher levels of inflammatory cytokines and liver inflammation have an increased risk for diabetes. Inflammation of the brain leads to leptin resistance. Women suffering from endometriosis may be surprised to learn that it is best defined as an inflammatory disease. Are you beginning to see why we want to minimize nonessential levels of inflammation?

Food allergies are quite different than food intolerances. Many Americans have food intolerances and unknowingly consume these foods. For example men and women respond differently to grains when it comes metabolic dysregulation. Some may be completely free of intestinal issues while other exhibit a constellation of symptoms such as a thick waist, abnormal cholesterol, high blood pressure, and or problems with blood glucose. Because you need special enzymes to break down gluten, a protein found in wheat and grains, some researchers think that up to 80% of the population lack the necessary enzymes to properly digest gluten. Dairy sensitivity is also common however it seem more problematic when patients have a leaky gut, dysbiosis and consume low-fat non organic dairy products.

In the 90’s we were told to eat more grains and cut the fat. According to the CDC the diagnosis of diabetes has tripled. Even more concerning is the increasing trend in autoimmune disease in general. This includes Hashimoto’s/ Graves disease, Sjogren’s, irritable bowel disease (IBD), rheumatoid arthritis , lupus and celiac’s disease. The unsettling truth is that these autoimmune diseases are on the rise and in some cases are 2-3 times more common than a few decades ago. Experts believe that symptoms of autoimmune disease may be prevented by re-establishing intestinal barrier function.

An improper diet can lead to increased levels of inflammation. This includes diets low in calories i.e. 40% or greater caloric deficits over a 6 week period. Diets that lack comprehensive nutrient profiles such as veganism, fruitarian or vegetarianism are at higher risk of elevated inflammation in the long term.

6.Too much or too little exercise

Regaining metabolic flexibility is directly tied to your diet. Too much exercise, with a sluggish metabolism, is a big stressor. This is especially true if your performing long workouts on a low calorie diet. However, the right amount of exercise can provide some amazing benefits including increased insulin sensitivity, fuel expenditure, muscle health, glycogen production and mitochondrial health. If you are too sedentary and maintain a poor diet your muscles atrophy and you body composition will creep to higher fat and lower % of lean muscle. When that happens your resting metabolism slows down.

It’s very important that you sort out your “chemistry” before exercise is able help you in maintaining a healthy weight. Don’t forget your liver has to process all the calories and fuel you burn up during exercise.

7.Hormone imbalance

Whether you have adrenal fatigue, more correctly referred to as HPA axis dysregulation, excess estrogen, low testosterone, PCOS or diabetes it alters your metabolic machinery. That new metabolism you’re fighting for through diet and lifestyle changes will seem recalcitrant.

Books are written on this topic so let’s touch on the thyroid since it’s a major player in regulating your metabolism, and assuring good general health. Most people wrestling with weight need to address their relationship with grains. In addition to providing high amounts of calories they may lead to intestinal permeability and the body’s immune system attacking itself. For example, people with Hashimoto’s disease are usually put on thyroid hormones. Dr. Kresser uses an analogy of bailing water.

People with low thyroid may need thyroid hormone as a necessary part of the treatment. But unless the immune dysregulation is addressed (plugging the leaks), whoever is in that boat will be fighting a losing battle to keep it from sinking. Meanwhile, that person will struggle with weight loss resistance.

8.Ignoring key body measurements

Time to move away from BMI as it’s not as predictive as other measurements. Waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-stature ratio have larger effects on increased CVD risk compared with body mass index (BMI).

For most of us we get an up close look of our bodies in the shower and when we are dressing. Measurements looking at central obesity, fat deposits in the abdomen, and around the viscera organs are better independent predictors of cardiovascular disease, fatty liver and diabetes.

9.Not testing basic biomarkers

Looking at the blood is an imperfect proxy, but it is one of the better ways to see whats going on under the metabolic hood. Below is a list of biomarkers that I would recommend for a baseline functional medicine workup.

CBC with differential

CMP (includes liver enzymes)

Fasting blood glucose, fasting insulin and HgA1C

Homocysteine

NMR lipoprofile

Full thyroid panel ( TSH , T4 reverse T3, w/Antibodies)

Perhaps a Urinary DPD (assesses bone resorption rates)

Earlier in the article I mentioned Metabolic syndrome or MetS. So what is MetS? The criteria have changed over the years, but here is the general consensus.

ANY three of the 5 Criteria below:

• Obesity -- Waist circumference >40 inches for male and >35 inches for females

• Hyperglycemia -- Fasting glucose ≥ 100 mg/dl or pharmacologic treatment

• Dyslipidemia – Trigylcerides ≥ 150 mg/dl or pharmacologic treatment

• Dyslipidemia (separate criteria) – HDL cholesterol < 40md/dl male, < 50 mg/dl females; or pharmacologic treatment

• Hypertension -- >130 mmHg systolic or > 85 diastolic or pharmacologic treatment.

*Note: LDL particle (LDL-P) number appears to be the most accurate marker for predicting metabolic syndrome. How do you test LDL-P. A test called NMR lipoprofile.

If you have questions regarding any of the topics covered in this article email them to nick@spineandjointoc.com

How to Avoid Spine Pain: Lessons From a Plane Crash

In 1972 an airplane carrying 163 passengers crashed into the everglades. This was a scheduled flight from NYC to Miami. The flight was routine until it began its approach into Miami. Shortly after lowering its landing gear the entire crew in the cockpit became preoccupied on an indicator light.

Normally this light lit up green signaling that the nose landing gear was locked down. It turns out that tiny indicator light only appeared to be off as the bulb was burnt-out. This created a diversion and the crew failed to notice that the autopilot had been inadvertently disconnected, resulting in a loss of altitude and a deadly crash.

Upon review the National Transportation Safety board cited the cause of the crash as “pilot error.” The crew was distracted by the landing gear light and failed to monitor critical instruments tracking their altitude.

By no means am I attempting to make light of this particular story. Instead, the story provides an essential lesson. This was a situation where the big picture was eclipsed by the hyper focus on the indicator light.

Patients will ask what causes joint misalignments, muscle pain and loss of range of motion.

Sometimes there is a simple answer, but most of the time it’s hard to boil it down to one specific cause. Unlike flight 401, the underlying cause of musculoskeletal pain is due to the inverse mistake:

relying on autopilot and not responding to the distress signals.

The demands we put on the musculoskeletal system are unbelievable. From the moment we wake up we are bombarding the system with information and postural requests. We begin to create movement habits to conserve the drain on cognitive energy.

The day begins

Negotiate a safe departure from the bed, shower, cook breakfast, dress the kids, empty the dishwasher, commute to work, sit for 6- 8 hours, back in the car, stop at the gym, take out the recycling, load laundry/fold laundry. I’ll leave out the most of the minutia. Whether you’re standing cock-eyed brushing your teeth or flexing over to tidy up some toys off the floor your muscle and joints are at work. Together the joint, muscles and connective tissue function as kinetic architecture. These movement patterns exist as kinetic images in the brain and make up an individual’s “autopilot coding.”

Eventually, through thousand of iterations, we establish a fixed set of movement patterns. We don’t think much about these patterns and in many ways we rely on this internal autopilot.

Over time a constellation of signs and symptoms emerge. Some examples include:

• Flexing from the torso,

• Slouching while driving

• Loss of trunk rotation

• Lack of hip mobility and independent movement from lumbar spine

• Preference towards forward head posture

• Rocking your pelvis back (posterior tilt) while sitting

• Rock your pelvis forward when standing

• Decrease in sacral flexion and extension

• Prolonged static positions where hips and shoulders are not squared up

• Walking using the lower legs as the primary movers

• Disengaging the core

When looking at the big picture we need take into account load and capacity. Capacity is the ability to do work and the load is the work you do. In all living organisms there is a relationship between structures. The postural problems mentioned above leave you susceptible to tissue damage. The paradox is that pain does not move in lockstep with tissue damage. By the time you are experiencing pain, (absent acute trauma such as rolling your ankle) injury has set in and your body is struggling to meet hose demands

What’s happening from a physiologic standpoint is a cycle of damage, inflammation, and compensation. Diet, sleep, gut health, weight, and immune function add complexity to the cycle of pain and healing, but we’ll save that for another post.

Overuse results from cumulative stress on the muscle, bone, tendon or bursa. This may lead to partial tears, joint instability, and promote non-anatomic joint position.

Periodically it’s beneficial to manually restore awareness and filter out poor mechanical patterns. In an effort to keep the muscles limber and joints healthy we have to rewrite some of the automatic patterns and inadequate muscle coordination.

If left unchecked these postural distortions will become harder to reverse and escalate through every day activities. I would encourage you to cultivate better sensory awareness and connect back to deliberate bodily movement.

This can be done through training conscious movement, adopting spine care, integrating breath and movement, and exercises that activate, strengthen, and balance.