Where to look if your health is stuck

It’s not unusual for one’s perspective on their personal health to change at different points in his or her life. For some there is indifference, frustration, and reactivity. For others there is clarity, deep involvement, proactivity, and even identity.

Each person has their own “health documentary.” Typically it’s a blend of factors that include your health history, family’s eating habits, psychological health, environmental factors, financial pressures, value systems, and other lifestyle habits.

I want you to pause and think about how you engage with your own health and possibly your family’s health. Do you think about the future of your health? Is it your responsibility or is it a transaction to be had with a doctor at a perfunctory check up? Are you competent enough to embrace your own inner doctor barring some critical situations?

You may be familiar with the term functional medicine. Functional medicine was born out of necessity. It is a systems-based approach that looks to reverse disease by identifying the drivers and causes. This form of personalized medicine is practiced by M.D.’s, D.C’s, D.O’s, Naturopathic doctors and a host of adjunct practitioners. Allopathic or conventional healthcare accels in acute situations and provides disease management. Where it is lacking is disease prevention and health optimization. If you only treat symptoms, people want pills. Show people the root cause and they will demand a fix.

For the most part you do not catch disease. You build it through life exposure, sometimes referred to as the exposome. The exposome is a collection of environmental factors, such as stress and diet, to which an individual is exposed and which can have an effect on health.

Let’s get back to your health. Imagine that you just landed in your body. Time for an appraisal. Can you move well? How do you feel? What’s your emotional and mental state? Is it a fixer-upper or does it require just some basic maintenance?

Perhaps you want to take a closer look at your physiology and chemistry by running predictive lab work. But before you even seek out a doctor, what is in your immediate control? Your lifestyle choices! Let’s touch on a few.

I. Manage stress wisely

Stress is a ubiquitous part of life that affects us all. Stress can have a profound effect on your gut. There is ample evidence that many chronic metabolic diseases start in the gut. Exposure to prolonged stress alters brain-gut interactions, ultimately leading to the development of a broad array of psychological and GI disorders.

II. Focus on nutrition

Food is one of the most effective tools for bringing balance to your body. When we optimize our diets we see improvements in detoxification, energy and metabolic health. We are a society in a chronically fed state. Too much processed foods derail our metabolism. Eating low-carb and the occasional keto cycle can retrain your metabolism and provide a necessary reboot.

III. Intermittent fasting

Our high school biology teachers failed to mention that fasting is not only a evolutionary skill , but also the best way to activate your body’s own “house cleaning” systems. It’s referred to as autophagy and it promotes healthy cell cycles and deep cellular detoxification. When paired with a proper diet it can help balance blood sugar, prune the microbiome, and build metabolic flexibility. Metabolic flexibility means your body can use protein, fats and carbohydrates efficiently.

VI. Exercise

Physical activity has endless possibilities. Research shows that we get the best results when we mix up our routines and change how we stress our bodies.

Fasted- cardio in the morning can help support healthy blood sugar and utilize body fat for fuel. (2-3 times per week)

Post-meal activity can put circulating blood sugar to work. This is 20-40 minute walks a few times a week after lunch or dinner.

High intensity interval training (HIIT) is a great way to work your metabolic machinery and increase insulin sensitivity (2 hours per week total)

Strength training you can’t go wrong having a higher proportion of muscle to fat mass ratio. Free weights, body weight, resistance bands all work well. (3 X per week 20-30 mins)

This article does not provide medical advice. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment.

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?

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

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