jim lavalle - atlanta presentation

7/31/2019 Jim LaValle - Atlanta Presentation

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The Metabolic Code Weight

Loss System for Life Time

Weight Loss Specialist Training


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Copyright 2009 James B. LaValle, Integrative Health Resources, LLC

Copyright 2010 James B. LaValle, Integrative Health Resources, LLC. All rights reserved.

No part of this material may be used or reproduced in any manner whatsoever, stored

in a retrieval system, or transmitted in any form, or by any means, electronic,

mechanical, photocopying, recording or otherwise, without prior permission of the

author.

This material is provided for educational and informational purposes only to licensed health

care professionals. This information is obtained from sources believed to be reliable, but its

accuracy cannot be guaranteed. Herbs and other natural substances are very powerful and

can occasionally cause dangerous allergic reactions in a small percentage of the population.

Licensed health care professionals should rely on sound professional judgment when

recommending herbs and natural medicines to specific individuals. Individual use of herbs

and natural medicines should be supervised by an appropriate health care professional. The

use of any specific product should always be in accordance with the manufacturer's

directions.


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Weight Loss - New ApproachesNeeded

Weight Loss - conventional approaches still

focusing entirely on calories in- caloriesout and is . . .

Not evaluating all the factors that can affect

the equation.

NIH - 2004 issued new strategic plan for

obesity


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NIH Obesity Plan ID - behavioral and environmental causes of obesity

Increase knowledge of molecular pathways ofintegrative body systems linked to obesity

Elucidate role of macro and micronutrient effects onenergy metabolism

Elucidate role of brain regulatory and rewardpathways on appetite.

In other words - leave no stone unturned when itcomes to obesity epidemic.


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Metabolic Code Diet

Develop a weight management plan that

will incorporate appropriate diet, exercise,lifestyle and, if indicated, appropriate and

safe dietary supplements to support all

metabolic needs.


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Shifts in Endocrine Function

and Regulation of Weight

Metabolic Effects of

Insulin Resistance and Inflammation


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Hormones and Neurotransmitters

Pancreas Thyroid

Adrenal

InflammationInflammation

Insulin ResistanceInsulin Resistance


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Weight Management

Controlled by interplay of endocrine organs

Function of organs

Balance of hormones

Outside influences on hormones


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Insulin Resistance Cells no longer respond to insulin release

Linked to chronic diseases: diabetes, heart disease,

cancer, Alzheimers, high blood pressure andmore

Many causes - high carb diets, mineraldeficiencies, increased number of fat cells(resistin), low activity, hormonal influences,inflammation, environmental toxicity

Triggers inflammation chemistry


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Inflammation and IR

Non-diabetic women, CRP levels highest in those with

highest fasting insulin

Fasting insulin was also strongly associated with BMI and

IL 6

Ridker PM, Pare G, Parker A, et al. Loci related to metabolic-syndrome pathways including

LEPR,HNF1A, IL6R, and GCKR associate with plasma C-reactive protein: the Women's Genome

Health Study. Am J Hum Genet. 2008 May;82(5):1185-92. Epub 2008 Apr 24.


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Insulin Resistance Study 46,578 members of Kaiser Permanente Northwest

FPG levels < 100 mg/dL (Jan 97-Dec 2000)

No previous diagnosis of diabetes or impaired fasting

glucose

Subjects assigned to 1 of 4 categories (


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Study Results and Conclusions

Every glucose rise of 1 point above 84, wascorrelated with a 6% increase risk of developing Type2 diabetes

Insulin resistance, which leads to Type 2 diabetes,is developing at least a decade before detection bytraditional lab markers

Nichols GA, Hiller TA, Brown JB. Normal Fasting Plasma Glucose and Risk of Type 2 DiabetesDiagnosis. Am J Med. 2008;121(6). 519-524.


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Inflammation and Diabetes

27,628 women free from diabetes and cardiovascular

disease (Womens Health Study)

188 women developed diabetes over 4-year follow-up

CRP and IL-6 strongly associated with development

of diabetes

Elevated levels of CRP and IL-6 predict the development

of type 2 DM. These data support a possible role for

inflammation in diabetogenesis.

PradhanPradhan AD, et al. JAMA 2001 Jul 18;286(3):327-34.AD, et al. JAMA 2001 Jul 18;286(3):327-34.


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Zeyda M, Stulnig TM. Obesity, inflammation, and insulin resistance--a mini-review.

Gerontology. 2009;55(4):379-86. Epub 2009 Apr 8. Review.


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Insulin Action

Whats Supposed to Happen

Glucose transport:

A very involved process


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Belly Fat Metabolic Activity High insulin levels visceral (belly) fat storage

Fat breakdown inhibited

Produces pro-inflammatory adipokines, including TNF-alpha, IL-6, resistin

Suppresses adiponectin, leptin, PPARs

Visceral fat correlated to metabolic syndromeCeriello A. Metabolism. 2000;49(2 Suppl 1):27-9.

Matsuzawa Y. Establishment of a concept of visceral fat syndrome and discovery of adiponectin. Proc Jpn Acad Ser BPhys Biol Sci. 2010;86(2):131-41.


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Insulin Resistance (IR)Profile of Client Exhibiting Signs of IR

Elevated Waist-to-Hip ratio

May or may not be overweight FPG 90 100 mg/dL or more

Post-prandial insulin elevated.

Lipids and trigs elevated with suboptimal HDL

Elevated Blood Pressure


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Insulin Resistance W/H ratio

Waist to hip ratio is one of strongestpredictors of CV disease

Women > 0.8, Men >.95 = increased risk


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Signs/Symptoms of IR Lab Values - Fasting BS > 90, elevated triglycerides, elevated BP

Elevated insulin response to carb load w/o elevated FPG

Excessive thirst or hunger

Eating calms or causes sleepiness

Carbohydrate cravings Fatigue

Brain fogginess

Fluctuating energy levels

Headache

Weight gain especially belly fat

Mood imbalances, agitation Low body temperature

Low blood sugar; anxiety or irritability with missed meals (precursor to IR,shows glucose dysregulation))


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Assessment QuestionsInsulin Resistance1. Do you have high triglycerides? Elevated triglycerides indicate

either high fructose or alcohol intake, or blood sugars stayingelevated.

2. Do you have high LDL cholesterol and low HDL? Cholesterolelevates when there are too many triglycerides being made

(cholesterol fractions are used to transport lipids.)3. Do you have an elevated waist to hip ratio? Elevated insulin

promotes storage of weight in belly.

4. Is your diet high in sugar and/or trans fats? Excess consumptionpromotes inflammation and elevated blood glucose.

6. Is your blood pressure starting to elevate? (> 135/85?) Insulinresistance leads to BP incr. Elev BP means ins resistance ispresent.

7. Is your fasting blood sugar > 90 mg/dL. Blood glucose shouldreturn to optimum levels after eating.


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Assessment QuestionsInflammation

1. Do you have an elevated waist to hip ratio? Any fat stored inwaist produces inflammatory cytokines.

2. Do you eat very few fruits and vegetables? These foods arebest sources of antioxidants. Low intakes createsusceptibility to increased free radicals from environmentand other sources.

3. Is your C-RP HS elevated? < 1 mg/L = low risk, 1- 2 mg/Lavg risk, 3 mg/L high risk

4. Do you have indications of insulin resistance? Any positiveanswers on insulin resistance indicators means someinflammation is present.

5. Do you have chronic pain or inflammation?


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Exercise and Insulin Resistance

Up to two hours after exercise, glucose uptake elevated

due to insulin independent mechanisms - increased

GLUT4 A single bout of exercise can increase insulin sensitivity

for at least 16 h post exercise in healthy as well as Type 2

diabetics

Acute exercise also enhances insulin stimulated GLUT4

translocationBorqhouts LB, et al. Exercise and insulin sensitivity: A review. Int J Sports Med. 2000.21(1):1-

12.


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Exercise and Insulin ResistanceHuman studies have reported that exercise:

Improves insulin sensitivity

Increases adiponectin levels Increases glucose transport

Reduces body weight and fasting insulin

Reduces postprandial insulin plasma levels

Increases delayed release of glucagon-like peptide-1


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ReferencesMartins C, et al. The effects of exercise-induced weight loss

on appetite-related peptides and motivation to eat. J ClinEndocrinol Metab. 2010 Apr;95(4):1609-16.

Koistinen HA and Zierath JR, Regulation of glucose transportin human skeletal muscle. Annals of Medicine. 2002.34:410-417

van der Heiden GJ, et al. Aerobic exercise increasesperipheral and hepatic insulin sensitivity in sedentaryadolescents. J Clin Endocrinol Metab. 2009.Nov;94(11):4292-9. Epub 2009 Oct 6:684-91.


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Exercise and Insulin Resistance

HIIT High Intensity Intermittant Training vs.Steady State Exercise

More effective in improving fasting plasmainsulin levels than steady state exercise

Study: 15 wk. program, 2 groups of women,CV fitness improvement in both groups, onlyHIIT group had decrease in TBM, fat mass,trunk fat, and FPG levels

Int Journal of Obesity (Lond). 2008; 32(4


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Exercise and Nutrients

Regular intense exercise that induces sweating . . .

Sweating - helps remove toxins Also lose nutrients - ie chromium excretion in

urine increases with exercise. Magnesium and

other trace minerals are excreted in sweat and

urine.Dunford and Doyle, Nutr in Sports and Exercise, 2008 Thomson and Wadsworth.

Lukaski, H. Magnesium, chromium and zinc nutriture in physical activity. AJCN, 72;2:585S-93S. Aug. 2000.


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Insulin Resistance andOvertraining-Underrecovered Overtraining can lead to neuro-endocrine immune imbalance

Increase in inflammatory cytokines (TNF-alpha, IL-1, IL-6)

Anabolic hormones (i.e. testosterone, growth hormone, IGF-1) andcortisol reported elevated during 15-30 of post-resistance exercise

Associated with sleep and mood disturbances, inflammation, immuneimbalances, fatigue, IR

Moderate, regular exercise actually improves anti-inflammatorycytokine release

Kraemer WJ, Ratamess NA. Hormonal responses and adaptations to resistance exercise and training. Sports Med. 2005;35(4):339-61. Review.

Main LC, et al. Relationship between inflammatory cytokines and self-report measures of training overload. Res Sports Med. 2010 Apr;18(2):127-39.

Astrom RE, et l. Persistent low-grade inflammation and regular exercise. Front Biosci (Schol Ed). 2010 Jan 1;2:96-105.


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Supplement Recommendations

Multivitamin/mineral support

A 2010 double blind, placebo controlled study followed 96 obese women (BMI >28) for 28 weeks

Patients receiving MultiVitamin/Mineral supplements reported:

BMI

Body weight

Fat mass

Blood pressure

C-reactive protein

Total cholesterol, LDL, HDL REE

Li Y, et al. Effects of multivitaminand mineral supplementation on adiposity,energy expenditure andlipid profiles in obese Chinese women. Int J Obes (Lond). 2010 Feb 9. [Epub ahead of print]


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Fish Oil Omega 3 in fish oil known to :

- Reduce inflammation (decr TNF alpha, IL 1 and 6)

- Help depression- Reduce triglycerides

Oh R. Practical applications of fish oil (-3 fatty acids) in primary care. Journal of the American Board of Family

Practitioners 2005;18(1):28-36.

Life Time Omega 3 Fish Oil provides 1200 mg

with optimum EPA 360mg and DHA 240 mg.


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Life Time Supplements withAntioxidants

FastFuel Complete

Menss andWomens multivitamins

Lean Source

Alpha Lipic Acid (Douglas)


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LeanSource Weight LossSupplement

Supports weight loss and metabolism,

Formulated for training and exerciseprograms

Helps improve insulin resistance andblood sugar regulation

Hormonal regulation

Improves thermogenesis


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LeanSource Ingredients

LTFBiChrom Complex (Chromium picolinateand Chromium

polynicotinate) 200mcg

Clarinol CLA Complex 2000mg 7Keto 50mg

Green Tea Extract (leaf, standardized to 45%EGCG and 90%

polyphenols) 400mg

Green Tea Extract (leaf, standardized to 50% polyphenols)

50mg American Ginseng (root) 300mg

Eleuthero (root) 20mg


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Douglas Products for IR

Alpha lipoic acid

Antioxidant nutrient

Stimulates PGC-1alpha via C-AMP Kinase

Keeps PPAR proteins from being damaged by oxidative

stress

Dose is 500-1000mg daily, sustained release

Weile S. et al. J Cell Biochem. 2008 Feb 7; : 18260126.


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Supplements for IR

Douglas Labs Vitamin D-1000 IU or 5000 IU

Supports healthy immune system

Low vitamin D levels linked to MS and other disease

linked to increased blood sugar and insulin resistance

Women with low Vitamin D more prone to gain visceral fat

Also linked to low testosterone in men and depression inmen/women

Am J Clin Nutr. 2010 April 14

J Clin Endocrinol Metab 2009 Jan 94 (1):67-73. Epub 2008 Nov. 4


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Magnesium Magnesium - from NHANES 1999-2000 68%

got less than RDA, 19% consumed less than50%.

Mg is requiredfor ins action and proper gluutiization. Def is assoc with Tpe 2 diab andHTN. http://www.ncbi.nlm.nih.gov/pubmed/15319146

Low magnesium levels were associated with1.48 to 1.75 times risk of increase CRP. Less

than 50% RDA was associated with 2.24 timesrisk elevated CRP

JACN, Vol. 24, No. 3, 166-171 (2005)


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Douglas CaMag 1001

Ingredients

- Vit C, Vit D, Boron (trace mineral)enhance absorption

- Equal ratio cal to mag, 500 mg ea.in

mineral chelated forms


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Other Metabolic Factorsrelated to IR

Low thyroid

Gut health Stress Hormones and Catecholamines

Low Vitamin D Status

Intoxication esp. pesticides Sex hormone imbalances


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Stress (Adrenal) and Thyroid

Endocrine Function and Dysfunction

and Regulation of Weight


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Hormones and Neurotransmitters

Pancreas Thyroid

Adrenal

Chronic StressChronic StressSustained Fight or FlightSustained Fight or Flight


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What is Stress? By-product of modern life--no longer Fight or Flight but sustained pressure

Im having a bad day.

Time commitments

Financial stress

Traffic

Spiritual and emotional issues

Family-Work-Environment

Exercise

Medical conditions

Drugs

Change


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Potential Signs of Chronic

Stress Chemistry Insomnia-unable to fall asleep and/or waking in the middle of the night

Less resistant to infection

Lipid profile numbers creeping up

Headaches

Allergies

Dizziness upon rising

Excessive perspiration

Cant recover from exercise

Short term memory Food Craving patterns especially evening


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Chronic Stress and Disease Effects of stress hormones are systemic

An estimated 85 percent of diseases have stress relatedfactors

Important factor in Metabolic Syndrome and insulinresistance and therefore weight control

Metab 47(12), Dec. 1998; 1440-9

Metab 45(3), 1996; 351-6.

Gynecol Endocrin 8, 1994; 247-254.


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Three Stages of Stress1. Alarm

Activated by acute stress

Massive release of catecholamines (epinephrine and norepinephrine)

from adrenal medulla

2. Resistance

Chronic, intense ongoing stress

Hypothalmus signal pituitary to release ACTH

ACTH stimulates adrenal cortex: release various steroid compounds

3. Exhaustion

Depletion of reserves, illness, disease and death

Body can no longer adapt to effects of stress


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Effects of Chronic CortisolElevationInsulin secretion and IR

Fat deposition (belly fat)

in immune regulation Muscle wasting

Hypothyroidism

Alterations in neurotransmitters

Oxidative stress

Cognition

Bone loss

Sodium and water retention

Elevated blood lipids

REM sleep

Regulation of in sex hormones

Retards regeneration ofconnective tissue, slow woundhealing


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Stress and Thyroid Function

Adrenal and thyroid function closely linked

Under control of hypothalamus and tropichormones

Thyroid competes with adrenals fortyrosine.


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Stress and Thyroid Function

Increased cortisol levels inhibit conversion of T4 to T3 and

favors conversion to rT3 secondary to diversion of tyrosine

to cortisol production vs. thyroid hormone production rT3 decreases cellular energy production

Increases in T3 reverse this decline

(Okamoto R et al. Adverse effects of reverse triiodothyronine on cellular metabolism as assessed by 1H and 31P NMR

spectroscopy. Res Exp Med (Berl) 1997;197(4):211-7)


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Thyroid and Metabolism Thyroid hormone increases # of mitochondria

Thyroid hormone influences rate of ATP production inmitochondria

Thyroid hormone increases the uptake of oxygen by thecells

Diminished secretion of thyroid hormone reducesmetabolic capacity up to 40 percent

Takashima N et al. Characterization of subclinical thyroid dysfunction from cardiovascular and metabolic viewpoints. CircJ. 2007 Feb;71(2):191-5.


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Far- Reaching Thyroid T3 modulates gene transcription

Thyroid hormones regulate myocardial gene expression/increases myocardial sarcoplasmic reticulum Ca2+-ATPase

Cardiac pace making

Neuroreceptor expression and development

Vasodilation of smooth muscle.

Stimulate the production of bile acids from cholesterol

Effects HCl production


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Metabolic Effects of SuboptimalThyroid Function

Glucose tolerance

Thyroid hormone influences the rate at whichglucose is absorbed from the GI tract and taken

up by cells

Insulin resistance

Hypothyroidism reduces target cell insulin

binding/number of insulin receptor expressed


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Metabolic Effects of Suboptimal

Thyroid FunctionCardiovascular health

Decreases metabolism of fats and increases serum lipids

Decreases the availability of cardioprotective essential fatty

acids

Inadequate T3 lowers oxygen consumption, contributes tolipids peroxidation and free radical damage (J Clin EndocrinMetal, 82 (10) Oct. 1997)

Subclinical hypothyroidism an independent risk factor inatherosclerosis and myocardial infarction (Ann Intern Med 132 (4)Feb 15, 2000)


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The Headlines

Stress/obesity linked

Stress and belly fat linked Stress and insomnia linked

Sleep deprivation/weight gain linked


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CortisoBelly Fat Linked Study finding: Cortisol stimulates enzyme

in fat cells, increases visceral fat storage

(Epel E, et al. Can stress shape your body? Consistently greater stress-induced

cortisol secretion among women with abdominal fat. Psychosomatic Medicine,

2000 (62); 623-632.)


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Stress/Obesity Link

Study symptoms of depression, anxiety, sleep

disturbances, psychosomatic illness, and lifesatisfaction are positively correlated with an

increased waist to hip ratio (belly fat)

Rosmond, R. et al.Mental distress, obesity, and body fat distribution in

middle aged men. Obes Res. 1996 May;4(3):245-52


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Sleep Deprivation/Elevated StressHormones Linked

First controlled study to demonstrate that chronicinsomnia leads to increased ACTH and Cortisol

levels.

Hormonal data suggest insomnia is a disorder ofhyperarousal.

Study authors suggested that down regulation of

HPA axis is the most promising approach forinsomnia

(J Clin Endocrin Metab 2001 Aug 86 (8); 3787-94)


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Sleep Deprivation and WeightGain Linked Subjects that avg. 4 hr. sleep/night:

Leptin (18%), Ghrelin (28%)

reported hunger (24%),

carb cravings, especially sweets, salty, andstarchy high calorie snacks

(Ann Intern Med, 2004, vol.141, pp.846850)

> 1,000 volunteers: those that avg. , 5 hr sleep had leptin (15.5%),

ghrelin (14.9%), BMI (3.6%). Results were regardless of the

subjects diet and exercise habits. (Mignot et al, Stanford School of

Medicine Dec. 2004)


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Sleep Deprivation/Weight GainLinked

Heymsfield and Gangwisch analyzed NHANES I data:

Found that subjects with avg. 5hr./night sleep had 73%

increased likelihood of obesity over those who slept 7-9hr/night. ( Findings reported at the annual scientific meeting of the NorthAmerican Society for the Study of Obesity. Nov, 2004)

Study showed a linear relationship: reduced amounts of

sleep are associated with overweight and obesity (Arch. Intern

Med, 2005;165:25-30)


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Sleep Deficits

Chronic partial sleep loss associated with decreasedglucose tolerance, decreased leptin levels, increases inevening cortisol levels, adverse cardiovascular events

Lack of sleep increases heart attack risk and developmentof arterial plaques

Spiegel et al. Lancet 1999 354; 1435-39.

Spiegel et al. J Clin Endocrin Metab 2004, 89(11);5762-71.

Taylor DJ, et al. Sleep. 2007;30(2):213-18Kapsimalis F, et. al. Sleep Med. 2007 Nov 15 [Epub ahead of print]


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Sleep

During sleep - we repair and restore body

tissues Blood pressure drops

Energy stores build up

Growth Hormone is released during sleep


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Insomnia or Disrupted Sleep

Alters Growth Hormone release

Increases TNF alpha, IL-6 Increases insulin resistance

Contributes to weight gain

Increases TBG


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Stress, BMI and Free Radicals

Increased free radicals-cause cellular

damage

Increased BMI linked to increased markers

of inflammationArterioscl, Thromb, and Vasc Bio 2003;23:434-493

Juge-Aubrey, CE, et al. Diabetes May 2003 (52); 1104-10.


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Stress and Sleep Deprivation Elevated cortisol decreases serotonin and

melatonin

Also causes PM blood glucose alterations Elevated evening cortisol disrupts sleep and

is the primary cause of insomnia

Sleep disturbances Inability to turn off the day

Waking in the middle of the night


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Stress and Cognitive Function

cortisoDHEA ratio correlated to short term

memory loss

cortisol intracellular Ca, oxidative stress, inflammatory cytokines, mitochondrial function

cell death = hippocampus atrophy

Net result: short memory loss, mood disorders,

neurological disorders, sleep deprivation


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Studies

Deficits in hippocampus mediated Pavlovian conditioning withendogenous Hypercortisolism Grillon, C et al

Biol Psychiatry, 2004 Dec 1:56(11) 837-843

Young AH, Gallagher, Porter RJ Elevation of cortisol-DHEA ration indrug free patients Am J Psychiatry 2002 July:159(7) 1237.9

Relationship between Cortisol and DHEA sulphate and IGF-1 systemin dementia Muriado G, etalJ Endocrinlogic Inves 2001March 24(3)139-146


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Assessing Adrenal Function

4 Point Salivary Cortisol (dont assume a

flat cortisol response means adrenal fatigue Serum Cortisol 8 a.m.

DHEA Serum or Salivary

Sodium


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Adrenal Questions1. Do you sleep at least 7 or 8 hours per night?

2. Are you under high stress from personal or work-related stress or from

being overcommitted in your life?

3. Do you have dark circles under your eyes?4. Do you crave sugars or carbohydrates in the afternoon and evening?

5. Do you feel tired and wired?

6. Do you have trouble falling asleep or staying asleep?

7. Do you often have a midday crash in energy?

8. Do you feel anxious or nervous?

9. Are you easily irritated, or snap easily at family or co-workers?


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Exercise for Stress-related

Weight Control Set goals to increase motivation

Use stress-control as a motivation

Yoga is one of the best modalities of exercise to reduce stress levels Yoga can result in weight loss void of other lifestyle and dietary

changes

Moderate exercise is key to prevent exercise-induced stress

Smith C et al. Complement. Ther. Med. 2007;15(2):77-83

West J, Ann Behav Med. 2004;28(2):114-8Gill JM. Health News. 2005;11(10):14


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Stress, Sleep, Ins. Resistance Signs of insulin resistance, evaluate stress levels

If report multiple chronic stress signs , suggest

stress management techniques, counseling, bettertime management, meditation, yoga, and/orsupplement support

If person cant sleep, down regulate daytimestress response


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Relora

Proprietary blend ofMagnolia officinalis

and Phellodendron amurense Marketed for stress-related appetite control

and reduction of stress-related fat deposition


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Relora

Anti-anxiety and anti-stress properties rival

benzodiazapenes, yet non-sedating Anti-depressant properties

Normalizes cortisol and DHEA levels

Low side-effect profile


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Relora

Unpublished human trial results:

250 mg TID for two weeks 50 subjects

227% increase in salivary DHEA

37% reduction in morning salivary cortisol


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Relora

78% reported feeling relaxed

94% reported no GI complaints Safety eval - toxicity study in animals found

that doses as high as 5g/kg yielded only

mild side effects


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Life Time Supplements for Stress

Douglas Labs Relora-Plex 2 capsules contain

Relora: 500 mg

Vitamin B1: 10 mg

Vitamin B2: 10 mg

Niacinamide: 10 mg

Vitamin B6: 10 mg Vitamin B12: 100 mcg

Folic Acid: 200 mcg


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Magnesium In animals and humans - stress brings on

sudden influx of calcium into cells, this canbring on hypertension and heart arrhythmia.

Magnesium block stress response byblocking the calcium channels.

Levin, R.M., et al. (1976). Biochem Pharmacol 25(17): 1963-9.

Shimosawa, T.K, et al. (2004). Hypertension 44(6): 897-902.Steinberg, J. S.,et al. (2004). Increased incidence of life-threatening ventricular arrhythmias in

implantable defibrillator patients after the World Trade Center attack. JAmCollCardiol 44(6): 1261-1264.


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Other Stress/Sleep Support5 Hydroxytryptophan (5-HTP)

Precursor to serotonin

Influences the synthesis of melatonin

Serotonin is the neurotransmitter that regulates sleep, mood, satiety,and even pain tolerance.

Stress leads to significant loss of serotonin

When serotonin levels are low, it can lead to carbohydrate cravings.

Dosage Range: 25-300mg


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Thyroid Questions1. Do you feel tired from morning to night?

2. Do you have extreme difficulty losing weight?

3. Do you have a lot of trouble getting up in the morning?

4. Do you have cold hands and feet?

5. Are you constipated?

6. Do your muscles feel weak?

7. Do you struggle with depression or low mood?

8. Do you have thin hair or lose a lot of hair with brushing andshampooing?

9. Do you have swollen upper eyelids?


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Gut Health

Intestinal Influences on Weight Gain


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Gut Function Primary function - digestion and absorption of nutrients while

maintaining a barrier between intestinal contents and bloodstream

Immunity - houses 70% of immune system - gut associated

lymphoid tissue (GALT), secretory IgA and otherimmunoglobulins produced in gut

Flora - number 1014 , over 400 species, aid digestion andimmunity, key to many gut fxs, ie teach immune cells whichantigens are harmful and regs permeability of gut

Peptides/hormones made in gut aid insulin, alter pancreas topresence of glucose, affect blood sugar and appetiteregulation


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Intestinal Permeability Dependent on the regulation of intercellulartight

junctions

Made from multiple proteins inc. occludin, claudins,

junction adhesion molecule (JAM)

Form a selective seal of the intracellular space-regulatespassage of ions and molecules through the paracellularspace

Must have rapid response due to diverse challenges

epithelial barrier is subjected to.

TNF, INF and nitric oxide trigger dysfunction


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Intestinal Permeability-Zonulin Zonulin-reversibly modulates tight junction permeability

Protects proximal intestine from colonization of microbes (innate

immunity)

Regulates fluid, macromolecules, & leukocytes from intestinal lumen

to blood stream and vice versa.

The gatekeeper of the gut, allows some substances through while not

allowing others

Upregulation is associated with increased permeability


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Intestinal Permeability, Gliadin

and Autoimmunity Intestinal cells of both celiac and non-celiac patients

exhibited increased permeability when exposed to gliadin

Chronic gliadin exposure resulted in down-regulation ofboth ZO-1 (zonula occludens-1) and occludin geneexpression.

Loss of the protective function of mucosal barriers is a keyelement necessary to develop autoimmunity (ingastrointestinal and lung mucosa).

Drago S, et al. Gliadin, zonulin and gut permeability: Effects on celiac and non-celiac intestinalmucosa and intestinal cell lines. Scand J Gastroenterol. 2006 Apr;41(4):408-19.

Curr Opin Gastroenterol. 2006;22(6):674-679


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Probiotics Hold down inflammation via proper immune cell

response to antigens

Up-regulate beneficial IgA-prevent allergies,

inflammation and disease Produce SCFAs (like butyrate)

fuel for intestinal cells

mucus production of goblet cells-prevents lectins fromnuts, seeds, legumes and grains (wheat agglutinin) fromdamaging mucosal lining

Promote proper pH of intestines (slightly acidic)yeastcontrol


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Probiotics Improve mucosal barrier function - suppress

growth and invasion of pathogens

Prevent apoptosis of epithelial cells

Prevent antibiotic associated diarrhea

Decreases childhood gastroenteritis

Increases lactose digestion

Eur J Nutr 2006 45, Suppl 1; 1-18.


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Probiotics and SCFA Probiotics - beneficial gut flora, different strains

being IDd for different effects

Butyrate - short chain fatty acid produced byprobiotics

increases gut mucosa cell proliferation

decreases apoptosis of intestinal cells

keeps immune system activity in

check/prevents overactivity


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Probiotics and Propionic Acid

SCFA-Propionic acid (PA) created by fermentation of dietary fiber in

the intestine

PA stimulated leptin mRNA expression and secretion by OAT andSAT

PA reduced pro-inflammatory resistin mRNA expression

May explain dietary fibers protective role in obesity, insulin

resistance and type 2 diabetes

Al-Lahham, S. et al, Regulation of adipokine production in human adipose tissue by propionic acid.

Eur J Clin Invest 2010; 40 (5): 401407


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Strain Specific Functions L plantarum (3 strains of) and 2 strains of L paracasei

found to control C. Diff (Med Microbiol 2004;53:551 and

L GG - improves gut barrier function

S thermophilus and L acidophilus - enhance tight junctionproteins and can prevent E coli (World J Gastroenterol Oct7,2006; 12(37):5941-5950.

L plantarum reduced systemic inflammation response (ClinNutr Apr.2005, 24(2):211-214)


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Factors Influencing Intestinal

Flora and Gut Integrity

Antibiotics

OCs/HRT

Radiation/chemo

Corticosteroids

NSAIDs

Sugar in the diet

Bactericidal chemicals

in drinking water

Pesticides in food

Alcohol

Heavy metals

H. pylori

Gastrointestinal pH

Stress

Bowel transit time


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Factors Leading to Bowel

Dysfunction Change in beneficial flora due to ABX

High stress + increased cortisol =

hypochloria and poor digestion

reduced IgA production

Poor diet high in sugar, refined flours, alcohol, processed foods

Yeast overgrowth (Candidiasis) as probiotics die out yeast multiplies

Decrease in gut enzymes (amount and potency) = poor digestions andnutrient absorption


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Antibiotics and Gut Health

Can wipe out gut flora-dependent on dosage,

length of administration

Studies show profound effects that can last for

months

Yeast overgrowth occurs when good bacteria are

lacking

Nord CE, Edlund C. J Chemother. 1990;2:218-237 Sullivan A. Lancet Infect Dis.

Sept 2001.1(2):101-114.


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Effects of Yeast on the Gut Ferments ingested sugars and starches creating gas and bloating after

meals

Puts out mycotoxins which can:

Damage and destroy intestinal cells

Dampen immune response of T cells in the gut, preventing normalfood substances recognition.

Crowds out good bacteria which direct production of tight junctionproteins

Produces acetaldehyde which can interfere with mood, mental clarityand can lead to chemical sensitivities.


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Yeast and the Endocrine System

Yeast toxins have a particular affinity for the endocrine

organs

Receptors for both estrogen and corticosteroids, identicalto human receptor sites identified on the cell wall of

Candida albicans

Create hormone masking and mimicry

Disrupt the negative feedback to the pituitary


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Dietary Link to Yeast

Overgrowth

Women who had increased urinary sugar levels were

more prone to vaginal yeast infections.

Higher urinary sugar levels were linked to higher

sugar and dairy intake (perhaps secondary to ABX

residues)

Horowitz BJ, et al. J Reprod Med. 1984;29:441-3


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Antibiotics from Food Sources

Antibiotics used in feedlot animals - cause weight gain in animals.

(Antibiotics may cause weight gain in humans.)

Antibiotics used in dairy cattle for infections, enter the milk or foodsmade with it (non-organic milk.)

Enter those who drink the milk/consume foods, enough to shift gut

flora.

Both uses increase the problem of antibiotic resistance.


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Effects of Flora Shift Can lead to immune shifts/incr infl

Immune shifts can result in food allergies and eventually toautoimmunity (e.g. Hashimotos thyroiditis).

Food allergies can also cause food cravings andunbalanced eating habits.

Lack of beneficial flora and yeast overgrowth in gut cangreatly reduce nutrient absorption, many of which are keyto weight management.


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Definition of Leaky Gut Loss of tight junction proteins

Destruction of mucosal barrier

Influenced by medications, antibiotics, NSAIDS

Calderone et al., Med Mycol 38 (suppl 1 ) 2000; 125-37.


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Allergenic Proteins and

Immune Response Lack of probiotic colonization in the gut results in immune cell

activation

Pro-inflammatory cytokines

Immune cells mature into antibodies, IgG, IgA, IgE that also

produce inflammatory cytokines

Inflammatory cytokines = inflammation, contribute to accelerated

aging process and chronic disease

Ghoshal UC, Ghoshal U. Trop Gastroenterol. 2007;28(2):43-4


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Food Allergies and Intolerances Food allergies trigger immune cell production of inflammatory

substances - internal inflammation damages insulin receptors andcause insulin resistance, a primary cause of weight gain.

Stress hormones can shift gut flora leading to gut flora imbalance and

the problems that follow. Food allergies can incr stress hormones production- can contribute to

insulin resistance and midsection weight gain or belly fat.

Stadnyk AW. Intestinal epithelial cells as a source of inflammatory cytokines and chemokines. Can J Gastroenterol.2002;16(4):241-6.

Keltikangas-Jarvinen L, Ravaja N, Raikkonen K, et al. Relationships between the pituitary-adrenal hormones, insulin, andglucose in middle-aged men: moderating influence of psychosocial stress. Metabolism. 1998 Dec;47(12):1440-9.


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Food Allergies- ReferencesRamagopalan SV, et al. Childhood cow's milk allergy and the risk of multiple sclerosis: a population

based study. J Neurol Sci. 2010 Apr 15;291(1-2):86-8. Epub 2010 Jan 21.

Michels AW, et al. Immunologic endocrine disorders. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl

2):S226-37.

Visness CM, et al. Association of obesity with IgE levels and allergy symptoms in children and

adolescents: results from the National Health and Nutrition Examination Survey 2005-2006. J

Allergy Clin Immunol. 2009 May;123(5):1163-9, 1169.e1-4. Epub 2009 Feb 23.

Resta SC. Effects of probiotics and commensals on intestinal epithelial physiology: implications for

nutrient handling. J Physiol. 2009 Sep 1;587(Pt 17):4169-74. Epub 2009 Jul 13. Review.


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Mercury in the Intestines

Ingested or inhaled mercury inhibits neutrophils and their subsequent

TH1 and TH2 cytokine effects which control Candida. Lowered

neutrophil activity allows proliferation of candida.

Candida organisms methylate mercury vapor from the mouth in the

intestines and the mouth.

Candida albicans may trap mercury.

Candida albicans and its mycotoxins are associated with chronic

fatigue and autoimmune disorders.


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Mercury and Candida

References M.L.S.Queiroz et al, "Immunoglobulin Levels in Workers Exposed to Inorganic Mercury",

Pharmacol Toxicol 74:72-75, 1994; & "Presence of Micronuclei in lymphocytes of mercury exposedworkers', Immunopharmacol Immunotoxicol, 1999, 21(1):141-50; & D.C.Santos, "ImmunoglubulineE in mercury exposed workers", 1997, 19(3):383-92..

S. Yannai et al, "Transformationss of inorganic mercury by candida albicans and saccharomyces

cerevisiae", Applied Envir Microbiology,1991, 7:245-247 B.J. Shenker et al, Dept. Of Pathology,Univ. Of Penn. School of Dental Med.,"Immunotoxic effects

of mercuric compounds on human lymphocytes and monocytes:Alterations in cell viability" and"Immune suppression of human T-cell activation", Immunopharmacologicol Immunotoxical, 1992,14(3):555-77

P.E. Bigazzi, "Autoimmunity and Heavy Metals", Lupus, 1994; 3: 449-453.

(235) H.J.Hamre, Mercury from Dental Amalgam and Chronic Fatigue Syndrome", The CFIDSChronicle, Fall 1994, p44-47.

M. E. Godfrey, Candida, Dysbiosis and Amalgam. J. Adv. Med. vol 9 no 2 (1996); & Romani L,

Immunity to Candida Albicans: Th1,Th2 cells and beyond. Curr Opin Microbiol 1999, 2(4):363-7


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Food Allergies and

Intolerances-Symptoms Seasonal (environmental) allergies

Headaches

Joint and other arthritis pain Autoimmune conditions

Thyroid problems

Metabolic imbalances incl. difficulty losing weightArroyave Hernndez CM, Echevarra Pinto M, Hernndez Montiel HL. Food allergy mediated by IgG antibodies associated

with migraine in adults. Rev Alerg Mex. 2007 Sep-Oct;54(5):162-8.

Kitts D, Yuan Y, Joneja J, Scott F, Szilagyi A, Amiot J, Zarkadas M. Adverse reactions to food constituents: allergy,

intolerance, and autoimmunity. Can J Physiol Pharmacol. 1997 Apr;75(4):241-54. Review.


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Allergenic Foods 7 foods make up 90% of food allergies

- Peanuts/Walnuts

- Shellfish

- Wheat

- Cows milk

- Eggs

- Soy

- Yeast

Food Rotation Diets help prevent food allergies and are strongly

encouraged by LMI


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Assessment Questions1. Do you have seasonal allergies?

2. Do you often feel mentally foggy?

3. Do you often get bloated and gassy, especially after eating?

4. Do you have chronic sinusitis?

5. Do you have trouble with constipation or diarrhea?

6. Do you have a history of taking antibiotics, birth control pills,NSAIDS or steroids?

7. Do you unexplained chronic conditions, ie headache, joint pain, ordepression?

8. Do you eczema or other skin rash problems?


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Supplements for Optimal Gut

Health Probiotic

L-glutamine

IgG powder

Grapefruit seed extract

Cats claw

Vitamin D

High mucin sialic adic

Zinc carnosine

Moducare

Rhodiola or Relora for improved stress response


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Potential Testing

Simple test is elimination diet.

Labs tests:

OAT test

Comprehensive Digestive Stool (DNA)

Allergy Panel IgG and IgE

Gluten and Gliadin antibodies

ANA, TNF alpha, IL6


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Health Douglas Labs Multi-probiotic 4000

Lactobacillus acidophillus: 1.5 Billion CFU

L. Rhamnosus: 1.5 Billion CFU

L. Rhamnosus (Type B, Bifidus): 775 Million CFU

S. Lactis: 275 Million CFU

Bifidobacterium Longum: 275 Million CFU

B. Bifidum: 275 Million CFU

S. Thermophilus: 150 Million CFU

Proprietary Blend: 215 mg FOS (fructooligosaccharides) andulmus fulva (inner bark)


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Health Douglas Labs Multi-probiotic 4000

Help with food allergies

Inhibit fungal colonization of the GI tract which leads to improvedgut health

Ponzio G, et al. Cell Signal. 1990;2(4):377-86Logan AC and Kataman M. 2004 Med Hypothesis. 64:533-538


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Health FastFuel Complete Ingredients

Dietary Fiber from Sunfiber (5 g)

gut fermentation of fiber produces SCFAs

Protein: 30 g

Builds and repairs intestinal tissue

Proprietary Fruit and Vegetable Blend: 750 mg

Antioxidants support against cellular damage


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Health FastFuel Complete Ingredients (cont.)

Proprietary Digestive Enzyme Blend: 30 mg

Supports proper digestion L-Glutamine: 2000 mg

Source of energy for intestinal cells

Supports digestive tract repair

Alander T. BMC Med. 2005 May 13;3-8


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Health Douglas Labs Vitamin D-1000 IU or 5000 IU

Supports healthy immune system

Low vitamin D levels

linked to MS and other disease linked to increased blood sugar and insulin resistance

Women with low Vitamin D more prone to gain visceral fat

Also linked to low testosterone in men and depression in men/women

Am J Clin Nutr. 2010 April 14

J Clin Endocrinol Metab 2009 Jan 94 (1):67-73. Epub 2008 Nov. 4


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Health

Douglax Labs Relora-Plex

Proprietary blend ofMagnolia officinalis and

Phellodendron amurense

Marketed for stress-related appetite control and

reduction of stress-related fat deposition


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Health

Douglas Labs Relora-Plex

Anti-anxiety and anti-stress properties rival

benzodiazapenes, yet non-sedating

Anti-depressant properties

Normalizes cortisol and DHEA levels

Low side-effect profile


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Detoxification


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Our Toxic Environment We are exposed to thousands of man-made toxins every day

Studies have identified as many as 300 foreign chemicals, including

several known carcinogens in the human body

National Human Adipose Tissue Survey http://cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=55204; Accessed April 15,

2010.


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Xenoestrogens Plastics containing BPA

PCB (polychlorinated biphenals)

Dioxins

Meat & Milk Birth control pills

Tap water

Car Exhaust


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Why are Heavy Metals Dangerous?

Bind sulfur groups on amino acids methionine,

glutathione, cysteine

Interfere with hundreds of chemical reactions Body cant detoxify


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Bisphenol A (BPA) BisphenolA (BPA)- production of polycarbonate

plastics and epoxy resins, found in plastic food

and drink containers. Over the past decade, more than 130 studies have

linked the chemical to breast cancer, obesity, and

other disorders.

Endocrine disruptor


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Environmental Toxins and IR Pesticides, BPA associated with increased risk for IR

Heavy metals also associated with increased oxidativestress and inflammatory response

Note - 90% of the pesticides in use today are used in theproduction of food

Ropero AB, et al. Bisphenol-A disruption of the endocrine pancreas and blood glucose homeostasis. Int J

Androl.2008 Apr;31(2):194-200.

Galanis A, Karapetsas A, Sandaltzopoulos R. Metal-induced carcinogenesis, oxidative stress and hypoxiasignalling.

Mutat Res. 2008 Oct 30.Lee DH, et al. Diabetologia. 2007 Sep;50(9):1841-51.


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Toxins and Weight Several pesticides have been proven to disrupt thyroid

hormones

Toxic metals promote free radical production in the body;free radicals contribute to IR and weight gain

Toxins increase inflammatory chemicals; Inflammation islinked to weight gain

Pelletier C, Imbeault P, Tremblay A. Energy balance and pollution by organochlorines and

polychlorinated biphenyls. Obes Rev. 2003 Feb;4(1):17-24.

Ruzzin J, Petersen R, Meugnier E, et al. Persistent organic pollutant exposure leads to insulin resistancesyndrome. Environ Health Perspect. 2010 Apr;118(4):465-71. Epub 2009 Nov 19.

Melov S. Mitochondrial oxidative stress. Physiologic consequences and potential for a role in aging. AnnN Y Acad Sci. 2000 Jun;908:219-25. Review.


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Toxins and Weight National Health and Nutrition Examination Study, 1999-

2002

Prevalence of DM strongly positively associated with

serum concentration of pollutants. Indivs in highest category of exposure (>90 percentile)

had prevalence of DM 38X higher than lowest category

Lee DH, Lee et al. DiabetesCare 2006;29:1638-1644.


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ADHD and Pesticides Groundbreaking Study

Cross Sectional Data on 1139 children aged 8 to 15 from 2000-2004

NHNES

The most commonly detected pesticide metabolite, dimethylthiophosphate, those with levels higher than the median had nearly

twice the odd of ADHD

Diet major source of pesticide exposure for children

Pediatrics. Published online May 17, 2010


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Liver Detoxification-Phase I

Oxidation and Reduction

Converts toxins to water-soluble compounds sothat they can be excreted in the urine

Network of enzymes known as cytochrome P450 Oxidation is the process of inactivating molecules

through the transfer of oxygen and subsequent lossof electrons


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Liver Detoxification-Phase I

Oxidation and Reduction

Oxidation generates free radicals within the liver.Therefore, the liver must have a continuous supply

of antioxidants. Compromised phase I detoxification are known as

slow detoxifiers


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Causes of Slow Phase 1

Detoxification Fasting

Low protein diet

Hydrogenated fats Age

Iron overload

Grapefruit juice

Some prescription drugs


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Liver Detoxification-Phase II

Conjugation and Elimination

Substances needed for Phase II pathways:

Sulfur compounds

AAs glutathione, methionine and cysteine

Glucuronic acid

Acetyl CoA


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Substances that Inhibit Phase II: NSAIDs

Low protein diet

Nutrient deficiencies

folic acid magnesium

selenium

B vitamins

Zinc


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Detox and Exercise Sweating aids detoxification

Exercise helps to increase the rate of bloodfiltration and toxin removal

When fat is burned, toxins stored in fat arereleased.

The more you sweat, the greater potential for toxinremoval, however if detox pathways are not

running efficiently toxins can stop metab again viaIR and decr thyroid activity.


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Toxin Burden Assessment Do you have extreme difficulty losing more than 10 pounds?

Do you have chemical sensitivities such as intolerances to fragrances?

Do you have chronic unexplained headaches, muscle pain and/or

fatigue? Do you live in a heavily industrialized area, or live near a factory, or

farms that use chemical fertilizers or pesticides?

Do you have allergies or asthma?


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Supplements to Support Liver Detox Womens and Mens Performance Multivitamin

(AM/PM) (cont.)

Mixed Vegetable and Fruit Complexes

Sulforaphane from broccoli, cauliflower, cabbage,Brussels sprouts supports Phase II detox

Calcium D-glucarate from apples, Brussels sprouts,broccoli and cabbage protects intestinal breakdownof glucuronic acid conjugates and allows

elimination via stool


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Supplements to Support Liver Detox Womens and Mens Performance Multivitamin (AM/PM)

(cont.)

DIM (Diindolylmethane) from cruciferous vegetables promotes

healthy estrogen metabolism Chelated Minerals magnesium, zinc, copper, manganese,

molybdenum grab and remove heavy metals

B-vitamins including folic acid important methyl donors


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Supplements to Support Liver Detox Douglas Labs Alpha Lipoic Acid

Powerful antioxidant

Supports detox enzyme function

Reduces toxic mercury exposure in the brain Detoxes cadmium from cigarette smoke and fuel exhaust

Petersen Shay K, et al. IUBMB Life. 2008; [Epub ahead of print]Smith AR, et al. Curr Med Chem. 2004;11(9):1135-46


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Supplements to Support Liver Detox Ultra-D Tox

Bentonite Powder, Psyllium Powder,Lactobacillus

acidophilus(minimum of 1 Billion CFU), Garlic (deoderized),

Celery Powder, Aloe Vera Powder, Prune Concentrate, Mint, FlaxSeed Powder, Barley, Chlorella, Anise, Vitamin C, Bromelain and

Magnesium Citrate


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Supplements to Support Liver Detox Ultra-D Tox (cont.)

Garlic

One of the most widely studied natural compounds

Increases Glutathione

Acts as metal chelator

Anti-viral properties imp. for complete removal of metal(some metals harbored within underlying viral and bacterialinfections)

Has antioxidant/anti-inflammatory actions


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Supplements to Support Liver Detox Ultra-D Tox (cont.)

Chlorella

A single-cell, fresh water algae that is rich in protein, chlorophyll,essential fatty acids, vitamins, and minerals.

Detoxifies mercury, lead, cadmium, as well as dioxin, PCBs anduranium.

Kay RA Crit Rev Food Sci Nutr 1991;30(6):555-73.

Horikoshi, T., et al. Uptake of uranium by various cell fractions of Chlorella regularis. Radioisotopes 1979 Aug; 28(8): 485-8.

Singh A, et al. Anticancer Res 1999 May-Jun;19(3A):1887-91


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Reducing Toxicity with Foods

First stop adding to the problem

Compared to kids on organic diets, conventional

diet kids had 6x higher levels of organophosphatepesticides

Curl et al. Environmental Health Perspectives, Volume 111(2003): pages 377-382.


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ABX/Hormones/Pesticides Beef - growth hormones, antibiotics,

pesticides on feed concentrate in fat

Poultry - pesticides concentrate in fat Dairy - growth hormones, antibiotics,

pesticides

Eggs - pesticides

Pork pesticides


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Dirty Dozen www.ewg.org

Celery

Peaches

Strawberries

Apples

Blueberries

Nectarines

- Bell Peppers

- Spinach- Kale

- Cherries

- Potatoes

- Grapes (imported)


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Metabolism and Nutrient

Deficiencies


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Reasons for Functional

Nutrient Deficiencies Diet - low consumption of nutr dense foods

Lower nutrient density of foods

Drug Therapy

Exercise Genetics

Stress

Disease or Condition Specific situations


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Nutrients in Foods Declining From 1950s to 1999 protein, calcium, phosphorus, iron,

riboflavin, and vitamin C all declined in 43 garden crops

Due to high yield crops, gradual depletion of soil

micronutrients and organic matter, and changes in pestcomplexes and levels

Mayer, Brit Food J 99(6), 1997

Davis, J Am Col Nutr 23(6), Dec. 2005.


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More Nutrients Needed? U.S. intake - kcals 1970 = 2300 /day, yr 2000 = 2800/day

(USDA Agriculture Factbook 2001-2002)

Grains - avg intake of flours 200 lb/yr/person. Only 7%

eating 3 whole grains servings/day. 2005 CDC survey 27% getting 3 veg/day, 33% ate 2

fruit/day.

Ad t I di id l


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Adequate Individual

Nutrients? Nutrients of concern for:

Adults - calcium, potassium, fiber, vitamin A (carotenoids), vit. C,

and E

Adolescents and children- calcium, potassium, fiber, magnesium,vit. E

Adults > 50 yr. - B12, vit. D

Childbearing - folate, iron

2005 USDA Dietary Guidelines for Americans.


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Fruit and Vegetable Consumption USDA recommends 9 servings per day (3 to 5 vegs, 2 to 4 fruits.)

Americans - < 20% consuming 5/day

Consuming too many refined flours, over processed foods

So, despite increase kcal, there is a nutrition gap.

Produce for Better Health Foundation. State of the Plate:

Study on Americas Consumption of Fruits and Vegetables, 2003, NPD National Eating Trends.

A A i G tti th RDA


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Are Americans Getting the RDAs

for Nutrients? Magnesium - from NHANES 1999-2000 68% consumed less than

RDA, 19% consumed less than 50%.

Low magnesium levels were associated with 1.48 to 1.75 times risk of

increase CRP.

Less 50% RDA was associated with 2.24 times risk elevated CRP

JACN, Vol. 24, No. 3, 166-171 (2005)


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K N t i t


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Key Nutrients

Magnesium -bl glu reg, ins fx, blocks stressresponse

Chromium - crucial for gl transport

Vit D - insulin and immune regulation

Vit C - improves energy transport in fat cells,incrs glutathione aiding removal of toxins

Selenium - antiox enzyme, needed for thyroidhormone conversion

Anitoxidants - C, E, Sel, Carotenoids,etc widearray needed to control inflammation


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Magnesium Intake Gallup poll 2004 commissioned by Purdue

Products (makers of Slo Mag )

80% not getting RDA just from diet 35% getting RDA between diet and

supplements

July 21, 2004 PRNewswire


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Magnesium and Type 2 DM 50 controlled, 110 non-controlled type 2 diabetes patients

190 healthy volunteers

Serum HDL-cholesterol value showed significant graded increase with

serum magnesium values regardless of glucose values.

Guerrero-Romero F, et al. J Diabetes Complications 2000 Sep-Oct;14(5):272-6.Guerrero-Romero F, et al. J Diabetes Complications 2000 Sep-Oct;14(5):272-6.

Nutr Res. 2008 Oct;28(10): 659-653

Si d S t f


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Signs and Symptoms of

Magnesium Deficiency Blood sugar dysregulation

Depression

Migraines

Kidney Stones

Osteoporosis

Low energy/fatigue

Si d S t f


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Signs and Symptoms of

Magnesium Deficiency Muscle cramps and spasms, including vasospasm

Constipation

Arrhythmia and heart palpitations

Anxiety, nervousness, and insomnia Increased BP


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Magnesium Supplements Generally recommended dosages are 250-

750mg daily.

Choose absorbable citrate, glycinate, aminoacid chelate or malate forms.


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Chromium Improves satiety

Carbohydrate cravings

Helps convert T4 to T3

Metabolism of carbs and fats

Docherty JP, et al. A double-blind, placebo-controlled, exploratory trial of chromium picolinate in atypical depression: effect on carbohydratecraving. J Psychiatr Pract. 2005 Sep;11(5):302-14.

Lau FC, et al. Nutrigenomic basis of beneficial effects of chromium(III) on obesity and diabetes. Mol Cell Biochem. 2008 Oct;317(1-2):1-10. Epub

2008 Jul 18. Review.


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Chromium 1950s- Discovered that chromium was required by animals to control blood sugar

1970s- In hospitals chromium was added to TPN alongside insulin therapy to lower

blood sugar. Insulin therapy wasnt effective on its own

1997- Dr. Richard Anderson (USDA) published a landmark study demonstrating the

efficacy and saftey of chromium picolinate supplementation in people with type 2 DM

Still not widely utlized to help control DM

Dietary Chromium: An Overview the Chromium Info Bureau Revised 1996

Chromium in Health and Disease Summit Summary 2003


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Chromium Important in insulin regulation and blood sugar control

One of the most critical nutritional factors in IR

Each insulin receptor needs four molecules of chromium

Chromium attaches to the IR and changes its configurationallowing the insulin in the bloodstream to bind with the

receptor allowing glucose to enter the cell


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Chromium Results Role in lowering cholesterol- triglycerides

Inverse relationship between chromium levels in toenails and risk of MI

including fatal MIs

Pregnant woman with gestational DM supplemented with chromium hadsignificantly lower insulin and glucose levels vs placebo

In patients with atypical depression (carbohydrate cravings, weight gain) 70%

of patients taking chromium picolinate experienced relief from symptoms

Guruprasad R, et al.Mutat Res. 2006 November 7; 610(1-2): 93100. Rajpathak S, et al.Diabetes CareSeptember 2004 vol. 27 no. 9 2211-2216

Jovanovic L, Gutierrez M, Peterson C. Chromium supplementation for women with gestational diabetes mellitus. J Trace Elem Exper Med

1999; 12: 917. Chromium Supplementation May Reduce Carbohydrate Cravings in Atypical DepressionJ Psychiatr Pract. 2005;11:302-314


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Stresses to Chromium StatusCan increase chromium excretion in the urine: Exercise- chromium excretion higher with intense exercise (90% VO2

max) and higher in less active more sedentary control subjects Pregnancy/Lactation- a normal state of chromium wasting

Infection and Physical trauma Chromium losses increase with age High sugar diets

Vincent J. The biochemistry of chromium. Journal of Nutrition. 2000;130:715-718.Lau FC, et al. Nutrigenomic basis of beneficial effects of chromium(III) on obesity and diabetes. Mol Cell Biochem. 2008

Oct;317(1-2):1-10. Epub 2008 Jul 18. Review.

Anderson RA, et al. Exercise Effects on Chromium excretion of trained and untrained men consuming a constant diet. JAppl Physiol64: 249-252, 1988;


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Chromium and Biotin 348 overweight and obese subjects with poorly controlled type 2 DM,

Supplemented with 600 mcg chromium picolinate + 2 mg biotin

Supplements added to current medications.

Supplement subjects had 6% drop in fasting blood sugar, HgbA1C decreasedmore in supplement group vs placebo

Preliminary studies show biotin may enhance chromiums effectiveness

Albarracin CA, et al.Diabetes Metab Res Rev 2008; 24: 4151.


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The Safety and Efficacy of


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The Safety and Efficacy of

High-dose Chromium Chromium supplementation does result in tissue retention, especially

in the kidney, although no pathogenic effect has been demonstrated

despite considerable study

The 350-fold difference between the acceptable daily intake and thecalculated reference dose for humans of 70 mg per day seems without

precedent with respect to other nutritional minerals.

Altern Med Rev. 2002 Jun;7(3):218-35.


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Exercise and Nutrients Regular intense exercise that induces sweating

Sweating - helps remove toxins

Also lose nutrients i.e. chromium excretion in urine increases

with exercise, magnesium and other trace minerals are excreted insweat and urine; need to keep nutr density high in diet.

Dunford and Doyle, Nutr in Sports and Exercise, 2008 Thomson and Wadsworth.

Lukaski, H. Magnesium, chromium and zinc nutriture in physical activity.

AJCN, 72;2:585S-93S. Aug. 2000


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Vitamin C Men with the lowest amount of vitamin C

have a 62% increased risk of cancer and a

57% increased risk of dying from any cause.Vitamin C status and mortality in US adults.

Loria CM, et al. Am J Clin Nutr 72:139-45, 2000.


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Deficiencies and Exercise Vitamin C up-regulates carnitine synthesis and increases

fat burning.

Study found people with marginal Vitamin C deficiency

burned 25% less fat during exercise. Repletion of Vitamin C raised fat burning 4 fold.

Nutrition and Metabolism 2006, 3:35 doi:10.1186/1743-7075-3-35


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Vitamin D Low Vitamin D levels are linked to increased blood sugar

and insulin resistance

Women with low Vitamin D more prone to gain visceral

fat.

Am J Clin Nutr. 2010 April 14J Clin Endocrinol Metab 2009 Jan 94 (1):67-73. Epub 2008 Nov. 4


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Vitamin D Supplemental vitamin D reduces the risk of colon cancer

by half compared to dietary vitamin D which reduces it

12%. Calcium, vitamin D, and dairy foods and the

occurrence of colon cancer in men.

Kearney J, et al. Am J Epidemiol 143:907-17, 1996.


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Delta-6-desaturase Enzyme critical for the conversion of linoleic acid

to gamma linolenic acid

GLA needed for the production of PGE1 and

PGE3 (anti-inflammatory prostaglandins)

Several nutrients required for Delta 6 desat

enzyme activity


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Essential Fats for Vegetarians Vegetarian levels of EPA/DHA are those of non-

vegetarians

Inefficient conversion of ALA to EPA & DHA due to high

n-6 diets, trans fats; protein deficiency; too much sugar,too much alcohol; vit B, magnesium and zinc deficiency

Conversion enzymes may not function well in people withmetabolic syndrome, diabetes


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Nutritional Co-factors Necessary for PGE-1 and PGE-3 synthesis

Vitamin B3

Vitamin B6 C

Zinc

Magnesium

Drug-Induced Nutrient Depletions


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Drug Induced Nutrient Depletions

Influence Metabolism Female Hormones: FA, B6, B1, B2, B3, B12, C, Mg, Se,

Zn, tyrosine,CoQ10, E Anticonvulsants: D, K, FA, Ca Anti-diabetic Drugs: CoQ10, B12

Anti-hypertensives: B6, CoQ10, Ca, Mg, K, Zn, Anti-inflammatory: Ca, K, Zn, Fe, B6, C, D, FA, Statins: CoQ10, Vitamin D Beta-blockers: CoQ10, melatonin Phenothiazines/TCAs: B2, CoQ10 Benzodiazepines: Melatonin

Anti-ulcer medications: B12, FA, D, Ca, Fe, Zn, Mg,protein Antibiotics: B-vitamins, vitamin K


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Studies More than 1,000,000 studies have been

conducted on the 69 most popular

supplements


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Multi Vitamins Multi-vit/min usage was assessed in RDBPC study 215

men ages 30 to 55 for effects on mood, stress, physicaland mental tasks.

Multi vit contained B complex, vit C and minerals

After 33 days on the Multi vit/min the men report sig.higher ratings on general mental health, reduced subj.stress, increased vigor and overall improved mood. Taskperformance was also improved and mental fatigue wasreduced after performing intense metal processing taskscompared to placebo group which had not sig. changes.

Northumbria University (2010, May 14). Multivitamins can add sparkle for healthy youngpeople.ScienceDaily. Retrieved May 20, 2010, fromhttp://www.sciencedaily.com/releases/2010/05/100514075108.htm


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Safety CDC data 2003 - 106,000 deaths from

adverse drug reactions (16,500 from

NSAIDS) 2003 - 12 deaths from dietary supplements


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Inflammation, Insulin

Resistance and Diet

What Are Our Desired


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EndpointsSupport health/Prevent Disease

Control weight

Control inflammation

Strong, balanced immunesystem

(Neuro -endocrine-immune)

Anti-inflammatory

high antioxidant

nutrient dense

low glycemic load

non-reactive (low

allergen)

pure, unprocessed


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Inflammation and Diet Trans fatty acids (found in hydrogenated oils) are extremely pro-

inflammatory.

Even small intakes are associated with increased health risks such asheart disease and cancer.

Trans fats induce insulin resistance and increase belly fat.

Of all fats, trans fats have the strongest association with weight gain

Mozaffarian D, Aro A, Willett WC. Health effects of trans-fatty acids: experimental and observational evidence. Eur J ClinNutr. 2009 May;63 Suppl 2:S5-21. Review.

Wallace SK, Mozaffarian D. Trans-fatty acids and nonlipid risk factors. Curr Atheroscler Rep. 2009 Nov;11(6):423-33.Review.

Willett WC. Trans fatty acids and cardiovascular disease-epidemiological data. Atheroscler Suppl. 2006;7(2):5-8.


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Inflammation and Diet Antioxidantrich diet can be one of the best

defenses against inflammation

Focus on getting adequate Omega-6 fatty acids

from fish, plant foods, walnuts and wild game Studies have shown that fish oil significantly

lowers C reactive protein, compared to omega 6fats like safflower oil.

Balk EM, Lichtenstein AH, Chung M, et al. Effects of omega-3 fatty acids on serum markers

of cardiovascular disease risk: a systematic review. Atherosclerosis. 2006;189(1):19-30.Madsen T, Skou HA, Hansen VE, et al. C-reactive protein, dietary n-3 fatty acids, and the

extent of coronary artery disease. Am J Cardiol. 2001;88(10):1139-42.


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Dietary Recommendations in IR


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y

A modified low carb/higher protein diet Increase non-starchy vegetable intake - improves

adiponectin levels Utilize high fiber foods like beans to fulfill carb

cravings without high adverse glycemic effects

Lean meats - fish, chicken, bison A low allergen diet may be helpful, i.e. low wheatand/or cows milk.

Cassidy A, et al. Plasma adiponectin concentrations are associated with bodycomposition and plant-based dietary factors in female twins. J Nutr. 2009Feb;139(2):353-8. Epub 2008 Dec 23.

Low Carb vs High Carb for Wt.


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Loss Brehm et al compared women on 15/28/57 vs 54/18/328

8.5 kg. vs 3.9 with no changes in bone mineral content in

either group

Low carb group had same body water as low fat group.Low carb had spontaneous restr of caloric intake (this

effect seen in other studies.)

The J of Clin Endocrin & Metab Vol. 88, No. 4 1617-1623

Comparison of 4 diets


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Comparison of 4 diets LEARN diet, -2.6 kg

Zone, - 1.6 kg.

Ornish (vegetarian, low fat), -2.2 kg Atkins, - 4.7 kg

Gardner et al. JAMA. 297 (9): 969 - 985.

4 Diets (contd)


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4 Diets (cont d) Ornish and LEARN favored LDL at 2 mo.,

differences leveled out and were not signif. at 6and 12 mos

Lowest carb was most effective for weight loss,

lowering of trigs, increasing HDL and loweringBP

Authors conclusions - Atkins diet led to greatest wt lossand most beneficial metabolic effects through 1 yr offollow up

Low Carb and Metabolic


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Syndrome Low carb/high fat diet improved BP,

increased HDL, lowered trig, reduced bl glu

and insulin, and reduced weight. Low fat/High carb diet exacerbated

Metabolic Syndrome

Authors discussed the persistance of

AHA/NHBL in recommending low fat dietsas being in error for Met Syndrome

Volek J, Feinman R. Nutr and Metab 2005,2:31


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Low Carb and Lipids Low carb diets lowered trig, increased HDL

and lowered apoB even in absence of wt.

loss or presence of higher sat fat whencompared to low fat diets

Krauss, et al. AJCN 2006;83:1025-1031


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Low Carb and Hypertension Obese subjects placed on low carb, high fat diet. No kcalrestriction. Sodium intake went from 2 g to 20 g

Lost 5% of body wt in 6 wks, had signif reductions infasting insulin and mean aterial pressure

Auth conclusions - we need to stop paying so much attn tosodium and start paying attn to fasting insulin

Hays JH Mayo Clin Proc 2003:78;1331-1336


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High vs. Low Carb Results


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g

Authors concl. - HP diet best overall approach for risk of CVD and Type II Diab ininsulin resistant people

HC HF HP

Weight - 5 kg - 7 kg -7 kg

Waist - 7 cm. -10.5 cm -9.7 cm

Trig - .32mmoL13% had

incr. LDL

-.56 mmoL

LDL signif lower, but

25% had 10% incr

LDL

-.63 mmoL

-LDL signif lower, but 7% had incr

LDL

Insulin -4.2

mU/L

-5.9 -3.8


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More Low Carb Support Considering the effectiveness of VLCDs in

promoting fat lossand improving the

metabolic syndrome, discounting orcondemningtheir use is unjustified. We

encourage a more unbiased, balanced

appraisal of VLCDs.

Volek et al. J. Nutr. 135:1339-1342, June 2005

Comparison of GI and GL


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p 120 young adults - comparing 2 low vs. 2 high GL (all

diets were low fat, reduced kcal)

All groups lost wt. and waist circum

High carb groups - one had lower GI, this group nearlydoubled fat loss compared to high carb, high GI

GI and GL influenced results even within a low kcal diet.Reducing GL increased rate of fat loss esp. in women

Arch Int Med, July 24, 2006


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Low vs High GI 162 subjects RDB study 1 yr. comparing high

carb/ high GI, high carb/low GI, and lowcarb/high MUFA

In well controlled Type 2 Diabetics (bl. glu nearnormal) a low GI diet led to lower 2 hr postloadglu and CRPs were lowest in the low GI diet(1.95), highest in high carb/high GI (2.75)

Am J Clin Nutr 2008;87;114-25

Low GI Foods and Stress


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Hormones Subjects (teenage boys) were given equal kcal

meals with either high, med. or low GI

High GI meals led to incr kcal intake and higher

serum insulin, lower plasma glucagon, andelevated serum plasma epinephrine

Ludwig, et al. High Glycemic Index Foods , Overeating and Obesity. Pediatrics 103:e26 (1999)

Low Glycemic Improves


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Nutrition Status The kidneys possibly lose their ability to retain magnesium

during periods of hyperglycemia (significantly elevated

blood glucose). The increased loss of magnesium in urine

may then result in lower blood levels of magnesium [4]. Inolder adults, correcting magnesium depletion may improve

insulin response and action [42].

http://ods.od.nih.gov/factsheets/magnesium.asp


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Low Carb and REE 2 calorie restricted diets, either low fat or

GL

Bl glu, trig, CRP and BP all improved morein low GL group

REEs reduced less in the low GL group

Low GL group also had less hunger

Pereira, MA, et al. JAMA. 292 (20):2482-2490

Safety of High Pro and Fat


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EvaluatedCarb Restricted Diets high in MUFA or Pro are equally

effective at promoting fat loss and improving blood lipids(Luscombe-Marsh, et al. AJCN Apr. 2005 81:773-779)

When substituted for carb, protein enhances fat loss. Thisstudy looked to see if the effect was from HP or higherMUFA. Both higher fat and protein diets led to fat loss,lower glucose and insulin responses and NO calcium loss,bone loss or renal changes.


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Evaluation of Ketosis Ketogenic (KLC) vs Non ketogenic (NLC) diets - 6 wks. Both were effective in weight 6.3 vs 7.2 kg and fat loss 3.4 vs 5.5 kg.

REE and insulin sensitivity incr in both.

Beta hydroxybutyrate was 3.6 x higher in KLC and was directly LDLcorrelated. LDL incr in 5, decr in 4 KLC. Incr in 2/Decr in 8 NLC

KLC had incr. Arachidonicacid:eicosapentaenoic acid ratios in plasmaphospholipids

Vigor, happiness, energy rated much higher in NLC

Johnston et al. AJCN May 2006 83 (5):1055-61

High Protein Diet and Hip Fx


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in Elderly Five hundred seventy-six women and 370 men from the Framingham

Osteoporosis Study-no previous hx of hip fx

946 participants-mean age 75 yrs.

Mean pro intake of 68g/d Increased protein intake associated with decreased risk of hip fracture

compared to participants with lowest protein intake

Misra D, et al. Does dietary protein reduce hip fracture risk in elders? The Framingham osteoporosis study. Osteoporos Int. 2010 May 5.

[Epub ahead of print]

High Protein Low Carb Diet +


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Exercise 48 women, 40 to 56 yrs. Randomly assigned to low carb:protein diet (PRO) or

high carb:protein diet (CH0) + light walking (control) or exercise (EX)

PRO and PRO + EX lost more total weight and fat mass and lost less lean

mass than CHO and CHO & EX.

CHO groups-greater reduction in chol and LDL chol.

PRO groups-greater reduction in TRIG and greater inc. in HDL

Exercise resulted in body fat loss and lean mass preservation

Diet + exercise synergistic for improving body compositionLayman, D et al. Dietary Protein and Exercise Have Additive Effects on Body Composition during Weight Loss in Adult

Women. J of Nutr. Downloaded from jn.nutrition.org on June 7, 2010

Net Acid Comparisons


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Net Acid Comparisons

Paleolithic era- meat was the only acid producingfood. Net acid producing load (NEAP) was -78 to-23 mEq/d

Modern NEAP is 48 to 132 mEq/d

The primary dietary change in ancient vs. moderndiet was replacement of roots, tubers, leafy greens,vegetables with grains and energy dense nutrient

poor foods (separated fats and sugars)

Net Acid Load (contd)


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Net Acid Load (cont d)

Authors of the study stated that by replacing grains and NDEPfoods with vegetables/plants would allow animal food intake toincrease considerably without becomin

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