Muscle Fiber Type Distribution with Age

• Aging leads to an increasing percentage of type-1 fibers compared to type-2

• Vitamin D supplementation mitigates the reduction in type-2 muscle fibers

Protocol

Vitamin D 5,000 IU daily

Sports Health. Jan/Feb 2014, p.49-55

Am J of Sports Med. 2013, vol. 4(2)

2016 News

• Vitamin D:• Fat-soluble vitamin

• High body fat = more need for “D”

• Helps lower c-reactive protein

• Raises testosterone

• Improves body composition

• Decreases VAT

• Better overall health

The European Male Ageing Study. European Journal of Endocrinology, Jan. 2012, 166: p75-85

Probiotics

L. acidophilus NCFM & b. lactis BI07a) Enhances digestionb) Strengthens GI barrierc) Balances immune functiond) Inhibit pathogenic microbes

(blunting inflammatory signalingthrough gut)

Weight Loss/Body Composition 2016 Summary

• Nutrition assessment• BIA findings• Detox with body composition program• Low glycemic index/load foods• Small, frequent meals

• Meal replacement:• To increase intake of targeted quality nutrients • To improve insulin sensitivity• Low glycemic index

• Quality EFAs, esp. omega-3 (EPA, DHA)• Exercise – progressively increase intensity

• Aerobic, strength, flexibility

• Additional supplementation as needed:• CLA• Alpha-lipoic acid

Weight has greater impact on diabetes than heart disease

JAMA Internal medicine

Gluten and the Gut

Gluten

• “Sticky” interferes with breakdown and absorption of nutrients

• Pasty residue on the gut

• Leads to immune response

• Results in assault of lining in S.I.

• Some experience G.I. issues

• Others – damage to nervous system

F.D.A. Sets Standard on Labeling “Gluten Free”

• 8/2/13 – Federal government set standard for gluten-free claims on food labels – would help the 3 million Americans with celiac disease

• Congress passed law in 2004 calling FDA to set standards for how much trace gluten could be in foods whose labels said they were gluten free – to protect people with the disease

• FDA set a gluten limit of 20 parts per million in products labeled gluten free

NYTimes.com, August 2, 2013

Gluten-free diet reduces adiposity, inflammation and insulin resistance associated with the induction of PPAR-alpha and PPAR-gamma expression

• Gluten-free animals showed a reduction in body weight gain and adiposity, without changes in food intake or lipid excretion

• Results were associated with up-regulation of PPAR-α, which are related to lipolysis and fatty acid oxidation

Soares FL, et al. J Nutr Biochem, 2013

Pass on the Bread

• Food is a powerful epigenetic modulator

• Can change our DNA for better or worse

• Average American consumption: 133 lbs of wheat per year

• Gluten “silent germ”

Grain Brain, Dr. David Perlmutter

Sources of Gluten

• Gluten is a protein found in wheat, rye, and barley

• It is also commonly found in oats (and sometimes other grains) that become contaminated during processingEur J Gastroenterol Hepatol. 2008;20:545-554

• There are also many hidden sources of gluten

Potential Hidden Gluten Sources

• Sauces and gravies (wheat flour often used as thickener)

• Marinades

• Soy sauce – use GF tamari instead

• Ketchup

• Cereal

• Stocks

• Salad dressings

• Yogurt and ice-cream (wheat flour often added to prevent ice-forming)

• Hot dogs

• Dips

• Mixed spices (flour often used to prevent caking)

• Candies

• Lunch meats

• Spaghetti sauces

• Soups

• Tabbouleh (contains barley)

• Alternative milks: rice, almond, soy (may contain gluten)

• Instant formula

• Some sodas (esp. those containing caramel coloring – may derive from wheat)

• HVP – hydrolyzed vegetable protein

• Matzo

• Imitation crab

• Miso

• Starch

• MSG (can be derived from wheat)

• Artificial color

• Etc…

Non-Food Possible Gluten Sources

• Charcoal briquettes

• Envelopes

• Stamps

• Dry wall

• Spray starch

• Play dough

• Glue

• Glue sticks

• Soaps

• Shampoo

• Lotion, hand cream

• Talcum/body powder

• Toothpaste

• Lipstick, lip-gloss/moisturizers

• Makeup

• Medications

• Vitamins

• Herbal supplements

Can I Have Some Gluten?

• Eating any amount of gluten can cause damage to small intestines and prevent nutrients from being absorbed into the bloodstream

http://plminstitute.org/wp-content/uploads/2014/02/TOB_2.jpg

Pregnant Women

• Babies born to women who are sensitive to gluten live with increased risk of developing schizophrenia and other psychiatric disorders in life

The American Journal of Psychiatry, 2012

Gluten Effect on the Brain

• An-gliadin anti-body – releases cytokines which are highly antagonistic to the brain

• Anti-gliadin anti-bodies combine with specific proteins in the brain that look like the gliadin protein found in foods leads to more cytokines

Marios Hadjivassilious, et at. Gluten sensitivity: From gut to brain, Lancet, Neurology, March 2010:318-30

Gluten-Related Disorders

WDEIA, wheat-dependent exercise-induced asthma BMC Med. 2012;10(1):13

Comparison of Gluten-Related Disorders

Celiac Disease Wheat AllergyNon-Celiac Gluten

Sensitivity

DefinitionGenetic, autoimmune disorder; gluten ingestion triggers damage to small intestine

Immune response to one or moreof the proteins found in wheat (can include gluten)

Intolerance to gluten or other wheat components

Gastrointestinal symptoms

Diarrhea, bloating, abdominal painNausea, vomiting, diarrhea, bloating, irritation of mouth or throat

Diarrhea, bloating, abdominal pain

Extra-intestinal findings (e.g. anemia, bone loss)

Weight loss, malnutrition, iron deficiency, dental caries, bone loss, skin issues, neurological disorders, liver dysfunction, joint pain, hair loss, fatigue

Hives, rash, nasal congestion, eye irritation, difficulty breathing

Brain fog, neurological disorders, joint pain, fatigue

Positive antibody test

Yes Variable (IGE, IGA) No

Abnormal intestinal biopsy

Yes No No

Non-Celiac Gluten Sensitivity

• The proposed definition of non-Celiac gluten sensitivity includes individuals in whom allergic and autoimmune mechanisms have been ruled out

• Symptoms include:• Abdominal pain

• Eczema and/or rash

• Headache

• Foggy mind

• Fatigue

• Diarrhea

• Depression

• Anemia

• Numbness in the legs, arms or fingers

• Joint pain

BMC Med. 2012;10(1):13

Gluten Digestion

Novak Djokovic's Gluten Free Recipe for Success

Ingredients1 GF Savvy Nutritionist1 Cooperative patient100% Gluten free diet

DirectionsGame.Set.Match.

ServingsOne happy, healthy life

When athletes go gluten-free

No effects of a short-term gluten-free diet on

performance in non-celiac athletes

Lis, D. et al. Med Sci Sports Exerc 2015. NYTimes Jan 19, 2016

PRPs are Difficult to Digest

• Due to their high stability, proline-rich proteins (PRPs) are very difficult to break down

• The digestive enzymes present in the human gastrointestinal (GI) tract are insufficient to completely break down PRPs including gluten

• This is true even in healthy and normal individuals

• In order to properly digest and absorb protein, the body must break down protein into individual amino acids

Food Microbiol. 2007;24:115-119Acta Paediatr Suppl. 1996;412:3-9Am J Physiol Gastrointest Liver Physiol. 2002;283:G996-G1003

A. niger prolyl endoprotease (AN-PEP) for digestive support

• AN-PEP is a naturally occurring enzyme produced from Aspergillus niger, a microorganism commonly cultured to make food and supplement-grade products including:

• Alpha-galactosidase (a digestive enzyme used in popular products to decrease flatulence)

• Gluconates (e.g. zinc gluconate)

• Citric acid

(Image: A. niger, genome.jgi-psf.org, 02/06/2015)

A. niger prolyl endoprotease (AN-PEP)

• A. niger prolyl endoprotease (AN-PEP) is considered a “proline-specific endoprotease” because it digests proteins and peptides over their entire length

• Other endoproteases include the endogenous digestive enzymes pepsin, trypsin, and chymotrypsin

• This is in contrast to “exoproteases”, which preferentially break down only the ends of peptide chains

AN-PEP: Resistant to Stomach Conditions — Acidic pH

• AN-PEP exhibited maximum activity at pH 4.5

• AN-PEP retained nearly 100% of it’s enzymatic activity after 1 hour in the presence of endogenous enzymes.

Am J Physiol Gastrointest Liver Physiol. 2006;291:G621-G629

AN-PEP: Digests Gluten Peptides

• In an antibody-based assay, AN-PEPwas incubated with 4 different gluten peptides (including gliadin and glutenin peptides)

• After 30 minutes, two of the 4 tested peptides could no longer be detected

• After an additional 90 minutes, one more peptide could no longer be detected and 90% of the remaining peptide had been destroyed

Am J Physiol Gastrointest Liver Physiol. 2006 Oct;291(4):G621-9

AN-PEP: Digests Whole Gluten Protein

• AN-PEP was incubated with intact/whole gluten molecules (along with the native digestive enzymes pepsin, trypsin and chymotrypsin)

• The mixture was then separated via HPLC and analyzed via mass spectrometry

• AN-PEP had digested the gluten molecules into 152 unique fragments

152 Peptides+ AN-PEP

Am J Physiol Gastrointest Liver Physiol. 2006 Oct;291(4):G621-9

AN-PEP: Digests Gluten Rapidly

• The speed of protein digestion was tested by incubating AN-PEP with 4 different gluten peptides at pH 4.5

• The half-life of the reactions ranged from 2.4-6.2 minutes

Gluten Peptide Half-Life (minutes)

α-Gliadin (Glia-α-9) 3.87

γ-Gliadin (Glia-γ-1) 2.36

LMW-Glutenin (Glt-156) 5.80

HMW-Glutenin 6.19

Am J Physiol Gastrointest Liver Physiol. 2006 Oct;291(4):G621-9

AN-PEP: Gluten Digestion in a Clinical Study

• In a randomized, double-blind, placebo-controlled, crossover study, healthy volunteers were fed gluten

Gastroenterology. 2014;146(5):S - 545

AN-PEP: Gluten Digestion in a Human Clinical Study• Compared to placebo: AN-PEP:

• Significantly lowered the concentration of alpha-gliadin in the stomach and in the duodenum

• Digested nearly all alpha-gliadin in the stomach within one hour

• Digested alpha-gliadin to the point that it was nearly undetectable in the duodenum

Gastroenterology. 2014;146(5):S - 545

Dr. Rob’s Key Take-Away

• Clinically shown to breakdown gluten before entering the small intestine

• Demonstrated to be effective in acidic condition similar to the stomach

• Digestion of gluten peptides is rapid

• Used when “dining out” in case of accidental, incidental trace exposure to gluten

• (Reality check) May benefit patients who deviate from their gluten-free diet for a special occasion

Endurance athletes who ‘go against the grain’ become incredible fat-burners

Conclusion: Elite endurance athletes who eat very few carbohydrates burned more than twice as much fat as high-carb athletes during maximum exertion and prolonged exercise in a new study – the highest fat-burning rates under these conditions ever seen by researchers

Jeff SV, Daniel JF, et al. Metabolic characteristics of keto-adapted ultra-endurance runners. Metabolism 2015

Breakthroughs in the Treatment of

Concussion

The Brain is the most nutrientdependent, energydependent and toxin and stressvulnerable organ

nutrient dependent,

energy dependent,

toxin vulnerable

Stress vulnerable

Howzabout you get involved all up in here

Skin (fascia)E.C. Matrix

Mechano Receptors

Nerves

Your Brain…

• Weighs about 3 lbs

• Has 100,000 miles of blood vessels

• Contains more connectors than there are stars in the milky way

• The fattest organ in the body

• Could be suffering this very minute without you having a clue

“Grain Brain”, Dr. David Perlmutter

Concussions

• Over 3.8 million concussions reported a year

• Over 250,000 kids every year present to the ER room with concussion from a sport

• Once you receive a concussion, you are 1.5 times more likely to receive a second concussion

• After the 2nd one, you are 3 times more likely to have a 3rd one

Dr. Rob’s Concussion

Protocol

Concussion rehab

Multisystem approach:

• Musculoskeletal system

• Balance

• Visual disturbances

• Dizziness

• Laser

• Nutrition support

Concussion Nutrition ProtocolFeed the concussionInitially After Injury – within 1 day

1) Protein: helps heal the injury. Take 1g/kg of body weight

2) Creatine: gives the brain an intense/immediate energy to heal cells

3) Reduce inflammatory damage to brain DHA, bromelain, quercetin, ginger, turmeric, resveratrol, grapeseed extract

4) Antioxidants: alpha-lipoic acid

5) Choline: critical for brain development

6) Vitamin D: neuroprotective

7) Zinc: enzyme for CNS

8) Magnesium: great weapon against delayed brain injury

9) Acetyl-L-carnitine: energizes the brain

If You Give a Mouse a Concussion

• Using glutathione after a concussion reduced brain tissue damage by an average of 70%

Sports Illustrated, April 17, 2014

Brain-Derived Neurotrophic factor(BDNF)

Supports Branching Network of Neurons

Helps Nerves Grow

Reduces Neurodegeneration

Risk

Makes Neuronal Synapses and Communication More Efficient

Improves Neuron Synapses

Concussion Nutrition ProtocolFeed the concussion (cont’d)

Symptoms persist

• Ratio of substance P to BDNF is excessive

Decrease substance P – natural anti-inflammatories plus magnesium and L-carnitine

Build-up BDNF – DHA, zinc, turmeric, alpha-lipoic acid

Long-chain omega-3 fatty acids (LC-n3-FA) improve brain function and structure in older adults

• LC-n3-FA exert positive effects on brain functions

• They exerted beneficial effects on:• White matter integrity

• Grey matter volume in frontal temporal, parietal and limbic areas

• Increased BDNF

• Decreased peripheral fasting insulin

Witte AV, Kerti L, et al. Cereb Cortex, 2014 Nov;24(11):3059-68

Concussion increases odds of sustaining a lower extremity musculoskeletal injury after return to play among collegiate athletes

Conclusion: Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal injury after return to play than their non-concussed teammates. Study results suggest further investigation of neurocognitive and motor control deficits may be warranted beyond the acute injury phase to decrease risk for subsequent injury

A single concussion may triple the long-term risk of suicide

• New study of mild concussions in Canadian adults suggests risks are even higher for recreational activities

• Published in the Canadian Medical Association Journal

• For weekend concussion – suicide risk increased to 4X the norm

Scientific American. Feb. 8, 2016

Young athletes have an increased risk of prolonged post-concussion symptoms

• Ages 13-18 took an average of 90% longer to recover

• Study demonstrated an increased probability of prolonged concussion symptoms among lighter weight females vs. heavier weight

• Consider “playing up” on varsity teams

J of Pediatricians, Jan 8, 2016

Women’s Brains May Have Tougher Time Recovering From Concussion• Research shows female athletes suffer concussions at higher rate than

male athletes playing similar sports

• One theory – women have weaker muscles in the neck that are a factor in how head injures affect them

Broglio, S., Ellemberg, D. Apr 28, 2015, Radiology online

Menstrual cycle influences concussion outcomes• Women injured during the 2 weeks leading up to their period

(premenstrual stage) had slower recovery and poorer health 1 month after injury compared to women injured during the 2 weeks directly after their period or women taking birth control pills

• Progesterone is known to have a calming effect on the brain and on mood

Journal of Head Trauma Rehabilitation Dec. 2010, p.2255-60

Menstrual cycle influences concussion outcomes (cont’d)• “Withdrawal hypothesis”: If a woman suffers a concussion in the

premenstrual phase when progesterone levels are naturally high, an abrupt drop in progesterone after injury produces a kind of withdrawal which either contributes to or worsens post concussive symptoms like headache, nausea, dizziness and trouble concentrating

Journal of Head Trauma Rehabilitation Dec. 2010, p.2255-60