There is one key thing about nutrition that modern Western Medicine gets wrong over and over and over.
I call it the "all or nothing" approach to nutrition. Basically, every food group, ingredient, or nutrient is either good for you (eat it all the time!) or bad for you (never, ever, ever eat that!). When the medical research seems to indicate a connection between a particular food item and a health condition, the response is to reduce the intake of that food down to as close to zero as possible. There have been many vilified foods: saturated fat in the recent past, carbohydrates currently, and for many people, ever since a high blood pressure reading at the doctor's office, salt. For a long time the recommendation has been to reduce intake of sodium as low as possible, with a maximum of 1,500mg/day for those with hypertension or cardiovascular disease. The problem is that nutrients don't work like that. Nutrients work in a way that has been described by many as "The Goldilock's Principle".
In 2013 the National Academies of Science's Institute of Medicine undertook a massive evaluation of all the available evidence. They combed through hundreds of studies on the relationship between sodium intake and cardiovascular disease, kidney health, blood pressure and blood lipid levels. What they found should change how we think about salt intake. (here's a link to the study)
Just right...What they found is that reducing your sodium intake down to 1,500mg/day doesn't provide additional benefits to blood pressure. It also increases the risk of adverse effects. It leads to an increase in triglyceride levels, negatively impacts insulin levels, and increases the risk of chronic heart disease when compared to those consuming a more moderate level of sodium. Reducing sodium intake IS an appropriate intervention only IF your sodium intake is extremely high, (say 5,000mg/day or more) but if you are getting the typical amount for an American (2,900-4,200mg/day) you are unlikely to gain additional benefits by further reducing your sodium intake. That's because optimal sodium intake, like most nutrients, is defined by "the Goldilock's principle" (you thought I'd never come back and explain that, didn't you?) Basically, you could draw the optimal intake for sodium as a bell curve with an optimal range somewhere in the middle. Get a lot more, or a lot less than that optimal range and symptoms start to pop up. You want it to be "just right.". (there are a few genetic variants for which sodium restriction will have a more pronounced effect, the bell curve moves to the left for people with these genetic variants. These "salt-sensitive" people are identified by our genetic consultations.) When you do consume salt, it's a good idea to move around the world (Himalayan sea salt this month, Mediterranean sea salt next month) as each region will produce salt with slightly different trace mineral content; mixing it up will optimize your intake of these trace minerals.
*A Little Aside: To Iodize or not to iodize?
The presence of iodine in the absence of sufficient selenium (rampant in America) can trigger autoimmune thyroid disease. Iodization of our salt coincided with a 4 fold increase in auto-immune thyroid disease. However, Americans are often also iodine deficient. What to do? My recommendation to my patients is to get your iodine by regularly consuming seafood and seaweed (sources that contain both iodine and selenium), and to avoid iodized salt.
So, what is the optimal Nutritional Approach to High Blood Pressure
There is, however, a large body of evidence supporting increasing potassium intake to improve blood pressure. (Here's a massive meta-analysis) This isn't surprising as sodium and potassium work in a push-pull relationship, controlling cell membrane gradients, and influencing kidney excretion of one another. Adequate intake for potassium is 4,700mg/day for adults. In addressing high blood pressure in patients, I've often had them track their daily potassium intake. The majority of my patients found they were consuming in the neighborhood of 2,000mg/day, or less than half of the recommended daily intake. Once they bring their potassium intake up, blood pressure drops. It is a great intervention because it is rapid, reliable, and simple to implement. Track your potassium intake for 1 week and maintain at least 4,700mg/day. By the end of the week you can expect your blood pressure to be down by around 15 points (seriously).
Two other important nutrients for blood pressure control are magnesium, and soluble fiber. You can get potassium, magnesium, and soluble fiber in plentiful amounts with a single intervention: eat more fruits and veggies. Aim for at least 6 servings per day. It's easy: reach for a fruit or veggie instead of potato chips or a granola bar when you want a snack. Have a fruit or veggie with each meal.
Just a few short years ago, everyone was taking Fish Oil.
Now it doesn't seem nearly as popular, and for good reason. The studies are not consistent on the impact Fish Oil has on the body. We'll cover what happens when Fish Oil goes in the body and why too much may be a bad thing.
Here's why we take it:
Fish Oil provides Omega 3 fatty acids (so termed because they have a double bond located 3 carbons from the end of the molecule.) You may have heard of Omega 6 fatty acids? Yep, you guessed it, 6 carbons from the end in that case. This fairly simple difference changes how easily these molecules bend, The Omega 3s are more flexible, and make structures built out of them more flexible The Omega 6s are stiffer and make structures more stiff.
Ok, so? Omega 3 and Omega 6 fatty acids have very different impacts on the body. They integrate into the cell membranes and influence the viscosity of the cell wall. They also become the precursors for hormones called prostaglandins. If there are more Omega 3s, then it will be more likely that an anti-inflammatory prostaglandin will be formed. If there are more Omega 6s, then the prostaglandins that are made are more likely to induce inflammation.
It's all about the ratio.Our evolutionary ancestors consumed between 1:1 and 3:1 omega 6s to 3s. The typical American diet, because of its reliance on certain types of oils and grains, runs closer to 20:1. Now you know why that's a bad thing, and means a lot more inflammation.
Omega Fats are fragileOkay, so omega 3s are good for you. But only up to a point. They are also very fragile molecules. If not sourced from from high quality fish oil, omega 3s can actually cause some harm. Not only that, but your total intake should be pretty low. (they should only make up about 1% of your total caloric intake, about 1 teaspoon) Chris Masterjohn (PhD in lipid biochemistry) likens Omega 3s to wine glasses. They are fragile, so you'd rather not have them all over your house. A few is good, more is not better.
Okay, so what should you do?Quick and simple, here's the take home:
Do you have a favorite brand?
I'd love to hear about your experience, questions or comments.
All the best,
Sometimes surgery is a necessary step in healing. What can you do to help make sure it is successful?There are some dietary and supplement strategies you can use prior to surgery to improve the success rate and reduce the risk of complications. Here's a step by step guide.
It's all about building your reserves. Surgeons are understandably a little wary about their patients taking supplements prior to surgery. Vitamins, supplements and herbal products can alter the way the liver breaks down medications, impact clotting ability, or create synergistic effects with anesthesia drugs. You should always follow the recommendations of your surgeon regarding avoiding supplements prior to your surgery. However, the few months leading up to your surgery are all yours. It's during these few months that you want to build up your stores and support the cell-level availability of these nutrients.
ZincZinc deficiency is especially common in America (I covered this topic earlier in this newsletter). Take 30mg per day for 6-8 weeks leading up to your surgery. Zinc is helpful prior to surgery because:
Fish OilThe omega 3 fatty acids derived from fish oil incorporate first into your cell membranes where they are then utilized as needed to synthesize important hormones in the body called prostaglandins. The more omega 3 fatty acids you have stored up in your cell membranes the more your prostaglandins will reduce inflammation. Think of it like stacking the deck for health. Start about 3 months before your surgery and take 2,000 mg/day. If you are curious about how well set up your system is with omega 3s already, there is a simple blood test that most alternative medicine practitioners can do to see what your omega 3 to omega 6 ratio is. Fish Oil is a tricky supplement to buy, because while good fish oil protects you, bad fish isn't just neutral, it is actually really bad for you. You want to make sure your fish oil is high quality, and you want to store it in your refrigerator. Here’s the product that I use for my patients. I have a newsletter article coming up on selecting good fish oil so stay tuned.
Vitamin DVitamin D is crucial for both infection reduction and to support healing. Vitamin D has been shown in studies to reduce the risk of antibiotic resistant hospital acquired infections such as MRSA. An optimal approach would be to do blood work to identify your vitamin D level, then supplement based on your needs. If blood testing isn't an option for you, take 4,000iu per day for a month before your surgery.
SeleniumTopical iodine wash is still used in the majority of surgical preparations. Enough iodine is absorbed through the skin by pre-surgical antiseptic wipes that iodine excretion in urine is 7 times higher the day after surgery. (study) Iodine is a benign mineral in many people, but in those with inadequate selenium stores, a sudden increase in iodine can exacerbate or trigger an autoimmune attack against the thyroid gland. Selenium is also a cofactor in the synthesis of the body's main antioxidant, glutathione (study). Take 200mcg per day for a month leading up to surgery. I prefer this product for its bioavailability. Brazil nuts are also very high in selenium.
Magnesium Magnesium improves perfusion by regulating blood vessel dilation. It supports healthy muscle contractions, helps to maintain regular heart rhythm, and is depleted by physical stressors (such as surgery)
ProbioticsPost surgical infection is one of the most common complications impacting patient recovery and surgical outcomes. Because of this risk, the importance of antibiotics in surgery is hard to overstate. However, those antibiotics can result in their own side effects. The most serious concern from antibiotic use is infection by an opportunistic pathogen called Clostridium Difficile. When the healthy bacteria in the gut are wiped out by antibiotics this unhealthy bacteria can take over resulting in long lasting and serious complications following surgery. Prior to surgery a product such as Ultra Flora Balance would be best to build up numbers of healthy bacteria. Following surgery, a stronger formulation such as Ultra Flora Intensive Care is more appropriate.
CollagenThis one is more appropriate after surgery, although, most people would benefit from adding collagen to their general supplement line-up as well. Collagen powder provides the building blocks to repair tissue. Collagen figures into the structure of most of our tissues: bones, skin, hair and, of course, cartilage. The main amino acids found in collage are proline and glycine, which are non-essential amino acids (meaning your body can make them from other amino acids.) However, the demand for these building blocks is so high during surgical recovery that it is likely that demand outstrips supply. Adding collagen speeds healing, and ensures scars heal more smoothly. Glycine (one of the amino acids found in collagen) also figures prominently in other body systems including neurotransmitter function and synthesis. When it is deficient, adding it back in usually has a calming effect.
Carb-LoadingBecause surgery is a physiologically stressful event for the body, there are several natural responses that take place. Stress hormones shoot up in response to surgery. These stress hormones mediate various effects, one of them is the rapid increase in blood glucose. Remember that glucose isn't all bad. It is a problem when it is elevated for a prolonged period of time, such as in diabetes or metabolic syndrome, but in the short term this increase in glucose is valuable. Glucose is the fuel the body uses to power the machinery of healing. The glucose is converted into ATP in the cells. The more healing that needs to take place, the more glucose and ATP is needed. When athletes carb load they are trying to fill the glycogen stores (where glucose is squirreled away for future use.) It's a good idea to spend the day before your surgery filling these storage sites as well. In fact many surgeons are beginning to relax their recommendations on fasting prior to surgery, sometimes suggesting a clear, sugar containing drink in the 6 hours prior to surgery. (Please ask your surgeon before adding this to your preparation) There have been several studies (study, study, study) examining the benefits of pre-surgery carb loading. Some of the benefits include:
RelaxationStarting off your surgery in a mentally relaxed state improves both short term and long term outcomes. Cardiac surgery patients have poorer outcomes if they were exposed to high stress prior to their surgery (study). Mental and emotional stress also reduce both immunological function and the healing response (study). Stress is associated with an increased risk of post-surgical complications, and poorer pain control. The clear take-home message is to stay relaxed prior to your surgery. Bring some headphones with your favorite music to get ready for your surgery. Bring along the people that calm you down. Take a nice walk the morning of your operation. Of course, staying calm before a surgery is easier said than done. However, the ability to relax at will is something that can be cultivated. Engaging in a regular, daily relaxation practice (prayer, meditation, etc.) for a month or two prior to your surgery will help to improve your ability to keep your cool when it counts.
Happy to help.
I hope you find this information useful. Feel free to hit the reply button and let me know about your experience, or any additional questions you have.
PS: Here's a link to an exercise you can do after your surgery if you (like many people) experience post surgical ileus (a common surgical complication where the intestines don't immediately start moving again). It was a great help to me after surgery.
How Nutrigenomics can Optimize Diet for Bone HealthIn the July issue of Jama (Journal of the American Medical Association) there was an article outlining the results of a huge meta-analysis of genes related to calcium absorption, use and excretion.
The study looked at hundreds of thousands of patients and compared their genetic data to their blood calcium levels. They found that there were several genes that influenced calcium levels, and 6 genes that had a significant impact on the circulating calcium levels.
In this week's article we look at why this is important in the treatment of osteoporosis and more importantly in protecting patients against cardiovascular disease.
Read the Abstract in Jama
Calcium is a double edged swordStudies are mixed on calcium supplementation. Although it has been recommended for osteoporosis prevention for decades, many studies have found that supplementing calcium increases the risk of cardiovascular disease. (Study, study). Calcium supplementation in women with existing cardiovascular disease has also been associated with an increased risk of dementia (study). In this current study those participants who had the genetic variants associated with higher blood calcium levels also had increased risk of heart attacks and strokes as well. Not all studies have been consistent on this topic. Many studies failed to find any significant connection between calcium supplementation and cardiovascular disease. These genetic variants influencing calcium absorption, utilization and excretion may provide the missing piece of the puzzle that explains these discrepancies.
It bears stating that this doesn't change the basic tenet of nutrition, namely, that nutrients exist and operate within the fabric of a complex diet consisting of various nutrients. You can't provide a single concentrated nutrient as a supplement and expect it to behave as it does in a healthy diet. Calcium is no different than any other nutrient in this regard, and depends on other nutrients for proper use. The best approach is, as always, a complex, nutrient dense diet rich in whole, unprocessed foods.
Vitamins D and K influence the function and absorption of CalciumIn those with sufficient vitamin D, calcium is less likely to end up plastered to the blood vessel walls. Sufficient vitamin D stores also seem to help regulate absorption. In order to provide adequate Vitamin D through sun exposure, a minimum of about 10 minutes in full sun, exposing arms and legs is needed 2-3 times per week. (study) Vitamin K2 also helps to protect blood vessel walls from calcification by supporting the proteins that clean calcium out of the blood vessels. (article)
So what about your Genes?Genetic consultations at The Parani Clinic consist of 3 one hour sessions where we dive deep into your genes. We evaluate genes like the ones appearing in this study as well as hundreds of others. Our goal through these sessions is to give you a detailed template for the best practices for your health; from the best diet for you to the most effective exercise approaches, and specific lifestyle strategies. We can often identify environmental toxins that your system is especially sensitive to and help you to form strategies to avoid exposure to them. As in the case of calcium for the participants in this study, there are nutrients you will need in smaller amounts and some you will need in larger amounts based on your genes. The capacity for personalized genetic medicine to optimize your health through uncovering all the specific fine adjustments about how your body functions is exciting and promising. It allows us to identify and treat disease long before it appears.
In the context of osteoporosis, if a person has multiple genes that increase circulating calcium levels, then attempting to address osteoporosis by adding a calcium supplement is not only ill advised, it should be avoided as it will likely increase their risk of heart attack or stroke without offering much benefit in terms of bone strength.
For those with genetic variants increasing calcium levels, here are a few simple interventions that are likely to be helpful:
You Can Sign up for a Genetic Consult Here
Did you enjoy this material?
Comment and let us know what other subjects you'd like us to cover.
Who should take CoQ10 and Why?
I've had numerous conversations about this subject in the past few weeks so I thought it would be a good time to do an article on it.
First of all, What is CoQ10?It stands for Coenzyme Q10. It is a compound that is naturally made inside the body. It performs various functions in the body including providing antioxidant support for blood vessels, helping to utilize energy in the cells, protecting cell membranes from damage and assisting in the production of other useful compounds and enzyme functions.
It protects the blood vessels
Coenzyme Q10 is one of the main fat soluble antioxidants that the body uses to protect the blood vessels from damage. Oxidative damage cause body tissues to break down and attracts inflammation. When this happens in the blood vessel walls it leads to arteriosclerosis, high blood pressure, and cardiovascular disease. CoQ10 protects the blood vessels from oxidative damage.
It helps make energy
Inside the cells there are small structures called mitochondria that convert sugar and fat into energy, CoQ10 helps this conversion to occur. For this reason it often helps to alleviate fatigue (study). In some kinds of migraine headaches where energy utilization contributes to the onset of migraines, CoQ10 has been found to be effective.
It lowers blood pressure
Coenzyme Q10 is effective and safe for the treatment of high blood pressure. As CoQ10 makes the blood vessel walls healthier they also become more flexible, reducing blood pressure. In a meta-analysis CoQ10 was found to lower blood pressure by as much as 18 points.
So who should take CoQ10?First of all, anyone taking a Statin should be taking CoQ10 because statins inhibit the body's ability to make CoQ10. (study) Especially those who experience adverse effects from statins such as muscle pain or brain fog (study). For these symptoms try 100mg/day for 4 days then increase by 50mg per day until your symptoms are reduced, up to 500mg/day.
Second, if you have high blood pressure you can use CoQ10 to reduce it. Try 200-300mg/day. (By the way, there are a lot of dietary interventions that are especially effective for blood pressure, here's a video I did on it.)
Lastly, if you are experiencing fatigue (or fatigue that triggers migraines) try CoQ10 200mg/day. This is more likely to be effective for you if you also suffer from fibromyalgia symptoms like muscle pain, mental fatigue, and metabolic dysfunction.
A Final Notes
CoQ10 is available in two forms (ubiquinone and ubiquinol). The research is unclear on which is better. Most studies seem to indicate they work equally well (although ubiquinol is much more expensive!). In our clinic we use ubiquinone and have only had good results with it.
Sinus symptoms have been especially frequent lately.
They are common this time of year. But here are some steps you can take to prevent, and treat them...
1. Start with DietFortunately for you there are quite a few easy steps you can take that have a big impact:
Consume a wide variety of fruits and vegetables. As excellent sources of the mast cell stabilizer, Quercitin, fruit and vegetables can reduce the frequency and severity of allergies that may precipitate sinus congestion or infections.
Also, by boosting the immune system fruits and vegetables can also reduce the frequency and duration of colds and viral infections affecting the sinuses. For the best results, emphasize capers, citrus, fresh herbs, and leafy greens. If you have a hard time getting enough fruits and vegetables in, download our daily tally card to keep you on track.
Unknown food allergies can also be a big contributing factor. Foods that irritate your digestive system stimulate the production of phlegm and mucus. If you feel increased mucus in your throat after consuming a particular food, chances are good that it is contributing to your sinus congestion. If dairy is an issue for you, check out our article on A2 milk.
2. Fix your PostureIncreased muscle tension in the shoulders, neck, upper back and pec muscles can trigger referral pain patterns that result in pain in the sinuses. More importantly, muscle tension in these areas also reduces lymphatic circulation resulting in a slower immune response to pathogens in the sinuses, making infections more frequent. Lastly, circulation and drainage of the sinuses can be impeded by structural problems associated with muscle tension in the upper neck and facial muscles, resulting in more congestion and more pressure.
Here's a good exercise for relaxing the neck, head and upper back:
-Imagine a string drawn from the top of the head up to ceiling is suspending you. Stretch up towards the ceiling from the top of your head.
-Now lift your shoulders up towards your ears and inhale.
-Roll your shoulders back, exhale, and let your shoulders drop.
-Roll your hips side to side feeling for any tension or asymmetries, relax into a neutral position in the hip.
-Carefully hold this position and take large, yawning breaths. If you did it right you may feel your ears pop. Nice job!
3. Hydrate!Your body needs fluids to support healthy circulation through the sinuses. The best fluids are warm liquids such as tea and broths. Sweet drinks, and dairy are likely to increase your congestion. Ideally, you should have water available to you all day. If you keep it next to you at your desk or work, and in your vehicle, chances are you'll drink enough without even trying.
4. Practice the Ancient Technique of Guasha. In Traditional Chinese Medicine, guasha is a technique done to increase circulation and reduce inflammation in a specific region, meridian or tissue. In the case of sinus congestion, you want to perform the Guasha on the upper back, on either side of the spine.
To perform guasha, you'll need a flat tool with a blunt edge, the ceramic soup spoons you get at a Chinese Restaurant are an ideal implement, but you can also use a ladle, the rim of a coffee mug, or the handle of a comb. Apply some lotion of oil to the skin, then scrap down the skin from top to bottom, applying a little bit of pressure. It shouldn't be painful, but you should use enough pressure to turn the skin red.
This opens up the lymphatic drainage from the throat and sinuses to help drain the fluid, but also transport antigens from the bacteria or virus present in the sinus cavity to the rest of the immune system so that antibodies can be formed to respond to the infection.
Work with a Professional!Acupuncture, Herbal Medicine, and Targeted Nutritional Recommendations can take treatment to the next level, and treat the root causes of your sinus congestion.Often, there is an underlying cause for frequent sinus congestion. Often stemming from issues in the digestive system. Working with a practitioner for these symptoms can speed up recovery, as well as prevent future illness manifesting from the same cause.
We'd love to hear from you. What works for you when you get sinus congestion? Any questions about treatment or management?
Thousands of years ago, all milk was A2.
All the cows in the world only made A2 milk. Then, a few thousand years ago, there was a genetic change, a mutation that changed the milk that some cows were making into A1 milk. From a structural, molecular level, it's a very small change, but this small change may have a big impact on your health.
More likely than not, all the milk you drink has always been A1 milk. Cows producing A1 milk tend to have higher production, so most dairy farms use A1 cows. The milk they produce contains varying ratios of the two proteins, but it's usually mostly A1. Cows genetically tested and certified to be producers of A2 milk, get to label their milk as such. The potential negative effects of A1 milk are thought to be fairly wide reaching (autoimmunity, allergies, diabetes, and autism). How a small change can have such a big impact comes down to how the digestive system breaks down proteins.
So here's the nitty gritty.
Humans, goats, and sheep all make A2 milk, but in some breeds of cows there was a genetic mutation, like said above, thousands of years ago which changed the milk these cows made into A1 milk. The A1 vs A2 differ in the structure of a protein found in milk called beta-casein. A protein is a long string of amino acids, like beads of a necklace, all strung together. In A2 milk the 67th position in that chain is a proline amino acid, while in A1 milk, it was changed into a histadine. That seemingly insignificant difference changes a lot. Your digestive system is very good at cleaving protein strands at specific bonds, depending on the types of amino acids located there. The histadine in A1 beta-casein makes a weak link in the chain and an easy spot for the digestive juices to chop that protein down, producing a 7 amino acid long chain called beta-casomorphin 7 (BCM-7). BCM-7 is the culprit here and the compound responsible for the damage that A1 milk is thought to cause. If BCM-7 makes it across the intestinal membrane intact, it is able to bind to opioid receptors, trigger the immune system, reduce neurological antioxidant status, and is likely the cause of the allergic reactions many people experience when they drink milk.
There is fairly robust evidence for the damage caused by A1 milk and BCM-7. Correlational studies have connected consumption of A1 milk to autoimmune conditions, milk allergies, autism, type 1 diabetes and milk intolerance. Schizophrenic and autistic patients tend to have higher circulating blood levels of BCM-7. Anecdotally, in my practice, patients who cannot tolerate cow's milk, often do well on goat's milk (which is exclusively A2). BCM-7 is especially problematic in patients who have compromised gut integrity, aka: leaky gut. When leaky gut is present the BCM-7 is able to cross the intestinal membrane and enter the blood stream, where it can significantly impact health. This may explain why many people can spend most of their lives happily enjoying dairy with no problems then suddenly develop an intolerance (after the gut integrity has been compromised). This is also a big problem for infants, who start out with a permeable intestinal membrane. It has been long known that cow's milk is dangerous for infants, implicated in sudden infant death syndrome, asthma, allergies and type 1 diabetes. BCM-7 may be the culprit.
Despite relatively robust evidence of the harms from A1 milk, the medical community is far from in consensus on the subject. Studies on the negative effects of A1 milk are not always consistent, and lively critiques of the A1 vs A2 distinction have been published in various nutrition journals. Any time a large industrial interest exists in a health debate the evidence has to be evaluated with more caution and there are financial interests on both sides of the A1 vs A2 debate. The final word should always be your own experience. While I personally believe that there is sufficient evidence to chose A2 over A1 milk, I think the importance of that decision is dependent on your gut health, your immune system and your overall health status.
Here's the bottom line:
Milk can still be problematic for reasons besides BCM-7. It can be the lactose, the whey, the casein, or various other proteins that you are reacting to. If you do fine with goat products, but can't do cow's milk, then you are more likely to do well with A2 milk. If you are suffering from mild symptoms like nasal congestion or skin reactions when you consume milk then, by all means, try A2 milk. If you are suffering from a severe autoimmune condition and you have eliminated milk from your diet because it impacts how you feel, it would be safest to continue to abstain from consuming dairy. Why? Well, when there is one immune activating agent present, the compounds around it are also more likely to develop immune recognition. In other words, it's guilt by association. While A2 milk may not have BCM-7, it still has whey, and other protein fragments, that your body may have become sensitive to while reacting to BCM-7. In your case, the stakes are likely too high.
Want more information?
"The Devil in the Milk", written by Keith Woodford in 2007
This Mother Jones Article
Here's a good review in the European Journal of Clinical Nutrition countering many of the arguments from the A2 camp.
SIBO stands for small intestine bacterial overgrowth, basically bacteria growing in the small intestine, where they shouldn't. You should have a healthy community of bacteria in the intestines, but they should be isolated to the large intestine, the colon, farther down the digestive tract. When these bacteria end up in the small intestine all sorts of problems ensue.
Why are there bacteria in the intestines at all?
Well, like we said they should be in the large intestine, where they play an essential role in good health. As long as it is the right type of bacteria, in the right place, they do a lot of good:
Patients with SIBO Often Experience:
Bacteria Digest Your Food Before you Do
When you consume food, especially starchy foods, the bacteria in your small intestine will digest that food. Unfortunately, when bacteria break down food they generate gas. That gas builds up in the intestines and results in bloating and pain. That's the same reason that people with lactose intolerance get pain. When they consume lactose and can’t break it down, bacteria do instead. Having SIBO is like being lactose intolerant, and gluten intolerant, and fruit fiber intolerant, and grain intolerant, etc, etc. The bacteria break down all these different foods before you can, and you end up with the gas and bloating.
Bacteria Impact your Intestinal Motility-Causing Diarrhea or Constipation
The gasses that these bacteria produce have impacts on your intestinal peristalsis. Peristalsis is the wave-like movement of the intestinal muscles that carry your food down your digestive tract towards your large intestine. There are different types of bacteria in the intestines, and depending on the type present you may get diarrhea (if they are producing hydrogen, which stimulates persitalsis). Or if you have a different type of organism (technically an Archaea rather than a bacteria) that produce methane, which paralyzes the intestinal wall and results in constipation.
The Small Intestine is an Immune System Headquarters
The immune system is extremely concentrated and active at the intestinal margin. As the contents of your meals are pass by, your immune cells are busily sampling and watching, trying to get the jump on any invaders and responding to any infections. With SIBO there is a constant presence of bacteria in the intestines, the immune system stays perpetually activated, and tires out. This results in a steady and constant low level of inflammation which is particularly problematic. Constant inflammation depletes the adrenals, affects hormonal balance, interrupts sleep, circles back and further disrupts digestion, taxes energy, and can disrupt immune function increasing risk of autoimmune conditions.
Bacteria Fragments are Inflammatory
When you get sick you get the usual, tell-tale symptoms of body aches, chills and fever. Those symptoms are your body reacting to highly inflammatory fragments of bacteria called lipopolysaccharides. (LPS for short) These LPS trigger your immune cells telling you that there is an infection present and to get into bed and let your immune cells get the job done. When you have SIBO the bacteria populating your small intestine are constantly reproducing and dying. As they die they break down and the LPS are absorbed into your body. Even though they are dead they still trigger the immune system and cause those same symptoms that come with getting sick. This usually leaves you feeling sore, achy, and tired but without any hope of a nap and some chicken noodle soup helping matters.
Bacteria Produce Compounds called Biogenic Amines
When proteins sit around bacteria break them down. That’s why they go bad. The amino acids (proteins) are broken down by bacteria. Well, when you have bacteria living in your gut they do the same thing with your last meal. Your food is aging as it is moving through your gut. This is obviously not a good thing. This is a little complicated to explain, but it really helps in understanding how some of the symptoms of SIBO come on so stay with me. Specifically, what is happening is the bacteria in your gut convert the amino acids in that protein to other forms of these molecules, forms called biogenic amines. One example of a biogenic amine is histamine. We all know how histamine feels: itchy eyes, swollen throat, sneezing, itchy skin, hives, etc. Histamine is a converted form (or a biogenic amine) of the amino acid histadine. As the amino acids in your food get exposed to the bacteria in your gut, they get converted into these irritating forms. This is a problem for your body. In fact there is a special enzyme in your intestinal wall called diamine oxidase that converts histamine back to histadine as it is absorbed. This enzyme works fine with the amount of histamine normally found in food, but it isn’t able to keep up with the increased histamine created by the bacteria in SIBO. The excess histamine is absorbed un-changed, causing a whole range of symptoms including itching, migraines, irritability, anxiety, and joint pain. Other examples of biogenic amines are tyramine from tyrosine, and trimethylamine from carnitine, and they can all be problematic in a variety of body systems.
SIBO Causes Leaky Gut
The most serious complication of SIBO is that it results in a breakdown of the intestinal lining. This lining is a sophisticated, "smart" membrane that allows the constituents of food through, but keeps out all the things we don’t want, things like chemicals, heavy metals, pesticides, and bacteria. When SIBO is present, bacteria build up at the intestinal wall and the immune system mounts a response against them. Because the SIBO usually can't be cleared without the use of additional supplements or medication, the immune response goes on and on. The prolonged immune response results in a breakdown of the intestinal lining, and permeability, or leaky gut ensues. The integrity of this lining is vital for all sorts of processes in the body, and most importantly, for proper immune regulation. When the gut becomes permeable, the immune system is constantly exposed to things that aren't necessarily invaders needing a reaction, but still cause an activation of the immune system. Among all the things absorbed, there are some proteins in our food that are, structurally, fairly similar to structures in our own body. (for example milk protein and pancreatic cells) The immune system sees these similar structures so much that, in time it begins reacting to tissues in our own bodies as well. This process of autoimmunity is called molecular mimicry, and the role intestinal permeability plays in it has become widely accepted among the world’s leading immunologists.
How Do I Know if I Have SIBO?
Most people are used to laboratory testing being an expensive and inconvenient experience. However, SIBO testing is both easy and affordable. SIBO is tested using a simple ingested solution and a breath test. It takes about an hour to complete and costs around $130. At our office we use the Metabolic Solutions test because it is easy for our patients, affordable, and tests for both hydrogen and methane producing organisms. We typically get results back within one week.
What is the treatment for SIBO?
There are two parts of treatment: Lifestyle and Supplementation. Lifestyle treatment involves dietary changes and lifestyle management (such as stress reduction, and sleep support). Supplements depend on the specific causes for your SIBO, but for the most part we follow the four Rs:
Thanks for reading.
I've recommended making bone broth to a number of my patients in the past. It's a fantastic source of nutrition for a lot of reasons that I'll get into in a moment. The problem is, I've had a lot of patients come back and tell me that either it was too much work to make, or it didn't taste very good and so they stopped doing it. I'm writing this post to try to make the process easier and make the final product more flavorful.
When made properly it's rich and flavorful. In classical french cuisine, bone broth is the first step in making the mother sauce known as Demi Glace. If you've eaten at a four star restaurant and ordered lamb, steak, or wild game chances are the sauce used on your plate started with a version of the recipe below. It's not only very good for you, it's also very, very tasty.
First, why is it so nutritious? Bone broth is rich in the amino acids proline and glycine. These amino acids are involved in various processes in the body, most importantly including the formation of collagen. These amino acids are linked together in long chains that ultimately become the collagen in your joints, the gut lining, your skin, and your hair as well as any wound healing that is occurring in the body. Proline and glycine are known as non-essential amino acids, meaning the body can make them out of other amino acids. In a normal state (not healing from an injury, without any chronic joint issues, and obtaining sufficient nutrition) the body does pretty good at making these two amino acids to meet demand. But in the case of people with injuries, gut issues, poor nutrition or very active lifestyles it is unlikely that enough of these amino acids are being made to fully meet demand. For these people it is important to get them from the diet. Bone broth is also rich in micronutrients such as calcium, magnesium, silica, chondroitin, and hyaluronic acid.
It's important to start with high quality ingredients: bone from traditionally raised animals. That means if it's cow bones you are using then they are grass fed, and organic. If you are using chicken bones the chickens should be free to graze, eating insects and foraging. There are many farms where you can get these "pastured" chickens. "Free range" or "cage free" does not necessarily mean that these chickens are out foraging. The important thing is that they are free to eat their traditional diet. If they do then they are packing their tissues with the nutrients that are best for them and for you, and not just with the limited nutrients that come in their feed. If you are using other bones such as fish, lamb, or game, again look for animals that are living as close to their natural life and diet as possible for the sake of your health (and their happiness). Look for the bones with lots of tendon and ligament attached. That will increase the amount of proline and glycine in the final product. Often these bones are labeled as dog bones. Don't be shy, those are usually the best ones. Look at your local store, or ask the butcher if you don't see them available.
Use organic vegetables as well, and the fresher the better. Clean, pure water from a well is ideal. If you are on city water then make sure you are filtering the water.
Here's the recipe:
-Large stock pot or crockpot
-Baking sheet pan
-A pile of bones:
4 or 5 large cow bones, a whole chicken carcass, or several fish heads and spines. There isn't an exact amount here. I keep a ziplock bag in the freezer and add bones to it over the course of a few weeks. Once I've accumulated enough I'll make another batch of bone broth. The amount of bones you use will depend on the size of your stock pot or crockpot.
Named for an 18th century French general, a mirepoix is a mixture of vegetables for making a flavorful stock. Traditionally this means onion, celery, and carrots. I use roughly equal parts each by volume. For one batch I typically use one to two large onions, one whole head of celery and 5 or 6 large carrots. In terms of volume I usually have about as large a pile of veggies as I have of bones.
-Tomato Paste (a small can)
-1 T grass fed butter, tallow, olive oil, ghee, or bacon fat
-Lots of cold pure water
-Various fresh herbs such as parsley, thyme, oregano, lavender, rosemary, whatever is handy, and a single bay leaf
-5 garlic cloves, each cut in quarters
-A dozen or so peppercorns
-Dash Sea salt
-1/3 cup red wine
-1/8 cup vinegar (apple cider, or red wine vinegar)
1. Throw the bones on a baking sheet, slather them with a little bit of tomato paste and put them under the broiler. Broil till slightly browned, turning over periodically, usually about 20 minutes.
2. While the bones are broiling chop the veggies roughly into medium a dice.
3. In your large stock pot add the olive oil butter, tallow, bacon fat, ghee or other source of fat. Saute the veggies over low to medium heat for about 30 minutes, until they are all softened and taking on just a very slight caramelization. Be careful not to over brown them as they can impart a burnt flavor into the broth.
4. Add the red wine to the pot and deglaze the bottom. Allow the red wine to reduce down for a few minutes.
5. Add the bones to the pot and fill with as much water as it can safely hold.
6. Add all the remaining ingredients. There is no need to chop the herbs. The larger cut of the garlic keeps that flavor from becoming sharp and makes the garlic flavor more mellow. The vinegar is added to create a slight acidity that pulls some of the other nutrients (like magnesium and calcium) out of the bones.
7. Simmer over a low heat for 8-24 hours until it has reduced down to about 1/3 its original volume.
8. Taste it periodically. Adjust the flavor as needed with some salt, pepper, or more herbs. When its flavor is sufficiently concentrated for your taste it's done. You know that you did a really good job if when you put a small cup of it in the fridge it comes out set, like jello.
9. Strain out the veggies and bones. Store the broth in (glass) jars in the fridge and freezer. As I strain the broth out I reserve the pieces of meat and tendon that have been softened for so many hours of cooking. They go great into soups. Sometimes I'll just eat them straight, or add them to a bolognese.
To warm the broth you can pour a 1/4 cup into a coffee cup and set the cup into an inch or so of water in a pot on the stove and warm it on low. I prefer not to microwave my broth. Ideally this broth should be consumed twice daily for those healing, resting gut integrity or in the case of post partum women. In the rest of us, just trying to stay as healthy as possible, I'd recommend it daily or every other day.
For more information take a look at Mark's Daily Apple, he wrote a great segment on Bone broth a while back.
How Important Is Zinc?
More important than you think.
Here's the short list:
Diabetes, Neuropathy, Mood Disorders, Digestion, Sleep, Immune Function, Cholesterol, and the sense of Taste.
Zinc is crucial for all of these and more. Zinc is required for the proper functioning of more than 100 enzymes in the body. Most people know, it supports immune function, reproductive health, but isn't even the really important stuff. Unfortunately, many people are deficient in zinc.
Most people fail to get enough zinc from their diet. This is a bad situation made worse by a very interesting relationship between zinc and another metal, one that is ubiquitous in our environment and crucial for our health, but too much of it blocks our ability to absorb zinc. (More on that below.)
Okay, back to zinc. It is an absolutely crucial, but way under appreciated mineral. Supplementing zinc (if it's deficient) can make all the difference in many conditions. One area of research that has exploded over the past decade is its effectiveness in the treatment of metabolic syndrome, diabetes, and obesity. In today's newsletter we'll examine why it is so important for these conditions, and how you can find out if you are deficient in zinc yourself.
Mineral function in the human body is extremely complicated and we'll just brush the surface in this newsletter. Simply put here are the basics: zinc works with insulin from start to finish as it regulates glucose levels in the body. It accompanies insulin like a trusty side-kick on its journey through the body. Here are a few examples
Chicken or the egg? Well...both.
So does someone with diabetes have diabetes because they are deficient in zinc, or did they become zinc deficient because they used up all their zinc battling their high blood sugars? Well, either can be the case. As blood sugars rise and the body is using more and more insulin to manage it, naturally more zinc is going to be depleted to accompany all that insulin. But, if zinc levels become too low from insufficient intake, then the insulin will not be able to function as well, the pancreas won't be able to produce as much insulin, and blood sugars will rise, making the zinc deficiency even more serious, in turn making the diabetes worse, and so on in a constant spiral.
Is Zinc Deficiency really a problem in The United States?
Surprisingly, nearly 50% of adults over 60 fail to get sufficient zinc in their diets. And because one of the most common sources of zinc is nuts and grains, the number may be a lot higher than 50%. You see, nuts and grains contain a compound called phytic acid that binds to zinc and other minerals, preventing their absorption. So, very likely, most of us already aren't eating enough. But, there's another problem. Zinc has a special relationship with another mineral in our diets, copper. Our traditional diets were often rich in both zinc and copper, and foods that contained a lot of one would most likely contain a lot of the other. Our bodies evolved to treat them as a pair. If there is enough of either in the body, our digestive system will stop absorbing both of them. If we have enough of one, our bodies assume we have enough of both. That's a real problem because lots of water pipes are made out of copper. Most people end up with plenty of copper in their systems, which means not nearly enough zinc. Studies have demonstrated that type 2 diabetics often have sufficient or even excessive levels of copper, but insufficient levels of zinc.
So, How Much Zinc Should I Take?
Not so fast. Zinc is an important mineral, but like all nutrients in the body, zinc is complicated. Just because some is good, that doesn't mean that more is better. Your body is like goldilocks when it comes to most nutrients, and that includes zinc. It doesn't want too much, or too little. It wants zinc intake and zinc stores to stay in a narrow range. If you are already getting enough zinc, then getting more can have some serious side effects for you, one of which being that you'll stop getting enough copper. It can also lower your good cholesterol, cause emotional disorders, and in the case of a dozen or so elderly patients who absorbed zinc from their denture cream in the early 2000's, cause debilitating nerve and spinal damage.
Okay, so I won't rush out and buy a zinc supplement. I promise. But, what now?
Well, you've got to figure out if you are zinc deficient. Unfortunately, a blood test is not particularly good at detecting zinc deficiency. The majority of zinc is tied up in the cells, and the amount in your blood is tightly controlled. A blood test won't accurately reflect your actual zinc levels. But, there is an easier and better way to test your zinc stores. A zinc taste test allows you to assess your zinc levels without drawing blood or playing a guessing game. Your taste buds will let you know if you need more.
It's called a zinc taste assay. You hold a specialized solution of zinc in your mouth. When you have sufficient zinc, your taste buds are able to perceive the unpleasant, strong metallic taste. It's clear that you don't need any more. When you are deficient, the solution tastes like water. Then, it's safe to supplement. Pretty cool huh?
Your response is evaluated on the following guidelines:
I look forward to seeing you!
I'm Kieran, clinician and founder at The Parani Clinic. I'm an acupuncturist, herbalist, and functional medicine practitioner for the past 8 years. I have a deep curiosity in health, biology, culture, medicine, history, and a healthy obsession with the pursuit of the perfect state of health.