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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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Supplements for Optimal Gut
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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Supplements for Optimal Gut
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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Supplements for Optimal Gut
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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Supplements for Optimal Gut
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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Supplements for Optimal Gut
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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Supplements for Optimal Gut
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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Supplements for Optimal Gut
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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