Why Will I Gain Weight If I’m Not Sleeping Well?

May 9th, 2012

As bizarre as it sounds, how well we sleep can have a direct impact on the amount of weight we gain.  While doctors often talk about how poor sleep impacts immune function and stress hormones, we’re only more recently beginning to understand how hormones that control appetite are also affected.

Leptin and ghrelin are hormones in our system that regulate feelings of hunger and fullness.  Ghrelin, which is produced in the gastrointestinal tract, stimulates appetite, while leptin, produced in fat cells, sends a signal to the brain when you are full.  Lack of sleep leads to both a lowering of leptin levels (lack of satiety) and a rise in ghrelin (stimulated appetite).  The combined effects of these changes leads to overeating, followed by weight gain.

One example of this effect was demonstrated in a joint study between Stanford and the University of Wisconsin.  Those who slept less than eight hours a night not only had lower levels of leptin and higher levels of ghrelin, but they also had a higher level of body fat.  Those who slept the fewest hours per night weighed the most.

While this information is certainly promising, the relationship between these hormones and weight gain is still not entirely straightforward.  Some patients who have sleep apnea, combined with obesity, actually have high levels of leptin, rather than low.  It’s been speculated that some patients may become resistant to this hormone, so elevated levels mean their body isn’t responding to the signals of this hormone, still making them more prone to weight gain as a result of sleep apnea.

I think the bottom line is that diet and exercise aren’t the only factors when it comes to addressing weight gain.  Poor sleep or untreated sleep apnea should always be addressed with any weight loss program, if any level of success is to be achieved.

 

Patients With Type II Diabetes Benefit From Naturopathic Care

April 26th, 2012

Diabetes is a complex, multi-factorial condition that takes many variables into account, including diet, exercise, and family history.  Typically, if certain markers are detected early enough (elevated blood glucose, increased hemoglobin A1C), lifestyle and/or pharmaceutical treatments can be implemented to slow or reverse the progression of type II diabetes before long-term complications arise.  Since the essence of naturopathic medicine is addressing core diet and lifestyle issues that may be contributing to disease, it’s essential for anyone who’s dealing with type II diabetes, or even “pre-diabetes”, to incorporate a naturopathic treatment protocol as part of their long-term strategy.

A new joint study by Group Health Research Institute and Bastyr University Research Institute found that type II diabetes patients who received naturopathic care (as an adjunct to conventional care) had lower blood-sugar levels, better eating and exercise habits, improved moods, and a stronger sense of control over their condition than did patients receiving only conventional care.  The findings, published in BMC Complementary and Alternative Medicine, show that complementary and alternative medicine (CAM) may have several positive effects on people with type 2 diabetes, which is very encouraging for patients who are seeking out alternatives to manage their symptoms.  Forty study participants received counseling on diet, exercise, and glucose monitoring from four naturopathic physicians (NDs) in addition to conventional diabetes care from their medical doctors, including prescription medications. Many of the participants also received stress-management care and dietary supplements. Researchers then compared these 40 participants with 329 patients receiving only conventional diabetes care.  After six months and about four naturopathic treatment visits, participants demonstrated improved self-care, more consistent monitoring of glucose, and improved moods. Hemoglobin A1c rates (a measure of blood-sugar control) were nearly a full percentage point lower for those patients. This compares with a drop of only 0.5 percent over the same time period for 329 clinically similar patients receiving only conventional diabetes care.

Hopefully, this will encourage medical doctors and patients alike to seriously consider the benefits of naturopathic medicine in the management of type II diabetes.  Doing as much as possible to get a handle on this disease is extremely important, as it’s one of the top 10 causes of death for Americans, racking up close to $178 billion per year in health care costs.  By making a collaborative effort, there’s no reason why we can’t be proactive about halting this epidemic from spiraling out of control!

Recognizing Lyme Disease and Related Infections

April 18th, 2012

Although we live in a state where Lyme disease is endemic, the diagnosis and treatment of this condition continues to be controversial.  Unfortunately, the political landscape surrounding Lyme disease has steered many doctors away from treating it altogether, putting many patients at risk for developing long-term complications.  It’s not uncommon for me to see patients who have been told that their testing for Lyme disease and other co-infections is negative, so therefore there is no possible way that these infections can be responsible for their symptoms.  This information can be extremely misleading, since the validity of testing is dependent on what stage of the disease they are performed.  Doctors who are well informed about Lyme will typically treat based on clinical criteria (outlined by the CDC), with the argument being that the risk of putting uninfected individuals on antibiotics is not outweighed by the risk of long-term Lyme complications.

Since there is so much variability from one physician to the next, the most important point is for patients to recognize the most common symptoms of Lyme disease and other co-infections, so they can consider seeking out a second opinion if they’ve been told their symptoms are unrelated, yet their health continues to decline.  Symptoms to watch for include the following:

Lyme Disease: Fatigue, headaches, cognitive difficulties, roaming muscle pain that comes and goes, intermittent paresthesias (numbness, tingling).

Babesia: Fever, chills, night sweats, “pressure” headaches, insomnia, “air hunger”, easy bruising.

Ehrlichia: High fevers, low WBC and platelet counts, elevated liver enzymes.

Bartonella: Fatigue, “ice pick” headache, cognitive difficulties, lymph node swelling, pressure behind eyes, seizures, painful feet (especially upon waking), sensitivity to light.

Other key points to consider:

-While known history of a tick bite is helpful, how often will you notice something the size of a poppy seed hanging around?

-Lyme disease can suppress many subsets of your immune system, so recurring viral infections and other signs of immune compromise can be another clue.

-If you do find a tick, don’t throw it away! You should save it, and have the tick tested for Borrelia.

-Exposure history (hiking, wooded areas, occupational hazards, etc.) and previous response to antibiotics (did symptoms improve or worsen) can be useful indicators.

-There are no definitive tests for Lyme disease!

If you’re suspicious of Lyme or related co-infections based on this summary, seek out a physician who has experience with diagnosing and treating these conditions.  Be persistent, and don’t be discouraged by negative test results, particularly if you continue to suffer!

Can Diet Reverse PCOS?

April 2nd, 2012
Polycystic ovary syndrome (PCOS) is a condition that affects the hormone balance in women, favoring the production of male hormones like testosterone over female hormones like estrogen and progesterone. This imbalance can lead to symptoms such as menstrual problems and infertility. Many women with this condition also develop insulin resistance, diabetes, obesity, and cardiovascular disease.  In a new study published in the American Journal of Clinical Nutrition, blood sugar control, weight loss, and cardiac risk were all improved when women with PCOS were put on a high protein, low carbohydrate diet.

The new study included data collected from 27 women with polycystic ovary syndrome. Participants were assigned to either a high-protein diet or a standard-protein diet for six months. Both groups received regular nutritional counseling and were guided to reduce their intake of sweets and soft drinks.

The aim of the high-protein diet was to get 40% or more of each day’s calories from protein and less than 30% of calories from carbohydrate. To achieve this, women in the high-protein-diet group were instructed to replace sugary and starchy foods with either protein-rich foods like meat, eggs, fish, and dairy foods, or with vegetables, fruits, and nuts. The aim of the standard-protein diet was to get less than 15% of calories from protein and more than 55% of calories from carbohydrate. There were no calorie restrictions with either diet.

At the end of the study, the following differences between the groups were seen:

  • Women on the high-protein diet lost 4.4 kilograms (10 pounds) more than women on the standard-protein diet.
  • Almost all of the extra weight lost by the women eating the high-protein diet was body fat, not muscle.
  • The high-protein diet was associated with a greater reduction in waist circumference, indicating a greater loss of abdominal or belly fat. This type of fat has a strong link to cardiovascular disease.
  • Women on the high-protein diet had lower blood glucose and C-peptide levels. C-peptide is a protein that is linked to insulin production. These findings show that blood sugar control improved more in this group than in the standard-protein diet group.

Implementing this type of diet is one of the first things I do with patients who have PCOS, and the results are consistently rewarding. Between these dietary changes and other nutritional and botanical interventions, I’ve witnessed the naturopathic treatment of PCOS being just as, or even more effective, than the medication regime often utilized in conventional medicine. Plus, these diet changes promote longer term health benefits, particularly with respect to cardiovascular health.

If you’ve been struggling with weight gain and other complications of PCOS, and you’ve only tried medications to address it, don’t feel like your options have been exhausted. Seek out a practitioner who can give you detailed dietary instruction, a method that has now been proven to work!

(Am J Clin Nutr 2012;95:39–48)

Rethinking Fat in the Diet

March 7th, 2012

With all the hype surrounding statin medications this past week (see http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html), it’s a perfect opportunity to take a step back and discuss some basic diet fundamentals.  For the past 40 or more years, the “benefits” of low-fat diets have been ingrained in our consciousness, and advocated by a majority of the medical community.  The thinking behind this was simple: high fat in the diet must lead to a buildup of fat and plaque in the arteries, so the less fat you eat, the better.  In recent years, research evidence has overwhelmingly refuted this concept, yet it continues to be the mainstream recommendation for preventing heart disease.  Even the “Dairy” section in the USDA’s “My Plate” emphasizes low or non-fat sources of dairy.

A scientific analysis of 21 earlier studies showed “no significant evidence” that saturated fat in the diet is associated with an increased risk of coronary heart disease.  In fact, the dietary evidence collected from these thousands of participants found no difference in the risk of coronary heart disease, stroke, or coronary vascular disease between those individuals with the lowest and highest intakes of saturated fat.  The bigger issue appears to be the added amounts of sweeteners and carbohydrates that people are eating instead of fats.  More and more evidence is suggesting that it’s this continuous increase in carbohydrate consumption that is truly responsible for an increased risk in diabetes and coronary artery disease.

I think the main take-away message from this information is that you don’t have to be afraid of good quality sources of saturated fat.  We’ve been so trained to be suspicious of it for so long that it becomes difficult to change our perception of how healthy it can be.  Now, does this mean you should be eating nothing but cheese, bacon, and beef for the rest of your life?  Of course not!  If you’re already consuming low-fat sources of dairy (skim milk, low-fat yogurt, etc.), switch to organic whole milk sources, and use butter instead of margarine or other processed forms of fat.  In general, try to limit your saturated fat intake to 10% of your total diet, while discontinuing the consumption of hydrogenated oils, artificial sweeteners, and high-glycemic carbohydrates.  By doing this, and continuing to emphasize fruits and vegetables as a mainstay, you’ll be much better off in the long run!

Don’t Let Pollution Get You Down

February 22nd, 2012

Lets face it, pollution is never a topic that’s easy to broach, particularly since we’re often left feeling helpless about what we can do to avoid it.  To make matters worse, the impact it can have on our health is rarely acknowledged by health care providers, unless a known, acute exposure has occurred.  The reality is that we’re all exposed to environmental pollutants on a daily basis, and there are indeed resources available to help identify the most likely offenders.  For example, www.ewg.org provides reports about the local water supply, showing contaminants that are the most consistently elevated. Another invaluable resource is www.scorecard.org, which evaluates local air pollution, toxin levels (heavy metals, superfund sites, etc.), and industrial pollutants.  It’s also recommended that you have your own water tested through an independent laboratory, which will potentially identify hidden sources of various pollutants.

So, why is this important? Many of these pollutants have been linked to a host of degenerative diseases, including cancer, autoimmune diseases, and neurological conditions.  In my experience, the medical community tends to largely ignore these underlying causes, only treating the symptoms of the respective disease.  I can’t tell you how many patients have come to me with serious, debilitating symptoms, only to find out that they have high levels of contaminants in their system.  PCBs, pesticides, heavy metals, and solvents, just to name a few, can all be measured with laboratory testing, and eliminated from your system with the appropriate treatment protocols.

If you have a known exposure to environmental pollutants, or suspect that they are having a negative impact on your health, you shouldn’t feel like there’s nothing that can be done about it.  Talk to your doctor about the appropriate tests, and use some of the resources mentioned above to identify and prevent any future exposures.

 

Is It Really IBS?

February 15th, 2012

Irritable bowel syndrome (IBS) affects one in five adult Americans, and is responsible for up to 40% of referrals to gastroenterologists. While there are legitimate criteria used to diagnose IBS (alternating constipation and diarrhea, bloating, abdominal pain), the term is generally used to label patients who don’t have Crohn’s disease, ulcerative colitis, or other underlying “organic” diseases. Once patients have been labeled with having IBS, they are often given one or more medications to treat the symptoms, usually with little to no relief.

Fortunately for IBS sufferers, a multitude of underlying factors may be the real cause of digestive symptoms, making the likelihood of recovery much more promising. One condition in particular that’s often overlooked is small intestinal bacterial overgrowth (SIBO). This is an abnormal colonization of bacteria within the small intestine by bacteria that are normally found in the colon, mouth, or pharynx. When left untreated, SIBO is not only mistaken with IBS, but has been linked to fibromyalgia and chronic fatigue syndrome as well. The cause of SIBO isn’t always clear, but patients who are at higher risk include those with chronic constipation, achlorhydria, diabetes, scleroderma, diverticulosis, and adhesions from prior surgeries.

Up to 78% of patients who are diagnosed with IBS may in fact be experiencing SIBO. Testing for this condition is performed by blowing into a tube that measures gases given off by the excessive amount of bacteria that are present in the small intestine. While these tests are typically offered by gastroenterologists, there are several commercial laboratories that offer test kits for home use, which are then mailed back to the laboratory for analysis. If diagnosed, SIBO can be treated initially with specialized antibiotics. Once the offending bacteria are successfully eradicated, measures should then be taken to improve the intestinal environment (probiotics, digestive enzymes, etc.), which should help to prevent recurrence.

A diagnosis of IBS does not mean all hope is lost. Explore the possibility of SIBO, and seek out a naturopath or other alternative practitioner who can focus on how the digestive tract functions, rather than just looking for a disease.

Celiac Disease or Gluten Intolerance?

February 9th, 2012

When people are experiencing nutritional deficiencies, anemia, weight changes, and/or other symptoms that seem to be of an unknown origin, it’s fairly common practice for doctors to rule out the presence of celiac disease with a small intestinal biopsy. While this is certainly considered the “gold standard” for identifying the pathological changes associated with celiac disease, many experienced physicians are finding that patients can still have a sensitivity to gluten containing grains, making celiac disease and gluten intolerance separate entities altogether.  This led experts at the recent International Celiac Disease Symposium to define the term gluten insensitivity for patients who don’t meet the criteria for celiac disease or wheat allergy, yet improve dramatically when following a gluten-free diet.

The incidence of Celiac disease has doubled since 1974, and gluten sensitivity alone is estimated to be 6 times the prevalence of celiac disease. Fortunately, for patients and doctors who have recognized this phenomenon for quite some time, there is finally a more established definition of gluten sensitivity. Some of the criteria being used to separate gluten sensitivity from wheat allergy and celiac disease include: Negative testing for the presence of IgE antibodies to wheat; Negative endomysial and ttg antibodies (typically present with celiac disease); Negative small intestinal biopsy; Resolution of symptoms following as gluten-free diet. Researchers have concluded that the genetic makeup and immune response of gluten sensitivity patients is unique, and may be more enzyme mediated (like lactose intolerance), rather than immune based.

Since objective testing is still lacking, people who are symptomatic should consider implementing a gluten-free diet. Some of the most common symptoms associated with gluten sensitivity include abdominal pain, rashes, headaches, “brain fog”, fatigue, depression, anemia, and joint pain. If your doctor tells you that celiac testing is negative, don’t give up hope!

 

PCOS and Diet

January 25th, 2012

A recent study in the American Journal of Clinical Nutrition (Jan 2012) showed that women with PCOS who followed a higher protein diet (>40% of energy from protein), as opposed to women who consumed the “standard” amount of protein (<15% of energy from protein), were able to lose weight more effectively. The study also showed that the women on a higher protein diet were also able to maintain healthier blood sugar levels, even after adjusting for changes in weight.

This is the type of diet I’ve always emphasized with PCOS patients, and have found this to be one of the most effective means of helping these women lose weight. Clinically, I’ve also found that this diet is the single most important factor when it comes to controlling other PCOS-related symptoms, such as hirsutism and menstrual irregularities. In fact, most women are able to discontinue metformin and related prescription medications upon adhering to a higher protein diet. Other nutritional interventions (chromium, fiber, etc.) can also be incorporated, with the main emphasis being that of blood sugar control.

If you’re currently undergoing treatment with prescription interventions, and not responding well, don’t be discouraged. Seek out a practitioner who can guide you through a high protein diet, and offer some of the many other nutritional options that will be effective in the management of PCOS.

 

 

 

Dairy Officially Deemed Unhealthy

January 5th, 2012

The Harvard School of Public Health sent a strong message to the United States Department of Agriculture (USDA) and nutrition experts everywhere with the recent release of its “Healthy Eating Plate” food guide.  The university was responding to the USDA’s new MyPlate guide for healthy eating, which replaced the outdated and misguided food pyramid.

Harvard’s nutrition experts did not pull punches, declaring that the university’s food guide was based on sound nutrition research. The greatest evidence of its research focus is the absence of dairy products from the “Healthy Eating Plate” based on Harvard’s assessment that “…high intake can increase the risk of prostate cancer and possibly ovarian cancer.”  The Harvard experts also referred to the high levels of saturated fat in most dairy products and suggested that collards, bok choy, fortified soy milk, and baked beans are safer choices than dairy for obtaining calcium, as are high quality supplements.

In my practice, I try to emphasize to people how “duped” we’ve been by the dairy industry, and that dairy products aren’t indeed the most nutritious source of calcium, as we’ve been brainwashed to believe in our society. Of course, this report doesn’t mean that you should avoid dairy entirely, especially when you can acquire local or non-commercial organic sources. Mainly, the take-away message here is that both past and present food recommendations from the government have emphasized dairy as a requirement, and this is clearly not the case!