Stress and Sleep

 Sleep and circadian rhythm have a great influence on the integrity of the immune system. Chronic stress impacts every biological and psychological system. When the chemical microenvironment is under long-term stress, it pushes the immune system response into chronic inflammation and increased acidity. The vicious cycle continues until the threshold of resilience and adaptation is exceeded, leading to vulnerability to many chronic diseases including damage to lipid structures and influencing the eicosanoid metabolism. The health of the immune system is dependent on the lymphatic system, which is supported by movement. The lymphatic circulatory system does not have a pump as compared with cardiovascular circulation. The lymphatic vessels are “pumped” by physical activity with arm and leg movement, abdominal breathing, laughing, etc. Remember learning cell structure back in school? All of those structure components ultimately allow the cell to function optimally, which in turn allows the tissues and organs that these cells comprise to work effectively. With a properly working cell membrane, essential nutrients are able to be adequately absorbed into tissues, while harmful waste is removed and excreted. Cells are able to effectively communicate with one another, a necessity for cells to work together to form tissues. Hormone sensitivity and utilization increases when the proteins that form hormone receptors on the membrane are intact. The overall health of our cell membranes, in addition to their ability to function at maximum capacity, is largely dependent on one’s diet and lifestyle habits. However, many are unaware that even our most subtle nutritional choices have the power to influence our bodies down to the molecular level, particularly in regard to the state of our cell membranes. Knowing how vital the role of a cell membrane is in the grand scheme of the human body makes knowing what causes harm to these membranes equally as important. Since cell membranes are composed of over 50% lipids, consuming a diet that is low in fat is damaging to the membrane. Chronic stressors can also cause inflammation in the body, which can lead to programmed cell death, so it is important to manage stress.

As we hopefully all remember, the Mitochondria are known as the powerhouse of the cell. There are many factors that can cause immense damage to the mitochondria. These include, but are not limited to, statin drugs, antibiotics, chronic stress, age, cigarettes, hyperglycemia, excessive arachidonic acid, excessive exercise, persistent organic pollutants (POPs), and heavy metals There are many diseases and illnesses that can be traced back to membrane damage or dysfunction. Fatigue is often the first indication of cell damage, due to membrane malfunction. When the membrane is damaged, cells may not be able to signal efficiently and hormone receptors may not work as well, resulting in either the overstimulation of hormone targets or the lack of hormone activity. There are numerous other illnesses that can result from dysfunctional mitochondria. Among these are neurodegenerative disorders, including Amyotrophic Lateral Sclerosis (ALS), Alzheimer’s, Parkinson’s, Huntington’s, bipolar, as well as cardiovascular disorders, such as diabetes, metabolic syndrome, atherosclerosis, and obesity. Mitochondrial dysfunction can also lead to gastrointestinal and musculoskeletal disorders, including fibromyalgia and muscular atrophy, as well as chronic infections and even cancer.

Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner

Lipids Part 2

Lipids play critical roles in membrane structure, cell signaling, energy storage, control of inflammation, and as base units for constructing messenger hormones. Sterols are naturally occurring unsaturated steroid alcohols, waxy lipids. The primary sterol for human metabolism is cholesterol, which is the base unit for all hormone production and vitamin D. Cholesterol is also an important component of cell membrane structure. Most endogenous cholesterol is synthesized by the liver, but dietary cholesterol can influence total cholesterol levels. Foods rich in cholesterol are of animal origin: fats from animal milk, meat, egg yolk, poultry, seafood, and organ meats. Fat-soluble vitamins have many metabolic roles. Their influence on structural integrity and defense and repair (e.g., inflammation and immune response) modulates the lipid environment and metabolic dynamics. The fat-soluble vitamins function synergistically, with the vitamin D and A receptors sharing their nuclear receptor, influencing each other. Vitamin D2/3 and A are found in their food-rich sources together (e.g., liver, caviar, /roe, egg yolk). Here is a list of lipid-supportive foods, gerbs, and dietary supplements: whole foods, avocado, raw seeds, olives, hearts of palm, macadamia nuts, pine nuts, almonds, brazil nuts, coconut oil, organ meats, meat, poultry, fish, shellfish, roe, krill, turmeric, resveratrol, boswellia, proteolytic enzymes: bromelain, papain, trypsin, evening primrose oil, black currant, EPA/DHA from algae, with co-nutrients (you need these to help absorb) of vitamin C/B, zinc, and magnesium. Lipids are the molecular components that comprise the lipidome—the complete lipid profile within the membrane, cell, tissue, or organism. The lipidome is in the dynamic metabolism of life expressing the genetic information in the DNA book of life. Damage to the cellular structure can result in a multitude of dysfunctions. Dietary and lifestyle choices can influence the overall health of our bodies down to the structure of our cell membranes. Maintaining a diet full of nutrients such as essential omega-3s and omega-6s, and even cholesterol, can help structurally stabilize our cell membranes as well as reduce the susceptibility to leakage of beneficial nutrients out of the cell. Cholesterol is a vital component of all biological membranes. In fact, cholesterol is the most abundant type of lipid in our membranes, accounting for 30–50% of the lipid molecules. In addition to providing stability, cholesterol also plays a vital role in protecting the cell membrane from nutrients that we consume that could be harmful to the cell. Such drugs that are intended to target membranes include, but are not limited to, antipsychotics, antitumoral drugs, antidepressants, tranquilizers, antihistamines, antifungals, and analgesics. As these drugs interact with the membrane, they cause it to lose stability, making it susceptible to compression and leakage. In addition to amphiphilic drugs, ethanol-based alcohols can also have a detrimental effect on the lipid bilayers of our membranes. However, cholesterol can help protect our membranes from damage due to medication and alcohol consumption.

 Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner

Lipids Part 1

Lipids are highly diverse molecules that are as important for life as proteins and genes with critical roles in membrane structure, cell signaling, energy storage, inflammation regulation, and as base units for constructing messenger hormones. The two functions of the lipids that can be modulated by nutrition therapy are membrane structure and inflammation control. The membrane structure is at least 50–75% lipids with embedded protein structures forming receptors, channels, and other structures. “You are what you eat.” What fats and oils and sterols you eat become the structural composition of your membranes and influence their function of cell signaling, communication, and transport. Inflammation control: The lipid eicosanoid molecules play a key role in our survival. They are the primary metabolites teaming with the immune system to manage the immune response and control inflammation. Cholesterol is essential to life by providing the base unit for production of hormones, neurological cells (neurons, myelin, brain tissue, etc.), bile, and others. As with all natural components of the chemical body, each cholesterol molecule has multiple functions. Each function depends on the balance of the amount of cholesterol deposited in the cell membranes. This balance is foundational to optimized cell function and may be related to compromised metabolism when cholesterol is too low. Hypocholesterolemia is total cholesterol <120–150 mg/dL. On the low-end of the spectrum, hypocholesterolemia is associated with increased incidence of mood disorders like depression, as well as cancer, and sepsis. Deficiency of Omega-6 could look like eczema, dermatitis, GERD, and Viral infections. Deficiency of EPA, DHA, LA, and ALA could look like altered mood and skin health, cardiovascular issues and cancer. One of our fat-soluble vitamins, Vitamin D, has many functions. It is a powerful immune modulator that plays a role in defense and repair. Vitamin A, another fat-soluble vitamin, is increasingly recognized in experimental and human studies to enable suppression of inflammatory reactions and plays a significant role in normal mucosal immunity, regulation of T cell-dependent responses, antiviral activity, and cell communication. Adequate vitamin A status, whether from intake of preformed retinol (e.g., animal sources: egg yolk, organ meats, fish, shellfish, and roe) or from b-carotene (e.g., yellow and green vegetables) is important for preventing excessive or prolonged inflammatory reactions and supporting the eicosanoid cascade.

Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner

More on Fatty Acids

More on Fatty Acids:

Saturated fatty acids are not only a source of body fuel but also are structural components of cell membranes. Various saturated fatty acids are also associated with proteins and are necessary for their normal function. They are synthesized as needed by the body to provide an adequate level required for their physical and structural functions. The average American diet provides approximately 15% of calories in the form of saturated fat. The saturated fatty acid intake ranges from 21 to 34 g per day in men and 15 to 21 g per day in women. The liver is the main organ responsible for the synthesis of monounsaturated fatty acids (MUFA). Plant sources rich in MUFA include olive oil (about 75%). High oleic acid variety sunflower oil contains as much as 80–85% MUFA. Canola oil has about 58% MUFA. It is also found in red meat, whole milk products, olives, and avocados. Oleic acid accounts for about 90% of dietary MUFA. MUFA neither elevates or lowers the level of serum cholesterol; thus, a high-fat diet is not necessarily associated with a high level of serum cholesterol in the population. Inhabitants in Mediterranean countries consume large amounts of olive oil but tend to have low levels of serum cholesterol. The average American consumes MUFA which makes up about 50% of total fat and provides 20% of the calories in the diet. Polyunsaturated fatty acids (PUFA) are required for normal growth and function of all tissues. These fatty acids must be supplied by a dietary source and are called essential fatty acids (EFA). PUFA are the major components of structural lipids of membranes of cells, mitochondria, and nuclei, and they play a major and vital role in the properties of most biomembranes. EPA and DHA have been assumed to reduce the risk of CHD and stroke by a multitude of mechanisms by preventing arrhythmias, reducing atherosclerosis, decreasing platelet aggregation, lowering plasma triglyceride concentrations, decreasing pro-inflammatory eicosanoids, and decreasing blood pressure in hypertensive individuals. The American Heart Association recommends that healthy adults, especially those at higher risk for heart disease, eat a variety of fish, preferably oily fish such as salmon, mackerel, and sardines, at least twice a week. The association also recommends increasing the intake of ALA-rich foods such as walnuts, flax seeds, and canola and soybean oil. Rheumatoid arthritis (RA) is an autosomal disease that causes inflammation of joints. Fish oils have been found to reduce symptoms of RA, including joint pain and morning stiffness. People with RA who take ALA may be able to reduce their dose of anti-inflammatory drugs. Fish oil also may help people with osteoarthritis. One study in rats has suggested that diets containing omega-3 fatty acids lead to lower levels of fat accumulation compared with diets containing other fatty acids. Population studies in Chicago have reported that people 65 and older who ate fish at least once weekly were 60% less likely to develop Alzheimer’s disease than those who never or rarely ate fish. Depression is associated with lower levels of W3 fatty acids in RBC membranes. Countries with the highest rates of depression ate the least amount of fish while those with the lowest rates of depression ate the most fish. W3 fatty acids may also protect the eyes. In one study, it has been reported that those who ate fish twice a week had a 36% lower risk of macular degeneration, the leading cause of blindness in old age.

Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner

Toxic Load, Stress, and Sleep

Toxic load, stress, and sleep:

Toxic load, stress, and sleep can all impact your health. Environmental toxins affect people in different ways, due to differences in body chemistry and effects from the food they eat, genetics, and lifestyle choices. These toxins include pesticides, air pollutants, heavy metals, excessive medications, and various toxins in our food and water supply, as well as the air we breathe. When it comes to total toxin load for an individual, many factors will contribute. Those factors will include some of the more obvious toxin exposures such as cigarette smoke, alcohol, and various drugs, but it will also include car exhaust, heavy metals, paint fumes, Teflon, aluminum cookware, mold, dry-cleaned clothes, pet dander, pesticides, nail polish, hair dyes, perfumes, fertilizers, plastics, etc. We use the word “stress” in everyday life, yet the meaning is ambiguous. Stress can be traumatic, or it can be eustress (good stress), simply reflecting the daily grind of life. The role of stress in health is well established, yet all too often overlooked by practitioners. Stress has many different triggers with many different manifestations. Therefore, identifying the presence of points of stress can be difficult. Psychoneuroimmunology is a term used to describe the impact of mental attitudes on the body’s resistance to disease, especially with respect to the links among and between the mind, the brain, and the immune system. The central nervous system and the immune system have constant communication. While short-term/acute stress can be healthy and important for our health (e.g., exercise), chronic/long-term stress is another factor increasing risk for development of chronic disease. After an acute stress response, the main stress hormone, cortisol, lowers again, and the body can return to a balanced state. However, in times of chronic stress, cortisol remains elevated, which has many negative effects on the body. During times of stress, the adrenal glands are working harder to produce cortisol. In this case, they also need additional nutrient support. Nutrients such as magnesium, potassium, and sodium are in higher demand when the body is under stress. The brain first perceives a stressor and determines what is threatening. It then determines the behavioral and physiological responses to the stressor. Physiologically, the sympathetic and parasympathetic systems, hypothalamic-pituitary-adrenal (HPA) axis, immune system, metabolic hormones, and molecular processes within all organs adjust to combat the response. That is, these organs activate to achieve stability. These adjustments are manageable in the short term, but when they are overused or imbalanced for too long, the body can become overloaded. This overload or imbalance can affect systemic physiology via neuroendocrine, autonomic, immune, and metabolic mediators. Nutritionally, this overload requires more nutrient support. Studies have shown nutrient therapy such as with B vitamins has a beneficial effect on perceived stress, mild psychiatric symptoms, and aspects of everyday mood to support those under chronic stress. ANother part of stress is sleep. Having a properly functioning circadian rhythm is critical to healthy hormonal balance, metabolism function, memory and mental performance, optimal cellular energy production, and the immune system. Sleep is essential to health and even if nutrition is optimal but sleep is poor, one’s health status will quickly decline. Sleep hygiene affects nutrition intake and status, but nutrition intake and status also affect the ability to establish proper sleep hygiene. A 1999 study conducted at the University of Chicago concluded that restricting sleep to just 4 hours per night for 7 days led to increased insulin sensitivity and characteristics of diabetes. Additionally, research shows sleep deprivation increases various inflammatory markers. Research by Van Cauter shows that individuals who are sleep-deprived have an increased appetite, which aligns with other findings that have identified the relationship between short sleep duration and increased intake of unhealthy food with more sedentary habits. When it comes to sleep and nutrition, some nutrients have been studied more than others. Caffeine, for example, has plenty of literature showing an inverse relationship. Not surprisingly, the function of caffeine is evidenced to disrupt sleep quality and quantity. Conversely, vitamin D has also been shown to promote circadian rhythm at a cellular level. Light exposure is the primary regulator of circadian rhythm. Too much light after sunset affects melatonin production. The blue light spectrum from many artificial light sources such as TVs, cell phones, and computers enters the eye and feeds a signal to the brain that “it’s daytime.” The combination of poor sunlight during the day and excessive blue light at night has major implications on circadian rhythm. Many other factors also contribute to circadian rhythm, including activity, stress, micronutrient status, and transition activities before bed, but each client will have different levels of readiness on where to start. Bringing awareness to the importance of sleep is step one and can begin during an assessment when collecting information on their habits. Colon motility is faster in the morning and slower at night. Disruption of the circadian cycle can provoke changes in gut motility. Circadian rhythm shifts that occur with traveling, night shifts, or other sleep disruptions can lead to gut symptoms, including bloating, abdominal pain, diarrhea, or constipation.

Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner

Inflammation and Lifestyle Factors

Vitamin A, vitamin D, vitamin E, zinc, omega-3 fatty acids, and omega-6 fatty acids are among the most-studied nutrients active in the immune response, though many other nutrients play integral parts in the optimal function of the immune system. Prolonged inflammation contributes to the progression of many chronic diseases, such as types 1 and 2 diabetes mellitus, cardiovascular disease, Alzheimer’s, psoriasis, lupus, and more. Modifiable lifestyle factors including diet, smoking, and exercise have profound impacts on these levels of inflammation. While acute inflammation is necessary for healing, chronic, low levels of inflammation appear to be major players in chronic disease etiology. Immune dysregulation and oxidative stress are closely related to inflammation in the body, with common etiology and positive feedback loops, compounding the detrimental impacts. For many, this inflammation may go undetected for years, leading it to be termed the “silent killer” by scientific and media reports. Regardless of a symptom manifestation, chronic inflammation poses a damaging impact, increasing risk of chronic disease and mortality. Western lifestyle behaviors such as poor diet, inactivity, and smoking are often underlying root causes of this inflammation. Relationships are a major part of an individual’s health and well-being. Often, a community or intimate relationships can have a direct influence on diet choices. Positive relationships can allow for easier implementation of nutritional interventions, particularly in the case of caregiver support. Spouses committed to health changes can promote reciprocal behavior in their partners; stressed relationships can also prevent adequate nourishment and be a burden to one’s health. Even beyond diet choices, induced stress, potentially from a relational cause, can alter digestive, lipid, glycemic, and inflammatory responses to meals. Physical activity is an integral part of an individual’s nutritional status. Physical activity has a long-established role in body composition and nutrient metabolism. One of the most-studied nutrients involved in mitochondrial function is coenzyme Q10 (CoQ10). CoQ10 is required for ATP production via the electron transport chain and also has a powerful antioxidant function. Deficiencies in CoQ10 caused by metabolic disorders or statin medications can result in mitochondrial dysfunction and reactive oxygen species.

Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner

The Standard American Diet

The NIBLETS assessment was developed as a way to assess factors that are affecting nutrient metabolism. The NIBLETS model is named for its seven components: Nutrient deficiencies/insufficiencies, Inflammation/immunity, Biochemical individuality (genetic/epigenetic influences on chronic disease), Lifestyle factors, Energy, Toxic load, and Stress and sleep. To treat a person rather than a condition requires a thorough assessment of external factors negatively impacting that person’s health. Regardless of the advances in pharmaceutical and nutraceutical support the medical community is able to make, patients will find themselves in a similar position once again if interventions are not made to change the patterns that helped cause the problem in the first place. The Standard American Diet, consisting of mostly nutrient-poor processed and fast foods, has left the majority of the public overfed and undernourished. Three-quarters of Americans consume less than the recommended intake of vegetables and fruits, and that is when fried potatoes and refined juices are included in these counts. The majority of Americans are not even reaching the estimated average requirement or adequate intake of potassium, fiber, choline, magnesium, calcium, and vitamins A, D, E, and C. Meanwhile, these standards for nutrient consumption are currently based on average needs for our population to remain in a disease-free state. For many individuals, nutrient needs may actually be much higher for optimal function, driving the chasm between need and intake even wider. Americans’ consumption of food prepared outside the home, as a percentage of total calories consumed, nearly doubled. This has a direct correlation with decline in diet quality. However, even within the home, the standard American way of eating is heavy in refined grains and added sugars and increasingly lacking in whole, nutrient-dense foods. Considering our currently overworked, under-rested, hurried lifestyles, it is no wonder why these convenience foods are highly sought after. For this reason, intervening to improve diet quality will undoubtedly require directives on addressing these time and budget constraints. Those who follow restrictive diets such as vegetarianism and veganism are at risk for further nutrient deficiencies. While many factors may lead a person to this dietary pattern including moral, religious, or even health-based motivations, it is still worth noting the increased risk. In addition to the aforementioned nutritional deficiencies for those with a Western-style diet, those who avoid animal products are at further risk of inadequate intakes of protein, omega-3 fatty acids, vitamin B12, iron, zinc, vitamin K2, and iodine. While a nutritionally adequate diet can still be achieved, special attention should be given to those adopting this dietary pattern to address the higher risk. 

Integrative and Functional Medical Nutrition Therapy by: Diane Noland, Jeanne A. Drisko, Leigh Wagner