Your GI Tract and Muscles

The lining of the small intestine is a major barrier tissue whose function is directly supported by the integrity of its structure. The gastrointestinal mucosa forms a barrier between the body and the lumen of the intestines. The role of this barrier is to selectively allow the passage of nutrients and other small molecules across the epithelium of the intestine, while blocking larger, harmful molecules. Disruptions to this barrier can lead to possible autoimmune disease, food allergies, mood disorders, and other conditions. Disruption to the intestinal epithelial barrier, namely increased permeability, leads to overall gut dysfunction and subsequent GI-related diseases, including irritable bowel syndrome, celiac disease, and leaky gut syndrome. Factors that affect gut permeability include infection, inflammation, immune dysfunction, environmental toxins, medications, and the composition of the gut microbiota. Lipid and zinc deficiencies have also been shown to disrupt tight junctions, alter membrane permeability, and cause intestinal ulcers. The probiotic species Bifidobacterium longum has been shown to prevent damage to intestinal cells as well as increase the production of tight junction cell proteins, improving intestinal integrity. It has also been shown to successfully treat increased permeability in patients with Crohn’s disease and ulcerative colitis. Antioxidants have also been shown to help prevent oxidative damage to the intestine. These include vitamin C, vitamin E, beta-carotene, grape seed extract, milk thistle, and quercetin. Foods that can damage the gut include gluten, dairy, and sugar. Even in non-celiacs, gluten consumption may damage zonulin production, which is a protein that is crucial in tight junctions, increasing permeability to unwanted molecules (we call this non-celiac gluten sensitivity). Dairy can be inflammatory for a lot of people, so it is best to avoid it when trying to prevent damage to the gut. Too much sugar in the diet feeds the bad bacteria in the gut, causing an overgrowth of bacteria and degradation of gut permeability. Nutrients that can provide some treatment to the intestine once it is compromised include L-glutamine, which is the primary amino acid source for intestinal cells and regulates intercellular junction integrity, and N-acetylglucosamine (NAG), which is a substrate for the glycosaminoglycans that are normally broken down in a leaky gut. A leaky gut diet should consist of bone broth, steamed vegetables, fermented foods, and healthy fats. Bone broth contains NAG, as well as collagen and glutamine, which are both elements that make up the gut, while steamed vegetables and healthy fats help provide essential nutrients, like L-glutamine, that keep the gut working properly. Fermented foods contain necessary probiotics, which keeps the microbiota in the gut healthy. Consuming a balanced diet and maintaining a regular exercise routine can aid in healthy and efficient regeneration of musculoskeletal cells as well as maintain current bone density, joint flexibility, and muscle strength. Resistance training of large muscle groups (biceps, triceps, chest, upper back, thighs, and abdominal wall) to fatigue with sets of 8–12 repetitions should be done two to three times a week. Also, consuming 25–30g of protein containing at least 2.5 g of leucine (a branched chain amino acid) can augment muscle building from resistance training and can slow age-related sarcopenia. It is also important for an individual to consume high quality protein on a daily basis of approximately 1g per kilogram of lean body mass.

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

Your Brain

 The key to proper function of the brain comes down to the integrity of the blood–brain barrier (BBB), as well as the integrity of axons, neurons, and mitochondrial membranes. The blood–brain barrier has the important function of letting nutrients and certain small molecules into the brain tissue while allowing waste to be eliminated. In addition, the composition of the cerebral spinal fluid (CSF) is important to consider along with its relationship with the glymphatic circulatory system (GCS) function of bathing the brain tissue with CSF four times daily. The glymphatic circulatory system has been more recently understood as separate from the body’s lymphatic system. If damage to the membranes of these neurons occurs to any extent, the entire cell will be absolutely compromised in its ability to complete its purpose in electrical signaling. The vagus nerve is the largest nerve network in the body impacting multiple systems including immune, gastrointestinal function, and others. Increased permeability of the BBB is synergistically worsened by increased small intestinal permeability for a number of reasons. Excessive permeability in the small intestine can be a sign of leakage of bacterial endotoxin, as well as food allergens, into the brain, leading to more damage to brain tissue. The brain is 60% fat, so it makes sense that consuming adequate fat intake in the diet helps nourish the cells of the brain. It is also important to restore the BBB in order to prevent brain autoimmunity, brain damage from free radicals, neuro-inflammatory molecules, neurotoxins, and electromagnetic fields. Nutritional support for the BBB includes optimizing fatty acids and phospholipid dietary and supplemental intake, increasing lipid protectors like fat soluble vitamins and CoQ10, and increasing polyphenols found in blueberries, especially wild blueberries, in order to decrease oxidative damage. Sulforaphane can activate the brain’s own anti-inflammatory and antioxidant systems. Sulforaphane supplements may not be very effective. Glucoraphanin is the stored form of sulforaphane in cruciferous vegetables. In order to yield usable sulforaphane, glucoraphanin requires the enzyme myrosinase for it to be converted into sulforaphane. Cooking cruciferous vegetables destroys the myrosinase enzyme, thus very little sulforaphane can be obtained from steamed or fried cruciferous vegetables. It is important when eating raw cruciferous vegetables to have a healthy gut microbiome in order to enable some myrosinase activity. The best sources of glucoraphanin include broccoli sprouts and raw broccoli. When considering maintenance or improvement in neuroplasticity, one must consider increasing the levels of various trophic factors, such as nerve growth factor, neurotrophin, and brain-derived neurotrophic factor (BDNF). Increasing levels of BDNF may lead to axonal and dendritic sprouting, nerve stem cell differentiation, and may enhance synaptogenesis. Aerobic exercise done in the training heart rate zone (220-age) 70–80% for 30–45 minutes can increase BDNF as well as prevent loss of genetic telomere length. Aerobic exercise can also activate NRF2 gene responses. These gene responses can decrease brain inflammation and oxidative stress, which can improve neuronal and mitochondrial membranes. EGCG green tea extract is also beneficial, either by drinking green tea or by taking 200–400 mg/day. Taurine is an amino acid that can improve brain structure through a number of mechanisms. It can protect the brain against osmotic changes, has a neurotrophic effect, can activate nerve stem cells, and can enhance neurite (axon or dendrite) growth. 

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

Your Skin

Let’s talk about all the nutrients we need to take care of our biggest organ, your skin! Carotenoids are not synthesized by the human body, so they must be obtained from the diet. Good dietary sources of lutein and zeaxanthin include leafy greens, such as kale, spinach, and lettuce, as well as broccoli, corn, peas, carrots, oranges, and eggs. Among the most concerning insults to the skin seen in healthcare settings are infection, skin cancers, allergies/sensitivities, and autoimmune diseases. For infections, underlying the vulnerability to protract these infectious insults can be an injury-wound opening access to the inner body. With skin cancers, allergies/sensitivities, and autoimmune conditions, the microenvironment terrain becomes the challenge to assess and know how to treat with considerations of potential antigenic dietary intake, environmental exposures, inflammation, pathogenic triggers of subclinical chronic infections, insufficient or deficient nutritional status, emotional and biological stresses, and genomic propensities. Wounds/wound chronic infection/post-op surgical wounds, Skin cancers such as Basal cell carcinoma, Squamous cell carcinoma, and Melanoma, Atopic dermatitis/Eczema, Psoriasis, Cracked lesions on or around lips and mouth, Dermatitis Herpetiforme (extremities and/or truncal), Acne/Cystic acne,  Blistering diseases, Pemphigus vulgaris, Pemphigus, and Vitiligo all involve your diet on a molecular level. The treatment for some of these and to help your skin out include: Vitamin C, Biotin, Linoleic acid, Gamma linolenic acid, Arachidonic acid, Saturated fats, Short-chain fatty acids (SCFA), Medium-chain fatty acids (MCT), CoQ10, Vitamin E, full spectrum tocopherols/tocotrienols, Vitamin D3 (dose per blood test vitamin D25OH/VDR genomic), Vitamin A retinyl palmitate (if indicated by testing vitamin A retinol), Protein, Amino acids, Collagen, Carnosine, Honey (medical), and Aloe vera. For healthier skin you want to limit trans fats, acrylamide, rancid oils, hydrogenated fats, heat processed vegetable oils, high oleic-vegetable oils, antibiotics, and hormone - containing animal fats.

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

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