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

Diets

Diets

Diet is the core treatment for many diseases, including obesity, hypertension, hyperglycemia, and dyslipidemia. Many interventions are beneficial, including replacing harmful fats with health-promoting fats; increasing fiber; increasing phytonutrient content such as flavonoids, polyphenols, and antioxidants from plant-based foods; reducing salt; and restricting calories. The Mediterranean diet is one of the most studied diets and recommends high consumption of extra virgin olive oil, fruits, vegetables, nuts, seeds, legumes, cereals, moderate fish, poultry, dairy, and red wine and lower consumption of eggs, red meat, processed meat, and processed foods. The Mediterranean diet improves blood pressure, lipid profiles, insulin sensitivity, CRP, oxidative stress, atherosclerotic disease, and cognitive function. To reemphasize, a one-size-fits-all diet or macronutrient recommendation is not plausible. The percentage of calories from carbohydrate, fat, and protein needs to be determined on an individual basis. Specific conditions such as chronic kidney disease will benefit from a controlled protein intake, and epilepsy can benefit from a very low-carbohydrate, high-fat ketogenic diet. For years, the field of nutrition has been bombarded with claims of various adjustments in macronutrient ratios having benefit. Nutritionists need to take into account individual disease states and give the patient the most sustainable, realistic plan to improve health. While the ketogenic diet (low-carbohydrate, high-fat) is showing promise for various conditions including epilepsy, cancer, weight loss, type 2 diabetes, metabolic syndrome, dementia, and neurological diseases, the ketogenic diet can be difficult for the average person to sustain. Intermittent fasting (IF) and time-restricted feeding (TRF) may prove to have as important cardiometabolic and neurological benefits as the ketogenic diet and may be appropriate for those who cannot sustain a ketogenic diet. Time-restricted feeding (TRF) may be a feasible alternative to calorie restriction, ketogenic diet, and intermittent fasting when compliance with more restrictive eating regimes is not likely or not recommended. TRF is an eating pattern based around circadian rhythms that occurs within a limited time span (usually 8–12 hours), with a span of 4 hours in between meals with no attention paid to calorie intake.

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

Fatty Acids

Fatty Acids

A balanced ratio of omega-6 to omega-3 fatty acids is important for overall health related to its impact on inflammation, immune balance, obesity, depression, and cardiovascular disease. Alpha-Linolenic acid (omega-3) and linoleic acid (omega-6) are the two essential fatty acids that must be obtained through the diet; The ratio of omega-6–omega-3, historically, was 1:1–4:1, and today it is reported to be around 20:1. This change in consumption correlates with the rising epidemic of obesity and inflammatory disorders. Omega-3 fatty acid-enriched diets improve inflammatory status of metabolic dysfunction and reduction in adipose tissue if kept in balance with other essential fats. Supplementation with omega-3 fatty acids and certain doses of omega −6 fatty acids was shown to help with decreasing body fat mass and hip circumference loss. Dietary interventions optimizing the ratio of omega-6 to omega-3 have shown significant reduction in low-density cholesterol as well. Short-chain fatty acids (SCFA) are the major metabolic products formed by anaerobic bacterial fermentation of soluble fiber in the gastrointestinal tract and may be the link between microbiota and host tissues. SCFA include acetate (C2), propionate (C3), and butyrate (C4). Acetate is utilized for lipogenesis in the liver and as a fuel source once it enters circulation; propionate is also used in the liver as a substrate for hepatic gluconeogenesis; butyrate is primarily used as a fuel source for the colonocytes. Besides serving as a fuel source for the intestinal epithelial cells, SCFA also modulates electrolyte and water absorption in the GI tract and regulates the inflammatory process in the GI tract. The concentration of SCFA in the GI tract and blood may predispose to or prevent illnesses such as inflammatory bowel disease (IBD), cancer, and diabetes. SCFA modulates different processes such as cell proliferation and differentiation, hormone secretion of leptin and peptide YY, and immune and inflammatory responses and serves as an energy source for colonocytes, the liver, and muscle. Recommend lowering omega-6 by changing vegetable oils from corn, sunflower, safflower, cottonseed, and soybean oils to oils that are high in omega-3, such as flax, perilla, chia, rapeseed, and oils that are high in monounsaturated fats such as olive oil, macadamia nut oil, hazelnut oil, and increasing fish intake to two to three times per week while decreasing meat intake. Processed foods are notoriously high in omega-6; therefore, consuming a whole-food, unprocessed diet is also an important factor in balancing the ratio of omega-6–omega-3 fatty acids. Hydrogenated oils are harmful fats also known as trans-fatty acids. Hopefully, trans-fatty acids will be less of a concern in the United States due to the phasing out of these fats in the food manufacturing industry. Trans-fatty acids are harmful because, although listed as unsaturated fats, they behave like saturated fats and lead to higher cholesterol levels, and they mimic unsaturated fats by binding to desaturase enzymes and interfering with the normal production of necessary substances. Trans-fatty acids have been shown to contribute to the risk of heart disease and cancer. Trans-fatty acids are found in margarine, hydrogenated peanut butter, baked goods, desserts, snack foods, and crackers.

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