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

Fat Soluble Vitamins and Minerals

Fat Soluble Vitamins and Minerals

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

Fat-soluble vitamins are at risk of deficiency with certain states of malabsorption and malnutrition. In postmenopausal women, 5 mg of vitamin K1 protected postmenopausal women from bone fractures. In nature, vitamins A and D are found together in balance such as in cod liver oil, egg yolk, and organ meats. Vitamins A and D function in many systems throughout the body beyond the eyes and bones. Furthermore, vitamins A and D are important as immune and hormone modulators as well as affecting structural forms such as bones, cell membranes, tissues, etc. Vitamin E is a family of fat-soluble antioxidants that mainly refers to alpha tocopherol, but naturally includes several tocopherols and tocotrienols. Vegetable oils contain higher amounts of tocopherols, while tocotrienols are found in palm oil. Both tocopherols and tocotrienols have four homologues consisting of alpha, beta, gamma, and delta. Gamma-tocopherol is known mainly for its beneficial function in maintaining cardiovascular health, whereas the tocotrienols have shown more diverse application and protection against cancer, cardiovascular disease, neurodegeneration, oxidative stress, fertility, and immune regulation. Magnesium is often left undiscussed in treating bone health and cardiovascular disease. Low magnesium status may lead to a greater risk of metabolic syndrome, type 2 diabetes, cardiovascular disease, skeletal disorders, chronic obstructive pulmonary disease, depression, decreased cognition, and vitamin D deficiency. Magnesium plays a critical synergistic role in the synthesis and metabolism of parathyroid hormone (PTH), vitamin D-binding protein (VDBP), and three major enzymes that determine 25-OH vitamin D concentrations. Inconsistencies have been found in observational studies around the world showing a relationship between high sodium intake and hypertension. Potassium is an electrolyte needed for normal cellular function and is easily excreted by healthy functioning kidneys rather than stored in the body. Therefore, humans need a constant supply of potassium through the diet. Adequate intake of fruits and vegetables is a major source of potassium. Zinc is used clinically in supplement form to facilitate wound healing; decrease skin inflammation; support immune function, tissue growth, and maintenance of thyroid function; promote GI tract healing; protect against such ocular diseases as macular degeneration; and promote testosterone balance. Symptoms of severe zinc deficiency include hypogonadism, dwarfism, growth-retarded infants and children, dermatitis, diarrhea, alopecia, and loss of appetite. More moderate zinc deficiency can result in decreased immune function, increased mortality due to infections, and brain damage in a fetus when the pregnant mother is zinc deficient.

B Vitamins Part 2

B vitamins Part 2

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

Homocysteine was mentioned in our previous blog and this blog will continue on with it! Elevated plasma homocysteine levels can be due to renal insufficiency, deficiencies of folate, vitamin B12, vitamin B6 and vitamin B2. Iron deficiency should always be taken into account when assessing folate and B12 status. Elevated homocysteine and low levels of vitamins B12, B6, and folate have also been associated with bone loss and structural deterioration of bone tissue. Deficiency of vitamin B12 is associated with lower blood levels of osteocalcin and alkaline phosphatase and may point to the activity of osteoblasts and bone metabolism being affected by vitamin B12 status. Deficiency of even one B vitamin will negatively affect the ability to generate energy in the cell. The active forms of thiamine, riboflavin, niacin, and pantothenic acid are essential coenzymes in the mitochondria to make adenosine triphosphate (ATP), the cell’s energy currency. Thiamine plays a role in the synthesis of fatty acids, steroids, nucleic acids, and aromatic acid precursors and in the synthesis of neurotransmitters and bioactive compounds essential for brain function. Thiamine also plays a neuromodulatory role in the acetylcholine neurotransmitter system and can relieve fatigue associated with hypothyroidism. Thiamine can be deficient in grain-free diets and depleted with high intake of alcohol. Thiamine also plays a role in glucose metabolism. Riboflavin is required for the synthesis of two flavoprotein coenzymes. The flavoproteins are also involved in fatty acid metabolism in brain lipids, the absorption and utilization of iron, and the regulation of thyroid hormones. Clinically, higher doses of riboflavin at 400 mg are helpful with preventing migraine headaches. Niacin's are critical for enzymes involved in every aspect of peripheral and brain cell function. Pantothenic acid is required for the synthesis of coenzyme A (CoA). CoA plays a role in oxidative metabolism and contributes to the structure and function of the brain via its role in the synthesis of cholesterol, amino acids, phospholipids (PLs), and fatty acids. Vitamin B6 plays an essential role in the folate cycle and amino acid metabolism and is a rate-limiting cofactor in the synthesis of neurotransmitters including dopamine, serotonin, GABA, noradrenaline, and the hormone melatonin. When GABA is unable to participate in its inhibitory role on neural activity, disordered sleep, behavior changes, cardiovascular function, and loss of hypothalamus–pituitary control of hormone secretion can result. Low B6 status has been found in oral contraceptive users, smokers, and people with celiac disease, alcoholism, and diabetes. Vitamins B6, B8, and B12 have been shown not only to reduce psychiatric symptoms but also shorten the duration of illness. Vitamin B12 is protective against neurological deterioration, and deficiency of B12 is associated with peripheral neuropathy, cognitive impairment, and neurodegenerative disease. Causes of B12 deficiency are largely related to absorption in the GI tract, lack of intrinsic factor, or dietary deficiency such as with vegan diets. Autoimmune pernicious anemia, intestinal surgery such as bariatric surgery, and chronic gastritis from H. pylori infections all decrease the release of intrinsic factor which can result in B12 malabsorption. Undiagnosed celiac disease can also result in malabsorption of B12. Metformin decreases serum B12. Proton pump inhibitors and other medications that reduce the production of hydrochloric acid are also associated with B12 deficiency. An effective test for B12 sufficiency is MMA in blood or urine. The take-home message with B vitamins is to supplement all the B vitamins (not just one) because they work synergistically.

Fiber and Iodine

Fiber and Iodine

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

There are key considerations for nutritional balance to look at. 1. The microbiome: use of probiotics and foods in different gastrointestinal conditions, 2. Fiber: appropriate needs for different diagnoses, 3. Iodine: finding the right balance and removing antagonistic toxic halogens, 4. B vitamins: appropriate amounts and forms based on biochemical individuality, 5. Mineral balance: sodium, potassium, zinc, copper, magnesium, calcium, iron, 6. Vitamin D status: associated requirement for magnesium, 7. Fat-soluble vitamins: individual requirements Omega-6 and Omega-3 fatty acids: ratios, adequate gamma-linolenic acid (GLA), and specialized proresolving mediators (SPM) Micronutrient and macronutrient ratios in different disease processes. Let’s talk about fiber. Research suggests that changing the diet to one that is plant-based and high in fiber is a rapid, effective way to cause a beneficial change in our intestinal microbiome. Conversely, for those with irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), or inflammatory bowel disease (IBD), this approach may not be appropriate. Foods high in certain types of fiber such as highly fermentable oligosaccharides, monosaccharides, disaccharides, and polyols (FODMAPs) may result in rapid gas production and discomfort for those with IBS and possibly those with SIBO or IBD. Fiber intake is critical for gut ecology because of its role as fuel for the microbiome. Many food sources of fiber contain a mix of both soluble and insoluble fiber. Soluble fiber becomes gel-like and is fermented by friendly bacteria in the colon to make short-chain fatty acids (SCFA). Insoluble fiber is not only indigestible but also important for stool bulking and better gut motility. Eating a wide variety of plant foods ensures a wide variety of the different types of fibers including pectin, gum, mucilage, cellulose, hemicellulose, lignin, and soluble fiber. Several studies suggest that the best tolerated and most effective fiber for IBS are those with low fermentability, such as psyllium. For IBS, soluble fiber was found to be better tolerated and possibly helpful compared with insoluble fiber such as wheat bran, which may worsen symptoms. Onto iodine. Those at risk with iodine-deficient diets include vegans and people who avoid dairy or iodized salt, as well as athletes who experience excessive sweating. Alternatively, people who consume kelp may have excessive iodine intakes. To protect thyroid health, one lifestyle recommendation integrative and functional clinicians make is to limit exposure to the halogens consisting of fluoride, chlorine, and bromine. Halogens have the potential to interfere with the production of thyroid hormone, iodine metabolism, and may contribute to hypothyroidism or thyroid hormone derangement. Homocysteine, a potentially toxic amino acid, is thought to accumulate when vitamins B12, folate, B6, and/or trimethylglycine (TMG) are insufficient. Elevated homocysteine is theorized to increase oxidative stress, inhibit methylation reactions, increase damage to DNA and dysregulation of its repair, promote atherosclerosis, and direct and indirect neurotoxicity, leading to cell death and apoptosis.

Deficiency and Co-factors

 Deficiency: 

Detecting nutrient deficiencies: Some laboratory tests might be useful in identifying the nutritional needs of some patients. These tests could be of special importance to patients who present genetotrophic diseases or genetic polymorphism associated with specific conditions. However, some laboratory tests do not necessarily reflect nutrient and enzyme levels within specific organs or tissues, particularly in the nervous system. The need for laboratory testing for nutrients varies among individuals. For many patients, therapeutic trial and dose titration is often the most practical therapy approach, especially when utilizing synergistic metabolic correction formulations. Biochemical individuality is a central precept of metabolic correction. Hence, the search for optimal nutrient combination doses is a practical issue. Doses of nutrients and their combinations above the recommended daily allowances are often effective. Many patients tolerate optimal doses and respond well; however, dose titration is indicated in otherwise unresponsive cases. Recommended daily allowances (RDA) for diseased individuals . RDAs for nutrients are intended for normal, healthy people. By definition, diseased patients are not normal or healthy and not likely to be adequately served by obtaining just the recommended daily allowances. Practically every person is deficient or insufficient in a nutrient at some level due to an insufficient diet among other limiting factors (genetics, medication, toxins, etc.). Environmental pollution of air, water, and food is an increasing problem and more common than is generally recognized, posing a very important risk factor for mitochondrial damage and related diseases such as cancer and neurometabolic disorders. Diagnostic search for toxic pollutants and treatment is necessary to identify these factors and design a proper treatment approach. Monitor and update metabolic correction over time . Optimal health is a lifetime challenge. Biochemical needs change, and our metabolic correction prescriptions need to change based upon follow-up, repeated testing, and therapeutic trials to permit fine-tuning of each prescription and to provide the best possible health outcome. Nutrient-related disorders are always treatable, and deficiencies and insufficiencies are curable. Most diseases encounter some nutrient-related disruption. To ignore their existence is malpractice. Nutrigenomics and pharmacogenomics. Genetic and hereditary disorders are often responsive to metabolic correction because it takes advantage of nutrigenomics and  pharmacogenomics. Inspire active role-taking responsibility for your health. Inspire patients to understand that health is not merely the absence of disease, but the positive attainment of optimal function and well-being. This requires an individual to take an active role in necessary lifestyle changes, and it requires a commitment to continuous education along with a responsible attitude about health. 

Co-factors:

To encourage the most efficient metabolism, we need basic macronutrients required for fuel: fat, protein, and carbohydrate. But we also need about 15 vitamins that are coenzymes and about 15 minerals that are required for enzyme function. We also need two essential fatty acids (omega-3 and omega-6) and seven or eight essential amino acids. In addition, other important nutrients – such as coenzyme Q10, acetyl-L-carnitine, and  lipoic acid – must also be considered in our quest for physiological optimization. Virtually every metabolic pathway requires micronutrients. Certain individuals have a greater need than that supplied by the diet (even if a good dietary regime is followed). This could be caused by an array of variables (digestive problems, malabsorption, food sensitivities, metabolic dysfunction, low levels of neurotransmitter precursors, etc.). This lack of needed micronutrient cofactors manifests insidiously and is difficult to identify. Some vague symptoms may be present, such as lethargy, irritability, insomnia, and difficulty in concentrating. This  also affects the body’s ability to resist disease and infection, its ability to recover from exercise, surgery, or disease, and the ability of the brain to function at an optimal level. Detecting and treating disease at its earliest stages of cellular biochemical abnormality, rather than waiting for clear clinical symptoms, is cost-effective and of benefit to the patient. We need to abandon outdated paradigms framing nutrient intake as needed merely to prevent deficiencies and expand them to include preventing chronic degenerative diseases and achieving optimal health.

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

B Vitamins and Thyroid

 B-Vitamins:

The basic B-complex consists of a group of eight water-soluble compounds: thiamin (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), cobalamin (vitamin B12), folate (vitamin B9), and biotin (vitamin B7). Although each B vitamin is chemically distinct, they often work together in various biochemical functions throughout the body, from cellular energy production to healthy red blood cell formation to healthy neurological function. Most B vitamins, with the exception of vitamin B12, are not stored in the body. They must be acquired daily from the diet in order to maintain optimal health. Supplementing with bioactive B vitamins (e.g., methyl folate) is important to everyone, especially individuals who may not be able to convert inactive or synthetic vitamins to their active forms in the liver because of compromised liver function, poorly functioning enzymes, digestive disturbances, genetics, or age. Dietary supplements containing these active cofactors have enhanced bioavailability, ensuring the body gets the nutrients it needs. Every process that goes on inside our bodies requires energy, specifically metabolic energy. When the body does not have enough energy to function properly, different components of the body may malfunction in their own ways. For example, if the brain does not have enough energy, cognitive processes, such as memory and focus, may become impaired. The body converts fats, sugars, and proteins into ATP that is then used for energy. However, there are other factors involved that can affect how well our body can  make this conversion into the ATP molecules. 

Thyroid:

The thyroid hormones are essential in maintaining and regulating the body’s metabolism. The thyroid gland makes the hormone T4 (thyroxine). T4 converts to T3 (triiodothyronine) and RT3 (reverse T3, rT3). T3 turns on the ATP (energy), while RT3 is a way to get rid of any unneeded T4, thus reducing energy output. This happens because the adrenal glands are too weak to handle the stress of the body’s normal metabolic energy and force a downregulation of energy production. Triiodothyronine (T3) is the most active thyroid hormone. Approximately 85% of circulating T3 is produced by mono-deiodination of thyroxine (T4) in tissues such as the liver, muscle, and kidney. Production of these thyroid hormones is controlled by TSH (thyroid-stimulating hormone), which is released by the pituitary gland in the brain. The pituitary takes its orders from the hypothalamus. The adrenal glands, located on top of each kidney, help the  body deal with stress. If the metabolic activity is excessive, the adrenals perceive this as stress. In response to this stress, the hypothalamus will signal the pituitary to produce less TSH, thus producing decreased T4 and thyroid activity. This metabolic control activity utilizes various enzymes whose main cofactors are B-complex vitamins. Lack of B vitamins may lead to hypothyroidism because the thyroid gland cannot make enough T4. Hypothyroidism is a condition in which an underactive thyroid gland produces less than optimal amounts of thyroid hormone. A lack of the thyroid hormones can lead to fatigue, constipation, hoarse voice, puffy face, unexplained weight gain, pain and stiffness in the joints, muscle weakness, sensitivity to cold, elevated cholesterol levels, brittle nails, and depression. Hypothyroidism has also been linked to other health issues, such as heart disease, infertility, autoimmunity, and obesity. Metabolic correctors, along with proper nutrition, should come first in medical treatment. Knowledge of the safe and effective use of nutrient combinations, enzymes, hormones, and other naturally occurring molecules in their bioactive forms is essential to ensure an effective outcome. However, some patients may need more acute treatment for their particular condition, for which pharmacological therapy is recommended. Metabolic correctors have a low risk of toxicity. Pharmacological drugs often carry a risk of negative side effects and, in a chronic condition, should be the second choice if there is a metabolic correction alternative available.

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

Vitamins and Nutrients

 Vitamins:

Vitamins fall into two general categories: water-soluble and fat-soluble. Water-soluble vitamins are found mainly in watery or starchy foods such as grains, fruits, and vegetables, while fat-soluble vitamins are found mainly in fatty foods such as butter, nuts, olives, seafood, and organ meats. Only water-soluble vitamins function as coenzymes, while cofactors can also be minerals and other micronutrients. Vitamin deficiencies or coenzyme deficiency can lead to serious health disorders because important biological processes break down when a lack of coenzymes prevents enzymes from catalyzing essential chemical reactions. Two well-known coenzyme vitamins are thiamin and niacin. Thiamin compounds serve as coenzymes for a variety of reactions involving cellular energy production, protein synthesis, and brain function. Thiamin deficiency causes a disorder known as beriberi, with symptoms such as irritability, weakness, and even heart failure. Niacin is needed for numerous reactions related to energy production and fatty-acid synthesis. Deficiency causes pellagra, which leads to dementia, skin problems, weight loss, and eventually death. Inadequate or insufficient dietary intakes of vitamins and minerals are widespread, most  likely due to excessive consumption of calorie-rich, nutrient-poor, refined food. Suboptimal intake of micronutrients often accompanies caloric excess (hidden hunger). Hidden hunger (or occult hunger) is a form of undernutrition in which a chronic lack of vitamins and minerals has no visible warning signs. The Standard American Diet lacks essential nutrients. This state of nutritional insufficiency is a possible reason why millions walk around with headaches, body aches, digestive upset, skin problems, sinus problems, frequent colds, and other signs and  symptoms that may quickly disappear when you start taking necessary vitamins and minerals. Nutrition is enhanced through supplementation. Hidden hunger can lead to mental impairment, poor health and productivity, or even death.

Nutrients:

The triage theory of optimal nutrition states that the human body prioritizes the use of vitamins and minerals when it is getting an insufficient amount of them to be able to keep functioning. Triage means deciding which patient to treat when faced with limited resources. When nutritional resources are limited, physiology (biological intelligence) must decide which biological functions to prioritize to give the total organism and the species the best chance to survive and reproduce. While short-term deficiencies or insufficiencies are common, they are often not taken seriously by mainstream medicine. Under such a limited scenario, the body will always direct nutrients toward short-term health and survival capability and away from regulation and repair of cellular DNA and proteins, which ultimately optimize health and increase longevity. We need to eat a wide variety of food to obtain the nutrients we need. A big problem we face is that the nutritional values of foods that people eat may be inferior to the listed values given in food  tables. Foods today have less nutrient content than foods 50 years ago. A study that assessed this issue showed declines in protein (−6%), calcium (−16%), phosphorus (−9%), iron (−15%), riboflavin (−38%), and vitamin C (−20%). There is a dilution effect, in which yield-enhancing methods such as fertilization and irrigation may decrease nutrient concentrations. A report from the US and UK Government statistics shows a decline in trace minerals of up to 76% in fruit and vegetables over the period from 1940 to 1991. Imagine what it is now. Nutrient imbalances impose a metabolic burden on all organ systems, with the greatest burden on those systems responsible for achieving and maintaining metabolic  equilibrium. Long-term disruption of metabolic equilibrium will most often adversely impact the cardiovascular, pulmonary, renal, gastrointestinal, neurological, and/or musculoskeletal systems. In the absence of an adequate supply of nutrients to satisfy normal physiological requirements or adjust to increased metabolic demand, compensatory mechanisms involving one or more of these systems must be initiated to re-establish homeostasis. As with metabolic adjustments to address short-term nutrient deficiencies, these compensatory responses are important for correction of temporary imbalances, but if sustained over the long term, they may become maladaptive and contribute to the degenerative changes responsible for development or worsening of chronic diseases.

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