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

The Five Spheres and Metabolic Correction

The five primary spheres of influence:

The five primary spheres of influence in the Radial are as follows: 

1. Food, lifestyle, and environment

2. Nutrition, physical, signs, and systems 

3. Biomarkers 

4. Metabolic pathways and networks 

5. Systems  

The four distinct, interrelated steps include nutrition assessment, diagnosis, intervention, and monitoring/evaluation. The Radial core illustrates the intermingling of mind, body, spirit, community, and earth and its association with personalized nutrition care. All of these factors influence one’s health and healing. Mind, body, and spirit are viewed as wholeness versus distinct and separate physiological, psychological, and spiritual units. The value of community and social networks as a component of health and wellness must be considered since social contexts influence biological systems. An appreciation of our intimate connection to the earth and the healing power of nature to foster one’s health is also valued as an integrative concept of food and sustainable nutrition. The microbiome revolution has established that microbial signatures vary between individuals far more than genetics. Dietary habits and lifestyle affect the gut microbiota composition in dramatic ways. This vital influence must be taken into account. The composition of the microbiome and its diverse activities are involved in most of the biological processes, and thus, it is a key player in health and disease at all stages of the life cycle. The Systems sphere radiates from the core of the Radial and underscores the imbalances that are created by poor diet, unhealthy lifestyle behaviors, and environmental exposures such as chronic inflammation, oxidative stress, digestive and detoxification disturbances, metabolic chaos, neuro-endocrine-immune disruption, and nutritional depletion.

Metabolic Correction:

A modern, integrated concept of food as medicine emphasizes scientific understanding of nutrition with lifestyle behaviors in relation to a person’s ability to realize vital goals of healthy living. Food is valued as an instrument for vibrant health and an essential tool to kindle healing by restoring nutritional integrity. Diet assessments may not always coordinate with laboratory values of individual nutrients. This may be due to many factors, such as an individual having a greater need for a nutrient than the RDA, poor-quality food or supplements, a genetic variation, impaired absorption, exposure to a specific toxin whose detoxification requires specific nutrients, etc. You also see different types of food reactions. By definition, IgE reactions are true allergic reactions, while other reactions are food intolerances or sensitivities, measured with immunoglobulins (IgG) or white cells, and have significantly less literature support. Metabolic correction (MC) is the utilization of a synergistic combination of micronutrients and cofactors in their active forms and proper doses to maximize the function of metabolic enzymes. MC is a functional biochemical/physiological concept that explains how improvements in cellular biochemistry help the body achieve metabolic or physiologic optimization. The MC concept provides the biochemical elucidation of the utilization of nutrients for preventive and therapeutic purposes against disease. The MC concept becomes important since our food is decreasing in nutritional value; diseases increase the demand for nutrients, and medications can deplete nutrients. These nutrient insufficiencies are causing enormous costs due to increased morbidity and mortality. In summary, MC increases enzymatic function that enhances biological functions contributing to better health and well-being. A nutritional deficiency is defined as an inadequate supply of essential nutrients (vitamins and minerals) in the diet, resulting in malnutrition or disease. Tissue levels are low enough in one or more nutrients that pathology results primarily from the nutritional deficiency and from secondary complications. Nutrient deficiency is described in medical pathology textbooks; unfortunately, this is the start and end to nutritional education for most physicians. A nutritional insufficiency is a subtle deficiency of a nutrient sufficient to affect health but not severe enough to cause classic index deficiency symptoms. Problems here are more of a functional and biochemical nature rather than pathologic, but they may lead to the disease state. A nutrient dependency refers to a unique genetic or acquired dependency on supra-dietary levels of one or more nutrients. At the point where altered cellular function has evolved into clinical manifestations of nutrient deficiency, cellular activity will have been compromised for some time, and the compensatory responses that might have allowed a temporary adjustment to the deficiency would no longer be effective. Detection of subclinical changes in cell processes early in the course of a nutrient deficiency, when cell damage is minor and more reversible, can have a considerable impact on the prevention and treatment of disease. If subclinical deficiency is not corrected by providing the lacking nutrient, then prolonged marginalization of cellular activity may not only increase vulnerability to disease, but it may also exacerbate progression of existing disease and interfere with effectiveness of treatment, since all drugs require some level of metabolic support to achieve their desired therapeutic effects.

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

Appetites and Protein

Appetites: 

Malnutrition, which includes overnutrition, undernutrition, and imbalanced nutrition, affects at least a third of the earth’s population and is by far the greatest contributor to the global burden of disease. Information about the dynamics of human appetite systems is essential for understanding why we eat the amounts of nutrients and energy that we do. The main conclusion that it presents is by no means obvious: it suggests that humans will overeat fats and carbohydrates not because they have a particularly strong drive to eat these nutrients, but because of a strong appetite for protein. On the other hand, we should not interpret this to suggest that the human appetite is exclusively about protein. Rather, in circumstances where it is possible, the appetites for different macronutrients cooperate to select a balanced diet, but when limits on available foods prevent this, protein regulation overrides and fat and carbohydrate intakes follow more passively. Just as the macronutrients combine in specific proportions in foods, so too do foods combine into meals, meals into diets, and diets into dietary patterns. Although some foods are eaten directly, the greatest portion of the human diet is eaten as mixtures of foods, called meals. Meals, therefore, are important levels of focus for understanding human eating choices. And yet neither foods nor meals are the primary link between nutrition and health; for that we need to consider the long term cumulative intakes of foods and meals, namely, diets. To close the circle, diets impact health and disease principally via their primary components, the nutrients.

Protein:

There is now strong evidence that excess protein intakes are associated with negative cardiometabolic profiles and accelerated aging, especially when coupled with low carbohydrate intakes. Consistent with this is the observation that the healthiest dietary patterns, including the Mediterranean, traditional Okinawan, Kitavan Islanders, and Tsimane diets, are associated with low dietary protein densities and low protein intakes. This should caution against high-protein diets, such as the Atkins, high protein Paleo, and Sugar Busters diets, except as therapeutic interventions for weight loss. It also raises questions about the high end of the protein range sanctioned by the US AMDR. A combination of low protein (60g-ish) and high fiber actually has the double health benefits of limiting protein intake while avoiding energy overconsumption. Another advantage of building such a model is that it provides a context for identifying important aspects of our food environment that might influence the relationships within the model. For example, among the most salient and influential aspects of industrialized food environments is economics, giving rise to the question of whether the cost of foods might play a role in influencing the macronutrient composition of our diets. Results showed that the cost of supermarket foods is positively related to their protein content. In this way, protein leverage might help to explain the well-established association between lower socioeconomic status and obesity. We might likewise address the question of why the USDA AMDR spans such a wide range of dietary protein densities, encompassing both low-protein diets (10–15% protein), which our model suggests are likely to be associated with excess energy intake, and the high end (25–35%), associated with excess protein intake and premature aging. One possibility is that this reflects influence on research and government policy by the food industry, rather than health considerations. For example, the sugar and affiliated industries selectively sponsor research that casts doubt on recommended upper limits to sugar intake, and the meat, dairy, and egg industries do the same for protein. These industries also exert influence on dietary guidelines through political lobbying that emphasizes the importance of dietary balance. In closing, we emphasize that our main goal is not to suggest that we have solved the problem of energy overconsumption, obesity, and related diseases, but rather to introduce a biologically inspired approach that can help to structure nutrition research. Beyond the macronutrients and their different types and constituents, other dietary components such as fiber and micronutrients clearly are relevant to the problem, and likewise, many nutrient combinations are important for various other aspects of health. We suggest, however, that these relationships are best examined in a framework that is guided by biological theory and which examines the interactions among nutrients rather than considering them separately.

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

Wellness and Health

Have you noticed the trend to perceive type 2 diabetes as a “normal” condition after age 50? Have you noticed the trend to perceive a little arthritis pain in the joints as a “normal” condition after age 40? These conditions have become so prevalent that adults are trending to consider these conditions as the “normal” for states of health. The “normal” today in this time of epidemic chronic disease is promoting amnesia of true wellness. Wellness certainly means freedom from the debilitating, weakening effects of chronic disease. As a side product of this level of wellness, one feels dynamic, energetic, alive, vital, and vibrant. From this healthy state, we can respond effectively to environmental stress, toxins, or infections, quickly returning to our previous state of health and wellness. The most recent study is that of Dan Buettner named The Blue Zones – those pockets of societies with the most healthy centenarians and generally healthy populations. Common factors that have measurable biomarkers among the healthiest societies are repeatedly found to be: 

1. Unprocessed, whole foods, plant-rich diet (diet history; nutrient status)   

2. Caloric and nutrient intake so as to maintain a healthy Weight (anthropometrics)   

3. Regulating insulin production (blood glucose/insulin fasting; HgbA1C)   

4. Moderate daily physical activity (minutes per day or week; handgrip strength)   

5. Small amount of alcohol frequently 

6. Strong community and social connectivity

7. Meditation and spiritual beliefs (time per week) 

8. Feeling of purpose in life (1–10; 10 highest)

Throughout the community of integrative and functional medicine practitioners’ concepts like Maslow’s hierarchy of needs have developed an agreement that the following factors are key influencers that summarize the findings of many studies on longevity and wellness: “Basic needs”: Biological, physiological, safety needs 

1. Foods (protein, fats, carbohydrates, fiber) 

2. Vitamins, minerals, accessory, or conditionally essential nutrients 

3. Light, water, and air 

4. Movement rhythm 

5. Circadian rhythm balance 

6. “Mind-body needs”: Love, belongingness, self-esteem, cognitive, aesthetic, and self-actualization needs 

7. Meaning and purpose 

8. Love, community, connection 

All seven are inherently interrelated in the context of the human experience that affects wellness.

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

Healthy Holiday's Guidelines

 

1. Healthy Swaps for classic meals:

• Greek yogurt or avocadoes instead of sour cream

• Cauliflower mash added to potato or sweet potato

• Grilled or baked fruit instead of pies

• Instead of a casserole, just sauté the veggie (green bean casserole vs sautéed green bean)

• Healthier dips such as hummus and tzatziki instead of cheese balls and French onion dip

• More Crudité, than charcuterie 

• Bake not fry

• Use olive oil, avocado oil instead of vegetable oil

• Always fresh or frozen never canned or boxed

• Swap out bread rolls for homemade whole grain bread rolls

• Cider instead of eggnog

• Don’t add salt, use other spices/herbs

• Chocolate covered, dusted, etc. nuts instead of candy or cookies

• Shrimp cocktail instead of fried apps

2. Portion Control: hand gestures

3. Tips and tricks

• Make your plate colorful

• Choose clear liquids (Think water, vodka, gin, rum, club soda, seltzer water, tonic water)

• Don’t skip meals; don’t go to a party with an empty stomach

• Eat until you are satisfied, not stuffed

• Eat slowly

• No feeling of guilt allowed!

• Wait 10 minutes before going up for seconds this gives your GI tract time to alert your brain of hunger/satiety cues

• Avoid anything that says diet/low fat/etc. because something else was put in their to make it that way (normally not good things)