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

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

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

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