CREATING HEALTH Lecture #3: Inflammation

Lecture by Mark Pettus transcribed by Carolann Patterson

INFLAMMATION: ARE YOU PLAYING WITH FIRE?

Learning Objectives from today's lecture:

1. Explore the root causes of inflammation that fuel chronic-complex disease
2. Examine the connection between inflammation and brain health
3. Examine the mechanisms that link many common environmental triggers with increased inflammation
4. Consider lifestyle changes that can reduce-reverse inflammation to improve longevity and quality of life

The proposition for this lecture: how the outside gets inside

1. Health and disease are byproducts of complex individualized gene-environment interactions that may go back more than a generation before our conception and continue throughout our lives.
2. Your DNA i.e., your “Book of Life” still has a Stone Age imperative, not often adapted for 21st century environmental inputs e.g. the foods in our modern food supply.
3. This incompatibility creates a distorted metabolic trajectory e.g. inflammation that forms the basis of chronic complex disease and diminished quality of life.
4. Through mindful living that aligns conscious choosing with what are are most designed to be in relationship with, our biology can be transformed to promote-restore optimal function and health throughout the life continuum.

Nutrigenomics studies the effects of food and food constituents on gene expression and focuses on the molecular-level interaction between nutrients and genome. It is where we look beyond “food as calories” and see food for what it is: information. Molecules of food have the power to influence life-sustaining pathways. Depending on the quality of a certain food, it will send information that will either trigger inflammation or reduce it.

Does the stress of our present diet create an epigenetic change in our health? Absolutely... 

This is the shape of things to come…and this is the route we are taking to get there…

1. Poor Quality Carbs - information from food leads to...
2. Excess Insulin - It is impossible to burn fat with excess insulin [leads to...]   
3. Fat storage [leads to...]
4. Down-regulation of insulin receptors [leads to...]
5. Insulin Resistance and then on to Leptin Resistance and then on to Eat More + Do Less = NO GOOD

It is not simply a matter of poor food choices that lead to Inflammation and then on to Insulin Resistance. All of the following factors eventually lead to Insulin resistance: Visceral fat, Changes in food consumption, Stress, Sleep disruption,  Altered gut-permeability/microbiome, Social Isolation, Hormonal imbalances, Toxin excess. 

INFLAMMATION IS AT THE CENTER OF IT ALL

Inflammation is connected to every chronic complex disease...and it's got everyone's attention. Scroll through the titles listed below to find articles related to Inflammation and Stroke; Inflammation, Atherosclerosis and Coronary Artery Disease; Inflammation and Cancer; Inflammation and Depression and the Brain; Inflammation and Obesity; Obesity and Periodontitis.

CRP. C-Reative Protein is a marker for inflammation. We can easily test for CRP levels. When tested for CRP, cancer patients' survival rates are higher when there is Low CRP. See graph below: 

Slide courtesy Jeanne Wallace PhD

Inflammation effects cancer prognosis and reaction to chemotherapy: Patients with higher CRP experience poor prognosis; toxicity of chemotherapy; cachexia; and fatigue...

NF-κB is Inflammation’s “Master Switch” - keep it turned off

NF-κB is a nuclear transcription factor that is triggered by diet, stress, environmental toxins, visceral fat, infections, intestinal barrier integrity disruption, oxidized LDL, free radicals, vitamin D deficiency, altered microbiome, LPS, inflammation from other sources. It up-regulates expression of 400+ genes involved with cytokine production, cell proliferation, apoptosis, angiogenesis. Exercise, meditation, Vitamin D, Spices [e.g. turmeric] and many plant flavonoids have shown to inhibit NF-κB in vitro and in vivo. 

Nrf2 is the antidote to NF-κB.

Nrf2 activation is a critical intra-cellular defense: keep it turned on. Exercise, Meditation, EGCG, Resveratrol, Coffee, Sulfurophane, Curcumin all boost Nrf2. 

FOOD AND INFLAMMATION

Changes in our diet trigger inflammation. Watch out for the following inflammation boosters:

• SUGAR and REFINED grain flours, PROCESSED poor quality carbs with high “carbohydrate density”FRUSCTOSE from sugar and High Fructose Corn Syrup
• Not enough vegetables and plant-based fiber to strengthen and balance your microbiome [we need 6-9 servings per day]
• Increased processed seed oils [they are too high in Omega-6 polyunsaturated fatty acids. Excess Omega-6 fatty acids build up in our cell membranes and contribute to inflammation]
• Insufficient healthy saturated fat [e.g. coconut oil and grass-fed-pasture-raised butter, whole milk, cream, eggs, red meat]
• Sensitivity to GLUTEN and DAIRY
• ENVIRONMENTAL TOXINS - contaminated foods such as game fish [mercury], non-organic fruits and vegetables [pesticide residues], food stored in BPA in plastics…and that’s just the short list

SUGAR

Obesity and Diabetes: The Twin Epidemics. Rates of Obesity and Diabetes have risen drastically in the past century. In 1890, one in thirty [adult 60 year old men] was obese. In 2000, 1 in 3 [adult 60 year old men] was obese. In the 1930's, one in 50,000 adults was diabetic. In 2000, one in 9 adults is diabetic [Johnson et al, American Journal Clinical Nutrition, 2007].

Inflamed About Obesity, Michael Lehrke & Mitchell A Lazar: Two studies find that adipocytes and macrophages have more in common than previously thought. The work bolsters the notion that the inflammatory response might link obesity to afflictions such as diabetes. The epidemic of obesity stems from a clash between genes that allowed our ancestors to survive extended periods of famine and the caloric excess and sedentary lifestyle of our modern environment. Obesity is a major risk factor for diabetes and atherosclerosis, afflictions associated with a constellation of insulin resistance, hypertension and lipid abnormalities that is now defined as Metabolic Syndrome [Nature Medicine, Vol 10, No. 2, February 2004]

What is metabolic syndrome? Metabolic syndrome is not a disease in itself. Instead, it's a group of risk factors- high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat at the following levels [Source AHA]:

• Waist Circumference > 35” in women and > 40” in men
• BMI > 30 (= obese)
• Elevated blood pressure: > 130/85
• High triglycerides: > 150 mg/dL
• low HDL: < 40 mg/dL men, < 50 wome
• Elevated fasting glucose: >100 mg/dL

Visceral Adipose stores [mid-section weight gain, belly fat] is linked to Insulin Resistance; Dyslipidemia [high TGA and low HDL]; Elevations of Blood Pressure; and increased risk of chronic complex disease. It is the outward signal that internal fat surrounds organs and can penetrate the liver, causing the liver to respond as though it is Hepatitis. 

The Quality of carbohydrates you eat matters. 

Different carbohydrates produce unique genomic responses. NF-κB is the Inflammation Master Switch: keep it turned off...

High Glycemic Carbs [NF-κB turned on = bad]. 

Low Glycemic Carbs [NF-κB turned off = good]. 

... and stay away from those seemingly innocent rice cakes and pretzels!

GLUTEN

Gluten attacks the intestinal tract. Boston Mass General's Alessio Fasano is a gastroenterologist and pioneering researcher whose team discovered Zonulin, the molecule which regulates intestinal permeability, a.k.a. Leaky Gut.

Gluten triggers Zonulin. Over-production of Zonulin has been linked to a series of autoimmune diseases, including Type 1 Diabetes, Celiac Disease and Multiple Sclerosis.

Gluten is the primary cause of Celiac Disease. Fasano's research in 2003 demonstrated the prevalence of Celiac Disease in the U.S. to be far higher than previously thought, at a rate of 1 in 133 persons. Currently, 1.4% of Americans have Celiac Disease.

Primary source of Gluten is Wheat, and Wheat is NOT what it used to be...

GLUTEN MIND and GLUTEN MOOD 

Inflammation is a systemic process. Inflammatory triggers such as Gluten cause inflammatory manifestations in all parts of the body, not just at the "point of entry" e.g. the stomach and can disrupt coordination/balance, cause joint pain and brain fog and... 

• Celiac Disease is caused by Gluten and associated with many neuro-psychiatric diagnoses e.g. ADHD seen in approx. 60%!
• Celiac Disease is associated with white matter changes on MRI…similar to that seen with MS
• Gluten increases insulin resistance in individuals who are sensitive
• Brain wave patterns in ADHD improve consistently with gluten restriction
• Gluten sensitivity enhances zonulin that increases intestinal permeability
• Gluten sensitivity can alter blood flow to frontal lobes

From Gut to Brain: Gluten sensitivity is linked to:

• Dementia
• Depression
• Headaches
• Movement disorders
• ADHD
• Pain 

The intestines are only one cell layer thick. What causes Intestinal Permeability?

• Food sensitivities
• Dysbiosis – Too much bad and not enough good bacteria. Gut microbiome needs diversity to balance
• Acid suppression [Causes overgrowth of bad bacteria. Prolonged acid suppression is not good for you Short-term use only e.g Prilosec]
• Stress response
• Environmental toxins
• Medications e.g. regular steroids and NSAID use [irony: anti-inflammatory drugs such as Tylenol and Ibuprofen promote inflammation]

A-cellular carbohydrates [not from vegetables or legumes] cause increased inflammation which leads to:

• Insulin-fueling lipogenesis
• Insulin resistance in muscle and liver
• Inhibits capacity to burn fat
• NF-κB goes up [bad]
• Increased LPS - Lipopolysaccharides elicit a variety of inflammatory responses and may be a part of the pathology of Gram-negative bacterial infections [bad]
• Cytokine up-regulation [bad]
• Leptin resistance [hungry and less energy to move]
• Poor health and many symptoms [including Periodontal disease]

The Host Genotype Affects the Bacterial Community in the Human Gastrointestinal Tract

Host genes shape the gut microbiota. 90% of our bodies is not human: it's microbial. Microbes are essential to our health and most of them live in the gut sending out messages to support digestion, immunity, metabolism. When the microbiome is disrupted and out of balance [dysbiosis] messaging in our body gets mixed up. Big time.

The F-Word: FIBER [and F. prausnitzii]

When the mucous layer in the intestines is reduced, opportunists can move close to the gut lining, inciting inflammation. Fermentation of plant-based fiber seems to keep the mucous layer intact. So does the presence of peace-keeping microbes such F. prausnitzii.

Speculative interpretation of current research is that gut colonization is most beneficial before the age of 3 and is strengthened by these three key factors at birth to age 3:

1. Vaginal delivery
2. Breast-feeding
3. Minimal or no use of antibiotics and anti-bacterial products [both contribute to a less diverse ecosystem and microbiome]

Diversity of gut colonization relies on:

1. One organism preventing overgrowth of another 
2. Cross-talk influencing the immune system

Late colonization/infection + poor microbial diversity + genetics = sickness

Scientific America explains why our progeny may not be inheriting their fair share... "Because the critical issue is the inter-generational transfer of microbes and its timed assembly, three periods are relevant: before pregnancy, during pregnancy and in the child's early life.

For all three periods, antibiotic use is relevant because it may directly change maternal microbes prior to transfer or the child’s microbes afterward. Elective cesarean sections mean that the child misses the birth canal transit, and anti-bacterials in soaps and foods directly affect microbiota composition. Infant formulas have not been constructed with the benefit of millions of years of mammalian evolution, because breast milk contains nutrients that specifically select for the growth of preferred co-evolved organisms and inhibit opportunists and pathogens.

The aggregate of modern assaults on the early-life microbiome suggests that our progeny may not be inheriting their fair share. Exceeding the developing microbiome’s plasticity predictably leads to consequences, as growing evidence evinces.

Studies have linked C-sections and exposures to prenatal and postnatal antibiotics to increased risk of obesity, diabetes, celiac disease, asthma and allergies, among other ailments that have their roots in development."

PSYCHOBIOTICS

The brain responds to the gut. Researchers have learned which strains of gut bacteria affect the nervous system and have mapped out the pathways they use to influence the brain.  Gut flora can improve mood; some can produce neurotransmitters such as norepinephrine, serotonin, and dopamine; while other microbes such as L. helveticus and B. longum operate through the neuro-endocrine system and can lower cortisol.

A specific strain of Lactobacillus reuteri can increase the level of oxytocin, the hormone that kicks in when you cuddle, hug, or have sex. Lactobacillis acidophilus [found in yougurt, sauerkraut, and kimchi] is critical to regulating pain. B infantis and L reuteri and other strains attack inflammation by suppressing pro-inflammatory cytokines. They also send signals to increase Leptin [The “I am Full” hormone].

Watch this space – Psychobiotics might just be the next happy pill because of their links to:  

• Protection of intestinal barrier function
• Influence on local and systemic antioxidant status
• Direct neurochemical production e.g. Gamma Amino Butyric Acid
• Indirect influence on neurotransmitter function
• Experimental evidence of links to depression, anxiety, and autism
• Stress-induced alterations in microbiota
• Direct activation of neural pathways between gut and brain
• Regulation of immune response - inflammatory cytokines
• Can influence production of Brain Derived Neurotrophic Factor [BDNF]*
• Loss of microbiome “heritage” a contributor to many modern diseases

[Psychobiotics: a novel class of psychotropic. Biol Psychiatry. 2013 Nov 15;74(10):720-6. doi: 10.1016/j.biopsych.2013.05.001. Epub 2013 Jun10. Fermented foods, microbiota, and mental health: ancient practice meets nutritional psychiatry Eva M Selhub1*†, Alan C Logan2† and Alison C Bested3 Journal of Physiological Anthropology 2014, 33:2]

*BDNF - Brain Derived Neurotrophic Factor

Up your Game and Up your Brain. Your Brain Derived Neurotrophic Factor [BDNF] is Known as "Miracle Grow." BDNF is decreased in Depression, Alzheimer's, Epilepsy, Schizophrenia and OCD.

BDNF increases with Exercise, Coffee [and other phytonutrients], DHA-omega 3, Curcumin-turmeric, EGCG [green tea], Meditation, Reduction in gut permeability. 

Evidence for increased inflammation in:

• MCI/Alzheimer’s disease
• Depression
• Pain
• PD
• MS
• ADD and ADDHD
• Brain fog i.e., trouble with concentration, focus, memory
• Anxiety and Panic
• Autism spectrum

What is happening in the brain doesn't necessarily originate there.

The contemporary convergence:

Gene-Epigenome + Environment + Microbiome = 

OUTCOME [how the outside gets inside]

Sugar triggers inflammation. Diabetes and pre-diabetes prevention and glucose control in midlife may protect against late-life cognitive decline. Higher glucose levels are associated with an increased risk of dementia. Studies show higher levels of fasting plasma glucose correspond to a higher rate of shrinkage of memory center [Neurology 2012;79:1019-1026].

High glucose is reversible and highly preventable.

High intake of energy from carbohydrates and low intake from fat may have inverse implications for development of Mild Cognitive Impairment [MCI]. In a study of 1,230 individuals age 70 and older, individuals with higher carbohydrate intake had nearly four times the risk of developing Mild Cognitive Impairment. Those individuals with the highest fat intake compared to the lowest fat intake were 42% less likely to have MCI.

MOTION is the LOTION:

Exercise training increases the size of the hippocampus and improves memory. "A physical activity program of an additional 142 minutes of exercise per week on average modestly improved congnition relative to controls in older adults with subjective and objective memory impairment" JAMA, September 3, 2008, Vol 300, No 9.

A six-month exercise intervention influences the genome-wide DNA methylation pattern in human adipose tissue. Studied followed 24 healthy men with low level baseline activity levels before and after 6-month exercise program. There were 30 controls as genome-wide methylation patterns were examined in adipose tissue. Several patterns changed in exercise group demonstrating reduced lipogenesis and a “silencing” of genes associated with obesity, inflammation and impaired insulin signaling.

SLEEP WELL

Disrupted sleep and loss of entrainment is a major inflammatory risk

• 15% of Americans experience insomnia
• 1 out of 3 has sleep disruption on one or more nights each week
• Major risk factor for many chronic complex diseases
• Neuro-endocrine-immune disruption
• Sleep hygiene
• Obstructive Sleep Apnea
• Avoid pitfalls of sleeping medications
• Follow the Circadian Rhythm strategy [below] and work up to a healthy sleeping pattern:

ALLOSTASIS

The process of achieving stability or balance through physiological or behavioral change in response to changes in one’s environment. Simply put: Ability to achieve stability through change. Here are some helpful tips that are at the heart of an an Anti-Inflammatory Lifestyle:

• Sleep well. Get your ZZZ's and your Zeitgebers [Time Givers] - Light, Ambient temperature, Social Interactions, Exercise, Meal Timing
• Get your Vitamin D through supplements or sensible sun exposure each day. Vitamin D influences many things - Cardiovascular Disease, Cancer, Autoimmunity, Depression, CHF, Osteoporosis, Fall Risk, Pain Syndromes
• Whole foods always trump processed foods
• Reduce-eliminate sugar, fructose and refined-processed, grain-based flour [carbohydrate-dense foods] e.g. breads, pasta, bagels, chips, pretzels, muffins, donuts, and many cereal grains
• Consider an elimination trial e.g. gluten, dairy, sugar
• Eat lots of vegetables, plant-fiber, sweet potatoes, plantains, beans
• Reduce processed seed-vegetable oils e.g. corn, safflower, sunflower, canola, peanut and introduce more healthy fats e.g. grass-fed butter, EVOO, coconut oil, lard, ghee, and an increase in O-3s fatty fish, nuts, seeds, avocados
• Lean, red meat  (grass fed-finished ideal), eggs
• Eat organic for “the dirty dozen” produce

Round off an anti-inflammatory lifestyle with these healthy practices...

• Movement: Motion is the Lotion: walking, aerobic, resistance, yoga, tai chi
• Mind-Body awareness
• Prayer, Breathing techniques, Relaxation Response, Meditation
• Mindfulness-based stress reduction; HRV-Heartmath
• Sleep hygiene-entrainment
• Laughter
• Volunteer Work
• Social connection
• Cultivate meaning in work, love, and play
• More time outdoors during sun season

Recommended Reading: 

The Wahls Protocol, by Terry Wahl, M.D.

For more "news to use" and the science to go with it, visit The Health Edge: Translating the Science of Self-Care. Not all research slides are shown in this article. To download complete lecture, follow this link to BHS Creating Health Wellness Series.

CREATING HEALTH Lecture #2: Understanding Metabolism

Lecture by Mark Pettus transcribed by Carolann Patterson

How did the fat switch get turned on? and why isn't it turning off?

This week's Creating Health lecture focuses on Metabolism, Insulin Resistance and Metabolic Syndrome.

The learning objectives of the lecture will be to examine the drivers of Weight Gain, Insulin Resistance and Metabolic Syndrome; the relationship between macro-nutrient content, lipogenesis [the biologic imperative to store fat] and leptin-insulin resistance; and the relationship between Biology and Behavior.

Four essential clinical pearls will emerge from tonight's lecture. Take note! 

1. Calorie restriction decreases metabolic rate, enhances hunger and reduces the drive to move. "Eat less-do more" is not a successful or sustainable strategy.
2. Different macro-nutrients produce different effects in thermogenesis, hormone regulation, and satiety.
3. Quality of calories is MUCH more important than quantity
4. The biologic goal is to reduce leptin and insulin resistance.

Last week I showed the image of "McPaleo Man" to illustrate "Health as a byproduct of gene-environment compatibility." There is a growing incompatibility between ancestral gene programming and modern 21st century lifestyle.

Healthy living happens in the healthy choices we make that align our modern life with our genes. Just because we are genetically pre-disposed to a condition does not mean we are prisoners of our genes.

How does a Functional-Systems Biology Model differ from the way we are currently looking at our health?Instead of looking at "the leaves" of disease to determine treatment, Functional Biology turns the model on its head and shifts analysis to begin at the roots, to find the root causes. Once we discover the root causes we can change our biology by changing our behavior. Our DNA is more malleable than we think: we are NOT locked in to our genetic legacy.

Leaves: Disease [how things appear] - Pre-Diabetes, Diabetes, Obesity, Metabolic Syndrome, Heart Disease, Stroke, Depression, Autoimmunity, Alzheimer’s, Cancer, Autism, ADD, Hypertension

Stem: Core Metabolic Imbalances [what drives them] - Inflammation-Immunomodulation, Fight-Flight (HPA axis), Microbiome (Gut-Immune), Detoxification, Hormonal, Insulin resistance 

Soil: Root Causes [what are their origins] - Gene-Epigenome Environment, Nutrition, Movement   Stress Response, Environmental -toxins, Sleep   Social Connection, Traumatic events, Conflict Management   Mindfulness, Meaning in Work, Love & Play

Let's set the stage with International Data from World Health Organization & US DHHS, NIH, NIDDK  

Global Problem [2005]

• 1.6 billion adults overweaight [age 15+]
• 400 million adults obese
• 20 million children under 5 overweight

Current Global Trends - by 2015

• 2.3 billion adults will be overweight
• 700 million will be obese

US Data: Fast Facts from the National Health and Nutrition Examination Survey [2009-2010], National Institute of Diabetes, Digestive & Kidney Diseases [NIDDK]

• More than 2 in 3 adults is overweight or obese
• More than 1 in 3 adults is obese
• More than 1 in 20 adults is extremely obese
• About 1/3 of children adolescents (6-19) is overweight or obese
• More than 1 in 6 children is considered obese

How do we get FAT?

The prevailing view of "how do we get fat" oversimplifies. While there is some truth, it is not entirely accurate when it states:

• Obesity occurs when a person consumes more calories from food than he or she burns. National Institute of Health, 2008
• Overweight is the result of caloric imbalance (too few calories expended for the amount of calories consumed) and is mediated by genetics and health. US Surgeon General, 2008

Weight gain is more than just "calories in, calories out" and it is not caused by genes. We get fat through the choices we make:

• Not exercising at all or exercising the “wrong” way [i.e, continuous tread mill isn't effective]
• Working indoors, not being outdoors [hunting-gathering]
• We move less - Walking less, driving more
• Poor diets, loaded with processed food [See what American eats in the Top 20 list below]
• Eating poorly, unethically raised chickens and meats [their stressful environment passes on to us]

Top 20 Sources of Calories in the American diet [2013] - illustrates dietary choices in America  

We consume more calories than we ever did before and they are not quality calories.

• Grain-based desserts (138)
• Yeast breads (129)
• Chicken & chicken mixed dishes (121)
• Soda/energy/sports drinks (114)
• Pizza (98)
• Alcoholic beverages (82)
• Pasta & pasta dishes (81)
• Tortillas, burritos, tacos (80)
• Beef & beef mixed dishes (64)
• Dairy desserts (62)
• Potato/corn/other chips (56)
• Burgers (53)
• Reduced-fat milk (51)
• Regular cheese (49)
• Ready-to-eat cereals (49)
• Sausage, franks, bacon & ribs (49)
• Fried white potatoes (48)
• Candy (47)
• Nuts/seeds & nut/seed mixed dishes (42)
• Eggs & egg mixed dishes (39)

In addition to poor dietary choices, the ongoing dietary recommendation to reduce fat intake is not making Americans skinnier, or healthier. In fact, just the opposite. The charts below show the most significant change noted in the growing gap between increased carbohydrate consumption and decreased fat consumption and its correlation to growing obesity rates:

Don't blame butter for obesity. Crisco oil replaced butter, lard and tallow, thanks in part to Ancel Keys' research [see below]. Proctor & Gamble's Crisco was the leading sponsor of the American Heart Association campaign to reduce fat. Studies later revealed substituting polyunsaturated vegetable oils for saturated fats increased cardiovascular risks and deaths from all causes.

The New York Times poses a provocative question: “Are we fat because we eat too much or do we eat too much because we are fat?” 

The pendulum is starting to swing towards how certain foods we eat interfere with our biology, producing excess Insulin and Leptin.

There is no obesity gene. There is no diabetes gene. The growing public health problem of obesity and diabetes is not driven by genes. The quality of the food we choose to eat impacts our weight. Food composition affects metabolism.

Different foods produce different changes

• in thermic effect [this is your metabolism. Fats produce higher metabolic rate];
• in direct hormonal responses [Fat lowers insulin/carbs raise insulin. Fat lowers Leptin/Carbs raise Leptin];
• in gene expression patterns [Epigenetic response - foods impact our Book of Life. Environmental factors need to change so that the On/Off switch can turn off];
• in the microbiome [drivers of hunger have little to do with calorie counting].

Less Carbs and More Fat, please. TEE [Total Effect of Exercise] differed by approximately 300 kcal/day. People on the low-carb + high-fat diet burned 300 kcal/day more than those in the low-fat + high-carb group, an effect corresponding with the amount of energy typically expended in 1 hour of moderate-intensity physical activity.  Just goes to show: 

A calorie is not a calorie…poor quality food causes a metabolic shift so that our behavior becomes a consequence of our biology. If we improve the quality of the food we eat, we change the outcome. Poor dietary choices lead to Obesity, Diabetes and Metabolic Syndrome...

What is Metabolic Syndrome? Metabolic syndrome is not a disease in itself. It is a group of risk factors - high blood pressure, high blood sugar, unhealthy cholesterol levels and abdominal fat associate with the following readings [Source: A.H.A]:

• Waist Circumference > 35” in women and > 40” in men
• BMI > 30 (= obese)
• Elevated blood pressure: > 130/85
•  High triglycerides: > 150 mg/dL
•  low HDL: < 40 mg/dL men, < 50 women
• Elevated fasting glucose: >100 mg/dL

The National Health and Nutrition Examination Survey (NHANES) 2003-2006, studied more than 3400 adults over age 20 and discovered the overall prevalence of Metabolic Syndrome in 34% of those studied. Metabolic Syndrome increased with advancing age and weight and there is a higher prevalence of Metabolic Syndrome in Black and Mexican American females.

What are the consequences of Metabolic Syndrome? Metabolic Syndrome is prevalent in 34% of Americans aged 20+ and can lead to the following: 

• Type II Diabetes
• CVD/CAD
• Dementia
• Stroke
• PCOS and infertility
• Fatty Liver [NAFLD] see below
• Breast, colon, prostate & other cancers
• Psoriasis, rheumatoid arthritis, gout

NAFLD [Non-Alcoholic Fatty Liver Disease] was not described until 1980 and has grown to become one of the most common diseases in America present in 45% of all Latinos; 33% of all Caucasians; and 25% of all African Americans. 5% of total cases progress to NASH [Non-alcoholic SteatoHepatitis, liver inflammation and damage caused by a buildup of fat in the liver]. 25% of NASH cases progress to Cirrhosis [chronic liver damage leading to liver failure]. NAFLAD is 100% preventable.

Among adults with type 2 diabetes, there was an estimated 1.6-fold increased prevalence for cancers of all sites among men and a 1.8-fold increase among women who reported being diagnosed with diabetes 15 or more years ago compared with those reporting diabetes diagnosis less than 15 years ago. Diabetes Care Jan 2013.

For breast cancer, 1.5–2.4 risk comparing women with highest levels of insulin to normal levels. Journal of the National Cancer Institute.

That's Ancel Keys on the left. He was an expert on Nutrition in the 1950's and advised the nation that "Fat is Bad." 64 years later butter can take its revenge...and so can John Yudkin...

This is John Yudkin. At the same time Keys was administering nutritional "liposuction" to an entire nation, Yudkin was banished for calling attention to sugar as THE issue, not fat. Yudkin could not get published until 1972 and his book Pure White and Deadly was largely forgotten until Robert Lustig's ground-breaking lecture Sugar: The Bitter Truth brought it to the forefront when hailing Yudkin's work as "prophetic".  Forty years after his book was finally published, we're wising up to the bitter truth about sugar...

Consuming fructose-sweetened, not glucose-sweetened beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. "Fasting plasma glucose and insulin levels increased and insulin sensitivity decreased in subjects consuming fructose but not in those consuming glucose."

“Dietary fructose specifically increases DNL, promotes dyslipidemia, decreases insulin sensitivity, and increases visceral adiposity in overweight/obese adults.” Stanhope KL et al. Journal of Clinical Investigation. 2009 May 1; 119(5): 1322–1334

 America sure stand outs. The US is THE world leader in...

Added Sugar Intake - link to research and JAMA article

We've covered Sugar and Fat, let's move on to Carbohydrates [CHOs]

Ian Spreadbury points to the single greatest difference between ancestral and modern life: acellular carbohydrates. Wheat just ain't what it used to be. 

Carbohydrate density isn't the lightest subject, but the grid below illustrates the carbohydrate choices we make. Stay away from those Rice Cakes!

Leptin - tells you you're full

Leptin is the appetite hormone. Many obese people appear to become resistant to Leptin. A healthy Leptin function signals satiety in the brain [hypothalamus] and promotes a “readiness” to move.

Disrupted Leptin signalling causes Leptin Resistance which leads to weight gain, hard-to-control hunger, and a deep desire to minimize activity. Inflammation is associated with Insulin Resistance. Insulin Resistance is associated with Leptin Resistance.

Fructose wasn't always available everywhere in the world 24/7. It was only available at harvest and was necessary "survival" trigger to induce Insulation Resistance in order to store fat through the winter. Fructose stimulates weight gain. We have evolved to be rewarded for caloric-dense sugary fat foods as part of survival, an adaptation challenged in modern times.

Kalle et al. Am J Clin Nutr; 2007:851:1417-27

Different carbohydrates produce unique genomic responses:

High-Glycemic Carbs [macronutrients]: Dozens of genes switched ON as 62 genes regulate increased inflammation, stress, and immune responses.   

Switch to Low-Glycemic Carbs [beans, legumes]: Same genes are silenced. Genes regulating insulin production are switched OFF. 

The Microbiome…an evolving story

The microbiome has evolved with humans to allow survival. It provides important functions in digestion, immunity, metabolism and detoxification. These "bugs" have allowed us to survive. From a cellular perspective, our body is 10% human and 90% microbial. The gut microbiome in each person contains 100-150 times as many genes as the human gene pool and over 99% of the genetic diversity in our bodies is due to microbial colonization. 

Gut microbes can drive appetite. Low Microbial Diversity in the gut drives obesity. Colonizing germ-free mice with the intestinal microbiome from obese mice led to an increased total body fat despite lack of change to diet.

Dirt is Good for Diversity. Increased diversity within the microbiome is seen with decreased hygiene. Early and diverse exposure to germs is key to a “healthy microbiome.”  

Increased carbohydrates [CHO] digesting microbiome in populations with higher CHO intake. Reduced microbiome diversity is seen in obesity, IBD, autism spectrum. 

Diet is a powerful factor that can shift the gut microbiome. 

70% of the immune system is located in the gut epithelium.

Now that we've explored why we get fat, how can we get "Un-Fat"?

Move More - Motion is the Lotion! 

• HIT [High Impact Training], Resistance training, and dance
• Muscle as a metabolic engine
• Cortisol, ­endorphins and dopamine
• Positive Epigenetic effects on reducing  inflammation, increasing insulin sensitivity and energy efficiency
• Enhanced strength, resilience, balance, concentration, mood
• Decreased cardiovascular disease, diabetes, cancer risk
• Longevity and quality of life profoundly enhanced

 Stress Less 

• Meditation, prayer, relaxation response, guided imagery, yoga, tai chi, biofeedback, gratitude journal 
• HRV-HeartMath
• Decreased cortisol, flight-fight response, BP
• Increased parasympathetic tone
• Improved mood, concentration, pain tolerance, resilience
• Positive epigenetic effects on inflammation, insulin sensitivity and energy efficiency e.g. mitochondrial health
• Decreased cardiovascular risk
• Enhanced neuro-plasticity [our brains are bendy]

Sleep. It's not a luxury. It's a Necessity.

We used to be a dark planet. Now we've got our lights on all the time. We're sleeping less. Sleep loss leads to weight gain. In animals, disruption of circadian rhythm precedes obesity. In humans, night shift work increases BMI by 15% and risk of obesity by 40%

• Disrupted Sleep-Loss of entrainment [see below for best strategy]
• 15% Americans experience chronic insomnia
• 1 out of 3 has sleep disruption on one or more nights each week
• Major risk factor for many chronic complex diseases
• Neuro-endocrine-immune disruption
• Sleep hygiene
• Obstructive sleep apnea
• Avoid pitfalls of sleeping medications

Zeitgebers "Time Givers" are external cues that drive circadian rhythms. Light, ambient temperatures, social interactions, exercise and meal timing are all known "Time Givers"

Try new strategies to enhance metabolic efficiency and to reduce insulin-leptin resistance. Approach it from all angles:

• Quality of calories trumps quantity of calories
• Cut – reduce sugar-fructose in all its forms
• For obesity, insulin resistance and diabetes, eliminate poor quality carbs and introduce healthy fats
• Whole grains trump refined grain flours, and carbohydrate-dense processed foods 
• Reduce omega-6 containing oils, replacing them with healthy fats e.g. extra virgin olive oil, fatty fish e.g. salmon, mackerel, sardines; grass-fed butter and coconut oil; lard, ghee, avocados, nuts and seeds
• Pasture-raised eggs are nutrient dense and a great value
• Consume pasture-raised meats, shellfish, organ meats
• [Organic] Dairy is good provided you are not intolerant and don't have allergies. Fermented yogurt, kefir
• Coconut Oil: Lauric acid; MCTs [medium chain triglycerides], gut permeability improved
• Gut health-microbiome: Elimination trial; pre-probiotics; digestive enzymes
• Motion is the lotion
• Meditation: Lower stress response e.g. meditation, HRV
• Circadian rhythm/entrainment – sleep strategies

Recommended Reading - keep up to date on latest research

For more "news to use" and the science to go with it, visit my website The Health Edge: Translating the Science of Self-Care. To download complete lectures follow this link to BHS Creating Health Wellness Series.