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Archive for August, 2018

813 defending adrenal fatigue

If you struggle with chronic exhaustion, insomnia, poor immunity, and persistent low blood sugar symptoms, you likely have poor function of the adrenal glands, which sit atop the kidneys and secrete stress hormones. However, your conventional doctor may have told you there is no such thing as adrenal fatigue based on guidance from The Hormone Foundation. What they may not understand is that there is a continuum of adrenal function and that the brain plays a role in adrenal fatigue.

The debate about adrenal fatigue versus primary adrenal insufficiency

The term “adrenal fatigue” has become a household word in the chronic illness world, and for good reason. The adrenal glands are our frontline against stressors large and small. In our constantly chaotic and nutritionally-depleted lives, these hard-working little glands can become worn down, sometimes to the point of barely working, right along with the areas of the brain that govern them.

What’s confusing is a recent statement by The Hormone Foundation which claimed adrenal fatigue does not exist and is not supported by any scientific facts, and that primary adrenal insufficiency is the only real version of adrenal dysfunction.

However, according to integrative physician Richard Shames, MD, both adrenal fatigue and primary adrenal insufficiency exist along the same continuum, but are separated by severity of symptoms and treatment methods. In a nutshell, adrenal fatigue can also be referred to as mild adrenal sufficiency.

Primary adrenal insufficiency is caused by damage to the adrenal glands, such as by an autoimmune condition like Addison’s disease that attacks and destroys adrenal tissue. Primary adrenal insufficiency is diagnosed through blood tests and can be treated with medications that replace adrenal hormones.

Symptoms of primary adrenal insufficiency include:

  • Weakness
  • Fatigue
  • Muscle aches
  • Loss of appetite with weight loss
  • Craving salty foods
  • Dizziness, low blood pressure
  • Feeling lightheaded when standing up 
  • Gastrointestinal symptoms such as nausea, vomiting, and abdominal discomfort

Adrenal fatigue describes when lab tests don’t support a diagnosis of primary adrenal insufficiency but a person still experiences adrenal-related symptoms such as:

  • Excessive fatigue and exhaustion
  • Non-refreshing sleep
  • Feeling overwhelmed by or unable to cope with stress
  • Craving salty foods
  • Difficulty concentrating
  • Brain fog
  • Poor digestion

Functional medicine practitioners diagnose adrenal fatigue by considering symptoms as well as results from a 24-hour saliva cortisol test.

Current blood tests are good at diagnosing severe forms of adrenal insufficiency such as Addison’s disease but not mild adrenal insufficiency, or adrenal fatigue. 

This debate between adrenal fatigue and primary adrenal insufficiency is reminiscent of the former debates about “mild” hypothyroidism. Twenty years ago, many endocrinologists denied mild hypothyroidism as a true diagnosis because they believed that as long as a patient was within conventional TSH reference ranges they could not possibly be sick. 

However, doctors trained in functional medicine recognize that a functional reference range — a narrower TSH range that reflects optimum thyroid health — means that a serious thyroid problem can exist within the conventional TSH range.

As testing and recognition of adrenal fatigue, which affects many people, continues to gain medical acceptance, we will start to refer to it as mild adrenal insufficiency.

The role of the brain in adrenal fatigue

It’s important to understand the brain plays an important role in adrenal fatigue. This explains why nutrients to support your adrenal glands may not go the full mile when the real problem is happening between your ears.

Adrenal fatigue has at its roots poor function of the hypothalamus-pituitary-adrenal (HPA) axis. The HPA axis refers to the feedback loop between your body and areas of your brain that govern adrenal function. Unrelenting stress beats up this entire system, not just the adrenal glands, and it is more complicated and involved that simply low cortisol. The problem is compounded by the brain’s predilection for efficiency, in this case becoming so efficient at stress until the tiniest thing triggers a big stress response. Or, you are so advanced you are too tired to respond to anything.

How the adrenals become fatigued

When our bodies experience stress, no matter how small or large, our adrenals pump out hormones such as adrenaline and cortisol to help us fight or take flight. Our bodies are designed to return to baseline after a stressor so the nervous system can return to a “rest and digest” state necessary for daily function.

However, in our chronically stressed modern lifestyles, our bodies are constantly reacting to stressors, many we are not even aware of, such as dietary triggers, toxins, and even electromagnetic frequencies.

This constant state of high stress hormones damages tissues in the body and brain and is linked to:

  • Suppressed immunity
  • Low energy
  • Depression
  • Insomnia
  • Insulin resistance and diabetes
  • High blood pressure
  • Heart problems
  • Increased belly fat

Removing all stressors in life is impossible, but there is much we can do to support adrenal function and buffer the damage of stress.

Adrenal adaptogens and phosphatidylerine are two natural routes that especially support the HPA axis and the brain’s ability to handle stress.

Contact my office for more support in taking care of your adrenals, HPA axis, and your ability to become more resilient to stress.

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812 carbs not fats heart health

If you shy away from fats for fear of heart disease, you aren’t alone, you may be surprised to learn that carbohydrates, not fats, are the culprits in heart disease.

For decades scientists and doctors have blamed dietary fats — especially saturated fat — for heart disease. We’ve been advised to stick to a low-fat, high-carb diet based on grains to keep our hearts healthy.

We now know this advice was based on outdated observational studies. As it turns out, none of the studies truly linked high-fat diets to heart disease, and numerous recent studies have debunked the theory.

In fact, the low-fat, high-carb diet promoted for decades by organizations such as the American Heart Association, the National Cholesterol Education Program, National Institutes of Health, and by the U.S. Department of Agriculture may have actually played a strong — yet unintended — role in today’s epidemics of obesity, type II diabetes, lipid abnormalities,  and metabolic syndromes.

Limit carbs, not fat, for heart health

For most people, it’s carbohydrates, not fats, that are the true cause of heart disease.

Since 2002, low-carb diets have been studied extensively with more than 20 randomized controlled trials. These studies show that limiting your consumption of carbohydrates rather than fats is the surer way to decrease heart disease risk.

An analysis of more than a dozen studies published in the British Journal of Nutrition found that subjects consuming a low-carb diet had a healthier cardiovascular system and body weight than those on low-fat diets.

The Prospective Urban and Rural Epidemiological (PURE) study not only found that increasing fat intake was linked to lower risk of heart disease, but as carbohydrate intake is increased, the risk of heart disease grew stronger.

Include plenty of healthy fats in your diet

We need plenty of healthy fats for our bodies and brains to function at their best. Low-fat diets have many risks, including decreased brain function, poor brain health, and hormone imbalances.

Essential to your body’s function, fats:

  • Provide a major source of energy
  • Aid in absorption of certain minerals
  • Help you absorb vitamins A, E, D, and K
  • Help reduce inflammation
  • Are necessary for building cell membranes
  • Help build nerve sheaths
  • Are essential for blood clotting and muscle movement
  • Help maintain your core body temperature
  • Protect your core organs from impact
  • Provide the key nutrient for your brain, which consists of nearly 60 percent fat

Four types of fat: Eat three, avoid one

Four types of fat are found in our diet, all with different characteristics and effects. Some are great, some are good, and one is purely horrible.

Saturated fat. Instead of being linked to heart disease, saturated fats actually offer important health benefits:

  • Supports brain health
  • May reduce risk of stroke
  • Raises HDL (your “good”) cholesterol
  • Changes the LDL (“bad”) from small, dense particles — dangerous for heart health — to large particle LDL, which does not increase heart disease risk. This has been intensively studied in the past few decades and the studies consistently show these results.

Saturated fats are solid at room temperature. Examples include red meat fat, cooled bacon grease, whole milk, cheese, and coconut oil.

Monounsaturated fats (MUFAs) are “essential,” meaning that your body doesn’t produce them on its own and you must get them through your diet.

MUFAs are liquid at room temperature and begin to solidify when refrigerated. They can be found in olive oil, nuts, avocados and whole milk.

Monounsaturated fats can help:

  • Prevent depression
  • Protect you from heart disease
  • Reduce risks for certain kinds of cancer
  • Improve insulin sensitivity
  • Assist with weight loss
  • Strengthen bones

Consuming higher levels of MUFAs than saturated fats has a protective effect against metabolic syndrome, a cluster of disorders that increases the risk for cardiovascular disease.

Polyunsaturated fats are also “essential,” meaning your body doesn’t produce them on its own and must get them via dietary intake.

Polyunsaturated fats can help improve blood cholesterol levels, which can decrease the risk of heart disease, and may also help decrease the risk of Type 2 diabetes.

There are two types of polyunsaturated fats: Omega 3 and Omega 6.

Omega 3 fats are linked with lowered inflammation, better brain function, and reduced risk of cardiovascular disease. Fish high in omega-3 fatty acids include salmon, mackerel, tuna, trout, sardines, and herring. Plant sources include ground flaxseed, walnuts, and sunflower seeds.

While we do need some omega 6 fatty acids in our diet, excess consumption is inflammatory and is connected to heart disease, type 2 diabetes, obesity, psychiatric issues, and cancer.

To prevent an inflammatory environment, increase your consumption of omega 3 fats and lower consumption of omega 6. Researchers recommend a ratio of omega 6 to omega 3 that ranges from 1:1 to 4:1.

Trans fats are the one type of fat to always avoid. A byproduct of a process called hydrogenation that makes healthy oils into solids and prevents them from becoming rancid, trans fat have no health benefits. Their risks include:

  • Increased levels of harmful LDL cholesterol in the blood
  • Reduced beneficial HDL cholesterol
  • Increased inflammation
  • Higher risk for insulin resistance (a risk for Type 2 diabetes)
  • Trans fats are so risky the FDA issued a ban in 2015 that required they be removed from processed foods within three years.

Six foods to include for healthy fat intake

Avocado

  • Rich in monounsaturated fats (raises good cholesterol while lowering bad)
  • High in vitamin E
  • High protein for a fruit
  • Provides folate

Coconut oil is rich in medium-chain fatty acids which:

  • Are not stored as fat by the body as readily as other fats
  • Support brain function and memory
  • Are easy to digest

Extra virgin olive oil

  • Very high levels of monounsaturated fats
  • Supports heart health and cognitive function
  • Best for low or medium heat cooking (not high heat)

Omega 3 fatty acids

  • Found in cold water fish such as salmon and sardines
  • Easy to consume via fish oil supplements
  • Anti-inflammatory

Nuts and seeds

  • Rich in ALA (alpha lipoic acid) Omega 3 fats for the brain
  • Helps lower LDL (“bad”) cholesterol

MCT oil (from coconuts)

  • Provides medium-chain triglycerides, a healthy form of saturated fat
  • Easily digested

Limiting intake of carbohydrates, rather than fats, is a surer way to decrease the risk of heart disease. Many doctors have seen how low-carb diets with plenty of healthy fats help patients lose weight, reverse their diabetes, and improve their cholesterol.

For more information on how to support your heart health, contact my office.

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811 circadian rhythm eating

Many of us start the day with a small breakfast as we run out the door, followed by a medium sized lunch and a large dinner. We also tend to snack throughout the day and even grab a bite before bed. However, while what we eat is important, a growing body of research suggests when we eat matters too.

The digestive system’s circadian rhythm

While you have likely heard of the circadian rhythm, the master “clock” in the brain that governs our sleep-wake cycle, we actually have a variety of circadian clocks that govern the daily cycle of activity for every organ.

These rhythms exist because every organ needs downtime for repair and regeneration.

The digestive system is no exception. During the day, the pancreas increases production of insulin, which controls blood sugar levels, and then ramps it down at night.

The gut has a clock that regulates the daily enzyme levels, absorption of nutrients and waste removal. Even our gut microbiome operates on a daily rhythm.

Circadian clocks optimize our health by aligning our biological functions with regular and predictable environmental patterns. Disrupting our circadian clocks — such as by skipping breakfast or eating at midnight — can result in health issues such as weight gain, metabolic syndrome, cancer, cardiovascular disease, and more.

Eat breakfast daily

About 20 to 30 percent of American adults skip breakfast. Some do it to save time, many do it in an effort to lose weight. However, studies show that people who eat breakfast daily are less likely to be obese, malnourished, suffer from impaired blood sugar metabolism, or be diagnosed with diabetes.

They are also less likely to have the heart disease risk factors of high blood pressure and high cholesterol. Even the American Heart Association recently endorsed biologically appropriate meal timing to reduce the risk of heart disease.

Just eating breakfast isn’t the only important thing however. It’s critical to start the day with a breakfast that provides plenty of protein and healthy fats, and a minimum of sugars. This helps support blood sugar balance and proper brain function throughout the day.

Make breakfast the largest meal for weight control and fat loss

The timing in relation to the size of our meals is also important.

Research shows having the largest meal in the morning appears to help with weight control compared to having a large meal in the evening.

In fact, a person eating the identical meal at different times of day might deposit more fat after an evening meal than a morning meal.

This is partially because insulin, a hormone that helps with blood sugar control, appears to be most efficient in the morning. In addition, we burn more calories and digest food more efficiently in the morning than later in the day when most of us eat our largest meal.

In one study, a group of overweight women with metabolic problems were put on a 1400 calorie-per-day diet. Half consumed 700 calories at breakfast, 500 calories at lunch, and 200 calories at supper, and the other half reversed that pattern.

Women in both groups lost weight and experienced reduction in fasting glucose, insulin, and ghrelin (a hunger hormone), but in the same time frame the large-breakfast group experienced added benefits:

  • They lost 2.5 times the weight compared to those who ate the largest meal at dinner.
  • They had significantly greater decrease in fasting glucose, insulin, and triglyceride levels.
  • Their satiety (sense of fullness) scores were significantly higher.
  • They also lost more body fat, especially in the belly.

According to the researchers, a high?calorie breakfast and a reduced calorie dinner is beneficial and might be a useful alternative for managing obesity and metabolic syndrome.

The body needs fasting periods for optimum health

Fasting signals to the body to start burning stores of fat for fuel. Most of us eat meals and snack from the time we wake up until shortly before bed — or even in the middle of the night. In fact, studies show the average person eats over a 15-hour period during the day. This short fasting time period may interfere with optimal metabolism and increase weight gain.

Researchers put a group of prediabetic men through two eating cycles. In one phase, they ate meals within a 12-hour window for five weeks.

Then in another phase, they ate the same meals in a time-restricted six-hour window starting in the morning.

They ate enough to maintain their weight, so they could assess whether the time-restricted regimen had benefits unrelated to weight loss.

The six-hour meal schedule improved insulin sensitivity, insulin beta cell responsiveness, reduced oxidative stress, increased appetite, and significantly lowered blood pressure.

In addition, the men who ate only one or two meals per day fared better than those who ate three meals.

A recent review of the dietary patterns of 50,000 adults over seven years provides added evidence that we should ingest most of our calories early in the day, including a plentiful breakfast, a smaller lunch, and a light supper.

The researchers said that eating breakfast and lunch five to six hours apart and making the overnight fast last 18 to 19 hours may be an effective method for preventing long-term weight gain.

Another recent study found that subjects who added snacks to their daily meals tended to gain weight over time, while those who had no snacks tended to lose weight.

Light exposure is key for proper metabolism

Sufficient exposure to natural light and darkness also play an important role in how we metabolize food for either energy production or fat gain.

At night, the lack of sunlight signals our brain to release melatonin, the hormone that prepares us for sleep. In the morning, the light stops melatonin production and we wake up.

When we change that signaling — whether from a late-night meal, artificial lighting at night (especially blue screen light), shift work, flying and travel, or changing our eating patterns — it confuses our bodies’ circadian clocks. Eating at the wrong time of day strains the digestive organs, forcing them to work when they are supposed to rest.

Shift workers, who account for about 20 percent of the country’s work force, have a particular problem with disturbed circadian clocks. Many frequently work overnight shifts, forcing them to eat and sleep at odd times. Nighttime shift work has been linked to increased risk of obesity, diabetes, heart disease, and breast cancer.

Studies have linked poor melatonin activity and disrupted sleep-wake cycles with increased risk of dementia and Alzheimer’s, cancer, autoimmune flare-ups, obesity, and more.

Low blood sugar may require a before-bed snack

One important exception to the “don’t eat right before bed” rule is for those who have chronic low blood sugar. For these people, keeping blood sugar stable throughout the day — and night — is critical for brain health, energy level, and more.

If you suffer from the following chronic low blood sugar symptoms, it may be best to take a small, high-protein low sugar snack just before bed:

  • Constant sugar cravings
  • Nausea or lack of appetite in the morning
  • Irritability, light-headedness, dizziness, or brain fog if meals are missed
  • Craving caffeine for energy
  • Eating to relieve fatigue
  • Afternoon energy crashes
  • Waking around 3 a.m.

Daily habits to maximize your dietary rhythm

To help maximize your meal timing and metabolism, incorporate the following habits into your day:

Make breakfast your largest meal and make dinner your smallest. While this may prove difficult for those with a busy social life or family that sits down to a big dinner every evening, make the evening meal smaller whenever possible.

Prioritize protein and healthy fats with breakfast, and minimize sugar and caffeine intake especially before lunch, to stabilize blood sugar and regulate metabolism.

Avoid between-meal snacks and bedtime goodies. The exception is for those who have chronic low blood sugar as mentioned above.

Try time-restricted eating pattern, or intermittent fasting, to maximize weight management.

Manage exposure to blue light at night:

  • Avoid screen light in the evening
  • Install the f.lux app on your phone and computer
  • Read a book
  • Wear blue-blocker glasses at night
  • Install amber or red light bulbs for evening use

If you have chronic low blood sugar, a small before-bed snack with plenty of protein may be a good idea to keep your blood sugar stable all night and prevent that 3 a.m. wake-up.

While studies suggest that prioritizing larger meals early in the day helps support metabolic health, it does not necessarily mean that you should skip dinner. Instead, have your dinners earlier and make them relatively light. 

The take-home message here is like the old proverb, “Eat breakfast like a king, lunch like a prince and dinner like a pauper.”

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810 summer SAD

Most everyone has heard of SAD, or Seasonal Affective Disorder, when winter brings on chronic blues. But if you feel better in winter than summer, you may have summer SAD, also called reverse SAD. While the jury is still out on the causes of summer SAD, there are ways to get through the season with more energy, better sleep, and improved mood.

Although both winter and summer SAD and summer SAD share symptoms of sadness and anxiety, they diverge in potential causes and remedies.

Winter SAD commonly involves sadness and anxiety, sluggishness, weight gain, oversleeping, cravings for high-carb foods, social withdrawal, and a loss of interest in typically enjoyable activities.

While summer SAD also causes sadness and anxiety, it differs from winter SAD by causing the following:

  • Agitation and irritability
  • Weight loss
  • Insomnia
  • Feeling overheated at night
  • Loss of appetite
  • Increased suicidal ideation
  • Increased sex drive

While five percent of the population suffers from winter SAD, researchers estimate roughly one percent suffer from the summer version, and women with summer SAD outnumber men two to one.

Both are considered major depression with seasonal patterns.

Spring and summer depression can be especially hard to cope with because sufferers feel very out of step — everyone is happier when you’re more miserable.

Suicide is a concern with summer SAD as suicide is more of a concern when people are depressed and agitated rather than depressed and lethargic.

Are the causes for winter and summer blues the same?

Most theories regarding the cause of the winter blues — what most of us think of as SAD — stem from the fact that short winter days reduce our exposure to daylight, leading to an increase in the hormone melatonin. This can negatively affect our body’s circadian rhythm, or sleep-wake cycle, as well as brain hormones that affect mood, motivation, and appetite.

Support for this theory comes from the overwhelming success of morning light therapy in the winter. When the brain is exposed to natural light in the morning, it helps regulate the circadian rhythm, improving sleep, energy level, and mood.

The causes for summertime SAD however, are not yet clear. The theories below are being studied, but a consensus has yet to be reached.

Allergies. Some patients report worse symptoms on high-pollen days.

Possible genetic component. More than two-thirds of patients with SAD have a relative with a major mood disorder.

Hypothalamus. Some scientists believe the root cause could lie in the brain’s hypothalamus, our brain’s control center for hormones.

Changes in light. While winter SAD has been linked to decreased light, summer SAD may be related to longer days and increased light offsetting the circadian rhythm by activating the body’s melatonin response at the wrong time of day.

Heat and humidity. Sensitivity to heat and humidity may come into play, including in areas with milder summers, although incidences go up in hotter areas.

Study subjects with summer depression were shown to experience a significant increase in body temperature at night compared to non-sufferers. When they were wrapped in cooling blankets at night their temperatures dropped and their symptoms disappeared. As soon as they went outside into the summer heat, their depression returned.

Without a known cause, how do I manage my summer SAD?

While the causes for summer SAD are not yet decided, here are some tools to help you cope with those summertime blues:

Early morning sunlight. Get 30 to 60 minutes of early morning sunlight as often as possible to help shift your body clock into the proper circadian rhythm.

Blackout curtains. Install these in your bedroom during the summer to mimic the cool dark of winter nights.

Open bedroom windows at night. This will improve air flow and keep room temperatures lower for improved sleep.

Sunglasses. Avoid bright light by wearing sunglasses outside the house. Even on cloudy days there is substantial exposure to sunlight. At higher latitudes, the blue light spectrum is more prevalent, making cloudy days have more glare.

Avoid blue light and screen light in the evening. This helps the body to adjust its hormone production in preparation for a proper sleep cycle. Some patients find wearing blue-blocker glasses and installing the f.lux app on phones and computers also helps immensely.

Cool your bed. While cooling therapies are not guaranteed to be permanent fixes, the temporary help can make a big difference in sleep quality. You can use low-tech solutions like frozen water bottles in your bed or opt for more high-tech solutions like a cooling pad or bed fan.

Check thyroid levels. Some evidence suggests those with summer SAD have low thyroid function, which can affect temperature regulation, mood, sleep, appetite, weight, energy, and more.

Exercise daily.

Eat an anti-inflammatory diet.

Eat plentiful and varied produce. This will support your healthy gut bacteria and help support production of neurotransmitters to support brain health and mood regulation.

If you suffer from summertime SAD, contact my office to find out how you can reclaim your energy, appetite, and mood.

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