Category Archives: Disease Physiology

45 or Older, Your Muscles Are Shrinking

Everyone loses 1% of their muscle mass every year starting at age 45. This is a big deal because our metabolism as well as the utilization of glucose for energy largely takes place in our muscles.  But we have the ability to stop the natural progression of muscle wasting called sarcopenia.  The anecdote?  Strength training and adequate protein intake as discussed in the previous blog.

Metabolism and Muscle Mass

Many people blame their excess weight on having a slow metabolism.  But in reality obesity is rarely due to a metabolic disorder like hypothyroidism.  Excess weight is due to how much we eat, what we eat and how much we exercise.  There are other factors that can impact one’s metabolism like body size, sex and age.  In general, people who are larger, have more muscle mass, are male and younger than 45 will have a higher metabolism.  Basal metabolic rate is the amount of calories needed to carry out the normal functions of the body and accounts for about 60-75 percent of the calories you burn each day.  Two other factors that also effect metabolism are thermogenesis or food processing, and physical activity. Thermogenesis is defined as the amount of energy used in the digestion, absorption and distribution of food consumed and accounts for about 10 percent of the calories used in a day. It is believed that diet induced thermogenesis can play a part in obesity.  They conclude that protein plays a big part in raising thermogenesis of food.  There is also some evidence that eating “whole” foods like whole grain breads and less processed food like cheddar cheese versus processed cheese product also increase thermogenesis.  In one study a diet higher in protein and carbs as opposed to one high in fat and carbs lead to higher thermogenesis as well as a longer feeling of satiety.  There has also been some evidence that the regular ingestion of chili or the capsaicin in it has been linked to increased thermogenesis.  I guess that is a good reason to eat a lot of chili soup and salsa!  In general, the more difficult it is to process the foods we eat, the more calories we burn in the process of digesting them.  Dietary fat is very easy to process, while protein is not.

muscle mass

That’s some muscle mass!

Physical activity also plays a role in our metabolism.  We also know that just doing aerobic exercise will benefit our heart and lungs  but will do little to maintain muscle mass.  Research at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston have repeatedly shown the benefit of strength training for reversing the effects of sarcopenia.  For adults 45 or older, adding strength training is nonnegotiable if you want to prevent sarcopenia.  Furthermore, muscle mass effects metabolism.  For those over 45, avoiding strength training will lead to a slowing of metabolism, a drop in caloric needs, and most likely weight gain.  The Centers for Disease Control and Prevention (CDC) recommends each week 150 minutes of moderate intensity exercise (like a brisk walk) and 2 strengthening sessions involving all major muscle groups – legs, arms, chest, shoulders, abdomen, hip and back.  If vigorous exercise is done then the time can be decreased to 75 minutes a week of the aerobic, along with the same strengthening sessions.  Evidence also supports that the aerobic portion can be broken up into 10 minute sessions – you will get the same cardio benefit versus doing it all at once.

Insulin Resistance and Muscle Mass

If you have a parent with type 2 diabetes then you have a 40% chance of developing it as well. Type 2 diabetes starts with the inability of the body to effectively recognize and utilize insulin.  Insulin is the hormone that helps glucose get into the cells for energy.  If the cells do not get adequate glucose, that person will not only feel tired but will increase the liklihood of developing diabetes.  There is a very effective solution to reduce insulin resistance.  You guessed!  Strength training.  Insulin resistance starts in the muscles, liver and fat cells.  When you do strenghthening exercises you are moving those muscles and improving the muscles ability to recognize insulin, not just while exercising but for the next 24 hours.  And you are increasing your muscle mass.  Pretty powerful and better than taking a medication for it.

Your Steps to Protect Your Muscle Mass

1.  To preserve muscle mass make sure you are getting enough protein.  If you don’t eat an adequate amount of protein your body will break down it’s own muscle mass to get the amino acids it needs.  If you are over 45 then make sure you are getting about 30 grams of protein each meal.  As mentioned in the previous post your needs go up with age as much as 1-1.5 grams of protein per kilogram of weight.  You might want to think about adding a protein powder shake as one of your meals. Next blog will discuss testing done by Consumer Lab on protein powders. If your are eatting 4 ounces of lean meat for your dinner then you are getting enough protein. Other good sources of protein include fish, fat-free or reduced fat plain Greek yogurt, low-fat cottage cheese, eggs and egg whites, tofu, edamame and even quinoa. 2.  Schedule a regular time on your calendar to get regular, moderate intensity exercise.  Perhaps take the bus to work, get off the bus early and walk the last mile to work or park a mile away from work and walk.  There are some wonderful walking DVD’s by Leslie Sansone, that you can also purchase on Amazon.com. 3. Twice a week take 20 minutes to do strengthening exercises.  Here is a good from the CDC link if you are new to doing strengthening.  There are tablet apps like the 7 minute workout that include a nice regimen that works all the muscle groups.  Or think about joining Planet Fitness where the memberships are cheap and you can work with a trainer twice a week to get your started on the machines and weights.  If you are new to doing strengthening and reluctant to do it then look for a Strong Living Program in your area.  This is a group exercise program designed by Tufts University that has well researched success. Much of what I have said here applies to those who are 45 or older.  But as we all know, habits are much easier to start the younger you are.  Why not take this information and jump-start your health by doing these suggestions now.  Not only will it help you to reach and maintain a healthy weight, but it will relieve stress, improve your health numbers, help you to sleep better and make you feel mahh-velous!  Bet you can’t find that in any pill!

Protein = Muscle Power + Healthy Weight

So what’s the scoop on protein?  You go to the grocery store and you see labels bragging about being “a good source of protein” or how it “satisfies hunger longer.”  In the past, eating low-fat foods was the best way to lose weight. Then came the Adkin’s diet that was all about eating an ultra low carbohydrate diet in order to go into ketosis and force the fat to melt away.  Now the focus is on protein and making sure you are getting enough of it – whatever enough is. Why is protein so important and how much is enough?

Protein Plays A Big Role In Our Body

Protein on a food label

You’ll find protein listed last on every food label

Protein is a food nutrient used to build and repair every cell in our body and to make hormones, enzymes and hemoglobin.  One of the biggest roles protein has as we age is to build and maintain our muscles.  This is important because as we age, we lose muscle mass.  According to Nathan LeBrasseur, a researcher at the Muscle Performance and Physical Functions Laboratory at the Mayo Clinic in a June 23, 2014 article in the Wall Street Journal, most people will lose about 30% of their muscle mass over their lifetime due to inactivity and inadequate nutrition.  And it is our muscles that determine our metabolism – how many calories we burn at rest.  When muscle mass deteriorates, not only do we get weaker which can lead to falls, but we burn fewer calories at rest as well.  Muscle loss usually leads to weight gain.  Most people do not decrease their caloric intake as they age to compensate for the drop in metabolism, so over time their weight gradually increases putting even more strain on the body and creating more difficulty with mobility.

How Much Protein Do We Need?

The USDA recommends 0.8 grams per kilogram of protein per day, but there has been a growing body of evidence to support consuming a larger amount as one ages.  In order to slow down sarcopenia, or the loss of muscle mass, the Society on Sarcopenia, Cachexia and Wasting Disorders recommends in a 2010 article that protein intake for the over 50 age group be as high as 1-1.5 grams per kilogram per day, divided over all three meals.  To convert pounds into kilograms, divide your weight in pounds by 2.2.  For example a 200 pound individual weighs 91 kg.  For someone less than 50, the recommended protein intake would be about 72 grams per day.  For someone over 50, the recommendation would be 91-140 grams of protein per day.  Furthermore, the society recommends 20-30 minutes of strengthening and aerobic exercise three times a week to prevent sarcopenia.  Just increasing protein intake alone without exercise will only slow down the destruction of muscle mass but will not prevent sarcopenia.  It is also advised that Vitamin D levels be in adequate range and may require supplementation.  As we age Vitamin D levels decline and low levels are associated with low muscle strength as well as other chronic diseases.

As we age, kidney function can decline, particularly if someone has diabetes or hypertension.  If someone has any of these conditions or has been told that they have kidney disease, then before you increase your protein intake discuss your kidney health with your doctor.  If you have any kidney disease, protein intake should be determined by your provider and a registered dietitian who can make other recommendations to preserve kidney function.  You should ask your healthcare provider about your kidney function and learn about your GFR or glumerular filtration rate.

Getting Enough Protein

As our bodies age, how we utilize the amino acids from the protein we consume also changes.  When protein is eaten, it is broken down in the gastrointestinal tract into amino acids which are then absorbed in the blood stream.  It’s the rapid change in concentration of amino acids in the blood stream that then triggers a chain of metabolic reactions that stimulate the formation of new protein.  However, according to research done at the University of Texas Medical Branch in Galveston as well as at Arizona State University and mentioned in the Staying Strong article in the April 2011 Nutrition Action Healthletter, older adults need a larger amount of amino acids to stimulate protein synthesis.  According to Douglas Paddon-Jones, a researcher at University of Texas, giving 30 grams of protein to a young or older adult will stimulate the same kind of protein synthesis.  Paddon-Jones states that if you give only 15 grams of protein to each age group, the younger age group will synthesize about half the protein, while the older age group will not synthesize any or a very minimal amount.  The older adult needs to get about 30 grams of protein in each meal to stimulate protein synthesis and preserve muscle mass.  This is why cereal for breakfast is not as good for the older adult as a large egg white omelet, with a side of lean Canadian bacon and a piece of whole grain toast.  Most cereals only have about 5-7 grams of protein in a serving size and a cup of milk has 8 grams of protein.  If someone were to boost the serving size in order to get the recommended protein they would be greatly increasing the carbohydrates and calories that can lead to weight gain and not muscle mass protection.

Types of Protein

Protein is made up of amino acids – 9 of them are “essential”, meaning we must consume them because our bodies can not make them like the other amino acids.  Amino acids are the building blocks for repairing our body.  Some proteins are considered complete, meaning they have all 9 of the essential amino acids, and some are incomplete meaning that they lack some of the essential amino acids.  Complete protein sources include meat, poultry, fish, eggs and dairy – but also include soybeans and quinoa as well.  Choose lean sources like poultry, fish and plant-based or very lean beef and reduced fat dairy since animal proteins can be high in saturated fat.  And if it’s in your budget, buy organic where the type of fat is higher in heart healthy omega 3’s.  Incomplete sources are those from plants like beans, grains and legumes.   A vegetarian diet can get all the essential amino acids needed as long as a variety of plant foods is consumed.  Of all the 20 amino acids, leucine is the amino acid that does the majority of protein synthesis and is a good one to focus on.  It is found in animal proteins but in the article, Staying Strong from the April 2011 issue of the Nutrition Action Health Letter, there is a list of good food sources of leucine.

How Much Protein Is In My Food?

Become aware of the protein in your foods.  Three ounces of cooked chicken breast has about 26 grams of protein.  Three ounces of cooked salmon has 21 grams.  A cup of plain fat-free Greek yogurt has 23 grams of protein.  A large egg has 7 grams of protein and a cup of edamame has 14 grams.  But remember that you don’t have to get all your protein from animal based foods.  A good breakfast for someone under 50 might be a cup of plain fat-free Greek yogurt mixed with some berries and topped with a couple of tablespoons of walnuts.  A good breakfast for someone over 50, particularly if they are getting daily aerobic exercise combined with some strengthening exercises, might include my smoothie recipe(email me for my recipe) along with a good source of protein powder.  Look for my upcoming article on good sources of protein powders.  In the meanwhile, put away the cereal unless you are using a small amount as a topping on your Greek yogurt or smoothie and consider a large egg white and veggie omelet for breakfast, or heck, even some of that leftover chicken from dinner last night!

In Pickles, Really??

pickles frontYes, both of these jars of pickles have the dye coloring, Yellow 5 in them.  Craved by pregnant women, accompanied with sandwiches and even touted as a healthy snack, many manufacturers of pickles are adding Yellow 5 to their spears, baby dills and sandwich toppers to make you choose them.  The only reason food coloring or dye is added to any food is to enhance visual appeal.  Doesn’t the yellow sharp cheddar cheese look more appealing than the white?  Isn’t cheese suppose to be yellow like in every cartoon?  Think twice before you choose your yellow and red foods unless they are in the produce section.

Safety of Yellow 5, Yellow 6, and Red 40 Questioned

pickles back

Yellow 5 is in both these jars of pickles!

It turns out that since 1955 United States consumption of food dye has increased five fold with 90% of the food coloring in foods coming from Red 40, and Yellow 5 and Yellow 6.  In 2010, Centers for Science in the Public Interest (CSPI) reviewed studies done on the safety of the nine FDA approved food dyes.   CSPI’s mission is to inform the public of unsafe products, unsafe practices and laws that need to be changed.  CSPI’s review revealed that the research done on the safety of food dyes was not done by independent researchers, nor were adequate mice samples used and testing was done only over two years – not sufficient time to test for the development of cancer.  Furthermore, all of the studies were done on individual dyes, therefore not taking into consideration the synergistic effect of multiple dyes as when people may eat a variety of foods with different dyes during a meal.  So the real safety of food dyes has not been sufficiently proven.  CSPI has petitioned the FDA to ban all food dyes due to their possible carcinogenic effects, cause of hypersensitivities and behavior problems, and insufficient testing.  The British government has banned the use of artificial food coloring and the European Union requires all food labels that contain dyes to label that they may cause hyperactivity in children.  In England, McDonald’s strawberry milkshake is made with real strawberries but here in the US, Red 40 is used.  In an article provided by the National Institute of Environmental Health Science, Bernard Weiss, a professor at University of Rochester, argues that there has been a link between artificial dyes and behavior problems in children, and goes on to say that the FDA’s “inaction amounts to approval of ongoing experiment with children”.

Foods That Contain Red 40, Yellow 5 and 6

Red 40 is contained in soda, candy, gelatin desserts, pastries, pet food, and even sausage!  Yellow 5 and 6 is found in candy, gelatin desserts, pet food, beverages, and baked goods.  Most likely if a boxed cake mix is yellow or pink, then it contains artificial food coloring.  To make that pet food look meatier, it’s got artificial dyes.  Do you really want Rover to be more hyper than he already is?  Could these dyes have the same effect on our four legged friends? To make that jello jiggle in reds, oranges or yellows, it contains artificial food dyes.  That red M&M your kids may fight over not only may have an accumulative cancer risk, but may truly be causing hyperactivity in your kids.  Basically, if it’s from one of those large food manufacturers, and it’s either made for you or saving you some steps, it contains artificial ingredients, including dyes that not only increase the chance of cancer, but they make your kids bounce off the walls.

Alternatives to Artificial Food Coloring

There are safe alternatives to making foods more appealing through color.  Beet extracts and other natural colorants can be added to your dogs pet food or to the jello.  Paprika or beta-carotene can be added for yellow.  WILD Flavors, Inc has a thorough list of all natural coloring substitutes that are an alternative to using artificial dyes.  Manufacturers should be required to use these alternatives and if the FDA won’t ban them, then as a consumer, demand that they use them by either writing to your favorite manufacturers or stop buying them and go back to basics.  If you want candy, eat dark chocolate.  If you want cereal, eat unflavored oatmeal and flavor it with a teaspoon of honey, raisins and some cinnamon.  If you want some cake then make one from scratch – they freeze well too!  If you want a popsicle then buy ones made from 100% juice or make your own with blenderized frozen fruit and vanilla Greek yogurt and get some popsicle molds.  If you want a pickle, then find a manufacturer like Rick’s Picks found online or sold at Whole Foods and many other specialty stores that even have a low sodium all natural pickle or look for pickles without yellow 5 listed in the ingredients.

Get Back To Basics

Doesn’t it just make sense to get back to simple ingredients?  If a label has more than 5 ingredients and it contains words that you cannot pronounce, then doesn’t it seem sensible to just not buy it?  Think back to your great grandparents, before there were more than 3 aisles in the grocery store and the only jar of pickles found were those canned in the fall.  Back then, they didn’t even have refrigeration.  At least now you can make foods and freeze in bulk to enjoy over many weeks or you can be a discerning consumer.   You should always be suspicious of the ingredients sneaking into your foods under the guise of enhancing nutritional experience, but really just making the foods more attractive and extending their shelf life.  Start looking at the labels in your closet to see what may be lurking on them.   Not only may you find making different food choices to help your children and household be calmer, but you may keep cancer at bay down the road.

 

Transcending Trans Fats

The FDA has moved forward with stating that trans fats are not “generally recognized as safe” for use in food.  Many food manufacturers and restaurants have been using them less and less but now the curtain is coming down on them.  Based on expert panels including the Institute for Medicine (IOM) the FDA finds that there is no safe level of consumption of artificial trans fat. The FDA has not set an official date for banning them but is in the process of meeting with food manufacturers to negotiate a time line.

Trans fats are made by adding hydrogen to vegetable oils to make them more solid.  Trans fats are used to enhance flavor, texture and extend the shelf life of food.  They are the worst kind of fat because unlike saturated fat that just raises the bad fat in our blood, trans fat also lowers the good heart protective fat in our blood.  Food labels have been allowed to claim a food item had zero trans fat on the label and actually contain up to 0.5 mg of the partially hydrogenated oil.  By eliminating trans fats from foods, Commissioner Margaret Hamburg from the FDA states many thousands of lives can be saved.  It is estimated that trans fats have been linked to over 20,000 heart attacks and 7,000 deaths.

In 2007, New York City and Philadelphia had passed laws forbidding the use of trans fats in restaurants.  Health care providers have been struggling to get trans fats out of the American diet for decades because of its link to heart disease.  A high LDL and low HDL increases the risk for heart disease.  By reducing the use of this artificially created fat, the prevalence and severity of heart disease can be reduced – as long as consumers become wise to substitutions for this fat that enhances flavor and texture.

Doughnuts get their light texture due to trans fats.  Coffee creamers have that smooth appearance due to trans fats.  Many peanut butters get their smooth “spread-ability” due to trans fats.  So it makes you wonder what food manufacturers will come up with to replace these food enhancing qualities.  How will this impact us as consumers?

What Will Replace Trans Fats?

Be a savvy consumer.  Although saturated fats do not lower the good cholesterol (HDL) in our blood they are still linked to coronary heart disease.  Saturated fats come from animals and certain plants.  They are found in:

  • High fat cheeses
  • Certain cuts of meat – the more marbling in the meat, the higher the saturated fat.  The cheaper cuts tend to have less embedded saturated fat.
  • Whole fat milk and cream
  • Butter
  • Ice cream
  • Palm and coconut oils.

The Dietary Guidelines for Americans 2005 recommend consuming less than 10% of your total daily calories from saturated fat.  That means in a 2000 calorie daily diet, no more than 200 calories or 22 grams should come from saturated fat.  To give you an idea of what that looks like, 1 ounce of cheddar cheese has 6 grams of saturated fat.  A Dunkin Donuts Apple Crumb donut has 9 grams and a Big Mac has 10 grams of saturated fat.  So you can see how it quickly adds up in a day.

Although it’s a big step to have the FDA push to reduce trans fats in the American diet, being aware of all the fats that cause heart disease is what puts control in the individual consumers hands.

Type 1 Versus Type 2 Diabetes

There is a big difference between type 1 and type 2 diabetes.  They are two completely different disease processes that really should not share the same name.  Type 1 is actually an autoimmune disease with a small genetic link that usually occurs in youth and causes damage to the insulin producing cells of the pancreas.  If diagnosed early then some of the pancreatic function can be preserved.   However in most cases of recently diagnosed type 1 diabetes significant permanent damage occurs requiring the individual to administer multiple daily  insulin injections to control blood sugar levels. With frequent daily blood sugar checking, insulin administration and dietary planning a person with type 1 diabetes can lead a full healthy life.  If blood sugars are not kept in good control,  blindness, kidney disease, heart disease and amputation due to poor circulation and infection can occur. Since the pancreas is not producing any insulin, it’s always a challenge for an individual with type 1 diabetes to find the balance between managing their disease and not letting it overrun their life.

Type 2 diabetes is actually a stress state of the associated with a strong family history of diabetes in conjunction with an unhealthy lifestyle.  The typical individual diagnosed with type 2 diabetes has excessive abdominal fat, leads a sedentary lifestyle and consumes a diet high in refined carbohydrates, saturated fats and not enough legumes, whole grains, and fruits and vegetables.  They often feel tired due to high blood sugars and/or sleep apnea.  It can lead to increased inflammatory markers that contribute to atherosclerosis or hardening of the arteries, decreased insulin production and sensitivity, and stress on the overworked pancreas.  Medications can help to control the disease process but without lifestyle changes as well, eventually the pancreas fails and insulin through injection is required.  Type 2 diabetes is really a vascular problem that if not controlled leads to circulatory problems resulting in slow healing of cuts, loss of vision from retinopathy, erectile dysfunction, painful neuropathies of extremities due to nerve damage, and kidney damage from high blood sugars that damage the intricate filtering components, the nephrons, of the kidneys.

The National Institute of Health did a large study involving 27 medical centers across the country on preventing diabetes in those diagnosed with prediabetes.   Prediabetes is diagnosed with a blood test as having a fasting blood sugar greater than 100 or an A1c greater than 5.8.  The results of the study were published in the New England Journal of Medicine February 7, 2002.  Initially the study involved  four groups of randomly assigned people to either a lifestyle intervention group involving motivational counseling, one of two medication groups or a placebo group.  One of the medication intervention groups was discontinued after the drug was found to cause severe liver damage.  The lifestyle intervention group involved losing 7% of body weight and exercising 150 minutes at moderate intensity level a week.  The drug group was given the oral medication, Glucophage.  The study was stopped early because the results found that a 7% weight loss in conjunction with 150 minutes of exercise a week to be the most effective in preventing diabetes in those already diagnosed with prediabetes.

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In prediabetes the pancreas makes extra insulin in order to help glucose get into the cells where it is needed for energy. Over time insulin production decreases, and blood sugars increase, leading to the development of type 2 diabetes. Once type 2 diabetes has developed there is some permanent damage done to the pancreas.

Almost 26 million people in the United States  have type 2 diabetes.  That’s 8.3% of the population!   It takes a good understanding of disease management, planning, and good support both financially and emotionally to maintain good control.  Can you imagine the cost savings of preventing this disease if everyone diagnosed with prediabetes could just lose 7% of their weight and find 150 minutes out of the 10,080 minutes in the week to exercise?  And for those already diagnosed with type 2 diabetes, just being physically active for 30 minutes daily and reining in the fast food, chips, sweets, cheese and full fat dairy and eating more whole grains, fruits and vegetables, could make all the difference in the world between just living and living well.  In this time of rising health care costs and limited resources don’t we all have a responsibility to take our health seriously and give it the focus that we give to other parts of our lives?

Exactly What Is Chronic Inflammation?

In terms of health, chronic inflammation is brought up often as a contributor to chronic diseases like heart disease, diabetes and even autoimmune diseases and cancer.  You might be wondering what is the difference between this inflammation and the kind that happens when you get a cut.   Inflammation of both kinds is initially a life saving response meant to heal damaged tisssue but when the damage happens over and over as in Crohn’s disease or GERD or even plaque forming atherosclerosis, the bodies response becomes detrimental.  Inflammation can be acute like when you cut yourself, or it can be chronic like when your body has to deal with a gradual accumulation of plaque in the arteries.

Acute Inflammation

Acute inflammation signals our body to send out the troops to heal the injury.  It is a healthy protective response involving plasma and white blood cells that then orchestrate a cascade of events involving proteins and chemical mediators that work together dilating blood vessels, increasing blood vessel wall permeability to improve access and clotting proteins to seal off the injured area.  This is why injuries swell, feel warm, become red and painful and can limit function temporarily.  The inflammation response happens quickly and then either gets better, develops into an abscess or becomes chronic.

Chronic Inflammation

Chronic inflammation happens when there is repeated exposure to pathogens, toxins like tobacco and other foreign substances, or a overactive immune system (like rheumatoid arthritis, inflammatory bowel disease, and asthma to name a few).   The same inflammatory response occurs as in acute inflammation but with time there is a gradual shift in the type of soldiers sent as the troop reserves are depleted.   The outcome, over several months or years, is the destruction of tissue, thickening and scarring of connective tissue, and death of cells or tissues.  It is important to address the cause of the underlying chronic inflammation in order to prevent scarring and tissue destruction.

Example of Acute Inflammation Becoming Chronic Inflammation

Take the example of intermittent episodes of heartburn.  Heartburn is caused by acidic stomach contents going into the esophagus where the tissue is more sensitive.  Microsoft PowerPoint - 59.pptxThere are several lifestyle and diet choices associated with it.  Combined with stress, being overweight and perhaps wearing tight fitting clothes, the perfect environment exists for heart burn.  If this is happening more than once a week this warrants seeing a healthcare provider.  When the esophagus is repeatedly exposed to the acidic stomach contents, it may be a problem Gastroesophageal Reflux Disease or GERD.  GERD causes chronic inflammation and scarring that can lead to problems with swallowing and even Barrett’s esophagus – a type of cancer.  This is an example of how an acute inflammatory episode can become a chronic inflammatory condition leading to scarring and cancer.  Other examples can be untreated asthma, irritable bowel disease and even atherosclerosis to name a few more.

Obesity, Sedentary Lifestyle and Inflammation

Visceral fat, or the fat around the waist, (for women having a waist circumference greater than 35″, for men greater than 40″ – and that is not just your pant size!) is linked to low grade inflammation.visceralfat   The fatty deposits around the belly triggers an autoimmune response causing a release of inflammatory chemicals.    These inflammatory chemicals interfere with normal metabolism and have been linked to type 2 diabetes, atherosclerosis and even cancer.   Research indicates that there is also a link between abdominal fat and  and COPD (Chronic Obstructive Pulmonary Disease).   The silver lining is that research also supports that with weight loss these inflammatory markers are decreased.

The Layering Effect of Lifestyle Choices, Health Conditions and Chronic Inflammation

When unhealthy lifestyle choices are combined with certain physical conditions it becomes exponentially more hazardous.  Imagine the obese person who smokes, has uncontrolled asthma, eats a lot of fried foods, overeats, has frequent heart burn, doesn’t sleep well, is sedentary, stressed and always tired.  Doesn’t that sound like someone you may know?  Now imagine if that person stopped smoking, stopped eating so many fried foods, ate healthier foods in smaller amounts and then started going for walks during the day.  Imagine how he would probably sleep better, feel less stressed, start to lose weight and have more energy.  Imagine how this would decrease those inflammatory markers and give him a better quality of life for the present and the future.

The Dalai Lama, when asked what surprised him most about humanity, he said:

“Man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

It comes down to lifestyle choices and being able to make gradual changes, one step at a time.

 

 

 

 

 

 

It’s About Inflammation, Not Your Weight!

We are our own harshest critics when it comes to our weight.   Appearance is usually the motivator for losing weight, but often times that is not enough to make the weight loss stick.  There is a stronger motivator but it is not as visible.  Shifting the focus from weight to the burning fire within your body is the best reason and the one that will give you the greatest payback.

Testing For Inflammation

What if your focus is on reducing the slow burning up of our body by inflammation?  This is what leads to the slow destruction of our organs and interferes with our ability to function at our best. fire It leads to chronic disease like heart disease, diabetes, dementia, depression and cancer.  Even though we may not “feel” inflammation, there is a strong likelihood that it is there if any of these diseases are present.  It can be tested for by checking C-reactive protein (CRP) in the blood.  Generally there is no CRP in the blood.  The presence of CRP is an indication that you have inflammation.  This is not a routine test because it is not disease specific and can lead to a plethora of further testing to identify the source of inflammation. There is also a more sensitive test, the high-sensitivity c-reactive protein or hs-CRP that can be done to test specifically for heart disease.  Results greater than 3 mg/L indicate high risk for cardiovascular disease.

Instead of going through the expensive testing assume that if you are obese with a BMI greater than 30, are feeling tired, are not getting adequate sleep, are being treated for heart disease, diabetes, high cholesterol, GERD or depression, there is a strong likelihood that there is inflammation.  How about making small changes that can smother the burn, soothe your organs and restore your energy?

Smothering the Burn of Inflammation

Instead of focusing on the scale, make your goal smothering the fire.  Let’s break it down into actions you can take starting tomorrow.

  1. Walk for 10 minutes several times every day.  Walk fast enough to breath a little hard and swing your arms.  Doing this for ten minutes after a meal can diminish the rise in blood sugars and insulin levels that often occur after eating.  Large swings in blood sugars and insulin levels can lead to weight gain.
  2. Take the stairs whenever you have a chance.  No more elevators unless it’s greater than three floors.
  3. Set a sleep schedule time and get a minimum of seven hours of sleep.  We know adequate sleep helps fat metabolism.  Too much fat, especially around the belly, is the fuel for inflammation.
  4. Avoid toxins from things like mercury (choose low mercury fish from below), excessive alcohol, and pesticides.
  5. Eliminate allergens that may be contributing to asthma and bowel disorders.  Lactose and wheat are fairly common ones.
  6. Eat fewer processed foods and whole fat dairy that are full of the inflammatory-causing trans and saturated fats.
  7. Eat more high Omega 3 foods:
  • Fish – particularly sardines, striped bass, wild salmon, herring and anchovies.
  • Eat two tbsp. of ground flax seed daily.  You can put it in hot cereal (after cooking), add it to sauces or put it in a smoothie.
  • Eat two tbsp. of walnuts daily- this makes a perfect topping for oatmeal or yogurt.
  • Eat one serving of either Brussels sprouts, kale, spinach and watercress daily.

8.  Eat more foods high in antioxidants like kidney and pinto beans, berries-especially blue berries, and artichoke hearts.

Try gradually adding these actions to your daily routine, be mindful of your energy level and see what wonderful things will happen one month from now.  Instead of your body burning up, your body and mind will be more stable and alert and you will notice some of those clothes fitting much better as a byproduct without even focusing on your weight!

 

Is It Menopause or Low Blood Sugars Causing Your Night Sweats?

Do you wake up at night and throw off your covers because you are feeling hot and damp?  Do you have a family history of Type 2 diabetes?  Did you eat a lot of crackers, ice cream, pretzels or chips in the evening and wake up with soaked sheets?  There are many causes of night sweats but often times people who have not been diagnosed with diabetes or prediabetes do not consider the possibility that they might be having low blood sugars in the middle of the night and not just hot flashes from menopause.

Low Blood Sugars Could Be Causing Your Night Sweats

If you have a family history of diabetes, you are “overwaist” with a waist circumference greater than 35 for a woman, you do not exercise regularly and you eat refined carbohydrates in excessive amounts, you might have prediabetes.   Eating a large amount of sugary foods or white flour products can cause a rapid rise in blood sugar which then tells your pancreas to release extra amounts of insulin.  This extra insulin can bring your blood sugar down rapidly and actually cause a low blood sugar.  Have you ever felt shaky mid morning after eating cold cereal or pancakes with lots of syrup for breakfast.  Have you munched on a whole bag of pretzels commending yourself for them being low fat but noticed you had night sweats that woke you in the middle of the night?  Have you noticed on the days you eat more whole grains, lean protein, Greek yogurt, nuts, lots of veggies with a small night snack of fruit that you do not wake up with night sweats?  To get a better understanding let me explain what happens with Type 2 diabetes.

What Is Type 2 Diabetes?

Type 2 diabetes is a completely different disease process than Type 1 diabetes.  Type 1 is an autoimmune disorder that results in complete loss of insulin production by the pancreas.   Those individuals are dependent on insulin from a needle in order to live.  Insulin is the transporter of glucose or sugar into the cells for energy.  Without enough insulin, cells lose their fuel source.   Type 2 diabetes is really a stress state in the body, highly genetic but really a problem with insulin effectiveness.   In Type 2 diabetes the body does not recognize its own insulin – this is called insulin resistance.  Having excessive abdominal fat is associated with insulin resistance.  Because the body does not recognize it’s own insulin there is a series of events that further exacerbates the situation:

  • The cells do not get enough glucose to do their work.
  • The pancreas works even harder making more insulin in an effort to get glucose into the cells.
  • Glucose builds up in the blood stream damaging the arteries and causing blindness, nerve damage, kidney damage and heart disease.
  • The pancreas begins to tire out and makes less and less insulin.

Before full fledged Type 2 diabetes develops, the pancreas makes extra insulin in order to get the glucose into the cells.  It’s similar to your furnace.  If your furnace has not been cleaned for years it gets more inefficient at burning oil due to poor mixing with the air and your furnace ends up burning through more oil (and on top of it can back fire making a huge mess!!).   That extra insulin is a sign that your body is not working efficiently.  In addition, the extra insulin can lead to low blood sugars at certain times depending on food choices.

Diagnosing Type 2 Diabetes

Type 2 diabetes has a history.   It does not just suddenly come on like a switch.  It begins with a gradual rise in glucoses that your healthcare provider can detect as part of the Basic Metabolic Panel, especially if the blood sample is taken in the fasting state.  Normally glucose is well below 100 but as the body gradually becomes more resistant to insulin, blood sugars begin to rise.  There are two other tests that are used for diagnosis.  The Oral Glucose Tolerance Test (OGTT) that looks at blood samples two hours after drinking a sweet substance.  And the A1c that looks at an average of blood sugars over 2-3 months time.  Below are the diagnostic criteria for prediabetes and diabetes:

  • Prediabetes – fasting blood sugar 100-125; OGTT 140-199; A1c of 5.7-6.4
  • Diabetes – fasting blood sugar > 125; random blood sugar > 200; OGTT > 200; A1c 6.5 or greater

What You Can Do

Connect the dots...look for patterns

Connect the dots…look for patterns

Know your family history.  Type 2 diabetes has a strong genetic link.  Then look for patterns and connect the dots between your food choices, your energy state 2 hours after eating and the frequency and timing of your night sweats.  Have your fasting blood glucose checked and either a OGTT or an A1c.  Being diagnosed with prediabetes and being willing to lose 7% of your weight and exercising at a moderate level of intensity 150 minutes a week can preserve your pancreas, decrease insulin resistance and restore your energy.  Use a health coach or sustainable weight loss program to get you started.  You will get payback for the rest of your life!!

Do You Know How Your Kidneys Are Doing?

You probably don’t think much about your kidneys.  ẢnhDid you know symptoms of kidney disease might not manifest until there is 90% loss of kidney function?  Decline in kidney function can be caused by certain disease processes, genetic defects, exposure to certain bacteria or drugs or congenital defects during birth.  Knowing your family history will alert your healthcare provider to test for it but knowing your numbers will heighten your awareness of what steps to take to maintain healthy kidney function.

Kidney Function

We have two kidneys, each about the size of a fist, one on each side of the back of our abdomen.   They filter all our blood several times a day while:

  • maintaining fluid and electrolyte balance
  • removing waste from our body
  • removing drug end products
  • producing an active form of vitamin D that helps strengthen our bones
  • releasing hormones that regulate blood pressure
  • making a hormone called erythropoietin that assists with the production of red blood cells

Types of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is defined as having some kind of kidney abnormality (such as protein in the urine) that results in declined kidney function for three months or longer.  There are many types of CKD.

Hypertension and Diabetes

Having poorly controlled  diabetes is the most common cause of kidney damage.  Diabetes is caused by a defect in insulin production or insulin use that results in high blood sugars.  Think of high blood sugars being like sandpaper inside the arteries of the kidneys gradually destroying the filtering units of the kidneys.  Poorly controlled high blood pressure is another very common cause of chronic kidney disease.   High blood pressure causes damage to the fine meshwork of arteries inside the kidneys – visualize the impact of a heavy rain on the banks of small brooks.

Inherited Types of CKD

Polycystic Kidney Disease is the most common type that results in the formation of large cysts that gradually harm kidney function.

Inflammation of the Kidneys

There are tiny filtering units called glomeruli in the kidneys that can be damaged from exposure to bacteria.  Some examples are E Coli from eating contaminated foods or streptococcus from strep throat.  Autoimmune diseases like Systemic Lupus Erythematosas can also cause chronic inflammation of the kidneys.

Congenital Defects

These are defects that happen while the fetus is developing in the womb.  A common defect involves the malfunction of a valve in the urine tube that causes urine to back up and damage the kidneys.

Drugs and Toxins

Many over-the-counter pain medications, such as Aleve and Ibuprofen, cause kidney damage.  Repeated use of antibiotics can cause kidney damage.  Exposure to poisons and pesticides and illicit drugs like crack and heroin can all cause kidney damage.

Simple Tests for Kidney Disease

There are several ways to detect kidney disease.  Early detection can preserve kidney function.

  • Check blood pressure with the goal of keeping your blood pressure under 130/80 for those with diabetes, and under 140/90 for those with hypertension.   Checking your own blood pressure at different times of the day – even at work when it can be highest – is essential.   Your heart is beating 24 hours a day, not just at the doctor’s office and often times the doctor office results can be less accurate due to anxiety, not sitting for five minutes or not having your arm at the right height.  You can purchase a reliable one at Walmart for less than $50.
  • Have your healthcare provider check for protein in your urine.  The presence of protein in the urine indicates some damage to the filtering units of the kidneys.   Heavy exercise can cause this so this should be repeated several times.
  • Have your healthcare provider check your blood creatinine- this is a simple blood test that is part of a basic metabolic panel.   Creatinine is a metabolic waste byproduct that are is indicative of how well your kidneys are working.  Used in conjunction with your age, race, gender and other factors  your estimated Glomerular Filtration Rate (GFR) can be calculated.   A GFR under 60 is considered the threshold of CKD.  Use this calculator to determine your GFR

Treatment for Chronic Kidney Disease

There is a lot that can be done to control the damage from CKD.  There are many drugs that can control and preserve kidney function.  There are many dietary changes that people can follow to keep kidneys healthy.  Eating a low fat, low sodium diet can go a long way in protecting the delicate filtering system of the kidneys.  The average American consumes well over 4000 mg of sodium daily.  Getting that closer to 1500 mg by avoiding high salt foods like smoked foods and deli meats; canned, prepared and packaged goods that are not low sodium; pickles; olives and many cheeses to name a few, can make a big difference.  Eating a low fat diet by reducing saturated and trans fats from foods like hot dogs, sausage, red meat, many chips and crackers, whole fat dairy will reduce the bad fat that leads to hardening of the arteries.  In addition, eating mostly grains that are whole (they are high in natural fiber that act like sponges soaking up the bad artery-clogging fats) will go a long way in keeping your arteries soft and flexible.  For those with diabetes, checking blood sugars, particularly checking 2 hours after a meal when blood sugars can be the highest, will give you an idea of your blood sugar control.  Eating a diet of carbohydrates that are high in natural fiber like those in whole grains and fruits in portioned amounts; lean protein from fish, chicken and tofu and emphasizing your lunch and dinner plate being one half nonstarchy veggies, can be more effective than medications in controlling your diabetes.  If this seems like a daunting task then schedule an appointment with a dietitian; dietary changes are as important as prescription medications in controlling hypertension and diabetes and often times can mean getting off some medications.

You Are In Control of Your Health

We can’t feel if our kidneys are being damaged.  Visible signs of kidney disease only happen when there is serious damage.  But being an educated health care consumer can alert you to early warning signs and put you in the driver’s seat of your health.  Know your blood pressure, find our your blood creatinine and calculate your GFR.  A result well over 60 (and hopefully over 90) is an indication that your are living a healthy life, a priceless payback!