Obesity is an epidemic that is sweeping the developed world. Stress, and in particular the stress-related hormone cortisol, play an important role in obesity. Learn how to address these issues and take action.
As we age, one of the most common concerns for all of us is loss of cognitive function and the risk of dementia. In the last few years it has been found that there are many ways to reduce that risk, including dietary practices and a bevy of new supplements including magnesium threonate, CDP choline, PQQ and lions mane mushroom.
I have previously written a blog post about diet’s impact on prevention and reversing of dementia (read Preventing Dementia). Now a new study from the University of Chicago has confirmed many of these ideas. The study’s authors are calling the best preventive diet for maintaining a healthy brain the MIND diet - a combination of Mediterranean diet and the DASH diet for hypertension.
The MIND diet includes:
3 servings of whole grains (avoid gluten if sensitive but whole grains are an important food)
2 vegetables per day
1 glass of red wine
nuts as snacks
beans every other day
berries twice weekly
poultry twice weekly
fish once weekly
People who adhere strictly to these suggestions have a 53% lowered risk for Alzheimer’s disease (these suggestions seem easy to follow and I know many of my patients already do better than this).
The connection between diet and dementia
In addition to dietary patterns, individual nutrients such as flavanoids in fruits and cocoa have shown benefits in preventing dementia. Higher intake of blueberries and strawberries in a study of 16,000 nurses over several decades was found to significantly reduce cognitive decline. Studies show EPA and DHA, omega 3 fatty acids mostly found in cold-water fish, can also reduce the risk of dementia. Genetics also play a role in what nutrients can make a difference. For example, people with high homocysteine levels from MTHFR mutations (this can be measured in blood tests) will reduce their risk of dementia by taking folate, B12 and B6, whereas others might not see benefit.
There are several supplements that have also shown promise in preventing cognitive decline. Some of them are included in a supplement we use in the office called Wellness Brain. One is something few people have heard of-a mushroom called lion’s mane (hericium erinaceus). The active compounds in this mushroom, hericenones have been found to stimulate Nerve Growth Factor, a protein that is needed for nerve cell growth and repair. NGF decreases beta-amyloid in animal models of Alzheimer’s disease leading to reversal of the damage found in this life-changing disease. In addition, hericenones have been found to reduce cell death in brain cells. Lion’s mane mushrooms also contain DLPE that protects brain cells from oxidative damage. In a 2009 study of 30 people with dementia, those given lion’s mane showed significant improvement in a double-blind study.
Can citicholine help with memory loss?
Another nutrient in this formula that can be of great value in preventing or treating memory loss is CDP choline or citicholine. It appears to work by increasing dopamine receptors in the brain. In rats with an Alzheimer like disorder, citicholine prevents nerve damage and reduces the number of dying cells. In Japan and Europe, citicholine is approved for use in head trauma, strokes and dementia - improving clinical outcomes and lowering death rates. Citicholine increases the amount of choline available for synthesizing the neurotransmitter acetylcholine as well as rebuilding cell membranes and restoring mitochondrial function in neurons. It prevents excess inflammation in the brain by inhibiting release of free fatty acids and preventing breakdown of the blood brain barrier. The many facets of citicholine’s effects make it a significant factor in maintaining a healthy brain.
Other newer nutrients that help keep the brain healthy include PQQ - a novel vitamin like compound found in plants such as parsley, green peppers, kiwi, papaya and tofu that acts as a powerful antioxidant and stimulates mitochondrial biogenesis. This impacts brain function since aging and diseases such as Parkinson and Alzheimer’s have mitochondrial disorders as a part of their pathology. PQQ also reduces inflammatory chemicals such as IL-6 and CRP that damage vascular walls and contribute to brain inflammation. In addition, it prevents neurotoxicity from toxins such as mercury and glutamate.
Brain-boosting benefits of magnesium
One other nutrient that has become an essential in reversing cognitive decline is magnesium. Magnesium is the fourth most prevalent mineral in the body and has a wide array of functions and is utilized in over 300 enzymes. I have been using magnesium treatments for asthma, migraine, fatigue and muscular problems for years, but a new form of magnesium, researched at MIT, is now available that promises dramatic benefits for the brain. Magnesium threonate (Opti-Mag) is the only form of magnesium that readily crosses the blood brain barrier, helping symptoms like anxiety, sleep disturbance and memory issues.
Magnesium threonate improves the plasticity of the hippocampus, the center of emotional memories, often damaged by excess cortisol and stress (it has been shown to help in recovery from PTSD). Improved plasticity is key to maintaining neuronal connections throughout the brain, resulting in improved memory, learning and cognition. Magnesium acts by controlling ion channels, which affect the electrical signals moving from neuron to neuron. In animal studies, magnesium threonate also was shown to protect synapses, memory and learning in diabetic rats prone to Alzheimer’s like dementia. It was also found to help clear toxic beta-amyloid from the brain. In human studies, magnesium threonate was found to increase brain reaction speed, working memory, and episodic memory and to lower markers of brain age.
With these promising new natural therapies, as well as the findings about diet, sleep and exercise, we can be more confident in maintaining a healthy brain as we age. With our increasingly polluted environment and food sources and greater societal and personal stress levels, protecting the brain requires good self care, healthy choices and judicious use of appropriate nutritional supplements - a worthwhile undertaking.
Back in the 1980s, a revolution in the practice of integrative medicine and thinking about health and illness occurred, though no one at the time realized its significance. William Crook, a physician in Alabama, recognized that candida albicans, a yeast organism found in all human digestive tracts, had a major impact on health. He found that patients with overgrowth of candida not only were subject to vaginitis and thrush (commonly recognized as being caused by candida) but fatigue, allergies, digestive problems and a myriad of other problems.
Academic medicine scoffed at the idea that an organism found in the gut of almost all humans and not actually causing infection, has any impact on health. Despite this attitude, those of us practicing what was then called alternative medicine found many of our patients had this problem and responded to a treatment approach including dietary restriction of sugar, simple carbohydrates and aged foods, medication like Nizoral, Diflucan and Nystatin as well as probiotic therapy. I frequently observed enormous improvements in energy, digestive complaints, headaches and allergies when treating candida problems.
Common treatments for candida load
Today I continue to use these treatments and more sophisticated botanical therapies to reduce the candida load in the gut and build immune tolerance to this organism. The revolution that Crook foretold was the realization that the inhabitants of the gut, now called the microbiota (including candida, bacteria, viruses and parasites and numbering in the 10 trillion cell range), has enormous effect on health and disease. (See previous blogs on the microbiota and obesity). Academic medicine has now embraced the importance of our gut organisms in staying healthy, yet the candida issue is still not widely accepted.
How antibodies affect the immune system
We are now discovering the mechanism of how candida is so disruptive to the immune system and overall health. One of the keys is the adherence to the digestive tract wall from the hyphae form of candida. In response to this, the immune system produces anti-gliadin antibodies, the same antibody associated with gluten intolerance. These antibodies are associated with fatigue, mood changes, attention issues and even depression. In addition, candida creates a biofilm of protein around the colonies, making the body’s immune response less effective. However, treatment can make a big difference. In a study done in Norway in 1998, 21 of 25 patients placed on an anti-yeast diet and oral Nystatin had resolution of symptoms of digestive issues, fatigue and depression over a 3 month period.
Connections between candida and disease
There are some studies showing candida colonization is also associated with inflammatory bowel disease (Crohn’s disease and ulcerative colitis) as well as celiac disease and gluten intolerance. Current treatments include the same medications I have used for decades, Nystatin, fluconizole and itriconizole as well as newer botanical therapies designed to disrupt the biofilm, including Interfase, saccharomyces boulardi and quercitin. We need to keep candida overgrowth and intolerance in mind as a contributing factor for any digestive complaint ranging from bloating, gas, heartburn to colitis as well as systemic problems such as fatigue, depression, attention issues and allergies.
One of the most gratifying experiences I have had during my medical career was visiting Dr. Len McEwen in London in the 1990’s at his office on Wimpole Street (next to famous Harley Street and the Royal Society of Medicine). Dr. McEwen, an immunologist and allergist and a brilliant clinician, has helped countless patients with complex medical problems. Most importantly he was the originator of a form of allergy treatment called enzyme potential desensitization, or EPD.
Today, the American version of EPD is LDA, or low dose antigen therapy. I have used LDA with my patients for the past 20 and have seen it dramatically help problems from food allergy, hay fever and asthma to colitis, IBS, arthritis, fatigue, migraine headaches, eczema, ADD and even autoimmune disorders. What these conditions have in common are immune and allergic aspects contributing to the cause of the illness.
The reason I call LDA a medical breakthrough is both its effectiveness for so many conditions and the way it works in the body. LDA uniquely builds tolerance in the immune system by targeting what are called T reg cells. Through the use of beta glucuronidase, (a lymphokine which is normally found throughout the body), the T reg cells are instructed to become tolerant to the antigens (extracts of food, pollens etc. that one can react to) in the LDA. The antigens are extremely dilute and include over 100 foods, molds, pollens, dust mites, environmental chemicals and gut bacteria (which have been associated with auto-immune diseases like rheumatoid arthritis, Sjogrens, lupus and ulcerative colitis).
Compared to other allergy treatments, LDA can be more precise at targeting the T reg cells to train the body not to react to substances, which in reality cause no harm. Through a series of doses given every 2 months, LDA instructs immune memory cells to stop producing inflammatory molecules leading to recovery from a multitude of symptoms. Though this can take many months to accomplish, a study we did on EPD in the early 2000’s with over 10,000 patients showed significant improvement in over 80% of patients. There is no other form of allergy treatment that has this level of success with so many diverse conditions.
Thank you Dr. McEwen for introducing us to this valuable therapy.
The gut microbiome consists of over 10 trillion organisms including bacteria, yeast, viruses and parasites. We know now the microbiome is one of the key determinants of our health, having a powerful effect on weight gain, diabetes, depression and digestive problems. In addition, an unhealthy microbiome can contribute to inflammatory bowel disease like ulcerative colitis and Crohn’s, arthritis and other autoimmune disease and even heart disease.
A healthy microbiome creates a healthy immune response in the gut wall which contains 70% of the entire immune system. Bacteria in the gut create neurotransmitters, enhance immunity, control gene expression aid in absorption of nutrients, and protect the gut wall from damage. A healthy microbiome is dependent on a diet rich in fiber, low in sugar and chemical additives, and avoidance of drugs like antibiotics, acid blockers and anti-inflammatories.
The average Western diet and use of these medications leads to an unhealthy microbiome in many people. The consequence of bacterial and yeast imbalance is often increased with intestinal permeability (leaky gut), leading to inflammation, obesity, depression, anxiety, food allergy and fatigue. Gluten (the protein in wheat, rye and barley) exposure often makes it all worse.
Repairing this problem has helped our patients regain vibrant health. We assess the microbiome through stool, blood and urine tests and institute a program of a diet rich in fiber and fermented foods, probiotics and specific nutritional supplements. Prebiotics and probiotics can aid in weight loss, improved energy and better mood. In addition, our food allergy treatment program and detoxification techniques will lead to a healthier microbiome and resolve many symptoms, help weight loss and improve mood.
Want to Lose Weight? Help Your Friendly Intestinal Bacteria Thrive!
Why are livestock given low levels of antibiotics to fatten them up? One way of adding more fat to an animal (or to a person for that matter), is to alter the gut bacteria, which the antibiotics do very well. It turns out that there is intimate connections between the bacteria that populate your digestive tract, how much fat you have in your belly and what your risks are for diabetes and other maladies.
Obesity is more than calorie consumption
Obesity is not just about consuming too many calories; it is also about how you treat your friendly digestive tract inhabitants. There is a scientific revolution occurring in understanding the enormous impact the bacteria in the digestive tract plays in obesity and overall health. Studies in animals have found that altered gut microbiota (bacteria) contributes to low grade inflammation, impact the permeability of the digestive tract leading to higher levels of cell wall fragments from certain gut bacteria (lipopolysaccharides) and have a huge effect on obesity and risk for diabetes. It appears that gut bacteria can determine the physiology of adipose (visceral fat) tissue and directly impact obesity. Gut microbes also influence the metabolism of cells in tissues outside of the intestines (in the liver and adipose tissue) and thereby modulate lipid and glucose balance, as well as systemic inflammation.
The importance of these finding can’t be overstated. Human studies have found significant differences in the bacterial populations in obese or diabetic individuals compared to normals. The complexity of the microbiota system with over a trillion bacteria and one hundred times the genomic information than the human body, has presented a great challenge to scientists that is only now being unraveled.
Impacting digestive-tract microbiota with diet
The good news is that you can have a significant impact on your digestive tract microbiota through diet and avoidance of certain over the counter medications, thereby controlling your risk for obesity and diabetes. A good first step is following the suggestions in The Adaptation Diet.
Put simply, to control your weight and reduce risk for diabetes and other major disease, you want to eat not only for yourself, but also for your helpful probiotic friends residing in your intestines. Odd as this may seem, we have evolved with this enormous ‘organ’, (the same weight as the liver), over the generations to provide us with vitamins like Vitamin K and B vitamins and fatty acids like butyrate which are crucial for the health of every cell. In addition, these good bacteria help us detoxify our own hormones including estrogen and other sex hormones protecting us against cancer triggered by excess sex hormones. Maybe of most importance, the good bacteria serve as another barrier to protect us against the thousands of toxic substances found in food and water.
How to maintain a healthy gut
The question is, how do we make these friends happy? No surprise, the most important thing we can do is to have a high fiber diet. 30-35 grams of fiber a day including soluble fiber from beans, broccoli and other chewy vegetables, and oatmeal, provide what is called "prebiotics", to stimulate growth of good bacteria. Next is to limit the simple carbohydrates, sugars, and white flour which induce excess yeast growth in the gut and impact the microbiota. High fat and high sugar diets have been shown in several animal studies to alter gut microbiota and induce inflammation and obesity. Many medications are not the friends of the good bacteria-antibiotics and directly reduce the gut bacteria allowing for overgrowth of inflammatory bacteria; acid blocking medications (PPI’s H2 Blockers) inhibit the normal defense of stomach acid and trigger abnormal gut bacteria growth; anti-inflammatories (ibuprofen, aspirin, acetaminophen) can increase intestinal permeability and add to inflammation and excess visceral fat growth.
In addition to fiber, the use of fermented foods with active probiotics including yogurts (organic is best), kimchee, sauerkraut and Kombucha is beneficial. In a recent study of 36 healthy women using active culture yogurt, it was found that compared to women not using fermented foods there was less emotional reactivity and a more balanced brain activity (functional MRI) in the yogurt eating group. The connection between the brain and gut is another example of how we can control weight gain by being less stressed through the consumption of fermented foods.
The power of probiotic supplements
Beyond these food choices most people would benefit from supplementing with probiotic capsules. I use a multi-strain formula with my patients that include many of the best studied species: Lactobacillus rhamnosus, Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus plantarum, Lactobacillus salivarius, Bifidobacterium longum, Lactobacillus bulgaricus, Bifidobacterium lactis. Choose probiotics with these species that have a guaranteed count of at least several billion organisms.
Losing weight and preventing weight associated disease like diabetes can be achieved through easy to follow dietary suggestions found in The Adaptation Diet leading to not only a healthier gut microbiota, but also a healthier you.
Susan was typical of many of my patients. She ate pretty well, watching her intake of calories and fats, but she could not budge the weight around her middle. She had been on a variety of diets, they worked to some degree, but the weight always came back. Even though she counted her calories, something was holding her back.
Connections between diet and adaptation
That something was poor adaptation to the foods in her diet. Unknown to her, she had multiple food allergies to which her body responded with increased cortisol, the main stress hormone. The cortisol increased the visceral abdominal fat which made further weight loss impossible. Poor adaptation also occurred from her lack of fiber rich foods, flavonoid rich foods (darkly colored vegetables and fruits such as cherries, berries, broccoli, kale, chard) and skipping meals to keep her caloric intake down. All of these patterns increased cortisol and stopped the weight loss.
Susan read my book, The Adaptation Diet, followed the program to a tee, identified her food allergies, added in the right foods and turned around not only her weight, but her energy level and sense of well-being. It is possible to stop weight gain in its tracks with a few simple dietary changes as outlined in The Adaptation Diet.
The different types of food allergy
Studies show that up to one of every two Americans could have some food allergy or intolerance. There are two types of food allergy: immediate and delayed. Immediate food allergy involves symptoms such as hives, breathing problems and bowel symptoms occurring within a few minutes of ingesting a food. Typically, this is limited to certain foods such as shellfish, peanuts, strawberries and tree nuts like Brazil nuts. The mechanism of immediate food allergy, which can be life threatening, is release of histamine triggered by IgE antibodies. These allergies are fixed, meaning they don’t change much over a lifetime.
A much more common form of food allergy and intolerance is delayed hypersensitivity where symptoms might not occur for up to 24 hours after ingesting a food. Symptoms can include fatigue, digestive problems, headaches, joint pain, muscle pain, urinary problems, skin rash and nasal congestion and asthma. The most common food triggers are wheat, dairy, sugar, beef, soy, tomatoes, citrus and corn. Many people have developed masking where frequent use of an allergic food prevents the person from seeing the connection between the food and symptoms. These allergies are mediated by IgG antibodies and often do not include major histamine release.
Next steps: How YOU can identify food allergies
If your physician is not able to order the proper blood or skin tests, one way to identify if foods are contributing to symptoms and unwanted weight is to do an avoidance and challenge diet. Simply avoid the most food triggers, wheat, dairy, corn, soy, tomatoes, beef and sugar for at least a week then reintroduce them one per day. This approach is detailed in The Adaptation Diet as well as information on rotation diets and reducing cortisol to enhance weight loss.
A recent study by Bredesen from the UCLA Alzheimer’s Disease Research (Aging September 2014, Vol 6) program has turned the concepts of preventing and treating Alzheimer’s and other dementia on their heads. He used a comprehensive nutritional, hormonal and cognitive program to reverse symptoms of dementia in 8 of 10 patients with Alzheimer’s disease. Much of his approach is similar to what I do in my practice: optimize diet, use specific nutrients for brain health, remove toxins including metals like lead and mercury and improve hormonal status with bio-identical hormones.
Recommended treatments for dementia
Here are some of the key recommendations from Bredesen’s study;
Employ a 12 hour fast between dinner and breakfast with minimum 3 hours between the last food intake and sleep to allow the brain to perform its detoxification function called autophagy
Assess and treat through chelation (using DMSA and EDTA) elevated lead, mercury or cadmium levels
Supplement with curcumin, folate, bacopa, citicoline, DHA, green tea, ashwagandha
Diet is based on large amounts of vegetable and fruits, fats from olive oil, protein from fish and seafood and fruit as dessert, little simple carbohydrates, in other words, a Mediterranean diet similar to what I have described in The Adaptation Diet
Exercise 30-60 minutes 4-6 days a week mix of resistance and aerobics
Lower homocysteine, a marker of vascular damage through the use of B 12, folate and B6 in the proper forms (methylated)
Optimize thyroid, estrogen, progesterone, testosterone and especially pregnenolone
Control excess cortisol through stress reduction and botanical adaptogens like ashwagandha
Optimize mitochondrial function with CoQ10, ALA, PQQ
Brain stimulation techniques
Connections between sleep behavior and memory
Sleep behavior is especially important in preserving memory, as sleep disturbance is associated with reduction in task related working memory. Obesity is another major risk for dementia since it impairs vascular function and leads to greater inflammation. In a study of 400 adults ages 20-82, the higher the BMI (measure of obesity) the greater the cognitive decline as they aged. Exercise, including yoga, also has a major influence on risk for dementia. 26 of 27 studies showed an association between exercise and either preservation or improvement of cognitive function in subjects over 60 years of age.
There is a growing awareness that Alzheimer’s, like diabetes and heart disease, is related to an unhealthy lifestyle with some experts even calling Alzheimer’s type 3 diabetes. Though this current study was with people already in dementia, every principle he discusses is even more applicable to prevention. I have found many of these ideas relatively easy to implement with my patients and urge everyone to change what they can in their self care to reduce the risk of this terrible disease.