Nutritional Path to Wellness

Nourishing Mind, Body, & Spirit

Diabetes, Metformin, Glyburide

First let’s explain how glucose gets into your cell. When you eat carbohydrates your body releases insulin. The glucose transporters in the cell migrate to the cell’s surface in response to the insulin to transport the glucose into the cell. When you have type 2 diabetes the glucose transporters do not respond to the insulin signal which results in high levels of glucose circulating in your blood. Since your cells are not receiving glucose they are sending out a signal saying they need glucose for energy. Your liver then creates glucose and releases it into the bloodstream. Your pancreas also releases more insulin in response to higher glucose levels.

You now have high levels of insulin and high levels of glucose in your blood. If your cells aren’t taking in the glucose then your body will store it for later. Insulin is also a fat storing hormone. Insulin triggers the liver to release VLDLs – Very Low Density Lipoproteins that carry triglycerides and cholesterol. We store fat in the form of triglycerides. High levels of insulin will result in fatty liver disease. This is also the reason people taking insulin injections gain weight. Insulin makes our body store fat.

As we gain weight our fat storage cells called adipocytes or adipose tissue, create cytokines. These are hormones that regulate adipose tissue metabolism. Cytokines also cause inflammation in the body. Meanwhile, the high levels of circulating glucose are causing oxidative stress throughout the body.

Two popular medications prescribed are Metformin and Glyburide.

Metformin works by stimulating the glucose transporters to migrate to the cell’s surface allowing the glucose to enter. It also acts on the liver to decrease glucose production. Metformin is then cleared through the kidneys.

From MicroMedex: “Glyburide stimulates functioning pancreatic beta cells to produce insulin, reducing blood glucose. Although the blood glucose lowering effects of Glyburide continue during long-term administration despite a decline in the insulin production response, the mechanism has not been discovered. It is thought that extra-pancreatic effects may be involved.”

If you are insulin resistant why would you want even more insulin circulating in your blood?

Metformin lowers vitamin B12 absorption and also causes a folate deficiency. This in turn causes an increase in homocysteine in the body. Homocysteine is an inflammatory marker. A healthy homocysteine metabolism requires vitamin B6, vitamin B12, and folate.

If you decide to take medication make sure your doctor is monitoring your vitamin B12, folate, renal function (kidneys), hepatic function (liver), homocysteine, and C-reactive protein (inflammatory marker).

Or you can manage your Type 2 diabetes with diet.

Ketogenic Diet, Ketones, Ketosis

A ketogenic diet switches your body from carbohydrate burning to fat burning. The trick is to stay in ketosis while enjoying wholesome nutrition. First we need to understand how our body burns fuel. Carbs are the body’s main source of fuel. Carbohydrates (except fiber) are metabolized into monosaccharides of glucose, fructose, and galactose.

A little on fructose, a very misunderstood sugar. Fruit and honey have a blend of glucose and fructose. Sucrose (table sugar) is a 50/50 blend of glucose and fructose. High-fructose corn syrup is formed through converting 55% (typically) of the corn’s glucose into fructose giving it a 55/45 blend. It has a higher fructose than glucose concentration, hence why it’s called “high-fructose.”

Galactose is a metabolite of lactose, the sugar in milk. Neither fructose nor galactose cause an insulin response by the body. Glucose, on the other hand, does. Insulin triggers the liver to release VLDLs, the lipoproteins that carry cholesterol and triglycerides, depositing triglycerides into fat cells. This is why that piece of cake goes straight to your hips, or belly! It also causes a rise in LDLs (bad cholesterol) leading to atherosclerosis.

Both fructose and galactose are used to produce glucose. The body uses glucose to create energy. Glucose is converted to pyruvate. Pyruvate is converted to oxaloacetate and acetyl CoA; both of which are needed to run the Kreb’s cycle. So, what happens when we fast or eat a low carbohydrate diet, such as a ketogenic diet? The first thing your body does, after it uses up its glycogen (storage form of glucose), is use amino acids to make glucose in order to produce pyruvate. However, after a week or so you will switch over to using primarily ketones and need less glucose.

When you consume protein your body breaks it down into its component amino acids and is stored in an amino acid pool. These amino acids are used as building blocks to create protein, cholesterol, glucose, ketone bodies; and, are stored as fatty acids (fat) when your body has exhausted its uses. Alanine and glutamine are the most utilized amino acids to produce glucose by the liver. If you are not eating enough protein your body will break down its own muscle for survival. A normal healthy adult should consume 0.8 g protein/kg body weight. In order to build muscle, you need to do weight bearing exercise and can increase your protein intake. To ensure an adequate amino acid pool available to build and repair muscle, endurance athletes need to consume 1.2 – 2 g protein/kg body weight while strength and power athletes need to consume 1.4 – 2 g protein/kg body weight. Exceeding 2 g protein/kg body weight could put too high a nitrogen load on the kidneys. Also remember, if your body is not utilizing the protein, then you will store it as fat.

Next, your body will start using its fat stores. Yay!! When this happens it also triggers amino acid ketone body formation, primarily with leucine and lysine. The byproduct of metabolizing fat is ketone bodies. Basically fatty acid oxidation overwhelms the Krebs cycle and it starts storing energy as ketones. Ketones can be converted into acetyl CoA to fuel the Krebs cycle. When you are producing ketones your body is in a state of ketosis.

The only caution to this situation is a type 1 diabetic not taking their insulin and on a ketogenic diet. They are not able to utilize glucose. So their body goes into overdrive breaking down fat and producing an overabundance of ketones. Too many ketones cause ketoacidosis, making the blood acidic which would lead to coma and death if not treated. A normal healthy individual with functioning hormones will maintain glucose and ketone body formation within healthy levels. Excess ketones are excreted in the urine.

Ketosis is a natural state. We go into ketosis at night. It is a survival mechanism. We store fat in times of feasting & use the fat in times of fasting. This is how we survived throughout history. Eating a ketogenic diet is low carb (less than 50 g of carbs per day). You can buy ketone strips to see if you are in ketosis. If not, you may want to lower your carb consumption. As with everything, if you eat too much protein and fat you will gain weight. It’s not a license to eat as much of anything else you want as long as it’s low carb. 🙂

Vitamin D – Calciferol → Calcitriol

Unless you live in Florida your vitamin D levels will begin to fall now that the weather is getting colder and we are not out in the sun as much. You may want to consider supplementation.

Vitamin D affects several body processes. The most well-known process is calcium regulation. Vitamin D also behaves like a hormone by binding to nuclear vitamin D receptors (VDRs). Nuclear VDRs have been found in over 30 organs! It also appears to exert its effects through interaction with messenger RNA to enhance or inhibit translation. Over 50 genes appear to be regulated by calcitriol! Calcitriol affects phosphorus homeostasis and is thought to help maintain normal cell growth, differentiation, proliferation, and prevent malignancy by down-regulating cancer cell growth and inducing apoptosis. Muscle dysfunction (myopathy) is well documented in individuals with vitamin D deficiency. Vitamin D also has roles in regulating blood pressure and diminishing risk of heart disease. Rheumatoid arthritis, Crohn’s disease, multiple sclerosis, and type 1 diabetes mellitus have been linked with inadequate vitamin D status.

Vitamin D is synthesized when 7-dehydrocholesterol in your skin is exposed to UVB light radiation from the sun producing cholecalciferol (Vitamin D3). Calciferol is converted by the liver to calcidiol, which is then converted by the kidneys to calcitriol. The blood is the largest storage site for calcidiol. This is the amount that is checked in a blood test for vitamin D status. The half-life of calcidiol is 15 days to approximately 3 weeks. When your body needs vitamin D for its many processes it will convert its storage form of calcidiol to the active form of calcitriol in the kidney. The half-life of calcitriol is 2 to 6 hours.

Dietary sources of vitamin D are found in animal sources in the form of vitamin D3 (cholecalciferol) or plant sources in the form of vitamin D2 (ergocalciferol). Liver, eggs, fatty fish including herring, salmon, tuna, and sardines, and shitake mushrooms are good sources. About 50% of dietary vitamin D is absorbed. Toxicity is rare. It is seen with intakes of 10,000 IU or more taken daily for several months.

Vitamin D is so important. If we are slathering sunscreen on in the summer months our skin is unable to synthesize the vitamin. In the winter it’s too cold to expose ourselves to the sun. This leaves most of the population with a vitamin D deficiency. Symptoms include bone pain, muscle weakness, fatigue, and depression. Most people will benefit from supplementing with 2,000 IU of vitamin D and some will see benefit from 5,000 IU per day. The best form is a combination of vitamin D3 and vitamin K2 since they work synergistically. Make sure to take with fat or in a gelcap lipid suspension as they are fat soluble and need fat to be absorbed by the body. If you are on a blood thinner, then vitamin K is not for you as vitamin K helps to coagulate blood and would counteract your meds. As always, best to seek out the advice of a health care professional, even when thinking about supplements.

The Skinny on Fat

Love that title! I’m actually not that clever. I heard that somewhere and it’s stuck. I’ve read so many articles and watched so many videos, I really don’t remember where I heard it. Newest research shows that dietary fat does not make you fat. Healthy fats such as omega-3s are antioxidants and help with reducing blood cholesterol.

Saturated fat, unsaturated fat, monounsaturated, polyunsaturated … It can all be so confusing! Hopefully I can help you out with understanding it all. And the biggest question I hear all the time: “Doesn’t eating fat make you fat?” The short answer is NO! Sugar is the real problem. I’ll get into that shortly but first we’re going to talk a little about chemistry. I know. I feel the same way. I’ll try to keep it brief but what makes a fat saturated, unsaturated, mono- or poly- is all about chemistry. Oh, and let’s not forget about the omega fats too! It’s all chemistry.

The type of fat is all about the strands of fatty acids. They are made up of strings of carbon atoms. They bond to each other and to hydrogen atoms, starting with a carboxyl group (COOH):

fat

When a fatty acid is “saturated” it is saturated with hydrogens and have no double bonds. When a fatty acid is “unsaturated” some of the carbon atoms are only bonded to one hydrogen and have a double bond with the carbon atom next to it. Depending where the hydrogen atom bonds to the carbon, it is considered a cis or trans bond:

fat

So, in a nutshell, monounsaturated has one double bond (mono meaning one), polyunsaturated has many double bonds (poly meaning many). Omega-3 fatty acids have their first double bond at the 3rd carbon from the omega end (the opposite end from the carboxyl group meaning the other end from the COOH group).

A saturated fatty acid is saturated with hydrogens that form straight lines and can pack tightly together. This is why a saturated fat stays solid at room temperature. It takes a higher temperature to break the bonds and melt. Hydrogenation is a process in which hydrogen is pumped into an unsaturated fat forcing it to bond to hydrogen atoms. This creates a fatty acid that can withstand higher temperatures. Hydrogenated oils are typically used for frying.

The number of carbons determines if it is a short, medium, or long chain fatty acid. MCT oil is quite the buzz right now. This just means it is a medium chain triglyceride having 6 – 12 carbons. Triglycerides are three (tri) fatty acids bonded to a glyceride. This forms through the carboxyl group (COOH) end. Small and medium chain fatty acids are absorbed through the stomach wall. They are absorbed differently since they are small enough to enter the blood stream directly. Long chain fatty acids are digested and absorbed through the small intestine with chylomicrons and need to enter the lymph system first. Have you ever seen oil and water mix? Yea, it doesn’t. So it needs a carrier to be sent to the liver to be metabolized.

So, getting back to the big question: Why doesn’t fat make you fat? Well, it’s all about our metabolism. The original thinking was that fat has 9 calories/gram and carbohydrates and protein have 4 calories/gram. So by eating more fat you’ll consume more calories and thus gain weight easier. What they’ve found is that all calories are not created equal, meaning that we metabolize fat, carbohydrates, and protein differently. Healthy fats provide satiety and we naturally eat less. Carbohydrates stimulate an insulin response which triggers our body to go into fat storing mode, and you need to eat more carbohydrates to feel satiated. By shifting your diet to eating higher amounts of healthy fats while consuming lower amounts of carbohydrates this will stimulate your metabolism, switching you to fat burning instead of fat storing. It’s all about our hormones and metabolism.

A good nutrition plan takes into account any other health issues you have going on, your lifestyle (work environment, exercise, stress), plus putting together a plan that works with your household. Remember that the stress hormone, cortisol, puts you into fat storage mode as well. So I’ll take a look at what’s going on in your life so we can work on strategies that can put you on a path to achieve optimal health.

The Athlete and Protein

An optimal nutrition plan for any athlete needs to take into account the type(s) of training being done and how often, any injury or illness, whether the athlete’s body is still growing and forming, other lifestyle factors such as what you do for a living (sedentary vs. a physically active type of work environment), plus whether the athlete would like to lose or gain weight.

Another lifestyle factor to consider is your perceived level of stress. If you are under stress and creating high levels of cortisol you will be inhibiting protein synthesis and stimulating gluconeogenesis creating a catabolic state and breaking down muscle.

In order to ensure an adequate amino acid pool available to build and repair muscle, endurance athletes need to consume 1.2 – 2 g protein/kg body weight while strength and power athletes need to consume 1.4 – 2 g protein/kg body weight. Exceeding 2 g protein/kg body weight could put too high a nitrogen load on the kidneys. It was previously thought that the body could only absorb up to 40 grams of protein at one time. New research suggests differently. Different types of protein have different rates of absorption, the best being whey at 8 – 10 g/hour.

The amino acid, leucine, seems to be the limiting factor in building and repairing muscle. Dairy products, beef, poultry, seafood, pork, peanuts, beans, lentils, and soybeans are foods highest in leucine.

 

It is recommended to include protein at every meal and snack, always eating before and after every training session. Optimizing carbohydrate intake will also ensure not going into gluconeogenesis – creating glucose from protein. We want to maintain an optimal amino acid pool and a positive nitrogen balance so we are in an anabolic state, creating muscle.

I am hungry all the time!

I eat and then I’m hungry in an hour. I’m trying to eat healthy but when I’m hungry I tend to eat the first thing I can grab. I’m gaining weight and don’t know what to do.

After we eat we shouldn’t get hungry for 3 – 4 hours. If you are feeling hunger before that, either you are not eating enough or you are eating the wrong kinds of foods. Usually this is due to an insulin response. If you start your morning with cereal, banana, and milk. You are having carbs, carbs, and carbs with some protein. As we get older we are more prone to insulin resistance. When we are younger we seem to be able to eat anything. But unfortunately that sets us up to have issues when we get older. We never really learned how to eat healthy.

When we have insulin resistance the insulin receptors aren’t working in our cells. Insulin is the key that when it binds to the receptor it unlocks the cell allowing glucose to enter. But, when the receptors aren’t working we have high levels of insulin in our blood along with high levels of glucose. Another function of insulin is to shuttle the excess glucose that the cells don’t need into the fat cells for storage for later. So, if the cells aren’t using the glucose it gets shuttled into fat storage. Meanwhile, the cells are saying we didn’t get fed and sends a response to the brain for the stomach to produce ghrelin, a hormone that stimulates hunger. And around and around we go.

To break this cycle, we need to lower our carb intake and increase our healthy fat consumption. Try a veggie omelet with some berries instead of cereal for breakfast. It does take some planning since this is not how we’re used to eating. But, once you get your insulin levels down you will feel better and start using your fat stores. As long as you have circulating insulin you will not produce glucagon. Glucagon is produced when you have low levels of blood glucose. One of the ways your body makes glucose is from fat storage. This is what we want.

Taking a look at what we’re eating during the day, the time you eat your carbs, and what you eat with your carbs is critical to create a new, healthier plan.

Why can’t I lose weight?!

I am doing everything right. I eat right and exercise. And I still can’t lose weight no matter what I do! I feel your frustration.

The first thing I am going to do is look at your hormones. The first hormone I will look at is your cortisol and adrenal function. How are you sleeping? Do you sleep through the night and sleep soundly? How is your level of stress? Belly fat is typical of high cortisol levels. The stress response is necessary when coming face to face with a lion and your fight-or-flight response kicks in. But most of us are not in that situation. Our stressors are running to work so we get there on time, meeting our deadlines, etc. These are not life or death situations but our body responds as if they were because of the way we perceive stress. When we are under constant stress our cortisol levels stay high and eventually overwork our adrenals which have to keep producing these high levels of cortisol. Eventually our adrenals can’t keep up with the demand and are unable to keep up. That’s when we start feeling extreme fatigue and have disrupted sleep.

The stress response is supposed to allow us to escape danger. So high levels of cortisol disrupt insulin function allowing glucose to stay in our blood stream to give us energy to run from that lion that is about to eat us. It is a vasoconstrictor which means it raises blood pressure. It also decreases immune function. It basically inhibits other functions of the body including digestion to shuttle all your energy into fight-or-flight.

If you live a stressful life it is going to be hard to lose that weight. We need to remember that our stress response is due to our perception of stress. Planning and organization go a long way to relieving stress as does meditation and taking time out for you!

The next thing I’m going to look at is your thyroid. Usually when your hormones are off, all your hormones are probably not working optimally. Are you getting the correct iodine? If you are using iodized salt that will be the first thing to go. Switch to using sea salt which contains many trace minerals including natural iodine from the sea. You can also add seaweed and seafood which also contain natural iodine.

Finally, I’m going to address the leptin resistance. Leptin is a hormone produced by your fat cells to tell your brain that your fat storage is adequate so no need to store more fat. Unfortunately, your fat cells also produce inflammatory chemicals. Inflammation cause a break in the signal from your fat cells to your brain. To fix this you need to increase eating healthy fats and stop eating sugar and grains.

Then, of course, we would need to tweak your plan to fit your lifestyle and goals, and any other health issues you’ve got going on. But the big message here is to not beat yourself up. It is absolutely not about willpower!! It’s about your hormones. And it can be fixed.

Diverticular Disease

Diverticula are small pouch-like little sacs in the colon. They are formed over time due to a low fiber diet and constipation leading to inflammation and diverticular disease. Diverticulosis is the condition of having diverticula. Diverticulitis is the inflammation of the diverticula.

Diverticulitis is accompanied by pain and fever. Since the colon is inflamed the bowel needs rest with only a clear liquid diet for a couple of days and then gradually reintroducing solids making sure to increase your fiber.

Anyone that has had diverticulitis does not want a recurrence and is hesitant about eating certain foods, namely nuts, seeds, corn, and popcorn. Studies in recent years have refuted this. Without any good evidence, certain foodstuffs such as nuts, seeds, popcorn, and corn have long been implicated in the development of diverticulitis and are often advised against by physicians. They were thought to provoke diverticulitis or diverticular bleeding by causing luminal trauma. In a large prospective study of men without known diverticular disease, Strate et al found that nut, corn, and popcorn consumption did not increase the risk of diverticulosis, diverticulitis, or diverticular bleeding (Beckham & Whitlow, 2009; Strate et al, 2008).

A high fiber diet will prevent and heal diverticular disease. Just remember if you are increasing your diet you would need to increase your fluids as well. Avoid processed and refined foods. Eating whole foods with whole grains and plenty of fruits and vegetables will ensure a healthy gut.

Beckham, H. & Whitlow, C. B. (2009). The medical and nonoperative treatment of diverticulitis. Clinics in Colon and Rectal Surgery, 22(3), 156 – 160.

Strate, L. L., Liu, Y. L., Syngal, S., Aldoori, W. H., & Giovannucci, E. L. (2008). Nut, corn, and popcorn consumption and the incidence of diverticular disease. Journal of the American Medical Association. 300(8), 907–914.

Gut – Brain Connection

The gut has a lot of the same cells that are in the brain, specifically neurons and glial cells. The glial cells mop up the neurotransmitters that are produced from the communication between neurons. The glial cells can become inflamed due to an immune response. When the glial cells aren’t working properly the neurons continue to be stimulated by the neurotransmitters that are hanging around. This creates a lot of “noise” in the brain hindering brain function.

If you have an imbalance of organisms in your gut, then the byproducts produced by these organisms can elicit an immune response causing inflammation. The brain needs nutrients to optimally function. If the gut is too irritated or inflamed to absorb those nutrients, then the brain becomes impaired. It would then appear that you have psychological issues, learning difficulties, memory problems, fuzzy thinking, etc.

Certain kinds of “bugs” in your gut can also manipulate your food cravings. If you have fungus, for example, you may crave sugar. It’s an evolutionary mechanism of the microbiota so it can be fed what it needs to survive. The microorganisms residing in your gut have a direct influence on how you feel.

When you are stressed your gut tenses up due to the sympathetic nervous system response. You are unable to digest or absorb food very well. This deteriorates the ecology of the gut. We therefore need to take the whole person into account when looking at what’s going on. The kind of food are you feeding your microbiota will be very telling of what types of microbiota that are inhabiting your gut. Plus, are you living a stressful lifestyle and inhibiting digestion?

The size of the hippocampus has been directly correlated with blood sugar levels. Brain atrophy is shown in people with blood sugar levels of 90, even before your sugar is high enough to give a diagnoses of diabetes. Eighty percent of adults in the United States have fasting blood sugar of 90 or above. We are literally losing our minds over sugar.

So, what’s the best diet? Whole foods with complex carbohydrates. Three quarters of a cup of cultured vegetables has ten trillion healthy organisms. The plan is to feed the good “bugs” and starve the bad “bugs” shifting the population into a friendlier environment. And, of course, lifestyle modifications to reduce stress. A nutrition and lifestyle plan can be implemented to fit into your unique lifestyle.

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