WHAT IS THE HYGIENE HYPOTHESIS AND WHY IS IT THE MOST IMPORTANT ASPECT OF YOUR HEALTH YOU'VE NEVER HEARD OF?Read Now
THE HYGIENE HYPOTHESIS
Besides the belly fat, when men consume too much sugar or simple carbohydrate, they begin making less testosterone (they are said to have "LOW T"). Although the result is certainly a lower sex drive, low libido is only the tip of the iceberg.
When women consume too much sugar, just the opposite occurs --- they make too much testosterone (HERE). Not only does this cause a diminished sex drive as well, but it tends to cause copious amounts of body hair as well as infertility.
SUGAR FEMINIZES MEN / SUGAR TURNS MEN INTO WOMEN
Have you ever heard of SKINNY FAT (sometimes referred to as MONW)? In a study from a 2013 issue of PLoS One (Prediabetes Is Associated with an Increased Risk of Testosterone Deficiency, Independent of Obesity and Metabolic Syndrome), eight Taiwanese physicians and researchers concluded that, "current evidence suggests that the causative relationship between testosterone deficiency and diabetes might be bidirectional, or even multidirectional and interrelated with obesity, metabolic syndrome, sex hormone-binding globulins (SHBG), and other factors." In other words, whichever comes first is not so important since either one can cause the other.
A 2009 issue of the Argentinian journal, Arquivos Brasileiros de Endocrinologia & Metabologia (The Role of Testosterone in Type 2 Diabetes and Metabolic Syndrome in Men), concluded that, "Over the last three decades, it has become apparent that testosterone plays a significant role in glucose homeostasis and lipid metabolism. The metabolic syndrome is a clustering of risk factors predisposing to diabetes mellitus type 2, atherosclerosis and cardiovascular morbidity and mortality. The main components of the syndrome are visceral obesity, insulin resistance, glucose intolerance, raised blood pressure and dyslipidemia (elevated triglycerides, low levels of high-density lipoprotein cholesterol), and a pro-inflammatory and thrombogenic state. Cross-sectional epidemiological studies have reported a direct correlation between plasma testosterone and insulin sensitivity, and low testosterone levels are associated with an increased risk of type 2 diabetes mellitus." This is saying that not only is the person described here a heart attack / stroke looking for a place to happen, it's only a matter of time before things stop working in the bedroom.
Another 2009 study, this one from the Journal of Andrology (The Dark Side of Testosterone Deficiency: Metabolic Syndrome and Erectile Dysfunction) stated, "The metabolic syndrome is considered the most important public health threat of the 21st century. This syndrome is characterized by a cluster of cardiovascular risk factors including increased central abdominal obesity, elevated triglycerides, reduced high-density lipoprotein, high blood pressure, increased fasting glucose, and hyperinsulinemia. Reduced androgen levels [testosterone and precursors] increase cardiovascular risk factors and produce marked adverse effects on cardiovascular function. Metabolic syndrome has been associated with erectile dysfunction, and may be considered a risk factor for erectile dysfunction." Like I said, ED is probably the least of your worries once this vicious cycle starts spinning.
One of the things that DIABETES and blood sugar dysregulation does is foul up the body's ability to circulate blood --- one of the chief reasons (along with NEUROPATHY) that virtually all diabetics struggle with foot ulcers. Be aware, however, that this lack of blood flow is not confined to feet, but affects the genitals as well. Not surprisingly, ED is the result. But it's actually much worse than initially appears as far as sugar turning men into women is concerned, and as you might suspect, it has to do with THE ENDOCRINE SYSTEM.
Did you realize that body fat (adipose tissue) --- particularly the belly fat packed around your internal organs --- has the potential to act as it's own estrogen-producing gland (HERE, HERE, or HERE)? If you cruise on over to PubMed and search the term "Adipose Tissue as an Endocrine Organ," you'll find page after page after page of studies --- hundreds of them --- that have either this exact name or a similar variation. Here's one from a 2013 issue of the kidney journal, Seminars in Nephrology (The Adipose Tissue as an Endocrine Organ), where the authors concluded that, "Since 1994, white adipose tissue was recognized as an endocrine organ and an important source of biologically active substances with local and/or systemic action called adipokines. Inappropriate secretion of several adipokines by the excessive amount of white adipose tissue seems to participate in the pathogenesis of obesity-related pathologic processes including endothelial dysfunction, inflammation, atherosclerosis, diabetes mellitus, and chronic kidney disease." Hold on to your seats because here is where the train start to go off the rails.
Although there were about 2,500 studies in this specific topic, I'm going to leave you with just one --- a piece of research from last September's issue of Biochemistry and Molecular Biology Reports (Extra-Gonadal Sites of Estrogen Biosynthesis and Function)........
"Recent evidence indicates that estrogens play important roles in the immune system, cancer development, and other critical biological processes related to human well-being. Obviously, the gonads (ovary and testis) are the primary sites of estrogen synthesis, but estrogens synthesized in extra- gonadal sites play an equally important role in controlling biological activities...... Adipose tissues are considered to be the major source of circulating estrogen after the gonads in both men and women, and the contribution made by the adipose tissues to the total circulating estrogens increases with advancing age."
If you did not grasp the importance of this paragraph, read it until you do. As you get older --- or fatter --- your fatty tissues are going to make more estrogen. If everything were in perfect HOMEOSTASIS, this would be wonderful as your body fat takes the place of your post-menopausal ovaries. The problem is that with ESTROGEN DOMINANCE already being a huge issue in both females and males here in America, we can begin to see how BELLY FAT (visceral adiposity) is affecting our population, setting up a vicious cycle of obesity and hormonal disruption.
And in case you were not aware, estrogen is the hormone given to commercially-raised livestock (beef & pork) in order to make them fat (peer-review frequently refers to commercially-raised animals --- particularly beef --- as "obese"). Estrogen is why the average woman carries about 10% more body fat than the average man. While men certainly need a bit of estrogen to function normally, anything more than that is a problem --- a big problem. Enter the Endocrine Disruptors and Aromatases (yes, they are affected by sugar because NAFLD (Non-Alcoholic Fatty Liver Disease), caused mostly by being overweight, dramatically affects your ability for your liver to clear excess hormones (HERE).
I recently showed you how we are all being exposed to a vast array of XENOHORMONES (most of which are estrogen-based 'obesigens') and ENDOCRINE DISRUPTORS. In case you think that this is no big deal, let me hit you with a study from the 2007 of a Spanish journal Revista de Investigacion Clinica (Endocrine Disruptor Compounds and their Role in the Developmental Programming of the Reproductive Axis). This study showed that, "Different perturbations during fetal and postnatal development unleash endocrine adaptations that permanently alter metabolism, increasing the susceptibility to develop later disease, process known as "developmental programming." Endocrine disruptor compounds are widely spread in the environment and display estrogenic, anti-estrogenic or anti-androgenic [anti-testosterone] activity; they are stored for long periods in the adipose tissue. The effects on the reproductive axis depend on the stage of development and the window of exposure, as well as the dose and the compound. The wide distribution of endocrine disrupting compounds into the environment affects both human health and ecosystems in general." In other words, many of us --- maybe most of us, whether male or female --- are being doused in estrogen from conception to death, and unfortunately, the problems it's causing are "permanent". And we wonder why our hormones are screwed up.
The commonest medical solution for men with Low T is giving them testosterone in various forms. While this sometimes helps for awhile, the results are usually short-lived. This is because your body's stunted / altered feedback loops are not only not addressed by this method of therapy, it actually makes the situation worse. Why? It's common knowledge that when men take Anabolic Steroids, their own testicles, sensing that there is plenty of testosterone in their system, shut down production. And this doesn't even begin to address the issue of STRESS.
When we get stressed, (the stress can come in numerous forms including emotional, physical, and / or dietary --- ie JUNK FOOD and JUNK CARBS) we release the ADRENAL HORMONE, cortisol. Among other things, cortisol makes us fat (see previous link). Bear in mind that it is impossible to solve adrenal issues without first addressing blood sugar. And unfortunately, the hits keep coming.
If you have not heard of aromatase, you need to become informed. According to Wikipedia, "Aromatase, also called estrogen synthetase, is an enzyme responsible for a key step in the biosynthesis of estrogens. It is CYP19A1, a member of the cytochrome P450 superfamily that catalyze many reactions involved in steroidogenesis. In particular, aromatase is responsible for the aromatization of androgens into estrogens. The aromatase enzyme can be found in many tissues, as well as in tissue of endometriosis, uterine fibroids, breast cancer, and endometrial cancer." Since we have a P-450 ENZYME that among other things, turns testosterone into estrogen, it's critical that we figure out what upregulates it.
As might make sense, aromatase inhibitors are used by the medical community to block estrogen in women dealing with BREAST CANCER. Interestingly enough, I found a number of studies from mainstream medical journals touting various anti-inflammatory HERBS, vitamins (C and D) or other compounds that act as inhibitors of estrogen as well. For instance, just two years ago, the Asian Pacific Journal of Cancer Prevention (Inhibitory Aromatase Effects of Flavonoids from Ginkgo Biloba Extracts on Estrogen Biosynthesis) concluded that, "Our results support the usefulness of flavonoids in adjuvant therapy for breast cancer by reducing estrogen levels with reduced adverse effects."
As far as upregulating the aromatase enzyme, I found almost 10,000 studies on the subject. And although there are slews of studies about biochemical compounds that I've frankly never heard of before, the big picture is fairly clear. What do I mean by "Big Picture"? A few years ago, the journal Molecular and Cellular Endocrinology (Aromatase Up-Regulation, Insulin and Raised Intracellular Estrogens in Men, Induce Adiposity, Metabolic Syndrome and Prostate Disease) put it this way.
"For some years now, reduced testosterone levels have been related to obesity, insulin resistance, type 2 diabetes, heart disease, benign prostatic hypertrophy and even prostate cancer, with little attention paid to the important role of increased estrogen, in the pathogenesis of these chronic diseases. Testosterone is metabolized to estradiol by P450 aromatase, to increase estradiol concentration at the expense of testosterone. It follows therefore, that any compound that up-regulates aromatase, or any molecule that mimics oestrogen, will not only increase the activation of the mainly proliferative, classic ER-α, estrogen receptors to induce adipogenesis [obesity] and growth disorders [cancer / endometriosis] in oestrogen-sensitive tissues.... This paper simplifies how stress, xeno-oestrogens, poor dietary choices and reactive toxins up-regulate aromatase to increase intracellular oestradiol production."
The authors went on to explain how the described situation is related to insulin resistance, fat deposition (especially around the midsection), metabolic syndrome, BPH, PROSTATE CANCER, obesity, gynecomastia [man boobs], Type II diabetes, low testosterone, and increased estrogen levels in men, among many others.
Although I came across many similar, I also found a study in a 2010 issue of Toxicology Letters (Bisphenol A-induced Aromatase Activation is Mediated by Cyclooxygenase-2 Up-regulation in Rat Testicular Leydig Cells) showing that the combination of inflammation and BPA created, "increased aromatase gene expression and its enzyme and promoter activity, but reduced testosterone synthesis; increased COX-2 mRNA expression and promoter activity, the production of prostaglandin E(2) (PGE(2)), and the gene expression of PGE(2) (EP2 and EP4) receptors." PGE2 and the COX-2 enzyme are both extremely inflammatory (COX-2 INHIBITORS are ultra common in Western Society).
And finally, we get to the hormonal FUBAR that occurs thanks to brain dysfunction (HPA-AXIS). When the body is low on either sperm or testosterone in males, the feedback loop kicks in and tells the HYPOTHALAMUS to send out a hormone called GRH (Gonaditrophin Releasing Hormone). This acts on the PITUITARY GLAND, telling it to release FSH to make sperm and LH to make both testosterone and SHBG. Any number of brain dysfunctions or certain kinds of drugs (particularly THIS MED taken by over 10% of the American population) can throw a monkey wrench into this pathway, leading to all sorts of dysfunction with the sex hormones.
SUGAR MASCULINIZES WOMEN / SUGAR TURNS WOMEN INTO MEN
PCOS is the number one female issue in America, affecting approximately 10% of the women of child-bearing age (some studies say the actual number is closer to 1 in 5) --- more than half of which are unaware or undiagnosed. Intimately linked to INSULIN RESISTANCE, there are many who believe it is another manifestation of diabetes / pre-diabetes in similar fashion to the way that Alzheimer's is widely known in the scientific community as TYPE III DIABETES. And while numerous stories and studies will tell you that PCOS is genetic, at best this is only partially true. Like hundreds of other health issues with a genetic component, the problem is far more related to EPIGENETICS than genetics.
Because there are no definitive blood or lab tests, the diagnosis is usually made clinically. What does it look like? The tell-tale cluster of symptoms includes....
- EXCESS TESTOSTERONE: Along with IR, this is the symptom that drives the others. Be aware that as I showed you earlier, testosterone overproduction is often the result of overproduction of LH (luteinizing hormone), which is a pituitary hormone. Another theory gaining traction in the scientific community is that this excess testosterone is the result of Androgen Receptor Resistance (HERE) --- which, kind of like Insulin Resistance, simply means the body has become "resistant" to the effects of testosterone (often times because the receptor sites are saturated), telling the body to make even more. While this is certainly true, It's hard to argue that it's not ultimately the result of IR.
- EXCESS HAIR GROWTH: Known as "hirsutism" medically, women with PCOS will grow hair in places they otherwise would not (particularly the face), as well as growing excess body hair in places they normally would. Interestingly enough, it is not uncommon to see women with PCOS develop or begin to develop male pattern baldness --- sometimes confused with THYROID ISSUES --- which are also not uncommon with PCOS.
- ACNE: ACNE (including "backne") is a common sequelae of PCOS.
- INFERTILITY: Already discussed and left a link.
- CHRONIC FATIGUE, ALTERED MOOD, AND LOW LIBIDO: All of these are characteristic of excess testosterone in women. Even though testosterone is the hormone that drives libido in both men and women, when women get too much of a good thing, it becomes a bad thing --- a very bad thing. For the record, realize that PCOS is one of the myriad of health issues considered to be "inflammatory". DEPRESSION is on this list as well.
- WEIGHT ISSUES: Women with PCOS have, or eventually will have if they are currently teenagers, difficulty losing weight. And, as we have already discussed, a common scenario is to see women who have man-like bellies (Central Obesity). As for those of you who say that this can't be your issue because you are normal weight, make sure to check out my earlier link on "Skinny Fat".
- DARKENING OF THE SKIN AROUND THE NECK: Known as "acanthosis nigricansis," it also occurs beneath the breasts and in the groin areas.
- SKIN TAGS: These are usually found in the armpit or the neck region.
- SLEEP APNEA: SLEEP APNEA is extremely common in women with PCOS.
Although the most common medical treatments include androgen-blockers, DIABETES DRUGS, STATINS, and going on "The Pill," these aren't very effective over the long term, while creating an array of extremely nasty SIDE EFFECTS. Be aware that plugging "PCOS" into PubMed brought up 12,500 studies to wade through. Although I only looked through a few dozen, not surprisingly I found plenty linking it to Endocrine Disruptors. Some others included CHRONIC SYSTEMIC INFLAMMATION, reduced TREGS (making you susceptible to AUTOIMMUNITY), increased HOMOCYSTEINE and decreased GLUTATHIONE levels, not enough VITAMIN D, OSTEOPOROSIS, and NAFLD. If I had more time, I could have found studies linking it to any number of others.
WHETHER MALE OR FEMALE, WHAT SHOULD YOU
DO IF YOU RECOGNIZE YOURSELF IN THIS POST?
Although there might be any number of people dealing with the situations discussed in today's post who could use some help from a FUNCTIONAL MEDICINE SPECIALIST, the truth is, many of you --- probably the majority of you (possibly even the vast majority of you) --- can start addressing this crisis on your own. And here's the doubly cool part of all this. I've given you a generic protocol free of charge (HERE) for helping resolve the behind-the-scenes inflammation. Getting started might be the hardest thing you've ever done, but after a week or two, it gets easier. Stick with it and you may even end up with results like THIS.
DEALING WITH CHRONIC PAIN OR CHRONIC ILLNESS?
TREAT IT SYSTEMICALLY
- THE AVERAGE AMERICAN IS SEDENTARY: Face it, the average American is not being regularly active in any meaningful sense of the word. Even if they are constantly "busy," they are frequently not active. In light of the peer-reviewed scientific literature, the body needs movement to function on a high level. Not necessarily a huge amount of movement, but movement nonetheless. A sedentary lifestyle will seriously inhibit your ability to solve your problem, no matter what your problem may be (HERE & HERE are examples having to do with CHRONIC PAIN).
- THE AVERAGE AMERICAN IS INFLAMED: Even in those who don't yet show the signs of overt disease or pain, INFLAMMATION is almost assured since it is virtually synonymous with being American. We are literally an "INFLAMMATION NATION". For the record, OVERWEIGHT / OBESITY is an inflammatory disease that affects almost 70% of our population. Another 10% are METABOLICALLY OBESE even though they fit nicely onto a height / weight chart. While a certain amount of ACUTE INFLAMMATION is needed for the body to heal properly, SYSTEMIC INFLAMMATION can be a deal-breaker for getting out of pain and solving your chronic problem(s).
Unfortunately, too many people are let off the hook by their doctors. They're told that their HIGH CHOLESTEROL is genetic (when it's actually EPIGENETIC). They're told that their problem is "ARTHRITIS" and that their joints are just worn away to nothing --- almost time for that REPLACEMENT. They're told that no one has any idea why they have FIBROMYALGIA and that beyond covering symptoms, there's nothing they can do. They're told that AUTOIMMUNE DISEASES are just an unfortunate luck of the draw for some people; no rhyme, reason, or solution. They're even told that deadly inflammatory diseases such as CANCER are nothing more than blind, random chance (HERE). Chalk it all up to bad luck and bad genes.
The result of all this? That's easy --- drugs. Even though the United States contains less than 5% of the world's population, our own government admits that we consume 75% of the world's medication (HERE). I see so many people on "THE BIG FIVE" it makes my head spin. Becoming a "DRUG CULTURE" has provided an easy way out for us. We never really have to take responsability for our own health because we pay others to do that for us --- that's our doctor's job. Unfortunately, the medications never really work over the long haul, and thanks to our "no fault" society, we can always find someone or something to blame for our collective plights. I want to show you a better way --- a way that actually addresses underlying causes of pain and inflammation, shutting it down at the source.
It's why I suggest that if you are dealing with any sort of pain syndrome, it's helpful to treat it as though it were a systemic problem, probably because often times it is (HERE, HERE, or HERE). Don't get me wrong; I'm happy to see you and help you find your way out of the ditch you are in --- usually with way less time and expense than anyone else suggests is possible (HERE). What I want to see, however, is you (that would be "you" as in you) take some personal responsibility. Frankly, I don't want to see you over and over again for the same old problem(s), simply because you won't take the initiative to start addressing them on your own. What do I mean by 'addressing them on your own'? Hang tight for ten more seconds.
If you are one of those people who has struggled with any sort of chronic health or pain issue, by all means, come and see me --- if I tell you I can help you I probably can (HERE). However, if you want to break away from the endless stream of doctor visits, get off the MEDICAL MERRY-GO-ROUND, and start taking your life back, you'll have to take some action steps. I promise I've helped people worse off than you are (HERE). And here's the thing; I've even provided you a blueprint for getting started completely free of charge. HERE is the brand new revamped version. The truth is, if you don't treat your pain / problem systemically, it may be tough to really get better (HERE is a person who took this message to heart).
DETOXIFICATION / BIOTRANSFORMATION PATHWAYS
IGNORE THESE CRITICAL LIVER
FUNCTIONS AT YOUR OWN PERIL
Unfortunately, our collective livers are under assault, not only from the thousands of chemicals we expose it to regularly, but from our typically crappy diets. For instance, a 2014 issue of the World Journal of Gastroenterology says this of Non-Alcholoic Fatty Liver Disease (NAFLD). "Non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of liver disease in the Western world. Furthermore, it is increasing worldwide, paralleling the obesity pandemic. Of relevance, fatty liver is also associated with increased overall mortality and particularly increased cardiovascular mortality and is strongly associated with insulin resistance / type 2 diabetes and the metabolic syndrome [PREDIABETES]." Same journal, same month, different authors.... "In the United States, NAFLD is the most common cause of liver disease, representing over 75% of the chronic liver disease." In other words, even though you probably learned growing up that alcoholism is what destroys livers, in the big picture it accounts for a relatively small percentage. OBESITY is what destroys livers (even if you are "SKINNY").
The question arises, what can we do to keep our livers functioning optimally? It should be obvious that maintaining a healthy weight is paramount. Beyond that the research talks at length about many of the same things I talk about on my site ---- controlling BLOOD SUGAR and staying far away from the HIGH CARB LIFESTYLE, GUT HEALTH, INFLAMMATION (this covers huge amounts of ground), EXERCISE, and any number of others (SLEEP APNEA has also been associated with NAFALD, possibly because it's so intimately linked to obesity). Today I want to talk about some of the detoxificiation / biotransformation pathways and show you, using the scientific literature, what you can do to support them.
I'll start with a brief overview taken from THIS POST written about what it takes to clear out excess female hormones and artificial female hormones. The same principles are at play for virtually every toxin and chemical in your body, whether made from within or there from the outside exposure.
- PHASE I describes the first step of your body's ability to turn various toxins to forms that can be excreted from the body. It is the body's first metabolic defense against foreign chemicals. Phase I reactions are primarily performed by via oxidation (oxygen) and the P450 Cytochrome Enzymes. This involves either adding or "uncovering" an active site so that the various components of Phase II can do their job.
- PHASE II reactions attach or "conjugate" the toxins to various compounds in order to increase their ability to be voided. This part of the equation is where the oxidized chemicals are combined with sulfur, specific amino acids, or organic acids, so that they can be excreted in the bile and eventually the feces, or in the urine. There are several different enzymes and different metabolic pathways for accomplishing this that can and will become depleted without replenishing them via a nutritious diet. Phase II can be inhibited by alcohol, drugs (prescription, OTC, or recreational), and nutritional deficiencies (including too little dietary protein).
- PHASE III is simply the process of your system actually removing / excreting the conjugated toxic chemicals from your body ---- without reabsorbing them. Be aware that this is virtually impossible without ample amounts of dietary fiber (something you must be careful of with SIBO / IBS).
As a side note, the field of Toxicokinetics or Pharmacokinetics studies how rapidly and effectively certain substances can be cleared from the body, or whether they or their metabolites accumulate in fatty tissue. I also want to take just a moment to discuss the term xenobiotics, since they will come up over and over again.
Xenobiotics are defined in many ways and can be chemicals (toxins) that should never be found in the human body, chemicals that should be there but are present in amounts that are far too high to be considered normal (ESTROGEN DOMINANCE), or chemicals that are put into your body on purpose but are not found there naturally (MEDICINES / ANTIBIOTICS). You will frequently hear the term xenobiotic and ENDOCRINE DISRUPTOR used synonymously.
Other xenobiotics include things like known carcinogens, cigarette smoke, pollutants, food additives, hydrocarbons (byproducts from oil and gas / gasoline), as well as pesticides and herbicides. Current research says that there are between eighty and ninety thousand chemicals that did not exist prior to WWII with an additional two thousand or so created annually. Thus, the question we need to be constantly asking ourselves is two-fold; what can we do to diminish our exposure, and what do we need to do to insure our Biotransfer / Detox pathways are working optimally in order to clear toxicity from our systems?
PHASE I DETOX / BIOTRANSFORMATION PATHWAYS
- OXIDATIVE REACTIONS (OXIDATION or OXIDIZING): Increasing the oxidation state of the toxin being worked on involves a net loss of electrons. The enzymes involved in this are Aldehyde Oxidase (AO), Flavin-containing Monooxygenases (FMOs), Monoamine Oxidases (MAOs), Xantine Oxidase (XO), and the most important and well known of the lot, the P-450 Cytochrome System (CYP450). These reactions tend to happen a bit slower, and are by far the most common and well known of the Phase I reactions. Oxidation is the most common of the Phase I pathways and happens to be the route whereby most xenobiotics are dealt with. Also realize that while oxidation is vital and necessary, it can present problems as well. Examples of oxidation reactions include rust on metal and the brown color of the part of the apple you took a bite of and then set down for a few minutes.
- REDUCTION REACTIONS (REDUCING): An increase in the reduction state of the toxin being worked on involves a net gain of electrons. These reactions involve enzymes such as Carboxylesterase, Peptidase, Epoxide Hydrolase, Choiniesterease, Paraoxonase, Alcohol Dehydrogenase, and Carbonyl Reductase.
- HYDROLYTIC REACTIONS (HYDROLYSIS): This simply means that chemical bonds of toxins are being broken down by the addition of water --- hydro (water), lysis (to unbind).
- OTHERS: Although there are others, we are not too concerned with them right now.
Of all these reactions, the one that you will hear about most often (by far) is the P-450 Cytochrome System, which also happens to be used for things like the production of CHOLESTEROL, steroid hormones (sex hormones and adrenal hormones), vitamin D, and fatty acid production (Cholesterol is the precursor of everything on this list). Like Hemoglobin, the molecule that carries oxygen throughout the body, the CYP450 molecule has a iron / heme center --- one more reason why ANEMIA is a deal-breaker as far as solving chronic health issues is concerned.
CYP-450 enzymes are found mostly in the small intestine and the liver, with as great as 5% of the total number of liver proteins said to be of the CYP450 family. As strange as it might seem, one of the tests used to see how well a person's Phase I CYP450 Cytochrome System is working is with coffee / caffeine as indicated by any number of studies (for instance Caffeine as a Marker Substrate for Testing Cytochrome P450 Activity in Human and Rat in a 2008 issue of Pharmacological Reports). You can test yourself to some degree. People who are really affected by coffee tend to have less ability to clear toxins via their CYP450 system. Likewise, those who are unaffected tend to clear Phase I faster.
If the intermediate metabolites created by Phase I outstrip the ability of Phase II to conjugate, the body will be exposed to increasingly higher levels of said metabolites as they back up and accumulate. One of the more common intermediates of Phase I is Free Radicals. Free Radicals are relatively simple to understand. Electrons never like to be alone, always wanting a partner to cozy up to. So when an electron is "free" or unpartnered, rest assured that it will be on the prowl for any available electron to pair up with. Unfortunately, these "Free Radicals" will attach themselves to an almost unlimited number of electrons, often times making compounds that can be very toxic. Free Radicals are always looking for stability (pairing up), even at the expense of other compounds. When the body's natural chemistry is robbed of it's electrons, these chemicals --- needed for normal metabolism --- no longer work. While the production of Free Radicals is a normal part of Phase I, anything that inhibits the conversion of the Free Radical to safer compounds is a problem.
When too many Free Radicals build up (CRUDDY DIETS, EXPOSURE TO RADIATION, STRESS, DRUGS (yes, prescription drugs), ANTIBIOTICS, overtraining (too much exercise), coffee, alcohol, and even CHRONIC PAIN), metabolic deficiencies, it creates something called "Oxidative Stress". In other words, the body can't get rid of these toxins by pushing them over to Phase II. Not only is Oxidative Stress associated with inflammation, it is associated with almost every chronic illness we can think of today --- the biggest being cancer. This is why we need the power of antioxidants in our diets --- things like YELLOW SPICES, FRUITS AND VEGGIES with plenty of color, certain berries, along with other foods that have a high ORAC value (Oxygen Radical Absorbance Capacity). There are lots of them. While cocoa can be a fantastic antioxidant, it needs to be at least 85% dark to be beneficial. And while there are any number of chemicals shown to be good antioxidants, the scientific literature has shown that these frequently do not work well in isolation (HERE).
Although there are many toxins / chemicals that are ready to be removed from the body after Phase I, many others (intermediate metabolites) will move on to Phase II, which consists of things like thiol conjugation, methylation, glucuronidation, glutathione conjugation (the heavy-hitter of the bunch), amino acid conjugation, sulfation, or acetylation. Today we are going to spend most of our time in the mythylation and Glutathione pathways.
It is important to be aware that the 'intermediate metabolites' created by Phase I can actually be more toxic to your system than when they were previously. This is why it is absolutely vital to have Phase II working properly. When Phase I is not working properly (or is working in overdrive while Phase II is suppressed), your chances of developing any number of serious diseases, including AUTOIMMUNITY, CANCER, PARKINSON'S, and many others, increases dramatically. Not surprisingly, there is even evidence showing that AUTISM is related to a diminished ability to undergo proper Biotransformation.
PHASE II DETOX / BIOTRANSFORMATION PATHWAYS
This is the big boy; the heavy-hitter of phase II that is said to account for over 60% of the toxins in the bile as well as MERCURY, ALUMINUM, ARSENIC, industrial wastes, and the xenobiotics we spoke of earlier. An amazing thing about the GLUTATHIONE PATHWAY is that it takes an extremely toxic byproduct of aminio acid metabolism --- homocysteine --- and if it has the proper nutrients and enzymes, converts it to Glutatione and SAMe (S-adenosyl methionine), which has several health benefits of its own as far as Phase II is concerned. However, when this conversion is blocked or hindered to varying degrees, homocysteine levels will rise, causing all sorts of health problems (homocysteine is easy to test via blood work).
For instance, when people have a high toxic burden, Glutathione is depleted faster than it can be consumed dietarily (or recycled from homocysteine / cysteine as I just showed you above). If you want to see just how big a deal Glutathione depletion is, cruise on over to PubMed and search "Glutathione (disease of choice)". For instance, a search for "Glutathione Alzheimer's" pulled up over 1,200 studies. I'll show you just one. Last month's issue of Neuroscience and Biobehavioral Reviews (The Effect of N-Acetylcysteine (NAC) On Human Cognition - A Systematic Review) concluded that 12 studies of Alzheimer's patients treated with NAC --- a metabolic precursor to Glutathione --- showed, "statistically significant cognitive improvements following treatment." Not to freak you out, but when I plugged in "Glutathione Cancer," it resulted in nearly 21,000 studies.
WHAT THE HECK IS METHYLATION?
Let me first say that if you really want to understand methylation (I do not consider myself an expert in the least), you need to follow Dr. Suzy Cohen (pharmacist and specialist in FUNCTIONAL MEDICINE), Dr. Ben Lynch (a naturopath with a degree in cellular and molecular biology), Dr. Datis Kharazzian (FUNCTIONAL NEUROLOGIST, Functional Endocrinologist, Chiropractor, Harvard researcher, and author of THYROID BOOK and Why Isn't My Brain Working?), or Dr. Amy Yasko (a Ph.D in Microbiology / Immunology / Infectious Disease as well as a Naturopathic degree, her curriculum vitae reads like a veritable Who's Who. Among others, she worked on the autism front with DR. HUGH FUDENBERG at South Carolina University as well as being a researcher at Yale). Since I have the brain power of a peanut compared to people like this, I am going to give you the Methylation For Dummies condensed version (those in the know might say it's closer to the Mad Magazine version).
With a lot of talk about methylation and MTHFR (methylenetetrahydrofolate reductase) these days, it would behoove us to know a bit about this as it relates to Biotransformation and Detoxification. I've seen experts say that nearly half of the population contains mutations in the MTHFR family of genes. While this sounds scary on the surface, the most important thing to remember is that EPIGENETICS TRUMPS GENETICS, meaning that in many important ways, you are not nearly as defined by your DNA as you have been led to believe, and that "bad genes" are usually switched on via bad lifestyle choices. But why do problems with MTHFR or methylation matter in the first place?
Not that the average Joe cares, but a methyl group consists of a carbon atom surrounded by three hydrogen atoms (CH3), which is structurally related to methane gas. Methyl groups are important in almost every physiological function that occurs in the body, and a failure to methylate properly is indicative of such a wide array of illnesses that it almost not worth listing them. These include neurological, endocrinological, malfunctioning thought processes, inflammatory, and mood disorders. Oh; and for the record, methylation dysfunction is not always genetic, but can be due to deficiencies in methylfolate (a vitamin catalyst) and subsequently Glutathione as well as others. Also realize that the most commonly methylated compound in the body is one we talked about earlier, SAMe.
A common method of treatment for methylation disorders is to essentially bypass both the MFTHR issue and your body's natural feedback loop by giving megadoses of folic acid (you always hear about folic acid --- VITAMIN B-9 --- being a critical part of fortified foods, including ORANGE JUICE, to prevent neural tube defects). This is why you need to use natural or food sources of folate (methylfolate aka 5-MTHF). A deficiency of folate is related to a specific kind of anemia, which is also related to STOMACH ACID PROBLEMS.
Some of the best foods for pumping up your methylation and Glutathione pathways include.... REAL FOOD. The internet abounds with lists of foods, herbs, and supplements that boost the methylation and Glutathione pathways. I discussed this earlier and showed you that while supplements can get you through a pinch, they are not typically the best long-term solution. Now allow me to share with you a quick note about liver as related to liver nutrition.
German Physician, Dr. Max Gerson, wrote his famous book (I own it --- preface by his amazing daughter CHARLOTTE) about sixty years ago; A Cancer Therapy: Results of Fifty Cases and the Cure of Advanced Cancer by Diet Therapy. The basis of his "cure" was organic WHOLE FOODS as opposed to SYNTHETIC NUTRITIONAL SUPPLEMENTS. The thing, however, that sticks out in my mind was the way he used liver. Liver was the foundation of his remedy --- raw and blended into a drink. I am certainly not suggesting anyone do that, but what I am suggesting is that if you can get your hands on completely organic beef liver (no hormones / meds) and eat it regularly, there are some amazing health benefits. Same with some of the other organ meats as well.
An article written by Kevin Cann for Paleo expert, ROBB WOLF (Understanding and Combating Oxidative Stress in Huntington’s Disease) echoed some of these sentiments in a quote from a conversation with medical doctor and MS expert (she essentially cured herself), TERRY WAHLS. Dr. Wahls said to Cann, "When I used supplements – I slowed my decline, when I designed my food supply to get those same nutrients – my strength began to return. Print that and put up where you work – stare it every day. The supplement studies are best used to guide how we create the food plans." An amazing truth from an amazing woman!
OTHER BIOTRANSFORMATION /DETOXIFICATION PATHWAYS
Truth is, there are several different pathways for Biotransformation and Detox.
- The Amino Acid Conjugation Pathway requires ample protein to get the five aminos involved --- the most important being glycine.
- The Sulfation Pathway (similar to the Thiol Conjugation Pathway) uses sulfur-containing foods (many of the cruciferous veggies, for instance, or eggs) and helps conjugate all the nasties we've already discussed, as well as dealing with your body's natural hormones and neurotransmitters. It happens to be a critical part of your body's ability to manufacture proteins and protein / carbohydrate complexes as well.
- The Acetylation Pathway uses acetyl-CoA instead of a methyl group to do its work. People with problems in this pathway tend to not conjugate antibiotics very well, as well as affecting the conversion of SEROTONIN to melatonin --- critical for the sleep / wake cycles known as Circadian Rhythms.
- The Glucuronidation Pathway uses glucuronic acid to attach itself to toxic substances, particularly PAH's (Polycyclic Aromatic Hydrocarbons such as creosote, exhaust fumes, petroleum byproducts) and nitrosamines (found in cosmetics, pesticides, rubber products and tobacco products --- both smokes and chew).
PHASE III BIOTRANSFORMATION / DETOXIFICATION
The first references I saw to this system in peer-review were in the late 1980's (they were talking about how this system could adversely affect the potency of chemotherapy drugs). Just after I started practice in the early 1990's, there were a pair of studies in Trends in Biochemical Science (The ATP-Dependent Glutathione S-Conjugate Export Pump and The Phase III Detoxification System) that stated, "The glutathione S-conjugate export pump (GS-X pump) plays a physiologically important role as a member of the 'phase III' system in xenobiotic metabolism as well as in the release of biologically active endogenous substances from cells. In addition, this export pump is potentially involved in the modulation of the antiproliferative action of certain antitumor agents." In other words, both exogenous chemicals (coming from outside your body) and endogenous chemicals (made by your body) are removed via Phase III.
Sometimes Phase III is referred to as the Antiporter System, and contains something like 350 different proteins, the most common being P-glycoprotein. These proteins typically hang out in the intestinal wall (epithelial lining) and grab hold of the conjugated chemicals so they can be kept in the digestive tract and eventually out in the feces instead of being reabsorbed by the body, back into the blood stream, where the process can start all over again. This is also another of the reasons, as mentioned earlier, that good bile production is needed by the liver (bile is important for good bowel function as well --- HERE). In Dr. Danny Urbinder's article for FX Medicine (What is Phase III Detoxification?), he states.....
"According to Dr Chris Shade, an environmental and analytical chemist who specializes in the human detoxification system, the most significant cause of Phase III dysfunction is inflammation, especially in the gut. When Phase III is blocked a negative feedback loop results in the down-regulation of Phase II enzymes. Intermediate metabolites produced in Phase I are then at risk of building up resulting in increased oxidative damage, which further impairs detoxification capacity."
Your intestines are constantly using energy to keep minerals, water, nutrition, and other "good" substances in your body, while getting rid of waste products, including the toxic byproducts of Biotransformation and Detoxification. Furthermore, if you are familiar with my site, you already realize that I tend to talk a lot about inflammation --- particularly as it relates to GUT HEALTH. If you can keep your Gut and liver clean and healthy, and your body free of inflammation, you are far more likely to be able to clear the junk that we citizens of 21st century earth are exposed to virtually every minute of every day (think about how much more toxic our lives are than they were throughout most of human history).
If you feel you've done due diligence as far as taking charge of your health (HERE), but cannot seem to get over the hump, it's not rare to have issues with these various pathways. Fortunately, there are some very cool oral swab, blood and saliva genetic tests available that can reveal whether or not an inability to detox might be at the root of your problem (currently 23 and me seems to be the best and least expensive option on the market). There are also some very cool tests by Cyrex Labs that reveal if you are making antibodies against some of the more common toxic chemicals such as BPA. Also, the OAT test for organic acids as well as a COMPREHENSIVE GI / STOOL TEST can be beneficial as well.
Finally, remember that this article was not in any way, shape, or form, meant to be definitive, but only to give you an idea of where to start researching. Hope it was helpful.
HORMONAL OR ENDOCRINE ISSUES? WHY PALEO CONTROLS INFLAMMATION AND HELPS HALT CHRONIC ILLNESS IN ITS TRACKSRead Now
HORMONAL OR ENDOCRINE PROBLEMS?
LET ME GIVE YOU A FEW MORE REASONS PALEO IS THE WAY TO GO
Once any anemia has been addressed, there are four distinct metabolic areas that need to be discussed and addressed, blood sugar regulation, fatty acid metabolism, the liver's detox pathways (Endocrine Disruptors live here as well), and of course, gut health. Today we are going to talk about the PALEO DIET for endocrine problems and why it is the cat's meow for dealing with each and every one of these points.
When it comes to problems of the endocrine system, they are not only ultra-common, they almost always get worse grow over time. This is because changing one hormone's ability to work properly can have adverse effects on all hormone's ability to work properly. This is because hormones are almost all on negative feedback loops. What is a negative feedback loop? A thermostat keeps your house at 72 degrees because when the temp drops below 72 or climbs above 72, the furnace or air-conditioner kicks, whichever is needed, kicks on and regulates the temperature. When your thermostat goes out, it becomes difficult to regulate the temperature of your home.
Successfully addressing endocrine system dysfunction is all about correcting aberrant or dysfunctional feedback loops so that the body starts to regulate itself. Sure, your doctor can look at a blood test and prescribe the hormones that might be low. But what if the problem is not that there is not enough of said hormone, but that the receptors for said hormone are either saturated or have lost their sensitivity. This is exactly what occurs in TYPE II DIABETES, including the earliest stages (Prediabetes aka CARDIOMETABOLIC SYNDROME). It's also the reason that while giving these people DIABETES DRUGS or even insulin might normalize their blood sugar for the short term, without diet and lifestyle changes, it will never do what it claims over the long haul. Let's take a brief moment to look at the Paleo Diet as related to these various aspects of endocrine support.
- BLOOD SUGAR REGULATION: We start here simply because a failure to control BLOOD SUGAR makes everything else impossible. Why? Show me a health-related issue that is not 100% GENETIC (Downs Syndrome, Cystic Fibrosis, etc), and I will show you studies --- in many cases, hundreds of studies --- linking it back to blood sugar dysregulation (HERE'S A KILLER EXAMPLE). Bear in mind that just because you are "NORMAL WEIGHT" or your blood sugar numbers fall within "normal" range, does not mean you aren't losing glycemic control. To better understand what I mean, take a gander and the numerous posts filed under the first link in this bullet.
- FATTY ACID METABOLISM: As I showed you just the other day (HERE), the fats you consume are either driving inflammation or controlling inflammation. Also, it is critical to understand that CHOLESTEROL (a fat of sorts) is the precursor for many, if not most of, your hormones. STATIN DRUGS and TRANS FATS, along our national fear of fat (HERE), have at best, contributed to, and at worst, caused, untold amounts of hormonal dysregulation. The Paleo Diet helps regulate fatty acid metabolism in a number of ways, not the least of which is the fact that it skews metabolism away from inflammatory PGE2 and toward anti-inflammatory PGE1 & PGE3, particularly pushing the body toward Omega-3's (see the first link in this bullet).
- LIVER DETOXIFICATION PATHWAYS: Although most of us (self included) refer to the body's ability to clear junk (CHEMICALS, MEDICATIONS, METALS, etc, EXCESS HORMONES, XENOHORMONES, etc, etc, etc --- most of which loosely fall into a category known as "ENDOCRINE DISRUPTORS") as detoxification, the scientific literature has a different name for the process --- "Biotransformation". Biotransformation includes the many various processes that "transform" these toxins into the biological forms that the body can excrete and get rid of in one way or another, most of which occur largely in the liver. While mopping up and getting rid of toxic chemicals is great, what's even better is not having to deal with them in the first place. Once you understand this simple concept, it's not hard to understand why avoiding said substances is a big deal. When you eat animals and animal products that were never given hormones or antibiotics to begin with, the end result is an endocrine system that is more capable of functioning as it was created and designed to from the beginning. Never forget that commercially-raised livestock are given estrogen-based hormones for the express purpose of making them fat (females carry far more body fat than males thanks to estrogen).
- GUT HEALTH: Understanding the two facets of GUT HEALTH (MICROBIOME and BARRIER INTEGRITY) is absolutely critical if you want to get your hormonal system under control. And no, I haven't forgotten the whole FODMAPS / IBS / SIBO THING either. Because 4/5 of your immune system (HERE) and 90% OF YOUR SEROTONIN come from the Gut, you'll have to get serious about Gut Health in order to solve problems in your hormonal system (BTW, serotonin is intimately related to melatonin --- the sleep hormone). Commercially-raised animals or the animal-based foods that come from them, have the ability to foul Gut Health. For starters, these animals are regularly fed low-dose antibiotics with their GRAIN for the express purpose of making them gain weight (HERE). ANTIBIOTICS cause DYSBIOSIS, while sugar along with highly processed carbohydrates feeds it (HERE). Furthermore, you can effectively use an ELIMINATION DIET to figure out what foods might be creating INFLAMMATORY RESPONSES in your body.
Bottom line, Paleo or something similar, is critical for you to get your life back --- so much so that I created a mega post on the Gut / Endocrine relationship called ENDOGUT. If you are struggling with hormonal issues and still eating a SAD (Standard American Diet), you've got to change that immediately. Use an ANTI-INFLAMMATORY, PROTEIN-RICH, VEGETATION-BASED, I'M-NOT-SCARED-OF-HEALTHY-FATS, diet to curb SYSTEMIC INFLAMMATION, allowing your body --- endocrine system included --- to start healing itself and regaining it's normal feedback mechanisms.
Trying to solve your endocrine problems without restoring the integrity of these feedback loops (ie, simply and only taking supplemental hormones --- see the list at the top of the page), while sometimes necessary short term, can be short-sighted, making you feel better and improving your blood work numbers for awhile, but never really restoring the body and hormonal systems to their natural state of balance and HOMEOSTASIS. While you certainly might require a FUNCTIONAL MEDICINE specialist to dig deeper, the Paleo Diet should help you get started on your journey (HERE).
WHAT IS THE RELATIONSHIP BETWEEN SIBO (SMALL INTESTINAL BACTERIAL OVERGROWTH) AND IBS (IRRITABLE BOWEL SYNDROME)?Read Now
SIBO (SMALL INTESTINAL BACTERIAL OVERGROWTH)
AND IBS (IRRITABLE BOWEL SYNDROME)
WHAT'S THE RELATIONSHIP?
The September issue of Therapeutic Advances in Chronic Diseases (Gastrointestinal Bacterial Overgrowth: Pathogenesis and Clinical Significance) said that, "Small intestinal bacterial overgrowth (SIBO) is defined as the presence of an abnormally high number of coliform bacteria [bacteria present in the large intestine and feces] in the small bowel. The most common symptoms associated with SIBO include diarrhea, flatulence, abdominal pain and bloating. The prevalence of SIBO in IBS varies from 30 to 85% depending on the source used. The prevalence of SIBO in liver cirrhosis is 50% and in celiac disease, the prevalence of SIBO in some studies is also estimated to be 50%. Interestingly, in asymptomatic morbidly obese patients the prevalence of SIBO was noted to be 17%." In other words, SIBO is far from uncommon.
As far as IBS is concerned, About IBS dot com says that, "Irritable bowel syndrome is the most common functional gastrointestinal disorder with worldwide prevalence rates in the area of 10–15%. IBS is the most common disorder diagnosed by gastroenterologists and accounts for up to 12% of total visits to primary care providers. There are between 2.4 and 3.5 million annual physician visits for IBS in the United States alone." MedScape parrots these statistics, adding to it that "only 3.3% are medically diagnosed." In essence, this means that these doctor visits are being driven by the very worst of the worst. The others --- like many of you --- are just sucking it up and living with it. BTW, I saw a major study from the past few months saying the international prevalence of IBS could be be over 20%. That would be 1 in 5 or about 65,000,000 Americans and about 1,500,000,000 worldwide.
As for the gas --- one of the single most distinguishing characteristics of both SIBO and IBS --- it is both foul-smelling and toxic. That's right; toxic. Several studies actually discuss IBS/SIBO-associated health issues in relation to CDT's (Cytolethal Distending Toxins), about which Wikipedia says, "toxins produced by certain gram-negative bacteria that trigger cell cycle arrest, leading to the enlarged or distended cells for which these toxins are named. Affected cell lines (including human fibroblasts, epithelial cells, endothelial cells, and keratinocytes) die by apoptosis [programmed cellular destruction]. CDT's are classified as AB toxins, with an active ("A") subunit that directly damages DNA. Many of these bacteria infect humans. Bacteria that produce CDTs often persistently colonize their host." In other words, not only are these creatures vile, they can be tough to get rid of as well. We'll talk more about how that's done later in the post. Oh, and don't ever underestimate the importance of the epithelial cells they mention (THE LEAKIES) or FIBROBLASTS.
Because the stomach is (OR AT LEAST SHOULD BE) extremely acidic, it acts as one of the defense mechanisms preventing bacteria from getting into the small intestine from the top of the GI tract (for an overview of digestion, ENDOGUT is the place to go). At the beginning of the small intestine the relatively few bacteria found there will be gram positive and at the end of the GI tract, they'll be gram negative. Due to the gas producing features of these bacteria, the bowel (large intestine) distends, compromising the doorway between small and large intestine (the illeocecal valve), thus allowing large amounts of gas to enter the small intestine. Interestingly enough, these gasses can be easily tested for using various breath tests. Hydrogen-based gases tend to cause diarrhea, while methane-based gases tend to cause constipation. One of the hallmarks of IBS for many individuals is that they make both gasses, depending on what they eat --- one reason they have alternating diarrhea and constipation
Although there are some physicians and researchers who say that the relationship between IBS and SIBO is controversial (for instance, this month's issue of Current Opinion in Gastroenterology published a study called Small Intestinal Bacterial Overgrowth as A Cause for Irritable Bowel Syndrome: Guilty or Not Guilty?), my humble opinion is that peer-review is clear on the subject. Not only is there a relationship, the scientific literature shows it to be both robust and underestimated --- a thought echoed by the title of a study in the August 2015 issue of Neurogastroenterology and Motility (Possible Underestimation of SIBO in IBS Patients).
Before we get into the nuts and bolts of the SIBO / IBS relationship, I want to show you a few things you need to at least thinking about. Because IBS is autoimmune, and because autoimmune diseases tend to travel in packs, there are very specific health issues that have been associated with this problem. Not surprisingly, it's been linked to INCREASED INTESTINAL PERMEABILITY in the large intestine (do not confuse this with diarrhea) as well as autoimmunity itself (HERE). Other studies have linked things as seemingly unrelated as rosacea (facial redness) and RESTLESS LEG SYNDROME (both are autoimmune diseases) to both SIBO and IBS. We'll get to the Depression / IBS / SIBO link shortly.
THE RELATIONSHIP BETWEEN SIBO AND IBS
- The March 2017 issue of Gut and Liver (Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy) revealed who is most susceptible to the IBS / SIBO combo. "Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients." What should we take away from this? Remember that ANEMIA is a deal-breaker as far as fixing any chronic issue is concerned. Also, women are far more likely to develop autoimmunity than men. I'll deal with PPI's later. Furthermore, we see why the breath tests work so well. "Eighty percent of the gases like hydrogen and methane are eliminated with the flatus and the remaining 20% are absorbed and exhaled by lung, which can be measured in breath." Lastly we learn about the, "paradigm shift in understanding this disorder, hitherto thought to be predominantly psychogenic in nature." In other words, even though the problem is FUNCTIONAL AND NOT PATHOLOGICAL, it's not simply in the patient's head as was believed for decades.
- Last June's issue of Gastroenterology Research and Practice (Small Intestinal Bacterial Overgrowth in Patients with Irritable Bowel Syndrome: Clinical Characteristics, Psychological Factors, and Peripheral Cytokines) dealt with the INFLAMMATION both created and caused by this issue, saying "Bacterial products, such as endotoxins, can affect gut motility. Gut bacteria are also important for activating an immune response. Immune-mediated cytokines have multiple actions. there is a large body of work demonstrating that patients with IBS have low-grade immune activation, and associations between psychological state and stress and immune activation have been detected in mucosa. Results from animal experiments suggest that low-grade gut inflammation can alter gastrointestinal tract motor function and that gut motility abnormalities can further predispose to bacterial overgrowth.... Previous studies have confirmed that anxiety and depression are more common in patients with functional gut and intestinal disorders than in the healthy population, particularly in patients with IBS, as confirmed here. Anxiety, depression, and life event stress were more prevalent in patients with IBS than in healthy controls." Inflammatory ENDOTOXINS (lipopolysaccharides) are commonly seen in the IBS / SIBO combo, while ANXIETY / DEPRESSION are both considered to be inflammatory disorders.
- Just so you are aware, this is not just an adult problem --- not by a long shot. Back in 2009, the journal Pediatrics published a study called Prevalence of Small Intestinal Bacterial Overgrowth in Children with Irritable Bowel Syndrome. The authors, seven gastroenterologists from Rome's University of Sacred Heart Gemelli Hospital, concluded that, "The prevalence of abnormal [breath test] results were significantly higher in patients with IBS (65%) with respect to control subjects (7%). Results from this study suggest a significant epidemiologic association between SIBO and IBS in childhood." What does this ultimately mean for your children? Stick around to find out.
All of this is great information and important to know if you struggle with this problem. But so far, I haven't covered much having to do with addressing / solving / fixing the problem. This section is short folks, and is where the rubber meets the road as far as dealing with IBS and SIBO are concerned! Oh; as far as diagnosis is concerned, you can do the breath tests, but honestly, if you have problems with gas coming from either end of your digestive tract after a meal, you have some degree of SIBO.
TREATMENT OF SIBO AND IBS WITH SOMETHING THAT CAUSES THE PROBLEM IN THE FIRST PLACE.... ANTIBIOTICS
ALTERNATIVE SOLUTIONS FOR IBS & SIBO
A year ago in January, the World Journal of Gastroenterology asked a question via the title of a study --- Is Irritable Bowel Syndrome an Infectious Disease? Listen to their own conclusions. "Irritable bowel syndrome (IBS) is the most common of all gastroenterological diseases, with a worldwide prevalence of 7%-21%. The presence of small intestinal bowel overgrowth (SIBO) has been documented in patients with IBS and reductions in SIBO as determined by breath testing correlate with IBS symptom improvement in clinical trials. The incidence of new onset IBS symptoms following acute infectious gastroenteritis also suggests an infectious cause. Alterations in microbiota-host interactions may compromise epithelial barrier integrity, immune function, and the development and function of both central and enteric nervous systems explaining alterations in the brain-gut axis." Not surprisingly the authors concluded that IBS is an infectious disease.
Don't, however, confuse infectious with communicable (at least in most cases). Due to the pressure of the excess gas, the bacteria is being forced up the small intestine from the bottom via post-meal distension and bloating --- the most defining characteristic of IBS / SIBO. This pressure opens the illeocecal valve, allowing both gas and bacteria into the small intestine. But besides ANTIBIOTICS, which we know will automatically create more dysbiosis, what can be done? For starters, let's look at a study done by nine gastroenterologists from the University of Pittsburgh's Department of Internal Medicine (Herbal Therapy Is Equivalent to Rifaximin for the Treatment of Small Intestinal Bacterial Overgrowth) and published in the May 2014 issue of Global Advances in Health and Medicine.
"SIBO is widely prevalent in a tertiary referral gastroenterology practice. Patients with SIBO have chronic intestinal and extraintestinal symptomatology which adversely affects their quality of life. Present treatment of SIBO is limited to oral antibiotics with variable success. One hundred and four patients who tested positive for newly diagnosed SIBO by lactulose breath testing were offered either rifaximin 1200 mg daily vs herbal therapy for 4 weeks. Of the 37 patients who received herbal therapy, 46% had a negative follow-up LBT compared to 34% of rifaximin users. Adverse effects were reported among the rifaximin treated arm including 1 case of anaphylaxis, 2 cases of hives, 2 cases of diarrhea and 1 case of Clostridium difficile. Only one case of diarrhea was reported in the herbal therapy arm, which did not reach statistical significance. Herbal therapies are at least as effective as rifaximin for resolution of SIBO. Herbals also appear to be as effective as triple antibiotic therapy for SIBO rescue therapy for rifaximin non-responders."
Did you catch that folks? Nine GI specialists from a major medical institution said that HERBAL TREATMENT is not just as good as, but better than, the medical standard of care --- rifaximin. Furthermore, said herbal remedies are at least as effective as the triple antibiotic therapy given to those who don't respond to rifaximin. Let the magnitude of these conclusions sink in for a moment. Not surprisingly there are some very good herbal formulas out there. There is also some total junk. The bottom line, however, whether we are talking about antibiotics or herbs, there are other steps that must be taken if you hope to solve the SIBO / IBS combination over the long haul.
- CHANGE YOUR DIET: Foods that produce gas (sugar -- especially fructose in the form of something called FODMAPS) must be eliminated. I've dealt with FODMAPS extensively in the past. FODMAPS also happen to mimic the GI portion of Gluten Sensitivity (HERE). Also be aware that FIBER and many common PROBIOTICS have the potential to cause bloating and distension as well. For those of you with hardcore sugar / carb addictions, THESE POSTS might be right up your alley. Bottom line is that you will need to be on a FODMAP-free, GLUTEN FREE, PALEO DIET that cuts all GRAINS and BEANS as well as DAIRY and many FRUITS. You'll also want to focus on consuming GOOD FATS. I always recommend an ELIMINATION DIET to figure out exactly what you are sensitive to.
- GET OFF THE ANTIBIOTICS: I've shown you in the past why antibiotics are arguably the single most dangerous drugs that people are regularly prescribed from cradle to grave (HERE). Worse yet is that the more of them you take, the more you'll need because they hammer the bacteria that make up 80% OF YOUR IMMUNE SYSTEM. Antibiotics create all sorts of physiological vicious cycles that will sooner or later destroy your health (see first link in bullet).
- GET OFF THE PROTON PUMP INHIBITORS: Without going into great deal here, suffice it to say that the acid-blocking drugs known as PPI'S are both extremely common and heavily associated with the double-headed monster known as IBS / SIBO. BTW, the warning labels on these drugs say that you cannot be on them more than three times a year for more than two weeks at a time.
- ADDRESS MOTILITY ISSUES: Based on the work of FUNCTIONAL NEUROLOGIST Dr Ted Carrick, there are exercises to address the motility issues by stimulating certain parts of your brain, your cranial nerves, or your enteric nervous system. Some of these include gargling, gagging, and ENEMAS / COLONICS. As your healthcare provider because all of them might not be right for your particular situation.
- ADDRESS GUT HEALTH: Because many of those dealing with these sorts of issues can't do fermented foods or probiotics, it makes it tough to not only address their intestinal permeability issues, but their MICROBIOME as well. Depending on what's feeding the problem or how severe it is, FMT might prove beneficial in some situations.
Every day there are people getting off the MEDICAL MERRY-GO-ROUND by creating their own EXIT STRATEGIES. And while there are no one-size-fits-all "cures," there are steps to take that will help most of you not only understand what's wrong with you, but start successfully addressing it as well.
ESSENTIAL FATTY ACID METABOLISM AND INFLAMMATION:
ANOTHER REASON THAT PALEO IS SUPERIOR TO LOW CARB
The first thing you have to be aware of when it comes to fatty acid metabolism is that it's not only possible, it's rather common to see people who have trouble digesting fats. This is frequently due to a lack of DIGESTIVE ENZYMES and diminished function of the liver / gallbladder, although it can certainly come from the pancreas as well (for the digestion of fats, STOMACH ACID is not the critical factor it is for protein). Let's take a brief look at how the metabolism of fats relates to the amount of inflammation you will deal with on a day to day basis.
FATTY ACID METABOLISM
OMEGA-6 FATTY ACID METABOLISM
The first fatty acid in this pathway is Linoleic Acid --- an essential fatty acid, meaning your body does not make it; it must be consumed dietarily. Unfortunately, most people get way to much LA in their diet in the form of various cheap cooking oils such as SOYBEAN, corn, safflower, and cottonseed oil --- oils that are almost universal to heavily processed foods. There is, however, a better form of LA --- CLA or Conjugated Linoleic Acid. Where does CLA come from? It comes from consuming the sorts of fats that were considered deadly while I was growing up --- RED MEAT, EGGS, BUTTER, and full-fat dairy (whole milk). It's important to realize that CLA has numerous health benefits as seen in peer-review, some of which include weight loss (in particular, it helps mobilize and burn fat), hunger control, blood sugar regulation, and down-regulating the part of the immune system responsible for inflammation.
A dysfunction or deficiency of the enzyme that converts LA to GLA (Gamma Linolenic Acid) is yet another way that people skew their Omega-6 metabolism toward the pro-inflammatory AA (Arachidonic Acid) pathway. What are the most common causes of this sort of metabolic dysfunction? Honestly, it's the usual suspects --- the same actors we see with any number of other health issues --- OBESITY, BLOOD SUGAR DYSREGULATION, hormonal issues (including THYROID), ADRENAL FATIGUE (stress as measured by HRV), alcohol and drugs (this includes PRESCRIPTION DRUGS), TRANS FATS, along with any number of others. The result is a myriad of inflammatory diseases that I have linked to throughout this post. As far as supplementing, the two best sources of GLA are Black Currant and Borage Oils. And while many people use it, the problem you get into with Evening Primrose Oil is that like soy, it tends to be a xenohormone (estrogenic).
DGLA is where we see the Omega-6 pathway split. Depending on any number of factors, most having to do with diet and lifestyle (EPIGENETIC FACTORS), this pathway will either be driven to the left --- the anti-inflammatory PGE1 pathway, or the right --- the pro-inflammatory pathway that leads to AA (Arachidonic Acid). While AA is certainly not a bad thing (it is a chief component of CELL MEMBRANES, THE BRAIN, MUSCLES, and liver), too much of a good thing is often a bad thing --- exactly what we see with virtually all INFLAMMATORY MEDIATORS. Too many highly processed, frequently rancid, grain, vegetable, and peanut oils, and you are going to make lots of leukotrienes and PGE2 --- both of which are highly inflammatory. Not only that, but LIVING THE HIGH CARB LIFESTYLE is one of the biggest blockers of the PGE1 pathway. As some of you might know, the AA pathway is blocked by NSAIDS and CORTICOSTEROIDS, but the side effects are numerous, accumulative, and potentially brutal.
Despite all the information on this topic, Americans continue to drive the inflammatory side of Omega-6 fatty acid metabolism to excess. Since the early 1980's, hundreds upon hundreds of studies have shown how inflammatory leukotrienes and PGE2 are (they are two of the many cellular messengers we refer to collectively as "inflammation"). What does peer-review have to say about these two mediators? As much as I would love to take the time to give you a long list of the problems associated with, you can freak yourself out by doing your own research (PubMed). Within five minutes you will realize that both of them (particularly PGE2) are associated with a slew of INFLAMMATORY DISEASES, including nasty creatures like CANCER, ARTHRITIS, DIABETES, and HEART DISEASE.
The anti-inflammatory PGE1 pathway is mostly about promoting circulation and blood flow as seen by numerous studies on PubMed.
OMEGA-3 FATTY ACID METABOLISM
I've run into lots of people over the years, who for various reasons, don't want to take fish oil (even the PHARMACEUTICAL GRADE FISH OIL that has had all the protein removed making it non-burpy). Instead, they think they can get their Omega-3's by taking flax seed oil. While I am personally a big fan of cold-pressed flax oil, it is critical to understand why it's not a substitute for animal-based sources of Omega-3's. It all has to do with the crappy conversion of LN to EPA / DHA. Again, according to numerous studies, and depending whose research you believe is most viable....
- To convert flax seed oil to equivalent amounts of EPA, you would have to consume approximately 15 times the amount of flax oil as fish oil since the conversion is only about 5 to 10%.
- To convert flax seed oil to equivalent amounts of DHA, you would have to consume between twenty to fifty times the amount of flax oil as fish oil since the conversion is even worse --- only about 2 to 5%.
The end-product of consuming EPA (it's better for inflammation) and DHA (it's better for brain function) is that you produce lots of Prostaglandin E3 (PGE3), which is extremely anti-inflammatory. I could easily sit here and give you study after study on the benefits of PGE3 for a wide array of inflammatory problems. Today I'm only giving you one.
Three years ago next month, the journal Cancer Letters published a study called Prostaglandin E3 Metabolism and Cancer. The authors, three oncologists from the University of Texas and MD Anderson Cancer Treatment Center in Houston, had this to say about EPA and DHA. "The anticancer activity of Omega-3 fatty acids, especially those derived from fish, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid) (DHA), has been studied for centuries. A number of studies have suggested that the anticancer activities of EPA and DHA are associated with their effects on eicosanoid metabolism by which they inhibit prostaglandin E2 (PGE2) production." Here's what's amazing about this study. Not only do EPA and DHA promote anti-inflammatory PGE3, they inhibit pro-inflammatory PGE2. This is true whether you are fighting cancer or arthritis, ASTHMA or ADHD, IBS or IBD.
SOME CONCLUSIONS ABOUT FATTY ACID METABOLISM
The second part of this equation is that there are any number of things that can adversely affect fatty acid metabolism, many of which have been mentioned today in passing. Furthermore, if you take a look at the Fatty Acid Metabolism Chart above, it's critical to realize that even though I have not included them, there are enzymes driving each and every conversion step. As I stated earlier, poor lifestyle choices are going to foul these conversions --- especially the conversions to PGE1 and PGE3 --- the anti-inflammatory part of this equation, while making the conversion to inflammatory AA the default pathway.
As per the title of today's post, this means that while LOW CARB DIETS (KETOGENIC included) can knock it out of the park as far as controlling the single most important factor as far as your health is concerned (blood sugar), it doesn't necessarily help you solve your SYSTEMIC INFLAMMATION as greatly as you were hoping it would. The beauty of the PALEO DIET is that you are eating meats and fats that have been raised in a "SUSTAINABLE" fashion, not only getting the blood sugar benefits of Low Carb, but the fatty acid / inflammation benefits as well as the benefits of cutting the endocrine disruptors / xenohormones / artificial estrogens (see earlier link). It's largely why I suggest that if you are doing low carb, it's just a hop, skip, and a jump over to paleo (HERE).
If you are struggling with chronic health issues and are not sure where to turn, realize that your case might require the intervention of a specialist in FUNCTIONAL MEDICINE. Also realize that before going the FM route, there are any number of things you can do to take matters into your own hands and start taking your life back. A basic outline of those steps can be found HERE. No, it's not a solution for everyone. But following steps that have been proven over and over again in the peer-reviewed scientific literature only makes sense.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
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