The Metabolic Syndrome

What it is and how to avoid it...

The metabolic syndrome (TMS) is a cluster of symptoms that is often seen as a precursor to diabetes. It is frequently referred to as "Syndrome X," and the estimates of how many people have it are going through the roof. In the United States it's estimated that 2 in every 5 adults are affected. That's a lot of people.

The American Medical Association lays it out like this--if you have three of the following, you're in the Metabolic Syndrome club. If you have them all, you're a VIP.

1. Waist measurement of 40 inches or greater in men, and 35 or greater in women.
2. Serum triglycerides level greater than 150mg/dL.
3. HDL cholesterol less than 40 mg/dL in men and less than 50 mg/dL in women.
4. Blood pressure of 135/85 or higher
5. fasting glucose of 100mg/dL or higher,

It all boils down to controlling your insulin levels and the corresponding blood sugar levels. If you are insulin resistant from eating too many carbs (especially refined carbs, but anything higher on the glycemic index will take its toll, such as all cereal grains), not getting enough exercise (more on this in a minute), not getting enough sleep, and/or getting too stressed out (guilty!), then you're either on your way to TMS, or you're already there. Fortunately, there are ways to reverse it.

Regular readers will not be shocked to hear me say that the number one way to reduce the effects of TMS is to stop eating grain products such as wheat, corn, and rice. Read my previous post on grains for details. Along with the grains, though, are the other sweet treats that permeate the check out lines and teachers' lounges of the world. Sugar can rob you of your health on multiple levels.

Insulin resistance happens when too many carbs have to be dealt with on a regular basis. Glucose is stored in muscle and liver tissues as glycogen. When those cells get full (which doesn't take much), the rest is stored in the form of triglycerides, which is bad. Your muscle and liver cells will literally "down regulate" insulin receptors on their cell membranes, which is akin to putting a "No Vacancy" sign on the marquee. All full at the inn, go somewhere else. So, we get fatter when extra carbs can find no room at the inn. Bummer.

The way to re sensitize your cells to insulin is to stop eating so much of the foods that are causing the problems in the first place. That's a good start. But if you really want to ditch TMS, you need to cause your cells to up regulate insulin receptors. This can be done most effectively with high intensity exercise. This doesn't mean running on a treadmill at a moderate pace for an hour. This means working so hard in short bursts that having a conversation or reading a magazine is out of the question. This means getting red faced and sweaty and icky. And this can save your life.

Extra insulin running around in your system leads to systemic inflammation, which I mention in just about everything I write. And, men, extra insulin in our systems is notorious for reducing testosterone levels, which can lead to depression, decreased libido, and reduced muscle mass. None of this is too appealing to me personally, so I avoid eating the afore-mentioned carbs (especially anything refined), and when I exercise I won't be able to answer the phone because talking will not be an option at the preferred level of intensity.

Because TMS is not just a precursor to diabetes. It is an indicator of systemic inflammation, and systemic inflammation is a precursor to all of the diseases of the west that get us in the end, including heart disease, cancer, Alzheimer's disease, arthritis, and on and on. What you get depends on what you're most genetically predisposed to getting. If you know your family history, and you have metabolic syndrome, it's likely that you're on your way to fulfilling your genetic destiny.   But it doesn't have to be that way.

The first step in determining where you stand, is to get some objective data. There are some blood tests that will tell you what you need to know--glucose panels, cholesterol (I recommend the VAP test to really know what's going on. It breaks the LDL into smaller categories to identify the particle size. Large and fluffy LDL particles don't worry me), hemoglobin A1C, CRP (which is a favorite of mine--it tests for a marker of systemic inflammation), and fibrinogen (to see if your blood is clotting too easily, which happens with elevated insulin levels).

There are supplements that can take the edge off TMS. Vitamin D, fish oil, magnesium, B vitamins, and a few antioxidants can all do wonders for your blood chemistry, but they do nothing compared to eating right and getting the right kind of exercise. Try taking my 30 day grain free challenge and see for yourself. This is the biggest stumbling block for most, but there are other things to eat. I promise. I've been doing this for years.

Exercise, by the way, doesn't have to take up your entire life to get the benefits. It's a matter of finding the perfect amount to get the job done. Some of us are gluttons for punishment. If that's not you, I can tell you that huge gains in health can be made in an hour a week if you do it right. That sounds like a subject for a future post.

By the way, if you're in the Houston area, and are interested in any of the blood test I mentioned, give us a call at Green Chiropractic. I can send you to any Lab Corp and we can get this thing going.

Tummy Troubles = Autoimmune Disease?

Well, not exactly "tummy," if by "tummy" you're thinking, "stomach." What I really mean is your small intestine, specifically the upper part of your small intestine, know as the duodenum. I've written about small intestine bacterial overgrowth (SIBO) before, but I think it's worth delving back into for a minute to give you options for dealing with it.

Before telling you how to manage SIBO, let's review why it should be eradicated in the first place. It basically goes like this: bacteria from your colon have overpopulated their home, so they move up the plumbing. If they get far enough up, they make it to the duodenum, where about 75% of the absorption of what you eat takes place. If you have increased gut permeability from too many lectins in your diet (which are found in high concentrations in all grains, as well as legumes), that bacteria can get into your bloodstream. The literature is starting to lean heavily on the idea that most auto-immune diseases start in the gut.

Common symptoms for SIBO are everything from reflux to diarrhea, and it has been implicated in Crohn's disease, ulcerative colitis, and rheumatoid arthritis, and some are even connecting it to lupus. Go to Pubmed.gov and start searching. It will blow you away. I have one paper on my hard drive at home where 100% of the fibromyalgia patients and and 84% of the IBS patients tested had SIBO. When fibromyalgia patients walk through the door here, we go hard core anti-inflammatory, otherwise we're just chasing symptoms.

To overcome the SIBO, you have to do two things: starve it and kill it. This is a war for your health, after all, so you can't be nice to the bugs. The prescription for starving SIBO is fairly straight forward--get off the grains. The indigestible carbs in grains are what feeds the bacteria. This is one of the major ways that grain consumption is so inflammatory. Uncontrolled inflammation leads to a whole host of the diseases of the west. Want to know what you're genetically susceptible to getting? What's your family history? Heart disease? Cancer? There's your answer. For me it's heart disease (dad's side), and dementia (mom's side). Both of those diseases are caused, in part, by uncontrolled inflammation. I think I'll do my best to pass.

As far as killing SIBO, my recommendation is to try 600 mg a day of oil or oregano for six weeks. Oil of Oregano (OoO) should be in an emulsified form that will help it make it to the bad bugs. OoO is also a potent anti-inflammatory in it's own right, so it's something that I dance with on occasion. If I even have an inkling that there's some gastro intestinal upset in the works I throw some down the hatch. If I had any kind of auto immune disease I would treat with OoO just to see what happens. There are no contraindications that I'm aware of, so the worst case scenario is that nothing happens and you're out a few bucks, but the potential benefits are huge. So, why not?

There are drug therapies for SIBO, too, most notably an antibiotic called rifaximin, which targets the specific area of the gut where SIBO does the most damage. Either way you go, the rub is that it will come back, even after a good killin', if you don't change the habits that started the whole process in the first place. So join me in the grain free challenge. People who did just that in January reported losing weight (some were dropping a pound a day for a couple of weeks straight), and less joint pain (which is something I ask people about all day long, since that's why they're here in the first place).

If OoO interests you, let it be known that I sell some here, and the brand I sell was recommended to me by the guy who wrote Integrative Rheumatology, which is a textbook that I regularly review when I write this kind of stuff.

Biscuits!

I thought I'd show you guys some love, since I've been beating you all down with my no grains talk since January. I stand by all that I've said, but I also want to give you some great ways to get around the whole no grains thing. There are basically two food groups that people miss the most when avoiding grains: crunchy, and biscuits. Today we'll cover biscuits, and we'll get to some crunchy soon, too.

First, you need to me my friend: almond flour. We prefer this brand, but I' sure there are others. We've started buying it in the 25 pound bags because we use so much. The recipe for biscuits I'm about to throw your way is from this book. I think we've (and by "we," I mean, "Cara") improved a little on the original recipe. We've also made the pancakes, which I don't like that much more than pancakes made from coconut flour, but it is a nice variation.

What you need:
2.5 cups of almond flour
.5 tsp of baking soda
.5 tsp of salt (or a whole tsp of kosher, which is my preference)
1 tsp of lemon juice
2 eggs
1/8 cup of maple syrup (the original calls for agave nectar, which I would advise against because of the super high fructose level. I'll write something about the reason for that soon.)
1/4 cup of melted butter (unsalted), or coconut oil (we use butter)
(Decimals! Fractions! I'll use them all!)

350 oven. 15 to 20 minutes on a Silpat or parchment paper (or just lube up a cookie sheet with oil)--divided into 8 servings.

We (and again, "we"="Cara") often add frozen blueberries, which is super awesome. A cup and a half of frozen blueberries adds about 15 minutes to the cook time. They should be golden on top, and a toothpick inserted into the biscuits will come out clean. Raisins and cinnamon go well in them too. Play with it. With our strawberry shortcake  a few days ago there was half a lemon's worth of zest in the batter. They were served with some fresh strawberries and  some whipped, unsweetened coconut cream. Delicious.

See? Who loves you?

Who's Been Eating Beans?

I made a comment on Facebook about peas being an irritant to the gut recently, and although I was referring to the Black Eyed Peas and their horrendous half time "song," the fact is that peas, which fall under the broader category of legumes, really can irritate the GI tract in the same ways that grains can. For some of you, this means you may be better off skipping the beans.

Legumes do have some redeeming qualities, though. Unlike grains, the protein in beans is fairy easy for your body to absorb when they're cooked well. A long soak helps beans become more gut friendly. Still, beans are full of fiber that we can't digest on our own. That fiber, however, gives the bugs in your gut a bean buffet to feast on, which can lead to, among other things, funny jokes about beans. If you know what I mean.

Some legumes have higher amounts of protein than others--lentils come to mind. They're no grass fed steak, but they do have some redeeming qualities. Some legumes are more starchy, like my personal favorites, lima beans. I generally try to avoid excess consumption of all legumes, but I'll happily eat some refried beans at a Mexican restaurant on the occasions when I eat out. Just being real with you. Some of the more hard core "paleo" crowd out there won't touch them, and I do understand the motivation, I'm just more of a moderation kind of guy when it comes to legumes.

Legumes do contain a high amount of lectins, which I wrote about in the above linked grains post a few weeks back. Lectins increase gut permeability, and can lead to some pretty nasty auto-immune disorders. But compared to wheat, legumes are a distant second, and not bad enough for me to shun entirely. If I had any of the signs of inflammatory or auto immune disorders, I would be a little more strict with myself.

In the end, I consider legumes a cheat food that I like, but not as much as other cheat foods like cheese or heavy cream. The carbs will add up with beans, and for my money, I'll take the carbs in the form of dark chocolate.

Even More Good News

Funny thing--people are still reading the bad news post about 2 to 1 to the good news post. To catch us all up I decided to give you a little more good news, and this time I'm going to try my best not to spoil it with anything negative. I'm sure I'll fail, but now you know my intentions at least.

Most of the bad news had to do with certain foods causing inflammation. Today's good news will be focused on all the delicious foods, spices, and seasonings that modulate inflammation. And by "modulate" I mean "make not as bad." Which is good. See? Good news!

I'm going to give you a list of these anti-inflammatory tasty treats first, and then, if you want to geek out on the why you can keep reading. And the list, my friends, is long. You see, most of the culinary traditions of the world have in their respective arsenals a virtual menagerie of inflammation fighters. They also have their bad news fare, so the strategy is to delve into the good, and leave the bad behind, or at least eat less of the bad.

Let's get on on with it: spices are where the party is. This is good, because there are practically unlimited combinations of  flavors that can be derived from the spice pantries of the world. Take ginger for instance. It's prevalent in many Asian and Indian dishes, but it's also known to pop up in plenty of other culinary hot spots. It's also one of your new go to modulators of inflammation. Speaking of Indian--many of the spices that frequently show up in Indian dishes are potent anti-inflammatories. turmeric (which gives many Indian dishes and yellow mustard their characteristic yellow tint) and garlic, which frequently show up in curries, are on my list of things to eat as often as you can. Meet you at the buffet.

Cinnamon is also one of the most important spices to add to your flavor enhancement repertoire. Cinnamon, by the way, goes great in meat dishes. Find yourself a Greek cookbook and start exploring. The Greeks figured that last one out a long time ago, and if it weren't for some valuable time I spent teaching at Annunciation Orthodox School in Houston, I may not have ever figured this out. So thanks, AOS!

The reality is, we're just getting warmed up. Other common ingredients from the herb section of the store that pack a healthy punch are basil, mint, rosemary, and thyme. And all of you Tex-Mex/Indian food lovers should be happy to hear that cilantro makes the list as well. The best part is the fact that not only do these spices greatly enhance flavor, they are also virtually calorie free as well as low carb. What's not to love?

Another class of foods that control inflammation are the flavanoids.  You know them as the compounds that give many foods their colors. Examples of flavanoid rich foods are berries, dark chocolate, green tea, dark beer, and red wine. How's that for a list? See? it's not all gloom and doom around here!

(Geeks only from here on out...)
You may remember medications known as "select COX-2 inhibitors," some of which were taken off the market because people were having some serious side effects. Celebrex and Vioxx are two that come immediately to mind (Celebrex is still available, but not Vioxx, just to be clear). COX, short for cyclooxygenase, is an enzyme that turns some of the fatty acids in your cellular membrane into either pro or anti inflammatory mediators.

When we eat too much of the wrong types of fats we make it far more likely that COX is going to be working on that type of fat, and consequently produce the pro inflammatory results we'd all prefer to avoid. All of the above mentioned items keep COX from working so hard to sabotage our biochemistry. The bonus comes with the fact that all that stuff tastes good, too. 

The Good Stuff: Magnesium

 I'm frequently asked which supplements I take--it's a fair question since the person asking is usually someone I just suggested take this or that. My answer: not much of anything, but what I take gives the most bang for the buck. Today I want to spread the love for a supplemental underdog, our old friend magnesium.

Magnesium is found naturally in green leafy vegetables of which we both know you're not eating enough. It's also found in nuts, legumes, and sea food. A quick list of the punch this mineral packs: glucose metabolism, cellular energy transport, calcium transport, nerve signal conduction, over 300 enzymatic reactions. Lack of magnesium in the diet is known for contributing to the following list of stuff I'd rather avoid:

• Muscle weakness, tremor, or spasm
• Heart arrhythmia, irregular contraction, or increased heart rate
• Softening and weakening of bone
• Imbalanced blood sugar levels
• Headaches
• Elevated blood pressure
• Insomnia
• Muscle Cramps
• Panic Attacks
• Hyperactivity

I've written about C-reactive protein (CRP) before, but to review, it's a blood test that measures a marker for systemic inflammation. It is often used to determine one's risk for a coronary "incident." A recent paper, however, shows that elevated CRP means you're at risk for all the inflammatory diseases of the west: cancer, heart disease, and so on. Another recent paper shows a correlation with inadequate dietary magnesium and elevated CRP. One of the diseases that shows up in my family history, and is at least in part a disease of uncontrolled inflammation, is dementia. And I don't want that. Therefore--I take magnesium.

Another important factoid on magnesium supplementation: it helps prevent, and even reverse, bone loss in post menopausal women. Along with that fact, you should know that calcium supplementation doesn't appear to do squat for bone loss. See the abstract here. That paper discusses women on hormone therapy, but my inclination is to think that magnesium, not calcium, is the way to go if you're at risk of developing osteoporosis. Mrs. Green supplements, too.

Another paper I reviewed while writing this post makes a strong case that many of us are deficient, and had this to say about the consequences of that deficiency:

"Patients with so-called exclusion diagnoses (as for example,
attention deficit hyperactivity disorder (ADHD) or chronic
fatigue syndrome (CFS) would have their symptoms improved
through Mg therapy.—Similarly, patients with diagnoses of
depression, epilepsy, diabetes mellitus, tremor, Parkinsonism,
arrhythmias, circulatory disturbances (stroke, cardiac infarction,
arteriosclerosis), hypertension, migraine, cluster headache,
cramps, neuro-vegetative disorders, abdominal pain, osteoporosis,
asthma, stress dependent disorders, tinnitus, ataxia,
confusion, preeclampsia, weakness, might also be consequences
of the magnesium deficiency syndrome."

Yikes!

I routinely recommend magnesium supplementation for headache sufferers with great results. It's also in my arsenal for hypertension control (along with CoQ10, which I'll address soon), and the final icing on the (gluten free) cake: it helps you sleep better. And good sleep alone can do quite a bit for a tired soul. This article in the Huffington Post calls magnesium a "chill pill" and describes how it helps you deal with stress.

I'll get into some more of the supplements I take in the days to come. It's a short list, and I've already written about vitamin D, which is my favorite supplement, here and here. Magnesium, though, is a close second. They both have anti-inflammatory functions, and of course we sell them both here at Green Chiropractic. As an aside. it may be worth reviewing my post on supplement quality before you run off to your local mega-mart to buy any of this stuff...

But What About Potatoes?

With the whole no grain challenge I've been getting the same question thrown at me repeatedly: can I eat taters? And of course, the answer is far more than a simple yes or no. Let's have a look at the good, the bad, and the tasty when it comes to these tempting tubers.

Like usual, let's get the bad news out of the way first: potatoes will definitely spike your insulin levels, which is one of the same reasons I advocate avoiding grains. If you're trying to lose weight and get healthy, keeping your insulin levels low and your sensitivity to insulin high is the order of the day. Like I said in the grain post, you only have so much storage capacity for glucose (stored as glycogen in your muscles and liver), and when those cells are full the remaining is shuttled off to your fat tissue. One of the big problems with extra fat is that excess adipose tissue is full of cells that essentially pump out inflammation at an alarming rate, and many of the diseases of the West are diseases of inflammation that's gone unchecked for too long. Even the main stream media is finally getting the message that fat doesn't make you fat.

It's not all bad in tater town, though. Potatoes have a decent omega 6 to 3 ratio of about 4:1. Grains, for example are almost all omega 6, and an imbalance of fatty acids is one of the main culprits in producing a pro inflammatory body chemistry. When I give nutrition lectures I speak of the "three legged stool of healthy eating." Leg one: eat to control inflammation. One of the main ways to do that is to maintain a balance of omega fatty acids, and  since potatoes have a decent ratio they satisfy that leg of the stool.

Leg two is keeping your acid/base balance in check. Your blood Ph is slightly alkaline, and when you eat too much acidic foods like pretty much all protein sources, alcohol, caffeine, dairy, and especially grains, your body has to buffer the load back to alkaline. Fruits and veggies are, for the most part, alkaline, so the idea is that you should eat some protein (acid), and buffer with vegetation. And potatoes, my friends, are alkaline. For those keeping count, that satisfies two legs of the three legged stool. Foods that get this far are cheat foods in my book, and if you time an intense workout and a tater eatin' session just right you can even use the higher glycemic index of potatoes to your advantage.

Leg three, by the way, is keeping your insulin levels in check, which we've already discussed. Sneaky, huh?

When I eat potatoes I try to make it on days when I've worked out hard doing something intense like sprints. Other examples are lifting heavy weights or even your own body weight. The key is to burn the glycogen stores out of your muscles first, so the insulin surge you get when you eat a starchy carb will actually get it's job done without resorting to putting more fat in storage. High intensity exercise on a regular basis will also make your cells more sensitive to insulin so your pancreas won't need to work so hard in the first place. Check back in the near future for a series on exercise...

If I haven't done much working out on a tater eatin' night I try to eat small portion of potatoes in combination with a much larger amount of vegetables of the green variety, which can help modulate the overall glycemic impact. Sweet potatoes, by the way, are lower on the glycemic index than regular potatoes, which I find odd, since they contain the word "sweet" in their name.

So, potatoes. A two-legs-of-the-stool cheat food, and a post high-intensity workout food, too.

See? It's not all bad news around here! And if you have neck or back pain, give us a call at Green Chiropractic!