Understanding inflammation: Why you can't fix a diet problem with exercise

Most people are under the impression that they can eat whatever they want and just rely on exercise to undo the damage by creating a calorie deficit.  The problem is that weight gain is a fairly complex problem with many underlying issues, a caloric excess being only one of them.  Two of these issues that have garnered a lot of attention over the last few years are chronic inflammation and insulin resistance.    While 10 years ago one could argue that these two are only associated with one another and one doesn't necessarily cause the other, there is a significant amount of data that shows that they are associated with one another, that one does cause the other, and, ironically enough, they both reinforce one another(1).  In this blog we will look at how modulating inflammation through diet can help improve fat loss.

Before we start off, I feel it's important to point out the purpose of this article.  First off, if you begin to deal with inflammation but you still eat more calories than you burn, you will gain weight.  Calories do matter, period.  However, managing inflammation tends to decrease calories by improving hormonal signaling in the body.  The end result typically leads to a decrease in appetite and better fat burning through better hormonal signaling.

Second, inflammation isn't bad.  Inflammation is a good thing and is necessary to fight infection as well as improve athletic performance by allowing you to adapt to training.  However, high levels of inflammation or inflammation at the wrong time is very detrimental to performance and overall health.  An additional factor to take in to consideration is the current physiological state of the person, which can determine how much of a negative impact their food choices can have.  The purpose of this article is to give a clearer understanding of what paying attention to inflammation can do for you as well as providing context to when it is something that should become a concern.

For years epidemiological research showed an association between inflammation and insulin resistance but up until recently we had no idea how, or in which direction, it worked.  Does inflammation cause insulin resistance or is it the other way around.  Recent research has shown that increased levels of chronic inflammation signal insulin resistance in fat and muscle tissue, potentially to preserve glucose for the immune system.  I covered this very topic in a blog found here.  In addition, as chronic insulin resistance persists and the pancreas begins to create less insulin due to damage, more inflammation is created as the anti-inflammatory effect of insulin on the inflammatory FOXO1 gene decreases(1).  So not only does inflammation cause insulin resistance, over time insulin resistance will reinforce inflammation by creating more inflammation.  Leptin, a hormone that tends to be high in people with insulin resistance, is highly inflammatory.  So how does this relate to diet?

Certain foods can increase inflammation, particularly foods containing gluten, a storage protein found in wheat and other grains(2).  This in and of itself is not a bad thing.  In fact, an otherwise healthy individual with a healthy diet can probably have foods that contain gluten with little to no problem.  Maintaining a healthy gut microbiota promotes an anti-inflammatory effect that potentially counteracts the inflammatory effect from gluten.  A diet that promotes healthy gut flora and this anti-inflammatory effect tends to be highly diverse and contains a large amount of fiber from vegetables and fruit.  However, I don't believe many people pay attention to this and a high vegetable/low grain diet is certainly not the norm, particularly in people who think they are going to eat whatever they want and exercise it away.  Unfortunately, excessive exercise can make the problem worse by contributing to the inflammation and increasing hunger, or at the very least not allowing the immune system to repair the damage caused by the low quality diet.

So what should you take from this?  First, pay attention to the quality of your diet and shift away from focusing on calories in and calories out.  Second, make sure your diet is diverse and you consume a large volume of vegetables.  Third, if you choose to eat foods that are more inflammatory, your need for vegetables likely increases to counteract the inflammation.  Finally, understand that you cannot fix a diet problem with exercise and shift your approach accordingly.

The walking dead: Is American agricultural policy creating a legion of zombies that will eventually break the bank?

When most people hear the term "the walking dead", it conjures up the image of zombies running amuck in a post-apocalyptic world.  Legions of the brain dead undead doing the Frankenstein and looking to devour the brains of any live person within their grasp.  However, many of us know a different type of walking dead, one whose transition is far slower.  It may begin in their late 40s or early 50s as they lose track of where they put things or misremember things that have happened in their past.  Slowly but surely the zombification progresses until they no longer remember friends and family, eventually losing the ability to express themselves, understand a conversation, or even respond to the environment.  The walking dead I am referring to are people going through dementia and/or Alzheimer's disease.

While there is an enormous emotional price to having a loved one with dementia or Alzhemier's disease that can't be quantified, there is also an enormous price tag to go along with it.  In 2013 alone, the direct costs of Alzheimer's disease in the US was $203 billion and is expected to balloon up to $1.2 trillion per year by 2050(1).  Not included in this number is the unpaid care that family give to people with Alzheimer's disease, estimated to be $216 billion in 2012. 

Many people associate dementia and Alzheimer's as being a normal part of aging.  While it is true that Alzheimer's progresses with age, it is certainly not a normal part of aging.  With Alzheimer's comes structural changes within the brain, an accumulation of beta amyloid plaques and tangles in a protein called tau that interfere with normal brain function.  While these plaques and tangles tend to accumulate in everyone as they age, they accumulate to a far greater extent and in a consistent pattern in people with Alzheimer's disease.  Furthermore, quite a bit of research has recently pointed to dementia and Alzheimer's disease as autoimmune diseases.  This is evidenced by high levels of cells of the immune system called immunoglobulins(2) and other immune system proteins(3) in the brains of people with varying degrees of dementia, including Alzheimer's disease.

The brain is meant to be a sanctuary from immune activity.  The blood brain barrier prevents large particles such as bacteria and antibodies from entering the brain and causing problems.  Within the blood brain barrier are proteins called tight junctions that seal off the area and help regulate what can or cannot enter the brain.  These tight junctions are dissolved by a protein called zonulin(4, 5).  What makes this interesting is the fact that both the lungs and the gut also contain tight junctions, and zonulin has the same effect on the tight junctions in those tissues as well.  Intestinal permeability occurs when the tight junctions between cells of the intestine fail to prevent large particles from entering the blodstream.  It is believed that this is due to zonulin dissolving the tight junction.  Making this an even more intriguing relationship is that intestinal permeability appears to be a necessary component of many, if not most, autoimmune diseases(6, 7).

A recent study comparing the postmortem brains of people with Alzheimer's disease to healthy controls found the presence of an oral bacteria known to cause periodontal disease in 4 out of the 10 brains of people with Alzheimer's disease and none in the controls(8).  Many look at this as evidence of there being a link between periodontal disease and Alzheimer's disease, but if it were a direct link all of the samples of brain tissue from people with Alzheimer's would have it.  However, in a person with a properly working blood brain barrier, this bacteria should not have access to the brain.  This study supports the notion that a poorly functioning blood brain barrier is a significant causative factor in Alzheimer's disease.  Could this be the result of zonulin dissolving the tight junctions?  We don't know for sure, but there is ample reason to suggest so.

Many people are aware of gluten.  All you have to do is walk in to any grocery store and you get bombarded with gluten free this, or gluten free that.  While many people go gluten free, many have no idea what gluten is or why they are going gluten free.  One of the few groups who do know what gluten is are people with celiac disease.  Celiac disease is an autoimmune disorder that affects the intestinal lining.  When someone with celiac disease eats gluten or any other grain containing gliadin, damage occurs to their intestinal tract that causes pain and discomfort as well as malabsorption of nutrients.  This can eventually put them in a malnourished state.  Part of this response is due to the release of zonulin, which occurs when gliadin interacts with the intestinal wall and causes intestinal permeability..

However, in a study looking at the intestinal tissue of people with celiac disease and people without celiac disease, zonulin appears to be released in both scenarios, albeit for 30 times longer in people with celiac disease(9).  It appears that gut bacteria may have a big role in this as people with celiac disease have different gut bacteria than healthy people, and gut bacteria heal the tight junctions when they ferment soluble fiber and resistant starch in to butyric acid.  It is important to point out that these tissue samples were removed from people and then treated with zonulin, and were not tested in a living person.

So we have a potential mechanism for Alzheimer's disease where gluten is ingested and interacts with the cells of the intestine causing zonulin release that dissolves the tight junctions there as well as in the blood brain barrier.  This allows particles, including inflammatory ones, that shouldn't be in the brain to cross the blood brain barrier and react with structures within the brain.  This doesn't necessarily mean that anyone who experiences intestinal permeability will experience Alzheimer's disease, there are far too many factors to take in to consideration.  However, I tend to think that people can realize that the blood brain barrier is there for a reason.  Compromising the blood brain barrier is a bad idea whether you are genetically prone to Alzheimer's disease or not.  One of the problems is you wouldn't know if this was happening or not, there are no pain receptors in the brain so inflammation doesn't typically show up as pain, it shows up slowly as brain dysfunction over time.  Furthermore, inflammation compromises the blood brain barrier further.

So what role does American agricultural policy play in this mess?  It's very simple.  Every year the federal government gives subsidies to "farmers" to grow wheat.  I put farmers in quotation marks because most of the people receiving these subsidies are not family farmers, they are large corporations that do farming.  The USDA, a lobbying group for these corporate farmers, lobbies the federal government to get these subsidies and then distributes the money to farmers.  From 1995-2012, farm subsidies for wheat alone were $35.5 billion(10).  This is the reason it's cheaper to buy bread than it is to buy fruits and vegetables.  Most people assume it's because bread is cheaper to grow, but this is only the case if you are subsidizing it's production.

This seems innocent enough, the purpose of most lobbying groups is to lobby the federal government for the organizations they represent.  However, the USDA has another role.  Many of you are familiar with the Food Pyramid/MyPlate which dictates which foods you should be eating regularly.  The problem is that it's not written by a bunch of doctors commissioned to make Americans healthy.  It's written by the USDA, a trade group that helps determine which foods can be easily produced and which ones are most profitable.  There was no grand experiment decades ago to help determine the foods that are fit for human consumption and then translated in to a set of ground rules for healthy human eating.  The USDA stated what could be made and that became the contents of the Food Pyramid, which most people assume are a set of healthy eating rules.  To make maters worse, physicians and nutritionists in the healthcare industry push these rules as if that is exactly what they are.

The problem doesn't end there.  As many of you know, much of the nutritional research to date has shown grains, especially wheat, to be a healthy food option that leads to positive health outcomes.  However, this research is tainted because they essentially told everyone that grains are a healthy food choice without having the research to back it up.  If you tell a group of people that a certain food product is healthy, which people do you think are going to consume that product?  Typically, you are going to get people who are interested in being healthy.  This means they are interested in doing other healthy things like exercising, not smoking, getting quality sleep, and a host of other healthy lifestyle choices.  This throws off the research because on one side you have people who are doing everything right and on the other side you have people doing everything wrong.  If the side doing everything right is told that they should be eating grains and they do, it's not scientifically valid to compare the 2 groups.

As you can see, there is much to be frustrated about with the way we determine which foods people should eat.  When you make foods cheap, you make them more appealing to people and increase the likelihood that people will consume them.  This drives people to make the wrong choices, especially poor people who are on a limited income.  What people don't realize is that these foods really aren't cheap when you factor in the tax dollars needed to subsidize them and the potential health ramifications they can cause before they are adequately tested.  Grains, especially wheat, may be costing us money up front in the form of tax dollars as well as on the back end with the emotional and financial costs associated with Alzheimer's disease.  Many people will read this statement and say that there is no research that supports this notion.  However, just because there is no research directly linking the consumption of grains with Alzheimer's disease doesn't mean it's not true.  At one time the "research" pointed to the Earth being flat, that doesn't mean it was flat until the research showed it to be round.

Why Paleo? Endurance athlete edition

Call it Paleo, call it Primal, for the most part you see many in either lifestyle poo-pooing endurance activities as unnecessary.  Personally, I don't do endurance type activities because I really don't like doing them.  Perhaps if I was better suited to doing them I would, but I am not.  I also don't recommend clients do them unless they like to do them.  More than any other criteria, your physical activity should be something you like to do, that way you do it often.  However, I feel the Paleo and Primal crowds aren't using very good logic when they say endurance exercise is unnecessary.  Is slamming in to a 300lbs lineman necessary?  Is lifting weights at an explosive pace with terrible form necessary?  For the most part, any sort of physical activity that doesn't involve you trying to attain food or procreate is unnecessary, so why try to exclude a group just because their mode of exercise isn't your cup of tea?  Let's take a look at how the benefits of a Paleo diet translate in to performance benefits for endurance athletes.

Many people are confused with what a Paleo diet is and what it can do for them.  Part of this can be blamed on the original message insinuating that if a food wasn't consumed regularly by your ancestors then it wasn't good for you and part of it can be blamed on people currently pushing Paleo that don't really know why it works.  Paleo does not mean that any food or environmental factor that has come in the last X number of years is necessarily harmful, there are many examples to the contrary.  Olive oil and broccoli are relatively new and are great for health as evidenced by the ample clinical research supporting both.

One of the biggest examples occurred millions of years ago when some of our herbivorous ancestors climbed out of the trees and began scavenging on the DHA rich carcasses left by carnivorous land animals.  Organ meats rich in DHA provided a nutrient that is vital for human brain development, and is potentially one of the primary reasons we branched away from other primates and developed a much better brain.  If this had never happened, certainly it would be seen as missing out on something that was a complete game changer for life on the planet.

However, on the flip side, many critics also create a logical fallacy.  The fallacy on the other side of the fence is that since we have been eating something for the last 30,000 or so years that it is a healthy food.  Look at the diseases killing humans today: Diabetes, heart disease, cancer, and Alzheimer's disease to name a few.  Few of these diseases affect younger people, they are called chronic diseases of aging because you get them in your 40s, 50s, and beyond.  Since these diseases don't typically affect your ability to reproduce and don't kill you before you can reproduce, you can't logically assume they are healthy unless your goal in life is to live to the age of 30, have 3 kids, and then die.

So then why should you be eating a Paleo diet?  Let's take a look at the primary reasons, the proteins in grains, legumes, and dairy.  The proteins in grains(1), legumes and dairy are immunogenic, meaning they elicit an immune response.  In a healthy person without celiac disease this doesn't mean they are necessarily toxic.  Look at hay fever.  Pollen isn't toxic, it just elicits an immune response that gives you itchy eyes, causes you to sneeze and cough, and gives a headache.  Does that mean not being able to see or constantly sneezing is something you want to do all day long?  It would certainly affect your performance.  Ironically, seasonal allergies as well as most other autoimmune diseases are linked to intestinal permeability(2) and many resolve on a Paleo diet.

However, therein lies the problem with the immune response to the proteins in grains, legumes, and dairy; the symptoms can range from headaches to gastrointestinal flares to metabolic dysfunction and can affect any system in the body.  In fact, a lot of people have no idea they have this response until they completely remove them from the diet for a couple of months because their body has become adapted to the constant firing of the immune system and the low grade inflammation accompanying it.  However, there are quantifiable things going on in your body that you may not be aware of.

When these proteins interact with the intestinal wall, they can cause intestinal permeability.  Intestinal permeability is a fancy way of saying that your gut is leaking it's contents in to your bloodstream.  By releasing a protein called zonulin, proteins found in grains, legumes, and dairy(Especially gluten) may dissolve the tight junctions between the cells that separate the contents of your digestive tract from your blood.  This process is well known in people with celiac disease, but studies on intestinal tissue taken from healthy people indicates that it may happen in everyone who consumes gluten, it just takes longer to repair in people with celiac disease(3).  In addition, zonulin is known to regulate the tight junctions in the lungs(4, ) and blood brain barrier(5).  Since zonulin from the gut enters the circulation, this means it is free to interact with the tight junctions in these areas, potentially compromising brain and lung function by increasing their permeability to toxins.

This can lead to some pretty serious performance consequences.  Obviously poor brain or lung function will have a big impact on performance in endurance sports.  An increase in airway infections will also negatively impact training.  However, one of the bigger impacts has to do with glucose utilization and insulin sensitivity.

Lipopolysaccharide(LPS) is a component of the cell membranes of bacteria found in your gut.  When it enters your bloodstream, your body sense it is under attack.  As a result, your immune system fires off and produces inflammation that signals your muscle and fat tissue to become insulin resistant.  This spares glucose for the immune system to fight off the attacker, which isn't even really there.  In addition, your immune system signals your liver to start dumping glucose in to the blood to help provide more glucose to the immune system.  This is one of the reasons fasting blood glucose is high in diabetics, even if they haven't been eating carbohydrates.

Now think about that from an endurance performance perspective.  You train hard which empties out your glycogen stores and burns some fat, but when you recover and eat some carbohydrate from grains you fire off the immune system.  This causes your immune system to consume some of the carbohydrate you take in to fight off the infection caused by what you are eating.  In addition, your muscles and fat tissue become insulin resistant so they aren't getting the energy they need to get ready for your next training session until the immune system clears the mess you created with what you chose to eat.  Maybe performance isn't affected immediately because you consume so many carbohydrates, but over time you are causing progressively more damage to your digestive tract and metabolism by consuming more grains.  Couple that with the fact that you are training hard which will compromise your immune system further.  Also, if your liver is constantly called upon to pump glucose in to your bloodstream, cortisol may increase due to gluconeogenesis.  I think all of these issues warrant some attention from the endurance sport crowd given how hard they train and how many events they participate in annually.

Before I go, let me preface what I say with a caveat.  We are all different, each and every one of us.  Some of us may be able to eat dairy, some may not.  Some of us may be able to eat a lot of grains, some of us a few, some of us none at all.  Unless there has been a 2-3 month period in your life where you've completely abstained from grains, legumes, and dairy you have no idea whether or not they are affecting your health and/or performance.  That's why you should just give it a try, replace grains with dextrose, potatoes, or other tubers.  If you or anyone in your family has Type 2 diabetes, heart disease, get frequent respiratory infections, or experience any form of autoimmunity I would strongly suggest you look in to the Paleo diet, not only from a performance perspective but also for general health as these conditions are associated with intestinal permeability.