Spaghetti Squash with Red Sauce

Ingredients

4 medium boneless/skinless chicken thighs, chopped
1/4 cup of mushrooms
1/2 cup chopped broccoli rabe
1/2 cup chopped onion
1 medium tomato, chopped
1 medium spaghetti squash
1 yellow sweet pepper, chopped
1 1/2 tbsp olive oil
6 oz can of tomato sauce or 1 large tomato

Instructions

Place a little bit of water in a microwave-safe pie dish.  Place spaghetti squash in dish and stab with a fork all the way around.  Cook on high for 15 minutes, rotate it 1/3 of the way and cook for 7 minutes, and rotate it the rest of the way and cook for 7 more minutes.  Feel squash each time you rotate it, if it's soft it's done.  Take out of microwave, let cool, drain water, and cut in half length-wise.  Take out seeds and guts and scrape the inside with a fork, it should come out the texture of spaghetti. Heat a cast iron skillet on medium high and add olive oil.  Once the oil heats, brown the chicken and then add the rest of the vegetables minus the tomatoes and tomato sauce.  Cook until vegetables are tender, then add tomato and sauce and cook for 5 more minutes.  Serve over spaghetti squash.

Nutrition info

Serves2
483 cals
24g fat
36g carbs
8g fiber
35g protein
1413mg potassium
1039mg sodium

Plantain Chips

Ingredients

1 medium Plantain, as green as possible(Yellow plantains won't slice well)
1 1/2 tbsp coconut oil
Approximately 1/2 tsp of garlic powder

Instructions

Preheat oven to 425 degrees.  Peel plantain by cutting off both ends, scoring length wise, and removing peel.  Slice plantain in to discs with a mandolin slicer to about 1/8 of an inch.  Heat up coconut oil and pour over plantains in a dish, sprinkle with garlic powder.  Space discs out on a cookie sheet and bake at 425 degrees for 7-9 minutes. Remove when browned on edges and salt to taste.  Serve with spicy mustard.

Nutrition info

Serves 1
234 cals
10g fat
38g carbs
3g fiber
1g protein
555mg potassium
121mg sodium including 4 tsp of mustard, more if you add salt

Sausage, Peppers, and Fingerling Potatoes

Ingredients

5 large hot sausage links
1 large onion
1 green pepper
2 red peppers
24 oz fingerling potatoes
6 oz can of tomato sauce or 1 large tomato

Instructions

Slice onions and peppers and slice fingerling potatoes in half lengthwise.  Slice sausage in to 1-2 inch lengths and brown in a cast iron skillet.  Place all ingredients in a crockpot and cook on low for 5-6 hours.

Nutrition info

Serves 3
461 cals
12g fat
60g carbs
7g fiber
30g protein
1776mg potassium
1123mg sodium

Sausage and Brussel Sprout Hash

Over the next few weeks I'm going to be putting up some of my go-to recipes.  This week we start with my favorite breakfast: Sausage and Brussel Sprout Hash.

Ingredients

2 slices of bacon
2 small breakfast sausage links (Pork or chicken)
2 large brussel sprouts
1 large carrot (7" long)
1 parsnip (9" long)
1 large sweet pepper
Oregano, basil, savory and marjoram to taste

Instructions

Shred all vegetables in a food processor.  Slice bacon length-wise and cut in to small squares.  Place chopped up bacon in a cast iron skillet on low heat.  Shred all vegetables in a food processor.  Chop sausage in to bits and place in skillet once bacon begins to get crispy.  When sausage is browned season pan with spices, heavily with oregano and lightly with basil, savory, and marjoram.  Stir seasonings in oil and let heat up for a minute or two.  Dump shredded vegetables in to skillet and stir well until meat, veggies, and spices are mixed well.  Increase heat to Medium-Low and cover for 10-15 minutes.  Uncover and stir occasionally for another 10 minutes.  It's done when the vegetables are just short of mushy.

Nutrition info

Serves 1
406 calories
21g of fat
38g of carbs/9g of fiber
19g of protein
1168mg potassium
908mg sodium

Does gluten sensitivity exist?

Last week, articles took the internet ablaze questioning whether gluten sensitivity exists.  Multiple articles written by multiple people claimed gluten sensitivity doesn't exist, including this one titled, Researchers who provided key evidence for gluten sensitivity have now thoroughly shown that it doesn't exist.  These articles take a look at a study published last year that had some very interesting findings, they just didn't find that gluten sensitivity doesn't exist.  In fact, it found the opposite, that it does exist.  However, the study raises questions on those who see improvements in GI symptoms on a gluten free diet.  Those findings are:

• Gluten may not be the primary trigger in grains that induces GI symptoms in susceptible individuals
• Most of the people who improve on a gluten free diet may be responding to reduced FODMAPS and not less gluten
• Gluten sensitivity is poorly defined and the criteria for diagnosis is terribly inaccurate

Let's take a look at the study to see what we can pull from it.  The study happened in 2 parts.  In the first part, the authors followed 37 people with non-celiac gluten sensitivity(NCGS) and IBS but not Celiac disease through 3 different diets that followed 2 weeks of reduced FODMAP intake.  FODMAPs are fermentable carbohydrates that humans cannot digest but resident bacteria in the digestive tract can.  The 3 diets contained either gluten only, gluten and whey, and whey only and each person underwent each diet for 1 week.  They tested the subjects for intestinal inflammation and immune system activation as well as a subjective assessment of fatigue.  In this part of the study, gluten specific effects were found in 3(8%) of the participants, and symptoms improved during reduced FODMAP intake but worsened when gluten OR whey were introduced in subjects.

In the second part of the study, 22 subjects were given diets that increased FODMAP intake and included either gluten, whey, or no additional protein for 3 days and subjectively assessed for GI symptoms.  All subjects received all 3 diets.  This part of the study found that GI symptoms increased by similar levels in all groups with no specific response to gluten.  However, there was an order effect which means that the order that a person received each diet had an effect on the results.  In other words, people who received the diet with gluten first all had similar results to one another but different results than people who had whey or no gluten first.

So what does this study show?  First off, this study supports the notion that NCGS exists, but that only a small number of people who respond positively to a gluten free diet are responding to lower gluten exposure.  Instead, they may be responding to a reduction in FODMAP intake.  But what does that mean?

First off, NCGS is poorly defined.  To be diagnosed with NCGS you simply have to have symptoms of gluten sensitivity, not have celiac disease, and see an improvement in your symptoms with a gluten free diet.  So anyone who has IBS or other GI problems who responds positively to removing gluten qualifies.  There are 2 problems with this.  The first problem is that a gluten free diet can mean many things.  For some people it means removing grain-based foods, for others it means removing the gluten from grain-based foods.

If the culprit is specifically gluten, either one should work.  The problem is, if it's not gluten and as this study suggests FODMAPS that are the problem for most people with GI symptoms, removing grain-based foods would be a successful approach while consuming grain-based foods with the gluten removed would have little effect since they would still contain FODMAPs.  But why are FODMAPs a problem?  The answer potentially lies in something called small intestinal bacterial overgrowth, or SIBO.

SIBO is a condition where bacteria overgrow in to the small intestine.  While the large intestine houses a large number of bacteria, the small intestine houses far fewer in comparison.  When an excessive amount of this bacteria begins to take up residence in the small intestine, people experience the same IBS symptoms associated with NCGS.  In fact, some studies put the number of people with IBS who also have SIBO at approximately 80%(1, 2).  Furthermore, those who eradicate SIBO see dramatic improvements in their symptoms(2).  While there is a simple test for SIBO, the authors of the study did not test for it.  This is ironic since FODMAPS should exacerbate SIBO and IBS symptoms by providing substrate for bacteria that make their way in to the small intestine to ferment, causing bloating and gas.

The second problem that was not tackled directly in this study was gluten sensitivity that presents with symptoms outside of the GI tract.  Though gluten sensitivity and Celiac disease are both associated with GI symptoms, Celiac disease presents itself most typically with symptoms outside of the GI tract(3) and gluten sensitivity often presents itself with neurological symptoms and no GI symptoms(4).  The brain is one of the most common sites for symptoms related to gluten sensitivity including headaches, brain fog, vertigo, and more(3).  This study only looked at people with symptoms of IBS and suspected gluten sensitivity and left out people who may fit the criteria of gluten sensitivity with no GI symptoms.  So people who see relief from vertigo, headaches, rashes, or any other manifestation of NCGS without IBS were not included in this study so the results don't pertain to them.

So what can we pull from this study?  In the majority of people with symptoms of IBS and self-diagnosed gluten sensitivity, their GI symptoms may be caused by FODMAPS and not gluten.  This does not rule out that they are sensitive to gluten as gluten sensitivity can present itself with symptoms outside of the GI tract, and it certainly doesn't rule out the existence of gluten sensitivity in the population since the study showed 8% of the subjects had gluten specific effects.  The good news here is that a large chunk of people who think they are sensitive to gluten may have SIBO which is something that can be improved with a low FODMAP diet.

On the other side of the coin, people who eat a gluten free diet that contains grain-based foods with the gluten removed who still experience GI symptoms may want to look at reducing FODMAP intake as well.  Dropping grains altogether as well as legumes and a few other fruits and vegetables for a brief period, as is seen in the specific carbohydrate diet, may fix the problem if SIBO is the culprit.  Once the issue is fixed, a normal diet can resume.

Conclusion

Most of these articles professing that NCGS doesn't exist are sensationalizing the research that they use to try and support their preconceived notion.  This study showed that most people who have self-diagnosed themselves with NCGS based on symptoms of IBS are not experiencing GI symptoms due to gluten.  This is backed up by a study published earlier this year that found that only 1 in 4 people who self-diagnosed themselves with NCGS fit the criteria for diagnosis(5).  Oddly the author of the article mentioned at the beginning of this blog took that as evidence that gluten sensitivity doesn't exist, which isn't the case.  It doesn't surprise me that most people who self-diagnose themselves with gluten sensitivity don't have it.  I'd imagine most people who self-diagnose themselves with aggressive colon cancer on WebMD don't have that either.

If you learn anything from this study, it's that you should see a doctor rather than self-diagnose yourself with anything.  Another thing you should pick up from the hoopla surrounding these articles based on a study is that the authors are trying to get clicks, they're not trying to be accurate.  The title Gluten sensitivity doesn't exist is likely to grab more attention than Gluten sensitivity exists but maybe less than we thought because it will grab the attention of both people who have already decided it doesn't exist and people who have benefited from a gluten free diet.  More clicks equals more $$$.  It doesn't help that so few people even check the sources these authors cite in their work.

The final thing you should take home is that we are in the embryonic stages of gluten research, a knee jerk reaction based on a few bloggers' incorrect opinion of a study that didn't show what they say it showed isn't going to change the science.  All it does is give you an incorrect opinion that goes against what the research and MDs working in this field are seeing on a day to day basis.  Spreading it on social media without checking that it's accurate only increases the confusion and doesn't do a service to anyone.

As the research progresses I'm sure there will be further refinement since the criteria for diagnosis is so crude.  This means that some people who are undertaking a gluten free diet may learn that gluten isn't a problem and their issue may be a much simpler fix that will allow them to eat foods they thought weren't right for them.  I don't see how that's a bad thing, even if you don't want to eat gluten regularly I don't see why having the option is something you should preoccupy yourself with.  On the flip side, if you don't believe gluten sensitivity exists, why not pick up some peer reviewed journals and read them?  The internet isn't peer reviewed so any yahoo with a computer can print something and send it out to cyberspace, I'm living proof of that.  :)

Confused about gluten?  The dude who is the go to guy on gluten research just wrote a book that I referenced in this article and it clears up a lot of the confusion about the research.  Take a look...

Gluten Freedom by Dr. Alessio Fasano

Understanding stress: Adaptation to stress

In my last blog I discussed the autonomic nervous system and how the 2 primary branches within it, the sympathetic and parasympathetic branches, prepare the body to deal with stress.  The sympathetic branch acts to mobilize resources to deal with a stressor while the parasympathetic branch works to help the body recover from a stressor so that it can be prepared when the next one comes.  The 2 branches work in concert with one another, albeit in antagonistic fashion, to make sure you are prepared with whatever the environment has to throw at you.  In this blog we will go over the effects of chronic stress and things you may be doing in your life that can exacerbate stress.

To help explain how the animals, including humans, adapt to stress, Dr. Hans Selye developed the general adaptation syndrome seen below.

This figure depicts the 3 phases of adaptation to stress and how an individual's resistance to stress changes over time.  In the first phase, Alarm Reaction, a stressor is experienced and the initial reaction is a decreased resistance to stress.  This is because the stressor startles the person experiencing stress, but this changes very quickly, in the blink of an eye.  In an instant, the sympathetic branch swings in to action to prepare the individual to deal with the stressor leading in to the second phase, Resistance.

During the Resistance phase, the individual has an increased resistance to stress as the sympathetic branch places them on high alert.  If the stress ends before resources are depleted, the parasympathetic branch will begin to swing in to action to help the person recover the resources used during the resistance phase.  You don't typically run in to problems unless the stress is unabating.  Eventually, if the stress is not resolved, the individual will enter the exhaustion phase which leaves them at a reduced ability to deal with stress.  This is where they are forced in to a parasympathetic state.

Now, given the name General Adaptation Syndrome, you may be able to figure out that this is the way the body responds to all stress.  In other words, even if you are able to defeat one stressor, all of the other stress that you are under can still force you in to the exhaustion phase.  In addition, whether the stress is physical or psychological is irrelevant, this same process occurs whether you are fighting off a lion or fretting over whether you can make your mortgage. This system is optimized to work with stress being experienced intermittently, it doesn't work so well when stress is chronic and never-ending.

Given what we know about the 2 branches of the autonomic nervous system and looking at the General Adaptation Syndrome, you can see that being in a sympathetic state day in and day out is not a good place to be.  Eventually your resistance to stress will tank and the slightest stress will set you off and force you back in to the exhaustion phase until you accumulate enough resources to deal with another stressor.  Since the pressures of work and life tend to accumulate very easily, it becomes important to make sure you take the time to incorporate some activities that activate the parasympathetic branch of the autonomic nervous system to help your body recover from the rigors of daily life.

Most people are familiar with the benefits of exercise so they often undertake programs such as weight training, distance running, or some other physically demanding activity to keep healthy.  The problem is, these activities are sympathetic branch activities so they add to sympathetic activity.  There are countless benefits to exercise, so I'm not suggesting you avoid it.  What you should do is incorporate other activities such as yoga, stretching, massage, foam rolling, meditation, or even steam room/sauna heat therapies that increase parasympathetic nervous system activity to help you manage your stress by increasing your stress resistance.

Other lifestyle factors can also have a big impact on your ability to deal with stress via the autonomic nervous system.  Sleep is crucial to helping your body recover from and deal with the stress of everyday life.  One not so obvious activity may also have a pretty significant impact on your ability to deal with stress: Reducing sedentary time.

While you may think of sitting down as a parasympathetic activity, which it is, the issue is actually a little more complicated than that.  While you want to incorporate parasympathetic activities to help you deal with stress, your perception of stress is equally important.  Recent research in inactivity physiology has identified changes in the brain that are associated with a sedentary lifestyle.

In studies done in rats, researchers have shown that high levels of sedentary behavior lead to changes in the brain in an area important to the regulation of sympathetic nervous system activity, the rostral ventrolateral medulla(RVLM)(1).  High levels of inactivity are associated with increased branching of neurons in the RVLM that increase sympathetic nervous system activity(2).  This increased branching of nerves would theoretically increase sympathetic nervous system activity for a given stressor and likely lower the threshold at which sympathetic nervous system activity is increased leading lower stress resistance and a shorter time to the exhaustion phase.

This shows that the relationship between stress and health is not about keeping stress as low as possible, but more about experiencing a sweet spot for stress that is neither too low nor too high.  This means that you want to balance activities between sympathetic and parasympathetic activity dominant, not drop sympathetic activities as low as possible while increasing parasympathetic activities as high as possible. This means that most people will have to increase parasympathetic activities such as yoga and meditation while reducing stressful activities through stress management and potentially even reducing intense exercise in Type A personalities, but not always.  The important concept to grasp here is to find balance between the two.

Understanding stress: The autonomic nervous system

Over the last 2 blogs I have gone over stress and how it affects the body.  Stress is one of those things that many people have heard about and few understand.  Over the course of the next couple of blogs I will break down how stress is handled and things that we do in our lives that can lead to mismanagement of stress.  First, to get a better understanding of how stress affects the body, it's important to understand a part of your peripheral nervous system that controls mostly involuntary functions such as heart rate, breathing rate, bood pressure and digestion called the autonomic nervous system.

Autonomic Nervous System 101

The autonomic nervous system is the control center of your vital organs.  It helps prepare the body for the environment it 's in by directing resources to the most pressing needs.  It does this through it's three branches: The sympathetic, parasympathetic, and enteric branches.  It used to be broken down in to the sympathetic and parasympathetic branches until it was learned that the enteric branch, which controls the digestive system, can function without assistance from the parasympathetic branch.  Since we know very little about the specifics of the enteric branch outside of how it's controlled by the sympathetic and parasympathetic branches, we'll simply consider those 2 branches.

The sympathetic branch of the autonomic nervous system is also referred to as fight or flight.  When sympathetic nervous system activity increases it diverts blood flow to muscles and away from the organs of digestion, increases heart rate and blood pressure to increases oxygen to muscles, and mobilizes energy for use to either fight or flee a stressor.  The parasympathetic nervous system directs blood flow away from muscles and towards the organs of digestion while decreasing heart rate and blood pressure.  The parasympathetic nervous system is referred to as rest and digest.  The picture below shows the primary functions of each branch.

Looking at this figure, it would be easy to think of the 2 branches as being antagonistic to one another, but that isn't the whole story.  While the effects of increased activity of each system is antagonistic of the other, they are actually complementary to one another in the grand scheme of things.  While fight or flight allows you to battle a stressor in the environment, rest and digest allows you to recover from that stressor and be prepared for the next.  In this way, proper function of one branch is dependent on proper function of the other.


The sympathetic and parasympathetic branches also have other effects throughout the body, but they are much more nuanced.  During the initial stages of increased sympathetic nervous system activity, the immune system is enhanced, but if sympathetic nervous system activity is increased chronically, it has a depressive effect on the immune system.  This is thought to be one of the processes underlying the increased inflammation found in the metabolic syndrome and heart disease.  In the reproductive system, increased parasympathetic activity promotes erection while increased parasympathetic activity induces orgasm.

At any time, most people are at varying degrees of both sympathetic and parasympathetic activity.  The autonomic nervous system doesn't function in an on/off manner; when sympathetic nervous system increases it doesn't completely shut off parasympathetic activity.  Instead, they are both typically activated to some degree with increased sympathetic activity typically causing a decrease in parasympathetic activity and vice versa.  Under extreme circumstances in either direction, one can  basically be forced in to the other due to dysregulation in the system.  In other words, if someone is under constant, unabating stress that is never recovered from due to poor parasympathetic "tone", they will be forced in to a long term parasympathetic state.  In converse, someone who completely removes stress and physical activity from their life is likely to see a lowered threshold for activating the sympathetic nervous system.  In other words, things that pose a minor threat are handled as major ones.

Conclusion

The autonomic nervous system is comprised of three branches with opposing, but complementary, functions that allow us to adapt to the environment we are in.  Increased sympathetic activity prepares the body to respond to a stressor while increased parasympathetic activity helps the body recover from it.  Under normal circumstances, the sympathetic and parasympathetic nervous systems work together to help you respond to the world you live in.  Under extreme conditions, the autonomic nervous system can become dysregulated making the individual's response to the environment exaggerated and maladaptive.

In my next blog I will go over how lifestyle factors can contribute to dysfunction in the autonomic nervous system.

L-Carnitine, red meat, and heart disease

In a recent article that hit most every newsroom last week, red meat kills people again.  Here is a link to one of the articles (1) and here is a link to the actual study (2).  The headlines that hit the newsstands were along the line of, "Red meat increases heart disease!" and things along that nature.  If the rate that nutritional information does a flip flop doesn't normally give you vertigo, it will today.  In an article published less than a week later, researchers note that an increase in L-Carnitine is protective in people who have just experienced a heart attack (3).  Before I show you why you should not rely on the news media to dictate your lifestyle choices, let's look at what each study showed.

In the first study, researchers compared the effect of L-Carnitine supplementation between meat eaters to non-meat eaters.  In meat eaters, bacteria in the gut fermented L-Carnitine in to TMAO, a chemical known to accelerate atherosclerosis while this effect was non-existent in non-meat eaters.  Since L-Carnitine is high in red meat, researchers believed that constant red meat consumption led to changes in gut flora that promotes an environment beneficial to creation of TMAO.  So, excessive red meat consumption leads to higher levels of bacteria that convert Carnitine to TMAO and this can increase atherosclerosis.  Check!

The second study was a meta analysis (Large study evaluating many studies) and found that using L-Carnitine was beneficial in the recovery from a heart attack.  People who used L-Carnitine were less likely to die from any cause, were less likely to experience arrythmia, less likely to experience angina, and had smaller infarct size than those who did not use L-Carnitine.  So, Carnitine conveyed a benefit to the person using it, specifically for heart health.

These 2 contradictory studies highlight a couple of problems.  First, the headlines that state, "Red meat increases heart disease" are wrong.  Having a specific type of gut flora that may be found in meat eaters would indicate you shouldn't take L-Carnitine supplements.  If you don't eat tons of red meat you are unlikely to have gut flora indicative of the people in this study that had a problem with TMAO.  Next, by looking at the study we can find the limitations of what the study can say.  One thing of note was that this study did not control for veggie intake.  What if the benefit of being vegan wasn't that you are not eating red meat, but that vegetable intake is high?  A meat eater that eats a lot of vegetables would have very different gut flora than a meat eater who eats none.  Maybe the vegan diet is beneficial because of the high vegetable intake, not because of a lack of meat.  This is one of the reasons the Synergy Wellness Program recommends a large diversity of foods.  A larger diversity of foods allows the bacteria in your gut to be diverse, preventing pathogenic bacteria from being able to grow to a capacity that could impact your health.

One of the problems with getting your science information from the popular press is that they seem to ignore what a study shows as well as the limitations study design put on what you can extract from a study.  When you see an article that one week shows coffee to be bad for you, then the following week find one that says it's bad for you, more often than not the problem isn't that the data is conflicting it's that people are ignoring the fact that certain types of data are not appropriate for drawing conclusions.  Even when the data is appropriate, the title of the article is meant to grab your attention, not be scientifically accurate.  Keep this in mind whenever you are looking at "science" in the popular press.

Physical warning signs of chronic stress

In my last blog I went over the relationship between chronic stress and heart disease.  One of the key products of chronic stress is chronic inflammation, which can take a toll on the body.  In this blog I will go over some of the ways that chronic stress can manifest itself in the body.

1)Tight muscles

Stress has a pretty significant impact on the musculoskeletal system.  The purpose of the stress response is to mobilize energy and prepare the body to deal with whatever stressor you encounter.  One thing that happens during this process is a tightening of your fascia.  The fascia is integrated throughout your body and helps muscle transmit movement from muscles to bone.  When you encounter a stressor, this allows you to create more tension in the musculoskeletal system which allows you to generate more force.  The problem is, stress is meant to be acute, not chronic; and psychological stress initiates the same stress response as physical stress.  This causes increased tension in the muscles that, in chronic stress caused by psychological issues, never gets used and causes increased tightness.  One of the best things you can do in this situation is have a foam rolling and stretching program to pull some of this tension off of the musculoskeletal system.  My foam rolling and stretching program videos can be found here and here.

2)Impaired immunity

The immune system and stress response system both prepare you for threats, the only difference is that the immune system prepares the body for threats within body while the stress response system prepares you for threats outside the body.  In the initial stages of acute stress, their is actually a slight increase in immune function.  Once stress becomes chronic, your body is preparing you to deal with a perceived threat from outside of the body so to do this, resources that you don't need such as immunity are put on hold until the stress is over.  If you find yourself getting sick often or taking an unusual amount of time to recover from sicknesses or even workouts, chronic stress may be compromising your immune system.

3)Impaired sleep

Sleep is one of the more important things a person can do.  Unfortunately, a lot of people don't sleep very well either because they are overstressed or they don't prioritize their sleep.  This is a double edged sword because poor sleep actually increases stress and decreases the threshold at which the stress response is activated.  People who are experiencing a lot of stress have a problem shutting down their brain prior to bed and can have a difficult time falling asleep or staying asleep.  When you sleep your brain does it's job of housekeeping by cleaning up debris, so prioritizing sleep should be at the top of your list.  A common manifestation of too much stress/too little sleep is twitching of the eyelids.

4)Impaired digestion

Doctors have known for years that there is a significant link between IBS/IBD and stress.  The autonomic nervous system is a part of the nervous system that is in charge of automatic processes such as breathing, heart rate, immunity, and digestion.  It's job is to select the resources that are most appropriate for the task at hand  and direct attention to them while dampening attention to the others.  While experiencing stress, this means shifting attention to the musculskeletal system and away from digestion and immunity.  As stress becomes chronic, these systems remain shut down and this can cause things like digestion to become compromised.  If you are being chased by a tiger, you don't need to digest your food, you need to mobilize energy and send it to your muscles, digestion can wait until the stress is over.  In chronic stress, the stress is never over.  To add further fuel to the fire, it appears that the bacteria within your gut can have a significant influence over how the autonomic nervous system works.  This means that not only does stress affect your digestive system, your digestive system can affect how you perceive stress.

5)Grinding your teeth or clenching your jaw

Grinding your teeth while awake or clenching your jaw is often associated with chronic stress/anxiety.  The science isn't really clear on the relationship between grinding your teeth while you're asleep and stress.  Many people who do this do not know they do it until they experience tooth pain or their dentist tells them they are wearing down their enamel.  Another sign that you may be doing this is if you frequently bite the inside of your cheek or lip.

Conclusion

Chronic stress can manifest itself in many ways.  Many people who are experiencing chronic stress may not even know they are experiencing it because it has become such a permanent part of their lifestyle.  Once you understand that you are under chronic stress, steps to manage stress can help improve your health and well being.  These steps include stretching, Yoga, meditation, and lifestyle modification that identifies avoidable stressors and attempts to limit them.

New study sheds light on the connection between stress and heart disease

A new study in the journal Biological Psychiatry has identified a link between chronic stress and heart disease, and you may not be surprised to learn that this link is inflammation.  The study looked at activity in a part of the brain that helps to regulate emotion called the dorsal anterior cingulate cortex(dACC) and levels of inflammation in the body.  The researchers found that increased activation of the dACC led to higher levels of the inflammatory molecule IL-6 and these higher levels of IL-6 corresponded with more plaque accumulation on artery walls.  Let's take a look at what all of this means.

To fully understand what this means, we first have to discuss something that is regulated by the dACC called cognitive reappraisal.  Cognitive reappraisal is a method of regulating the emotional response to stimuli.  If this sounds familiar, it's very similar to what one tries to achieve while practicing mindfulness meditation.  The problem is, cognitive reappraisal can be either positive or negative.  If a stimulus causes enhanced activation of the dACC but this emotion does not make it to the amygdala to generate an emotional response, that's a positive thing.  If a stimulus continually activates the dACC but also activates the amygdala constantly, that leads to a constant emotional response and chronic stress.

In this study, they found that constantly reappraising a stressful situation caused increased activity in the dACC which increased inflammation.  Since this area of the brain helps control many autonomic processes, it's not surprising that activation of this area of the brain can modulate the immune response.  Furthermore, the dACC is associated with anxiety and OCD-type behaviors in so much that severing the area has been shown to benefit people with OCD not responsive to medications(1).

Obviously you shouldn't severe your dACC, but this study points to the importance of reducing stress and letting things go to reduce heart disease risk.  The increased level of IL-6, an inflammatory cytokine highly associated with heart disease and Type 2 diabetes, is likely a large player in the relationship between stress and health.  In my next blog, I'll go over some of the physical warning signs that you may be experiencing chronic stress.

The 2am low carb wake up call...

As the Paleo diet becomes more popular and people give it a whirl, it's important to understand that many early versions that were low carb presented problems for some people, especially people who were training hard in exercise modalities that primarily use glucose for fuel such as Crossfit.  One of the more common experiences under this scenario is waking up between 2am-4am, often times with heavy heart pounding.  This phenomenon can be explained and potentially remedied using what we know about blood glucose regulation and what I went over in my last 2 blogs found here and here on allowing the intestine to help the liver with blood glucose regulation.

Now, there is a simple fix, eat more carbohydrates; and you should probably do this over the long term anyway if you are training hard.  There is a solution that you can use during short term low-carb dieting to lose weight or if you want to stick to a low carb diet over longer periods.  But first, let's take a look at what may be happening to wake you up.

The modern Western diet, being high in carbohydrate and low in fiber, relies heavily upon the liver to regulate blood glucose levels.  While it is pretty good at doing it's job, not providing carbohydrates to help it do it's job can make blood glucose regulation difficult.  To help your liver keep pace, glucagon and epinepherine levels rise in the blood to communicate to the liver that it needs to release some of the glucose it stores as glycogen, provided it has stored up enough glycogen from the carbohydrates you consume and made enough glycogen from non-carbohydrate sources.  But what happens if there is not enough glycogen stored in the liver to keep blood glucose above the critical level?

When you are up and moving around, muscles break down glucose in to lactate that the liver can use to make glucose via a process called the Cori cycle.  This likely contributes to blood glucose regulation while you are awake.  The interesting thing here is that epinepherine, more commonly known as adrenaline, causes muscle to break down glucose in to lactate and activates the Cori cycle(1).  As you may know as well, adrenaline also rapidly increases heart rate and the force of contraction of the heart.  Could the 2am low carb wake up call be due to blood glucose levels dipping too low and the adrenals correcting this issue by secreting epinepherine?  This could certainly explain why people get woken up and experience a pounding heart.  If this is the case, there is a simple correction that should remedy the situation.  Remove some of the burden of blood glucose regulation on the liver by allowing the intestine to participate.  In other words, increase your fiber intake.

Most Americans get less than 20g of fiber per day and a person who is undertaking a low carbohydrate diet likely gets less if they are avoiding vegetables.  Bumping this number up to 60g or more could potentially help a person who wishes to maintain a low carbohydrate diet not have to worry about large drops in blood glucose.  Optimally the fiber would come directly from the diet, but you could also take a fiber or resistant starch supplement to get your daily fiber intake up.  Many people are taking Bob's Red Mill unmodified potato starch as a supplement to increase fiber intake, just start with a low dose and space out your intake throughout the day to prevent gas.  You can work up to 4 tbsp per day which adds approximately 32g of resistant starch/fiber per day.

It may take a while to see significant improvements, especially in people who may not have a large amount of bacteria that ferment fiber/resistant starch in to the short chained fatty acids that help the intestine participate in blood glucose regulation.  Be persistent and, most of all, pay attention to what your body is telling you.  Gas tends to be a good thing, but if it becomes painful or smells putrid you may have to take it slower.

Evolution and diabetes part 2: Blood glucose regulation by ancestral humans

In my last blog I went over a study that casts some doubt on the notion that the liver is critical for blood glucose control.  In this study, they found that mice who had their liver blocked from contributing to blood glucose control adapted by shifting that duty over to the kidneys and intestine(1).  The assumption that the liver is king as far as blood glucose control is a fairly widely held concept due to the fact that it can store 100g of glucose and produce glucose from non-carbohydrate sources.  The problem arises when you take in to account that easy access to carbohydrates is a fairly recent phenomenon.  Taken together with other scientific evidence, it appears that the intestine should likely play a larger role in blood glucose regulation than it does today, and the modern diet prevents this from happening.

In this study the kidneys took on a much larger role in blood glucose regulation during times of fasting as the gene crucial for blood glucose regulation increased in expression.  The intestine also saw an increase in expression of this gene, but the total expression of this gene was 50x greater in the kidney.  These results may understate the importance of the intestine in blood glucose regulation, especially in the non-fasted state.

When you compare the diet of ancestral, pre-agricultural humans to that of today, one glaring difference is the fiber content of the diet.  Today, the average human diet contains less than 20g of fiber per day.  In his book The Story of the Human Body, Dr. Dan Lieberman's assessment of the literature points to the consumption of 100-150g of fiber per day by pre-agricultural humans.  This number is in line with what previous research has shown(2) as well as Jeff Leach's experience living with modern day hunter gatherers.  While the difference in fiber intake may not seem important when you consider humans don't absorb fiber, when you look at what it does to the microbiome and the effect it has on blood glucose regulation you can see that it is likely very important.

When bacteria in the intestine break down fiber, they make short-chain fatty acids(SCFAs), specifically butyrate and propionate.  Both of these SCFAs promote intestinal gluconeogensis in complementary ways(3).  Gluconeogenesis is the generation of blood glucose from non-carbohydrate sources and it allows the intestine to participate in blood glucose regulation through the fermentation of fiber by bacteria in the gut.  Interesingly, when gluconeogenesis is shut off in the intestine, all of the metabolic benefits of a high fiber diet are lost despite having a similar microbiome.  So, in a population where people consume low amounts of fiber, the intestine likely has a negligible role in regulating blood glucose.  Ironically, in this population, blood glucose tends to run high.  In a population where fiber is consumed in large quantities, the intestine likely takes on a much larger role in regulating blood glucose.  In this population, blood glucose tends to remain low.  This is not the only piece of the puzzle, however.

There is another issue that arises when bacteria in the intestine don't ferment fiber in to butyrate.  Butyrate is the fuel of choice for cells of the colon(4), but they are able to metabolize glucose as well.  A problem occurs when there isn't enough butyrate for the cells of the colon(Colonocytes), they must rely on glucose as a source of energy(4, 5).  When colonocytes are provided enough butyrate, they break it down in to the ketone beta-hydroxybutyrate which can be further broken down for energy.  When there isn't enough butyrate, they are forced to metabolize glucose which colonocytes break down in to lactate.  Colonocytes cannot metabolize lactate so it is sent to the liver to undergo gluconeogenesis.  In a mouse model of colitis, this is how colonocytes metabolize energy(5).  Unfortunately, glucose is unable to provide enough energy for efficient  gastrointestinal function in this manner(4).

In addition to having an effect on gluconeogenesis by the intestine, SCFAs also stimulate secretion of a hormone called glucagon-like peptide 1(GLP-1)(6).  GLP-1 has several roles in the body, but of interest to our discussion is it's role in insulin and glucagon secretion.  Insulin lowers blood glucose by causing cells to take it in while glucagon causes blood glucose to increase by increasing gluconeogenesis in the liver, kidney and intestine as well as causing those organs to release glucose.  GLP-1 stimulates insulin secretion in a glucose dependent manner, when glucose levels are high GLP-1 stimulates more insulin than when glucose levels are low while it causes glucagon levels to fall independent of glucose levels.  It is worthy to note that carbohydrate consumption also causes GLP-1 to be secreted, but since carbohydrate consumption will cause blood glucose levels to rise, it will cause more insulin secretion than one would see going the fiber route.

People with Type 2 diabetes tend to have a large amount of insulin in their blood, but their cells don't respond to it because they have become resistant.  This causes their blood glucose to run high because insulin can't do it's job of lowering blood glucose.  Since glucagon increases blood glucose and runs high in Type 2 diabetics, it is believed that lowering glucagon levels can help correct the high blood glucose levels associated with the disease.  Metformin, the Type 2 diabetes medicine of choice, works by causing the liver to make less glucose, which causes the same effect as lowering glucagon.  GLP-1 and drugs that mimic it accomplish the same thing, are being used as pharmaceutical therapies, and the result is lower blood glucose levels(7, 8).

The positive effect of administering GLP-1 to improve blood glucose regulation brings up a few interesting questions.  Is the intestine a more important component of blood glucose regulation than we give it credit for?  Is bacterial fermentation of fiber in to butyrate the first step in blood glucose regulation given how important it likely was for blood glucose regulation in ancestral humans?  Finally, is administering pharmaceutical GLP-1 merely restoring an ancient signal from the intestine to the liver saying, "I have your back" with regard to gluconeogenesis and blood glucose regulation?  While we are unlikely to find answers to these questions any time soon, it is very interesting that higher fiber intake is very protective against Type 2 diabetes (9, 10, 11, 12).  Furthermore, people with Type diabetes tend to have more disturbances within the digestive tract than healthy people(13, 14) with the most common disturbance being constipation.

Between the evidence provided above and comparisons of the ancestral diet to our modern one, it seems likely that the modern diet may be presenting an environment that causes blood glucose to be regulated in a way that is not efficient for humans.  Our long history of high fiber consumption likely selected for people who were good at using the fermentation of fiber by resident bacteria as the first step of blood glucose regulation that involved the intestine to a much larger degree than it does today.  The modern diet puts a much larger burden on the liver to make and regulate blood glucose due to the high carbohydrate and low fiber content of the diet.  This provides less fuel to allow the intestine to participate in blood glucose regulation and may be a contributing factor to Type 2 diabetes and the increased occurrence of GI disorders associated with the disease.