6 important nutrients overlooked by athletes

Elite level athletes are always looking or an edge over their opponents.  Enhanced training or recovery modalities, better skill training, or better nutrition are all things an athlete can use to improve their performance.  When athletes look to nutrition, they are typically looking for something that they can take supra-physiological doses of in an effort to push their performance to the next level.  What they often neglect to do is look at nutrients found within a standard diet that are often deficient in those living a modern lifestyle.  In this blog I will go over 4 key nutrients that athletes should be paying attention to.

1)Vitamin D3 

Only 2 nutrients have receptors on every cell in the body: Thyroid hormone and Vitamin D3.  Research in to Vitamin D3 has uncovered quite a few physiological roles in the body, so many that the vitamin has been reclassified as a hormone.  Vitamin D3 is important for intestinal absorption of many minerals including magnesium, calcium, zinc, and iron.  Deficiency of any of these minerals can weaken the immune system, decrease muscular contractility, decrease insulin sensitivity and impact energy generation.  In addition to it's role in aiding absorption of these nutrients, Vitamin D3 also plays an important role in muscular contraction and a deficiency can lead to a decrease in performance(1).  Furthermore, sufficient Vitamin D3 levels also improve adaptations in Type II muscle fibers, the muscle fiber type associated with power sports such as tennis, football, and basketball(2).  The great thing about Vitamin D3 is that you don't need to focus on getting it from your diet.  The body makes Vitamin D3 when exposed to sunlight in the absence of sunscreen.  Most athletes should make a goal of getting their blood 25(OH)D above 50ng/mL.  This can be accomplished by getting between 20-30 minutes of sunlight in shorts and a T-shirt every day for a light skinned person.  Wearing more clothes or having darker skin tends to lower the amount of Vitamin D3 you absorb and many northern latitudes have time periods where you cannot get the necessary UV rays from the sun.  There is an app called D-finder that can help you optimize your sun exposure and Vitamin D3 levels based on many of the variables that affect Vitamin D3 status.

2)Magnesium

Magnesium is a mineral that is used as a cofactor for over 300 enzymatic reactions that go on within the body including energy generation, fuel storage, insulin sensitivity, and calcium regulation within muscle cells.  Despite being a nutrient critical to athletic performance, data on the performance benefits of magnesium is lacking with little to no effect found in some studies and a positive effect in others, with most of them suffering from several methodological failings(3, 4).  One of the biggest issues with these studies is that the predominant way that we measure a person's magnesium status is via serum magnesium even though 98% of the magnesium in the body is found within cells.  This would be like trying to measure the amount of gas in a car by looking at the amount in the fuel line, it doesn't work.  Cellular magnesium tests such as RBC magnesium are more valid because they measure magnesium where it is primarily found.  The reason magnesium is important for athletes is because strenuous exercise increases urinary magnesium excretion by up to 20% and sweating and stress also increase excretion(5).  Diuretics such as coffee also increase urinary magnesium losses.  For now, the key takeaway should be to ensure sufficient magnesium in the diet or through supplementation.  College athletes tend to get approximately 70% of the RDI(400mg for men, 310mg for women) of magnesium(4) and most Americans get around that level.  Foods that are high in magnesium are raw nuts, seafood, milk, seeds, bananas, potatoes, beets and leafy green vegetables.  If you supplement, magnesium citrate, glycinate or dimagnesium malate are preferred forms of magnesium since the oxide form found in most supplements is not very bioavailable to humans which could contribute to the lack of effect seen in studies.  While I mostly recommend getting nutrients from food, magnesium may be an exception as modern farming practices reduce the amount of magnesium in the soil and thus the amount that makes it in to crops.  At the very least you may want to overshoot on your daily magnesium intake if you choose not to supplement.

3)Pro/Prebiotics

Pro- and prebiotics are fairly new on the scene but have the potential to have a profound effect on the way an athlete performs by improving digestive efficiency, nutrient absorption, and modulating the immune system.  I went over some of these effects in the blog found here.  Eating pro-and prebiotic foods and limiting the amount of processed food you consume should be the target intervention here.  Under certain situations, probiotics may be a useful therapeutic tool but we are still researching the effect of individual strains of probiotic bacteria.  Even if a strain is useful, it's important to provide food for that strain in the form of prebiotics if your goal is to colonize your digestive tract with beneficial bacteria, although colonization isn't necessary for a positive effect.

4)Sulforaphane

Sulforaphane is an interesting nutrient.  Found in most cruciferous vegetables, sulforaphane activates the NRF-2 antioxidant pathway.  As a result, the body produces more glutathione which helps clean up free radicals and reduce oxidative stress(6, 7, 8) which in turn reduces inflammation.  Since free radicals are generated as a natural byproduct of aerobic energy generation, intense training, particularly endurance training, increases oxidative stress dramatically.  For a good rundown of oxidative stress and training/exercise, take a look here.  The best way to get sulforaphane is from cruciferous vegetables such as broccoli, cauliflower, brussel sprouts, spinach, and cabbage.  Broccoli sprouts are loaded with sulfurophane, about 50x more than found in regular broccoli(9).  Since the effects of sulforaphane last for a few days and cruciferous vegetables, especially raw ones, contain goitrogens that can interfere with iodine uptake in the thyroid, having a serving of cruciferous vegetables every other day is adequate to keep glutathione levels high without a significant effect on thyroid function.

5)Thiamin 

Thiamin is a B vitamin that is used heavily in energy metabolism.  I've gone over the ins and outs of thiamin here.  The takeaway is that anyone who relies heavily on the glycolytic energy pathways should make sure they get enough thiamin in their diet.  Many people who eat a low carbohydrate diet may feel that this doesn't pertain to them, the problem is that energy metabolism is activity specific, not specific to the diet.  So if you are in any sport that is explosive in nature, or that taps in to carbohydrate or lactic acid metabolism over the long-term, it's important to ensure adequate thiamin intake.  Thiamin also plays a crucial role in proper nervous system function and most of the diseases of thiamin deficiency lead to nervous system dysfunction.   Thiamin is also fairly important for the formation of myelin.  Thiamin can become depleted as a result of intense training and diuretics such as caffeine and alcohol can also deplete thiamin.  As mentioned in the blog, the most effective form of thiamin, allithiamine, is found in garlic and is fat soluble so it stands up better to cooking and is better absorbed from the digestive tract than the standard water soluble form of thiamin.  Eating garlic yields similar blood levels of thiamin as injecting the water soluble version.  If you aren't a fan of garlic, pork is also high in thiamin.

6)DHA

I've saved the best for last.  DHA, or Docosahexaeonic acid is an omega-3 polyunstaturated fat with many benefits.  In addition to its ability to activate the NRF-2 pathway that sulforaphane activates(10), it is a major component of myelin.  For those of you who have not read The Talent Code, myelin is the "insulation" that covers nerves that makes nerve conduction more efficient.  In the book, the author explains that neural circuits becomes hardwired through practice and this process is only possible through myelination of the nerves that help accomplish the task you are performing.  DHA is the most abundant fatty acid in the mammalian brain, likely through it's role in myelination, and improves speed of nerve conduction and neuroplasticity/neurogenesis(11).  DHA is an omega-3 fatty acid that can be found in fish, grass-fed beef, eggs, and organ meats.  As you would assume, brain tends to be very high in DHA.  For those of you not so daring, wild salmon has a very high DHA content.  While flaxseeds are considered to have a high level of omega-3 fatty acids due to their high alpha-linolenic acid content, humans do a terrible job of converting ALA in to DHA, a rate of less than 5%.  Since DHA is not an essential nutrient, there is no recommended daily intake.  I recommend shooting for at least 500mg per day.

Conclusion

Athletes should take special care to ensure that they are getting adequate amounts of nutrients in their diet.  The more typical approach to improving athletic performance via nutrient intake is in supplementation with supra-physiological doses of certain nutrients in the hope that it will improve performance.  A more logical approach is to look at nutrients that can become depleted by training or modern lifestyle factors and make sure that adequate levels are attained through the diet.

A microbiome modulating "drug" improves glycemic control in prediabetic adults

A company named Microbiome Therapeutics has just issued a press release on a microbiome modulating "drug" they have developed that improves glycemic control in prediabetics.  Interestingly enough, this drug is basically just a couple of different types of prebiotic fiber and some polyphenols.  I think it's great that the power of the microbiome, as well as the anecdotal evidence of quite a few people who have been messing around with resistant starch, is being looked at as a therapeutic way of improving something that affects so many people.  However, I am a little concerned with calling prebiotics drugs since they occur naturally in our food.  I've seen my blood glucose levels improve dramatically through diet and the use of a prebiotic supplement, I just don't now that I'm interested in having to go through a doctor with 5 minutes of nutrition training to get it.  Let's hope that we don't go don that path.  Check out the press release below.

http://www.newswise.com/articles/blood-sugar-improves-with-first-gastrointestinal-microbiome-modulator-nm504

If you are prediabetic and interested in something along a similar line, Biotagen by Klaire labs likely accomplishes the same thing.  Start with 1/4 of a scoop and slowly work up to 1-2 scoops a day to prevent flatulence.

Eat Butter: My take on the Time magazine article on saturated fat

An article recently came out in Time magazine that takes saturated fats like those found in butter off the hook for cardiovascular disease.  For the most part I agree with the article that saturated fat isn't the demon that we made it out to be and switching from saturated fat to processed carbohydrates was a move in the wrong direction.  However, you have to take this article for what it is while most people are taking it for what it isn't.

First off, no longer vilifying saturated fat doesn't mean you should start eating it ad libitum.  In other words, put down the coffee and coconut oil and step away.  Stating that saturated fat isn't the boogeyman it was made out to be isn't stating that you can eat all of the saturated fat that you want without repercussions.  Just like any recommendation, people will take the recommendation differently.  In my opinion this advice should be taken in a manner that saturated fat, as part of a diverse diet that includes fiber from the high consumption of plant matter, is basically harmless and likely beneficial.  It should not be taken to mean that every one of your meals can now become a meat orgy made up entirely of pigs, cows, and chickens with the occasional sprig of lettuce.  You have things other than yourself to worry about, and a diet devoid of plant matter and high in saturated fat consumption is likely terrible for your microbiome and could lead to high levels of inflammation and colitis(1).

The second thing to consider is that these recommendations are based off of epidemiological research, the same type of research that gave us the original recommendation to avoid saturated fat in the first place.  I agree that saturated fat is mostly benign; but again, I don't believe that is a blanket statement.  What we have is a lack of association between saturated fat and heart disease and a mechanism by which we made the mistake: While saturated fat does raise LDL cholesterol, we didn't have a full understanding of how LDL cholesterol works and this caused us to make a bad recommendation.  However, we could be making the same mistake in lumping all saturated fats together.  Maybe some are beneficial, some are benign, and some may not be quite so good for you.

While this article in Time magazine may fall in line with your opinion towards saturated fat, that doesn't mean you should take the analysis as fact.  It's based on research that can't be used to draw conclusions and is likely incomplete.  Other factors likely play a role in how benign saturated fat is including the content of the rest of the diet.  Another factor to be considered is how the animal that you are eating, or that made the product you are eating, was raised.  While grass-fed and grain-fed cattle tend to have the same percentage of unsaturated to saturated fats, the types of fatty acids are different.  Grass-fed cows tend to contain more healthy Omega-3 fatty acids on the unsaturated side and less palmitic acid on the saturated side than their grain-fed counterparts.  Palmitic acid is potentially inflammatory and the World Health Organization states that the evidence is "convincing" that palmitic acid increases heart disease risk and should be considered in the same light as trans fats.  So don't celebrate this article with 20 chicken wings and a cup of bulletproof coffee, celebrate it with some brussel sprouts fried in bacon grease and sprinkled with crumbled bacon.

Catching Fire: How cooking made us human

Richard Wrangham is a primatologist and professor of biological anthropology at Harvard University who, in 2009, wrote the book Catching Fire: How Cooking Made Us Human which goes over the role of cooking in human evolution.  The video above goes over some of the key concepts for his hypothesis that the cooking of food, particularly tubers, liberated more calories from the food our ancestors ate which helped fuel the evolution of the human brain.

In the video, Dr. Wrangham goes over quite a few concepts.  He discusses the ever-changing anthropological evidence for when mastery of fire started, how most species of animal prefer their food cooked when given the choice, and a new coming out with evidence of lower primates mastering fire.

The most interesting part of this video comes in the question portion at the end where Dr. Wrangham discusses micronutrients(vitamins and minerals) and the effect of cooking on them.  While it is known that cooking liberates more calories from food, it also tends to destroy vitamins and minerals.  An audience member questioned this and Dr. Wrangham's response was very interesting:

"...I've been focusing totally on one aspect of nutrition, and that is calories.  And the reason I do that is because if you study wild animals, and if you think about hunters and gatherers, then calories are what really matters and I think that's for 2 reasons.  One is that they are so important and so difficult to get, and the other is that vitamins are relatively unimportant in the wild because, with the diversity of foods that people tend to eat, they almost always get enough vitamins.  I don't think we have a single case of a study of primates in which there is a shortage of vitamins in their natural diets.  It's when you get in to agricultural foods, and you start eating...90% of your diet is cassava or something, that there is a risk of getting vitamin shortage of one kind or another or, in that particular case, a protein shortage...It's true you'll get fewer vitamins so if you have the kind of diet which makes you susceptible to low vitamins, you know, too much time spent at McDonalds, then cooking does matter."

I think this illustrates a fairly repetitive thing we see in human history.  Often times, we have solved one problem only to create others.  We found a way to create giant communities only to find out what happens when people live in large communities, communicable disease.  We identified bacteria as a primary culprit in these diseases and saved numerous lives with antibiotics while at the same time destroying the healthy bacteria that live in harmony with us, potentially creating other issues such as IBS, allergies, and GERD.  We processed rice by removing the husk which leads to the deficiency disease Beriberi, which comes from a lack of thiamin in a higher carbohydrate diet.  Finally, we know the Sun causes skin cancer(Probably not), so we told people to stay out of the Sun and spray themselves with sunscreen to prevent skin cancer without realizing it also blocks synthesis of vitamin D3 that we make from the UVB rays that sunscreen blocks.  The end result...a large population of people with low levels of a vitamin that is now considered a hormone.

With agriculture, we've made it possible to have unfettered access to foods we normally would only have seasonally.  I don't think this is a bad thing, it's only bad because people make it bad.  Having yearly access to foods high in nutrients is a great thing.  But we don't make the best out of it.  When people develop their diet based on only 6 or 7 different ingredients(Corn, wheat, soy, dairy, meat, and maybe a few vegetables sprinkled in there), and all of this food is cooked and processed so much that it's devoid of micronutrients, it shouldn't be surprising that health will suffer as a result.  What is surprising is that people would find this surprising.  If you take anything from this, it should be that diversity in the diet is extremely important to health.

Gut health in sport: Implications for athletic performance

As science progresses and we learn more and more about the importance of gastrointestinal health to overall health, opportunities arise to apply these principles to the athletic population.  Given the many roles that gut bacteria and health of the intestinal tract play in basic human physiology, there is ample pretext to the belief that GI health is important to athletic performance and that athletes and their coaches should be monitoring and taking steps to improve GI health.  In this blog we will go over the role of the gut in athletic performance, how impaired gut health can negatively impact athletic performance, and steps to take to optimize athletic performance by improving gut health.

The role of the gut in athletic performance

The role of the gut in athletic performance is more extensive than one might believe.  There is the obvious fact that athletes absorb the nutrients they need to recover from athletic activity through the GI tract.  In order to do this properly, athletes must break down their food by producing adequate digestive enzymes as well as providing a healthy GI barrier for the proper absorption of nutrients including macronutrients as well as vitamins and minerals.

In addition, the gut also plays several other roles that may impact athletic performance.  More than 70% of the cells of the immune system are located in the gut, and the resident bacteria found in the gut are known to exert many of their functions via the immune system by regulating inflammation as well as the adaptive immune system responsible for fighting off infections(1).  Since inflammation is something an athlete encounters as a byproduct of their sport and is essential to the healing process, and proper immune function is critical to avoiding infection when stress is high, a fine tuned immune system plays an important role in sport performance.

Gut health also plays a critical role in management of the stress response.  Multiple studies have shown that the bacteria in your gut can have dramatic effects on the way the brain functions via two-way communication(2, 3, 4, 5).  This means that the bacteria in your gut can affect the way you respond to stress and that stress can change the bacteria found in your gut.  The conduit through which this 2 way communication works is called the vagus nerve.

To further illustrate the importance of gut health, it's interesting to note that severing the vagus nerve does not cause the GI tract to stop working.  This means that the GI tract is actually a separate component of the autonomic nervous system called the enteric nervous system.  Since the autonomic nervous system is the regulator of physiological processes that are out of our control such as heart rate and blood pressure, there is little question that this part of the ANS likely has huge implications to athletic performance.

The bacteria in the gut also help with nutrient and mineral absorption, generate nutrients that we cannot get from food alone including vitamin K2, and help regulate blood sugar and insulin sensitivity through the generation of short chain fatty acids as a byproduct of fermentation(6, 7).  These short chain fatty acids are preferential fuel for the the cells of the intestine and thus have the ability to maintain the health of the colon by promoting peristalsis, reducing inflammation, and regulating the permeability of the intestine to the contents within it.  This is important because increased intestinal permeability can wreak havoc on recovery and blood glucose regulation by triggering the immune system and tying up resources better used for recovery.

Impaired gut function and athletic performance

In athletics, every edge counts no matter how small.  Over the course of the 10,000+ hours it requires to become elite at something, small changes add up to big advantages.  Getting sick or entering a period of overtraining due to insufficient recovery can pull an athlete out of their groove and take away precious practice time.  In addition, achieving optimal recovery from workouts, practices, and competitions allows an athlete to become bigger, stronger, and faster.  There should be no doubt that being able to get the most out of your food is in your best interest, but how can poor gut function directly impact performance in athletes?

Increased intestinal permeability can cause a multitude of issues that an athlete should try to avoid.  Increased intestinal permeability occurs when areas between the cells of the intestinal tract called tight junctions dissolve.  This allows undigested food within the digestive tract to interact with the immune system and enter the blood circulation.  Under several circumstances including high levels of stress, inflammation, and certain dietary influences, intestinal permeability is increased and can negatively impact performance.  In addition to poor nutrient absorption, it can increase insulin resistance and delay recovery.

When bacteria from the gut are able to translocate in to the bloodstream from a leaky gut, it sends the immune system in to a frenzy.  Inflammation is created and signaling molecules induce insulin resistance in muscle and fat tissue to conserve glucose for the immune system as glucose is the fuel of choice during an infection.  This reduces an athlete's ability to store glucose as this is the primary function of insulin.  Glucose can be used as fuel, but an athlete would need to clear the "infection" before being able to utilize insulin properly and store glycogen for later use.  I've broken this down thoroughly in two other blogs found here and here.

One of the primary proteins involved in this process is called zonulin.  When zonulin is secreted, it dissolves the tight junctions that secure the intestinal wall and typically prevent unwanted particles from entering circulation.  Zonulin is hypersecreted in people with Celiac disease and gluten sensitive enteropathy and people with these conditions have a difficult time re-sealing the tight junctions when compared to a healthy individual.  However, tissues from healthy people also react to gluten by secreting zonulin, but the intestinal permeability seen in these people is much more transient in nature than that of people sensitive to gluten(8).  This effect is likely due to changes in gut bacteria and a lack of the fermentation byproduct butyrate, which helps reseal tight junctions exposed to zonulin.  In addition to regulating the tight junctions between enterocytes of the intestinal wall, zonulin also dissolves the tight junctions in the blood brain barrier as well as the epithelial cells in the lungs(9, 10), allowing unwanted substances to interact with the brain or enter the body during respiration.

For the most part, one of the primary goals for athletes should be to promote good gut health by maintaining a healthy microbiota, the collection of bacteria that are inhabitants of our GI tract.  There are 10x as many bacteria in your gut as there are cells in your body, and the genetic material contained in these bacteria outnumber your own genes 150 to 1.  This means they perform many biological functions that are necessary for optimal health that you cannot.

There are 2 steps that can help in this situation.  First, probiotics and probiotic/fermented foods can be consumed to populate the gut with healthy bacteria.  The interesting part here is that these bacteria don't even need to populate the gut to exert their effects, they also interact with the immune system and promote health through that route.  The second thing that needs to be taken in to consideration is prebiotic foods.  Prebiotics are essentially food for your gut bacteria and include fiber, resistant starch,  polyphenols, and more.  Since we don't break these nutrients down, they are free to feed the many bacteria that line our GI tract.  This is one of the problematic things about gluten, no human can digest it.  To date there is no evidence that any human can digest gluten and humans lack the adequate amount of the enzyme necessary to do so, therefore it is free to interact with the microbiome.

Most people focus on probiotics but neglect prebiotics, a major mistake.  Prebiotics feed the good bacteria and keep them as permanent residents of your GI tract, taking probiotics is worthless if you aren't providing an environment that they can proliferate in.  This is why probiotic foods such as kimchi, sauerkraut, kombucha, and kefir are likely your best bets, they contain both the bacteria as well as the foods they consume in one package.  For the most part, prebiotics haven't been studied at length in athletes, but probiotics have.  Let's take a look at some of the studies.

Probiotics in sport

A recent study in endurance athletes found that intense endurance exercise performance in trained men led to an increase in zonulin that was attenuated by use of a multi-species probiotic strain(11).





Supplementation with the probiotic also decreased inflammation and reduced exercise induced protein oxidation.  Another study using two Lactobacillus strains of probiotic bacteria found that supplementation with these strains reduced exercise induced oxidative stress through increased endogenous antioxidant activity(12).

Probiotics may also have an effect on overtrained or fatigued athletes.  A study looking at fatigued, well trained recreational athletes found that supplementation with a lactobacillus strain reversed fatigue and led to improvements in interferon-gamma secretion(13).  Interferon-gamma plays a role in preventing the reactivation of viruses including the Epstein-Barr virus(EBV).  The fatigued athletes in this study showed evidence of EBV reactivation that was attenuated with 4 weeks of probiotic supplementation.

These studies are fairly small and further testing needs to be done to determine if probiotic supplementation can provide an ergogenic effect to athletes.  However, it's important to re-emphasize that gut health is not dependent on probiotic supplementation.  Other factors such as diet and stress likely play a much larger role than probiotic supplementation ever will.  If probiotics have a role in athletic performance, it is likely as a therapeutic tool to replace bacteria that may be lost due to poor diet, the use of antibiotics that wipe out the gut flora, or other factors.  Even if an athlete gets the desired effect from a probiotic, they still need to support colonization of the probiotic by providing a healthy GI tract that the bacteria can live in.  This is only possible through diet.

Special considerations

Activation of the stress response causes the sympathetic nervous system to divert blood towards muscles and away from the organs of digestion.  When the stressor ends, blood is diverted away from the muscles and back towards the organs of digestion.  Intense endurance exercise can cause decreased motility, maldigestion, and poor nutrient absorption in many who participate in it(14) through this mechanism.  This means that it's crucial to make sure that the athlete recovers appropriately from training and competition.  Optimizing gut health is a critical step in preventing these symptoms from becoming a nuisance, even transiently.  Since the enteric nervous system can function autonomously from the autonomic nervous system, and many of the functions within the enteric nervous system are performed by the bacteria there, maintaining a healthy gut and a diverse population of bacteria within it should be a consideration for optimal athletic performance.

Another issue of relevance to athletes is the use of non-steroidal anti-inflammatory drugs(NSAIDs) such as ibuprofen.  Athletes commonly use NSAIDs to help recover from exercise induced inflammation.  Exercise, in and of itself, causes injury to the small intestine and increases intestinal permeability in otherwise healthy individuals.  The use of NSAIDs aggravates this response and leads to greater levels of intestinal permeability than in those not using NSAIDs(15).  Long term use of NSAIDs has also been shown to lead to chronic levels of gut inflammation as well as blood and protein loss(16).  Therefore the use of NSAIDs, while they help reduce inflammation in the local musculature, may delay recovery in the long run.  In the event an athlete needs to use these drugs, special care should be taken to support overall gut health in the process.

Conclusion

Gut health is something that is furthest from most athletes' minds but should be one of the first things they think of.  For the most part, athletes have been primarily concerned with the number of calories they get or their macronutrient ratios and have given little consideration to the quality of their food.  Since the science behind gut health is relatively new, it's difficult to give specific recommendations.  However, there are a few usable concept that have emerged.  First, fiber is your friend.  Along with keeping digestion moving along, it promotes an acidic environment throughout the digestive tract which makes a less than hospitable environment for pathogenic bacteria and helps maintain the intestinal barrier.  Second, if there's one concept that can be universally agreed upon with gut health it's that a diverse microbiome tends to be the primary goal.  Eating a diverse array of foods, including lots of vegetables and fruit, is the best way to maintain a diverse microbiome and has the added benefit of providing fiber to help repair the intestinal barrier.  Finally, in the event an athlete needs to use antibiotics or NSAIDs, it's important that they pay particular attention to their diet to reduce the damage that typically comes with the use of these pharmaceuticals.

Stress and heart attack...Are gut bacteria involved?

There has been a long established link between stress and heart attack.  A new study published in the open access journal mBio may provide a key to why atherosclerotic plaques rupture due to stress, causing a heart attack.  The key to this process may reside nowhere near your heart, but about a foot lower in your gut.  The researchers found some unusual things in this study, so let's take a look piece by piece.

In the first part of the study, the researchers were looking for evidence of bacteria in arteries with plaque accumulation removed from 15 people with advanced atherosclerosis.  Prior to this study, there had never been evidence of bacteria within plaques found on blood vessel walls.  All 15 tested positive for bacterial genes indicating the presence of bacteria in these plaques.  The next step was to test for biofilms, a colony of multiple species of bacteria that adhere to surfaces and one another while providing a matrix that is impervious to the immune system and antibiotics.  They looked at 5 random samples and found that each contained between 10-18 different strains of bacteria that were confined within a matrix, indicating that they indeed had formed biofilms.  This is important because the researchers believe that activation of the stress response could cause these biofilms to breakdown and potentially cause a rupture, which was what they tested for next.

In 6 of the 15 samples, the bacteria Psuedomonas aeruginosa was found.  When biofilms of P. aeruginosa are exposed to free iron, they disperse and break apart, potentially due to the use of degrading enzymes by the bacteria.  When stressful events occur, they cause the release of norepinepherine which frees up iron bound to the protein transferrin.  The next step for the researchers was to determine whether P. aeruginosa biofilms dispersed under physiological conditions similar to what one would experience during activation of the stress response, which did indeed happen.  The researchers hypothesize that this could be happening due to degrading enzymes that may cause the plaque to weaken and break off, with the plaque finding it's way in to a narrower vessel and blocking it, causing a heart attack.  However, they also point out that other factors are likely involved.  This is all fine and dandy, but how is the gut involved?

P. aeruginosa is commonly found in the human digestive tract where it typically remains benign*.  Under certain environmental conditions, it can step out of the gut and in to the bloodstream where it typically takes up residence in blood vessel walls(1, 2).  The interesting part is the environmental conditions that cause it to leave the gut.  One method involves zonulin and the dissolution of tight junctions, aka leaky gut(2).  The second involves the presence of immune system activation, specifically the cytokine interferon-gamma.

When interferon gamma binds to a receptor on P. aeruginosa, it causes it to secrete a toxin that makes the gut more permeable and another that allows it to move across the intestinal lining and enter the bloodstream(3).  Both of these mechanisms are related to Celiac disease and Non-celiac gluten sensitivity in people with the genetic variant for Celiac disease.  In all people, gluten causes the release of zonulin which opens up the tight junctions and causes a leaky gut; in people with Celiac or gluten sensitivity, this response is exaggerated.  In both of these groups, interferon-gamma levels are high.  In people with celiac disease, it's always high; in people with NCGS that have the genetic variant for Celiac disease, interferon-gamma levels are high when gluten is consumed but normal under gluten free conditions(3).  Approximately 30% of Caucasians carry the variant that is associated with Celiac disease and an exaggerated interferon-gamma response.

All is not lost, however.  The composition of your gut flora can prevent P. aeruginosa from becoming a problem.  Butyrate, a short chain fatty acid produced by bacteria in your gut, helps prevent a leaky gut.  It also has antibacterial activity against P. aeruginosa, as do other short chain fatty acids produced by fermentation by our gut bacteria(4).  To promote butyrate and other short chain fatty acid levels in your gut, increase the amount of fiber and resistant starch from vegetables in your diet.  This can also improve overall colon health as butyrate also blocks interferon-gamma signaling there, which reduces inflammation in the gut.

More interesting than the potential mechanistic relationship between stress and heart attacks found in this study is that they found bacteria of multiple types in biofilms on blood vessel walls.  We are entering some very interesting times.  More and more health complications are associated with poor GI health, even ones with seemingly no relationship from a symptom perspective.  No one ever thought that past infections could accumulate in the way this study showed evidence for.  In my opinion, people are going to need to shift away from looking at their diet quantitatively(How many calories, carbs, etc.) and more qualitatively(Types of foods, specifically vegetables) if health is their goal.  In other words, calories in vs calories out needs to be buried.  With gut health seemingly related to so many health conditions and the food environment being optimal for gut health problems, I will not be the least bit surprised to see an uptick in many of the chronic diseases that we are currently dealing with.

*It's important to note that P. aeruginosa can also enter the blood via a lung infection and wounds.

Bacon Beet Hash

Ingredients

4 strips of bacon, chopped
1 large beet, shredded(Approximately 1 cup)
1 medium onion, shredded
1 large carrot, shredded
6 asparagus, shredded
1 large parsnip, shredded
3/4 cup shredded baby potatoes
1 red sweet pepper, shredded
2 cups chopped beet greens
1 tsp basil
1 tsp thyme

Instructions

Preheat cast iron skillet on medium heat.  Chop bacon and add to skillet.  Shred all vegetables except beet greens in a food processor, chop beet greens.  Once the bacon is crispy but not quite done, add spices and mix to extract oils.  Add all vegetables except for the beet greens and cook covered for 10 minutes on medium/low heat, stirring occasionally.  Cook uncovered for an additional 10 minutes or to desired texture.

Nutrition info

Makes 2 serving
426 cals
10g fat
71g carbs
22g protein
3043g potassium
946g sodium

Roast Chicken with Root Vegetables

Ingredients

3 lbs chicken, whole
2 cups parsnips, chopped
2 large carrots, chopped
2 medium sweet potatoes, chopped
3 tbsp olive oil
2 cloves of garlic, chopped
1 1/2 tsp rosemary
1 1/2 tsp thyme
1 1/2 tsp black pepper

Instructions

Preheat oven to 400 degrees.  Chop vegetables in to uniform cubes of approximately 1 inch and place in bowl.  Mix spices in with olive oil.  Remove chicken from package, rinse thoroughly, and pat dry.   Remove innards from cavity.  Place in roasting pan and separate the skin from the meat starting at the neck.  Take approximately 1 tbsp of the oil and spices and rub between the skin and the meat.  Take the remainder of the oil/spice mixture and cover the vegetables with it. You can either mix it by hand or cover the bowl and shake.  Place vegetables around the chicken and place in oven.  Allow to cook for between 60-70 minutes.  The chicken is done when the juices that come from cutting between the leg and rib cage run clear.  Remove chicken and cover roasting pan with tin foil and allow the vegetables to cook for about 10 more minutes, they are done when they are fork tender or to your liking.

Nutrition info (Approximate)

Makes 4 servings
533 cals
25g fat
38g carbs
41g protein
1256mg potassium
392mg sodium

Gluten Freedom: Everything you wanted to know about gluten from the leading expert

I was recently looking for a new book to purchase when I came upon the book Gluten Freedom by Dr. Alessio Fasano.  Dr. Fasano is considered the expert when it comes to Celiac disease, gluten sensitivity, and gluten research.  I'm sure Cameron Diaz's new diet book will sell more copies which is kind of sad, but this book is not only solid on information, but it manages to do so while also being engaging.  I have followed Dr. Fasano's work and thought this book would provide me with the most up to date information on gluten and how it affects human health since it was just published late last month.  I wasn't wrong.

It's hard to come across a good reference book that is also easy to read on a topic as complex and scientific as this.  For the most part they are loaded with jargon and provide scientific facts with little practical information.  This book literally should be called Everything you Ever Wanted to Know About Gluten but Were Afraid to Ask.  The book is broken up in to 4 parts and each part has quite a bit to offer.

The first part, called Gluten Enters the Picture, goes over the history of gluten: what it is, and why it's problematic.  I don't want to give out a ton of the book since it's so good, but let's just say there are several reasons why most people should pay attention to gluten.  He begins by discussing the three gluten related disorders: wheat allergy, gluten sensitivity, Celiac disease, and the way each condition causes problems.  If you think this is primarily a genetic problem, think again.  The gene variants that cause Celiac disease can be found in 30% of Caucasians and Celiac disease is literally exploding everywhere from Asia to Europe to all around the globe.  Even so, you don't need these genetic variants to become sensitive to gluten and just because you have them doesn't mean that you will get Celiac disease.  Despite the gene being so common in Caucasians, Celiac disease currently affects only 1% of them which points to the environment being as important in its development as having the gene variants. One of the more troubling aspects of this disease is that studies show that as many as 3,000,000 Americans likely have Celiac disease, but only around 200,000 have been diagnosed.

Even if you don't get Celiac disease, you can become sensitive to gluten.  This is because no human has the enzymes necessary to break it down and it causes an immune response...in everybody.  Now, this doesn't mean everyone should avoid gluten and Dr. Fasano states this emphatically.  Many things we eat initiate an immune response, whether they become an issue is based on many things including age, health, and the microbiome.  Given the history of Celiac disease, looking at blood samples from every decade shows that it doubles in occurrence every decade, it's becoming a growing problem heavily influenced by our environment.  Dr. Fasano also discusses whether GMOs could be to blame(Unlikely), things that likely contribute to it, and even diagrams the specific components of gluten that are problematic for people and the responses they elicit.

Probably the most interesting part of this section was that while most people think of Celiac disease and other gluten related conditions as specific to the digestive tract, most people who get diagnosed with Celiac disease present with neurological symptoms, not digestive symptoms.  Many people never even experience digestive disturbances making the disease a chameleon.  There is a lot more to this section including leaky gut and zonulin, the brain, and autoimunity.

Part two is called Learning to Live Without Gluten and goes through most of the diet stuff: what to avoid, what you can eat, and provides a basic template for developing gluten free meals.  Part 3 is called Gluten-Free Life and goes over many of the trappings of trying to live in society gluten free, discusses pregnancy and gluten, and provides a chronological guide to living gluten free.  This is important because gluten related disorders, including Celiac disease, can strike people at any age with no history of issues with gluten containing foods in the past.  This is a drastic change from the early days of research where it was considered a solely pediatric condition that wasn't even present in the US.

There are quite a few stories of people coming down with the disease and the years of misdiagnosis that most people experienced during the early stages of Celiac research.  Despite many advances thanks to the research, many people still wait to get a proper diagnosis.  There are also quite a few tips given by people who have learned to live a gluten free lifestyle the hard way: by being diagnosed at a time when no one knew what gluten was and when availability of gluten-free food was scarce at best.

Part four is one of the primary reasons I bought the book.  It's called Going Beyond Gluten and covers what is currently going on in gluten research including the environmental factors at play(Aka the microbiome) and therapeutic interventions that could possibly lead to the previously unthinkable: worry free consumption of gluten by people with Celiac disease and gluten sensitivity.  As Dr. Fasano points out in the book, throughout the history of gluten and Celiac disease research, many things that were once held as gospel were eventually overturned as the science clarified the picture.  This includes existence of the disease in the US and Asian populations, it's prevalence, when it can afflict you, and how to successfully diagnosis the condition.

Overall this is an amazing book that clarifies quite a few things that I was uncertain about with regard to gluten.  It thoroughly goes over the research on gluten to date and also gives a glimpse at what we can expect to see come out in the future.  For someone with a gluten related disorder, it provides quite a bit of insight from people who have personal experience in dealing with a diagnosed gluten related disorder.  It contains recipes as well as helpful tips in navigating society while going gluten free, whether you are doing it for yourself or your family.  In addition, there are several resources in the back that provide help to people who may be having a difficult time going gluten free on their own.  This book should be required reading for anyone with a gluten related condition as well as people who work with them who wants to know the science behind gluten as well as how to successfully live a gluten free life.

Gluten Freedom by Dr. Alessio Fasano

Banana Pancakes with Blue Potato Hash

Ingredients

2 large eggs
1 overripe banana
1-2 teaspoons of pumpkin pie spice
1 1/2 cup chopped blue potatoes
1 medium onion, chopped
1 large red pepper, chopped
2 large carrots, chopped
6 brussel sprouts, shredded
2 tablespoons coconut oil
1/2 teaspoon each of rosemary, thyme & marjoram

Instructions

Beat 2 large eggs and banana until consistency is like pancake batter and add pumpkin pie spice.  Heat cast iron skillet with half of a tablespoon of coconut oil and add mixture.  Once you've made half of the mixture add another half tablespoon of coconut oil to prevent sticking.  In another skillet, heat up 1 tablespoon of coconut oil and rosemary, thyme, and marjoram.  Add vegetables and cook covered for 15 minutes, stirring occasionally.  Remove cover and cook for an additional 5-10 minutes.

Nutrition information

Makes 2 servings
473 cals
12g fat
67g carbs
10g fiber
13g protein
1300mg potassium
477mg sodium

Probiotic Sardine Salad

Ingredients

2 cups spring mix
1 medium tomato
1 can sardines
1/4 cup sauerkraut
2 tablespoons Bubbies dill relish
2 tablespoons of olive oil

Instructions

Chop tomatoes and sardines and place all ingredients in a bowl.

Nutrition info

Makes 1 serving
427 cals
31g fat
12g carbs
5g fiber
26g protein
1102mg potassium
1225mg sodium