The multi-system symptomology of adrenal fatigue: Is thiamine deficiency at play?

People with adrenal fatigue tend to have symptomology that ranges across many body systems.  While these systems likely affect one another due to the fact that they must work in concert with one another to help us adapt to our environment and are controlled by the autonomic nervous system, it's an assumption that one system is throwing the others out of whack.  While this may be true, there is the potential that what we are seeing in adrenal fatigue isn't just one system throwing other systems off, but all systems being thrown off by a deficiency in a nutrient that they all rely on for proper function. 

Dr. Derrick Lonsdale, MD has written many articles on dysautonomia, dysfunction of the autonomic nervous system, which is the defining characteristic of adrenal fatigue.  He points to dysfunction in oxidative carbohydrate metabolism as the primary cause of dysautonomia(1).  He discusses the early stages of beriberi, a disease of thiamine deficiency, as the prototypical example of dysautonomia(2, 3).  His perspective is coming from the Standard America Diet and it's reliance on processed carbohydrate as being causative in thiamine deficiency.

It is interesting to note that beriberi was discovered as being caused by an imbalance between the level of dietary carbohydrate and thiamine.  In 19th century Japan, beriberi was extremely common in the Japanese Navy and the culprit was eventually determined to be diet related.  Rice that has been polished, white rice, is stripped of its thiamine content while leaving the carbohydrate levels intact.  Cadets who had relied solely on white rice were far more likely to experience beriberi than cadets fed a more varied diet.  This led to the discovery of accessory nutrients, aka vitamins, that were necessary for proper cellular metabolism.

It is assumed in modern medicine that the only people who experience thiamine deficiency are alcoholics or the malnourished.  Dr. Lonsdale and his co-workers have published multiple case studies showing thiamine deficiency as a product of micronutrient deficiency brought on by excess processed carbohydrate consumption.  Dr. Lonsdale calls this high calorie malnutrition.  These people are neither alcoholics nor malnourished by macronutrient standards.  Many of these people are told that their symptomns are in their head by their mainstream doctor, and when they are tested for thiamine deficiency by Dr. Lonsdale they are shown to be deficient because a mainstream doctor isn't on the look out for thiamine deficiency.  Thiamine defiency is known to affect the limbic system very hard.  The limbic system is an area of the brain responsible for emotion, adrenaline flow, motivation, long-term memory, and contains the hypothalamus: the H in the HPA axis,.

The symptomology of these case studies closely reflects autonomic dysfunction, similar to the early stages of beriberi(3), and are corrected by increased thiamine intake.  As mentioned above, thiamine needs are known to be dependent on carbohydrate intake, but the question is are they dependent simply on carbohydrate intake or are they also dependent on how much a person relies on oxidative carbohydrate metabolism for their physical activity?

In people on the Standard American Diet, high intake of processed carbohydrate in the absence of adequate thiamine presents as a thiamine deficiency because they are forcing glucose in to their cells which increases their need for the nutrients needed to efficiently oxidize glucose.  While these people may meet the RDA for thiamine, these RDAs were likely determined based on a lower consumption of carbohydrate.  Eating larger doses of carbohydrate with the same level of thiamine may actually reflect deficiency as cells are unable to oxidize the level of carbohydrate contained in the diet.  In addition, higher levels of free radicals brought on by hyperglycemia may require higher thiamine intake to produce NADPH in the pentose phosphate pathway for reduction of these free radicals via reduction of glutathione(We will cover this in the next blog).  Another problem is that people with insulin resistance and type 2 diabetes have dysregulated thiamine status evidenced by a 75% reduction in plasma thiamine levels in comparison to controls(4), most likely due to thiamine loss in the urine.  It's also interesting to note that these people also tend to be sedentary, so muscle stores of thiamine are likely to be fairly low as well.

Participating in intense exercise that relies on these same glycolytic pathways should cause the same problem.  Compounding the issue is that people doing this who also eschew grains and legumes are eliminating 2 of the better sources of thiamine in the diet.  One could probably meet thiamine needs with other food sources, particularly liver, the question is are you?  If a person is already at marginal thiamine status from insulin resistance or random bouts of hyperglycemia and they cut out 2 significant sources of thiamine, deficiency seems likely.  One has to question what would happen if a person with Type 2 diabetes/insulin resistance went from eating the Standard American Diet with already low to marginal thiamine status to cutting out grains and legumes from their diet and exercising intensely.  Sounds like a recipe for autonomic dysfunction, aka adrenal fatigue.

Hopefully this blog has put thaimine on your radar screen, particularly if you plan to undertake a diet such as the Paleo diet, which I hope you do.  A nutrient dense diet that limits processed food is universally considered the optimal human diet.  However, one has to be sure to meet thiamine requirements as well as not overdo the intense exercise portion of the lifestyle right off the bat.  Before you go out to the store and buy regular old thiamine, let me save you the time, if you already have adrenal fatigue it's not going to work.  Don't worry, we'll get to that later.  In the next blog we will look at the science of how thiamine deficiency affects adrenal function.

The importance of addressing thiamine status in adrenal fatigue

"Adrenal Fatigue", intense exercise and the Paleo diet

Adrenal Fatigue, or the more aptly named HPA axis dysfunction, has seemingly taken the online world by storm.  There are countless support groups, online lifestyle programs, and dietary interventions aimed at preventing adrenal fatigue, but so far we have a fairly limited knowledge of what adrenal fatigue is.  Sure, there is the general notion that as people light the candle at both ends too frequently their autonomic nervous system goes haywire, but what is truly causing it to go haywire?  Are we dealing with a situation where a person's perception of stress has gone wonky, are they exhausting the adrenals to the point they no longer have the raw materials to make cortisol when they experience stress, or is something interfering with the signal?

Honestly, I don't know that everyone experiences the same thing, but looking at biology and the stress response can give us clues to what is considered the most common pathway to adrenal fatigue in the Paleo world: overexercise and nutritional deficiency.  When you look at the symptomology of adrenal fatigue, you get a picture of the systems that are affected:

• Electrolyte balance
• Hypotension, dizziness, headaches, frequent urination, cramps
• Immune system
• Frequent respiratory infections, prolonged length of infection, parasitic infections
• Digestive disturbances
• IBS, loose stools, gas/bloating, parasitic infections
•  Blood glucose control
• Low or high blood glucose, irritability, fatigue/low energy
• Neurological
• Muscle twitching, heart palpitations/arrythmias, brain fog
• Hormonal
• Thyroid issues, sex hormone issues, irritability

While this is merely a small list of the things that people with adrenal fatigue experience, we can use it to look for commonalities between these systems and compare them to some of the things we may expect to see in a person who decides to cut out certain foods from their diet and partake in intense exercise modalities.  This allows us to identify some factors, particularly nutritional, that could be playing a causative role in adrenal fatigue.  Ironically enough, some of these same factors may predispose sedentary over-eaters to the exact same symptoms.

The typical culprit framed for the intense exercise/Paleo diet link to adrenal fatigue is low carbohydrate consumption, but upon further research, I believe other factors related to the type of carbohydrate to be at play.  Many also indicate a link between low carbohydrate intake in general and low thyroid output, but  I don't really feel this link is entirely comprehensive as well.  I do believe carbohydrates, or rather, carbohydrate metabolism, is a central player in this phenomenon.  Where I part ways with this line of thought is when the solution is throwing carbohydrates at the problem.  I believe that merely throwing carbohydrates at the problem can make it much worse if you look at the way cells work.

Understanding cells

Before we move further, it's important to understand how your cells work. All of your cells are constantly interacting with their environment by identifying environmental conditions and performing the biological function that they are programmed to do under those environmental condition via your genes.  For example, when the beta cells in your pancreas identify an increase in blood glucose, they secrete the hormone insulin in to your bloodstream which causes other cells in the body to take in glucose.  Most biological functions occur in this manner, a manner similar to the way the heating system in your house adjusts the temperature.

The thermostat in your house is programmed to the desired temperature and when it senses the temperature drop below that point, it signals your furnace to increase the heat.  An ignitor in your furnace turns on and gas is blown past the ignitor which turns it in to a flame that can distribute heat through the heating duct.  Failure in the system can occur if:

1. The thermostat doesn't sense the temperature or is improperly programmed
2. The ignitor fails to turn on, preventing the conversion of fuel to fire
3. The gas flow doesn't turn on or is obstructed.

This analogy holds for the microscopic physiology of the cell as well as what's happening during adrenal fatigue.  Things like lowering stress, getting better sleep, meditating, and other ways of manipulating lifestyle are, in essence, changing the setting of the thermostat.  Specific enzymes and their cofactors that perform functions within the HPA axis as well as other, related, systems are the ignitor which can be handled with nutritional supplementation.  Finally, the gas flow can be looked at as energy in the system and is most often related to carbohydrate consumption.  While I feel most programs meant to deal with adrenal fatigue take care of resetting the thermostat and increasing gas flow, most fail to address the failed ignitor.

Over-stoking your furnace

While I see no harm and much benefit to changing the setting of the thermostat through meditation, proper exercise, and good stress management, I don't feel the problem is truly being addressed by simply doing these things.  Stress is unavoidable, and it's my opinion that being able to deal with high levels of stress from time to time is important.  I don't feel simply removing all of the stress in one's life is in the best interest of the individual.

On the other side of the equation, simply increasing carbohydrate consumption can be disastrous if not done properly.  There is a lot of clinical evidence supporting this notion and the refeeding syndrome is simply the clinical manifestation of what happens when you increase gas flow in your furnace without addressing the ignitor.  Going back to the furnace analogy, imagine if the heating system in your house kept calling for gas and the gas kept flowing but the ignitor didn't turn on.  Your house would quickly fill up with gas, a far from ideal situation.  In the refeeding syndrome, introducing carbohydrates before all of the nutrients/cofactors needed to utilize carbohydrates properly have been restored leads to symptoms of vitamin deficiency and electrolyte imbalance(1, 2).  In other words, your heating system is filling your house up with gas, not heat.  Bad idea.

A better approach to dealing with this issue is to adjust the thermostat by bringing stress back to a manageable level through lifestyle change, fix the ignitor by replenishing the enzymes and cofactors that are necessary to kick it on, and then gradually increase carbohydrates to a level that is suitable to your activity level.  The first and third parts are easy, but what are the important steps in fixing the ignitor?  The immediate thought is to simply begin supplementing with vitamins and minerals, but it's not as simple as that.  Unfortunately, this is the direction most people go in and progress drags along slowly for several reasons.

First, many of the things you do in everyday life impact nutrient status, and you are going to have to avoid or cut back on some of these things to restart your ignitor.  If you have adrenal fatigue, you are likely avoiding some of these things but may be doing others.  Second, There are multiple steps in getting nutrients in to cells that become an issue.  This includes absorption, maintaining high levels in the bloodstream, and getting them in to your cells.  While there are many nutrients that are important in restarting your ignitor, there is a large amount of scientific evidence linking one specific nutrient to all of the systems mentioned above, and strong evidence that a deficiency in this nutrient quickly induces stage 1, followed by stage 2, adrenal fatigue.  Deficiency in this nutrient is highly dependent on carbohydrate intake, and deficiency can occur both in people who exercise too intensely and don't ingest enough carbohydrates as well as people who eat tons of carbohydrates while living a sedentary lifestyle.  We will cover that nutrient and all of the ins and outs of it, after the jump.

Next Blog

Looking for the reason why you can't I lose weight or why you keep gaining it?

I am a member of quite a few facebook groups and work with people trying to lose weight and this question comes up very often.  To me, it really isn't rocket science and I can typically find at least a couple of things that people do that hold them back from attaining whatever health or weight loss goals they are trying to attain.  More often than not it's because they take an overly myopic attitude towards weight loss.

Over the course of the last couple of weeks I have come up with a checklist that I will be using with my clients to help them troubleshoot their weight loss issues.  The impetus for this is two-fold.  First, I may see someone in a Paleo group say they are sticking to the diet to the T but not losing weight or someone in a Fitbit group say they are getting their steps in but nothing is happening.  More often than not, when I question what they are doing for the other variables they should be paying attention to, they aren't doing anything.  I see the same thing with clients.  They may be getting their steps in every day, eating a proper diet, or getting in 3 weekly workouts but they aren;t doing all of these things consistently.  The second reason for the checklist is that it will gamify the process and provide a measure of accountability for my clients that they didn't have before.  Gained some weight this past week?  Look at the list.  Think you were good on your diet this week but not sure?  Look at the list.

While I am only using the checklist with my clients right now, I think a lot of these, "Why am I not losing weight?" questions can be answered simply by paying attention to the primary lifestyle factors that a person trying to lose weight should be paying attention to and creating a checklist to make sure yo are doing them.  I have my own specific way of dealing with each factor that I won't get in to, but most people will have an answer to that question simply by knowing what is important for weight loss and general guidelines for each.

1)Sleep

If you're not winding down at the end of the day and getting to bed at a reasonable hour, you basically trash your ability to lose weight by messing with hormone signaling, especially insulin.  You should put yourself in bed with the lights off and no distractions at least 8 hours before you need to get up.  This is a bare minimum.

2)Stress

Stress should be managed for the same reason.  One thing that sticks out like a sore thumb to me is that people who manage stress poorly also tend to have a difficult time losing weight.  I don't think there is a single reason why this is the case, there are many.  However, one glaring issue for me is that people who are not "planners" don't typically manage stress well and are the first ones to regress on weight loss when an opportunity presents itself.  I used to be guilty of this myself on numerous occasions.  If I put myself in to a situation where people are eating junk food and I haven't planned for this by having a healthy option for myself, I'll eat junk food.  If I know I am going to have a heavy client load one week and don't attend to it until the last minute, I won't work out that week.  If I am taking a 7 hour car trip and I don't make a point to get some low level physical activity in before and/or after it I won't get any in.  A quote attributed to Benjamin Franklin sums this up nicely, "If you fail to plan you plan to fail."

3)Intense physical activity

Whether it be working out with weights or playing a sport competitively or in a social setting, people really need to get intense physical activity in regularly.  I used to believe that 2 times a week was sufficient, but now believe that 3-4 times a week is significantly more effective.  In order for something to qualify for this factor, it should include the entire body and generate a significant sweat.  Good examples are weight training, flag football, rowing, or rock climbing. More often than not, this activity should also be 45 minutes to an hour long.

4)Daily physical activity

Many people feel that blowing themselves out at the gym 3-4 times a week is enough physical activity to lose weight, but multiple studies show that it can't make up for sitting around all day long.  At a bare minimum, people who wish to lose weight should be taking 10,000 steps a day which equates to 5 miles of walking throughout the day.  If I were to say that any one of these factors is the most underutilized, it's this one.

5)Nutrition

People who are trying to lose weight should be eating a highly diverse diet that is mostly of plant origin by volume and contains little to no processed food.  If most people did this they would have no problem losing weight and would score quite a few weekly points on my checklist.  Where it gets tricky for most is that this requires a lot of preparation and a lot of people shop for convenience.  However, if I had a dollar for everyone who told me that they'd give anything to get to their goal weight I'd be a rich man.  In the grand scheme of things, utilizing 5-10% of your day preparing the proper food is a fairly small price to pay for someone willing to do "anything".

6)The "It" factor

What is the "It" factor and who has "It"?  Some may call it mental toughness, some may call it willpower, but I believe it to be more than that.  The "It" factor is knowing what you need to do to achieve a goal and the willingness to do that to achieve it.  Michael Jordan had the "It" factor.  Michael Phelps has the "It" factor, and many captains of industry and people who have become elite at what they do have "It".  From a weight loss perspective, "It" is preparing lunches for the week on Sundays if that's what you need to do to eat properly at work.  "It" is waking up 20 minutes earlier so that you can take a 20 minute walk after breakfast before your 30 minute commute.  "It" is resisting the inertia holding you down on the couch to watch TV after you eat dinner and going for a walk or work out.  "It" is realizing that the end of the fiscal year is a busy time of year for you at work so you plan your workouts accordingly.  Neglecting these things may seem small, but it adds up over the course of a year.  People with the "It" factor just do "It", and as a result they typically get "It".  The whole reason to develop a checklist for yourself is to determine if you are getting "It" done.  In fact, "It" is exactly what your checklist should measure.

Conclusion

Looking at these 6 factors, it may seem like weight loss is a lot more than burning more calories than you eat, and it is.  However, knowing about these factors and paying attention to them is just part of being successful when it comes to weight loss.  More than any other factor, success in any field is dictated by persistence, or the "It" factor.  Pick a sport and anyone who is highly successful at it can be found practicing while their friends and lesser talented competition are on a beach or hanging with friends.  Look at any successful business person or parent, and you will find that their priorities align with what it is they truly want to be great at.

None of these things just come to people, they have to be worked on and perfected over years of practice, failure, and refinement.  Weight loss is no different.  People who want to be successful at it work at it and prioritize it in their life.  They don't run in to situations every week where they have nothing to eat but food that goes against their goals.  They don't skip workouts because something else comes up or because work or family life is getting busy.  Day in and day out they make sure they get done what needs to get done.  If something pops up and they can't work out at their designated time, they are working out late that night or first thing the next morning.  They get their steps no matter how busy they are.  There are 24 hours in a day, there is plenty of time to work, enjoy your family, AND work on your goals if you truly want to attain them.  The trick is to know yourself and learn the techniques necessary to prioritize your weight loss goal.

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.

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.

4 stress reduction tips to balance your stress account

I discuss balancing your stress account often on this blog because it's one of the things that anyone can do that will have a fairly dramatic impact on their health.  The first step in balancing your stress account is identifying that you have one.  Anyone can see that as they accumulate more stress the need to unwind or get away becomes greater.  For some reason, most people only take the chance to unwind when they go on vacation or have a special event such as a wedding or birthday that allows them to get together with friends and just relax.  While good times such as these are always great to have, incorporating stress reduction strategies on a daily basis can help improve health and well being.  Below are four strategies to help add funds to your stress account.

Daily commute?  Try laughing.

Most people begin their work day with a commute to work.  Whether your commute is 15 minutes or an hour, a good strategy to reduce the stress of being in traffic, or just get your day started off on the right foot is to laugh.  A great way to add humor to your car, bus or train ride to work is to listen to some comedy on your iphone, ipod, or radio.  There are many apps that will allow you to listen to stand up comedy or even funny podcasts that will take the stress out of your commute and get your day started right.  Pandora and Spotify are 2 free apps that have multiple options for comedy stations.

Get to bed early

We live in a very sleep deprived society.  We have tons of things going on during the day and those things don't just go away at night.  Whether you set yourself up for failure by not getting to bed early enough or you have a problem clearing your head once you get to bed, poor sleep can take a toll on your health and negatively impact your ability to handle stress.  Spend a week trying to build better sleeping habits by getting to bed with the lights out and all electronics off by 10pm.  If you have trouble falling asleep because your mind races, try focusing on your breath as you fall asleep.  If your mind begins to wander, don't get upset, just slowly bring your focus back to your breath.

Practice mindfulness

Many people are familiar with mindfulness as it pertains to mindfulness meditation.  While meditation is a great way to begin practicing mindfulness, it is not the end all be all for mindfulness.  Being mindful is about being in the present and not focusing on the past or future.  By focusing on the now, the stresses of what has happened and/or what will happen won't have as detrimental of an effect on your ability to deal with stress.  In addition, one of the added benefits of mindfulness is that it teaches you how to process information without generating an emotional response.  Brain imaging studies show practicing mindfulness decreases brain activity in the amygdala, the emotional center of the brain.  The amygdala has a direct connection to the hypothalamus which is the part of the brain that initiates the stress response. 

Foam roll/stretch

Many people realize the importance in maintaining their flexibility with a regular stretching program.  Whether you end every workout with a good full body stretching routine or participate in a yoga class, you may not be getting the full benefit from your program if you fail to address your fascia.  Fascia is a network of connective tissue that runs throughout the body.  It contains many mechanoreceptors and allows muscles to transmit forces more efficiently as well as glide over one another without friction.  During times of chronic stress, the fascia begins to tighten which does a couple of things.  First, it can lead to pain and fatigue as blood vessels and nerves run through it and can become entangled.  Second, while stress causes the fascia to tighten, tight fascia increases stress which can lead to an endless cycle.  Compounding the problem is that fascia doesn't respond to stretching, it responds to pressure, so merely stretching the muscle isn't enough.  In fact, the muscle is 300x more extensible than fascia so most of the restrictions people have in their range of motion have to do with tight or restricted fascia, not tight muscles.  Massage is a good way to address the fascia, but you can also address the fascia by using a foam roller and then stretching afterward.  This allows you to free up restrictions and break up adhesions in the fascia with foam rolling and then restore length to the muscle with stretch.  This is a killer combination for relieving stress and reducing or eliminating pain. 

Foam rolling the IT band

Taken from realfitnessblog.com

Conclusion

There are many ways to help manage your stress account.  By digging deep in to the physiology of stress, you can identify many tools you can use to help balance your stress account.  Laughing, getting 8 hours of quality sleep, practicing mindfulness, and performing a foam rolling/stretching routine regularly are all helpful tools you can use to manage your stress account.  Each of these tools works through a different mechanism so combining all of these methods should have an additive or synergistic effect on helping you manage stress.

Conquering Type 2 Diabetes: Lifestyle

When trying to overcome Type 2 diabetes, lifestyle modification trumps medicine most of the time.  If you have done so much damage that there are not enough beta cells in your pancreas to make insulin you may be dependent on insulin for life, but you can still limit the amount of insulin you need via lifestyle modification.  In the previous blog on diet we went over why you should avoid processed foods and eat plenty of fruits and vegetables to help promote good gut bacteria and a healthy intestinal lining.  In this blog we will cover other lifestyle factors that impact blood glucose control.  These factors can be broken down in to three primary categories: Sleep, physical activity, and stress management.

Sleep

Sleep is incredibly important for human health and insufficient sleep duration and/or quality can have a major impact on your health.  A study published in 2013 found that insufficient sleep affected the expression of 711 genes that help modulate the stress response, immune system, and metabolism(1).  The study found that 1 week of sleep restriction of slightly less than 6 hours per night lead to a host of problems at the genetic level including increased oxidative stress, altered circadian rhythm, and altered energy metabolism, three hallmarks of many of the chronic diseases we see today including Type 2 diabetes.  This study is a fairly good representation of the sleep habits of many Americans as a good chunk of the population gets less than 6 hours per night(2).  Other studies have found that restricted sleep lead to changes in glucose regulation, insulin sensitivity, and leptin sensitivity(3, 4).  These changes begin to occur in as little as 2 nights of restricted sleep and a single night of no sleep(Hear that night shifters?).  Typically, the progression of Type 2 diabetes begins with leptin resistance followed by insulin resistance.  Over time, blood glucose regulation becomes permanently affected and Type 2 diabetes ensues.  The research on sleep and Type 2 diabetes is pretty much settled at this point, not getting good quality sleep for 8 hours dramatically increases your risk for Type 2 diabetes(4).

Physical Activity

When most people think of physical activity they think of exercise.  This is a mistake, because an hour of exercise per day cannot make up for prolonged sedentary time in helping prevent Type 2 diabetes and the metabolic syndrome(5, 6, 7).  Even just breaking up prolonged periods of sitting with 2 minutes of physical activity every 20 minutes helps improve glucose metabolism(8).  Most of the data points to spending as little time per day sitting being more important than exercising.  Certainly exercise is also important, but try standing more throughout the day first.

Next, walking more throughout the day is also something that is very beneficial in preventing and reversing Type 2 diabetes.  Aside from the benefits of not being sedentary, taking a 15 minute walk after each meal has been shown to decrease the risk of Type 2 diabetes(9).  Furthermore, people who maintain their daily step count over 5 years have been shown to maintain their insulin sensitivity better than people whose daily step count decreased over that time(10).  A good goal to shoot for and the recommendation by the American Heart Association is 10,000 steps per day.  The average American tends to get about 6600, quite a bit lower than the recommended number.  Just taking a 15 minute walk after each meal will give you 4500 steps, so it's not that difficult to accomplish.

Stress

Physical inactivity can also lead to changes in the brain that can modulate the stress response in a negative way(11).  In addition, sleep restriction can cause an overactive stress response(1).  To complete the circle, sleep restriction in the face of physical inactivity has been shown to negatively impact insulin sensitivity and blood glucose regulation(12).  All three of the factors we have discussed today are interrelated when it comes to the risk of Type 2 diabetes.  While it may be easy to put yourself to bed early or make sure you get enough daily steps in, managing stress is a completely different ballgame. Fortunately, doing the other two usually helps with the third.

It's very easy to see the importance of the stress response when it comes to physical stress.  When you are out in the jungle and about to become a lion's lunch, the stress response springs in to action to partition your resources for fight or flight.  This puts all non-essential processes on hold and floods the body with stress hormones.  The stress response begins and ends in the hypothalamus.  In what is basically a game of hormonal telephone, the hypothalamus tells the pituitary gland to tell the adrenal glands to make stress hormones.  These hormones help mobilize energy, particularly glucose, to provide the body with fast acting energy.  Over time, these hormones act on the hypothalamus and tell it to cools it's jets.  Obviously mobilizing energy is key to fighting or fleeing, the problem is that there is a direct line from the amygdala to the hypothalamus and that can turn on the stress response in the face of a perceived threat.

The amygdala is the emotional center of the brain.  Under the proper circumstances, the amygdala can tell the hypothalamus to initiate the stress response.  The problem is that in today's society, there are so many psychological stressors that can initiate the stress response.  How am I going to pay the mortgage?  What if my wife divorces me?  I have a big deadline that I need to make.  Any sort of situation that we deem as stressful has the potential to initiate the stress response.  The problem is, what do you need energy for to flee an emotional stressor?  Furthermore, can you ever really flee an emotional stressor?  Even if you do, there is typically another one right behind it.  As these stress hormones and glucose enter your bloodstream, there really is no need for them because it's not energy that you need.  What you need is to stop processing this information through your amygdala.  This is the goal of mindfulness.

The reason you have been hearing so much about mindfulness and mindfulness meditation is because mindfulness is a way to alter your thought processing so that you avoid generating an emotional response to psychological stress.  Many companies have begun mindfulness meditation programs as a way to help reduce stress for their employees and top executives tout it's benefits in helping them deal with stress.  How does this relate to Type 2 diabetes?  People with Type 2 diabetes have increased sympathetic nervous system activity(13).  This basically means that their stress response is activated more often and more easily than a normal person.  This flood of stress hormones and blood glucose is not good when it isn't needed.  Just to get a firm grasp on how important the stress response is in Type 2 diabetes, one of the ways that the stress response increases blood glucose is by causing the liver to produce more of it.  One of the primary pharmaceuticals used in Type 2 diabetes is metformin and it's mode of action is...It causes the liver to make less glucose.

Developing good stress management tools is key to helping prevent or reverse Type 2 diabetes.  Mindfulness is probably the best tool out there and can provide a one-two punch combined with proper sleep to help manage stress and help prevent or reverse Type 2 diabetes.  Add in a little physical activity to make you tired, and you have a pretty good jump start on living a healthier, Type 2 diabetes-free life.

Conclusion

There is tons of research on the aspects of lifestyle that will negatively impact blood glucose regulation and increase your risk for Type 2 diabetes.  Getting enough sleep, partaking in  regular physical activity, and managing stress are all important in preventing Type 2 diabetes as well as managing your blood glucose if you have it.  Making an effort to get 8 hours of sleep every night, getting at least 10,000 steps a day, spending as little time as possible being seated/sedentary, and utilizing stress management strategies such as yoga and practicing mindfulness should be on your to-do list if you want to live a long, healthy, happy life free of Type 2 diabetes.

Part 1-Overview
Part 2-Diet

How to lose weight the Synergy Wellness way. Part 6-Stress and sleep

When trying to lose weight, absolutely nothing has a greater impact than stress and for good reason.  Every other variable we have talked about including diet, exercise, and physical activity all use the stress response in some way to produce their effects on your ability to lose weight.  In addition, optimal health requires a properly operating stress response.  In this blog we will discuss how sleep and understanding the stress response teach you how to lose weight.

How proper sleep helps you to lose weight

Sleep restriction has multiple effects on your ability to lose weight.  Poor and/or restricted sleep duration leads to an approximate 20% decrease in leptin levels(1).  Leptin is a hormone secreted by fat cells that tells you when to stop eating.  A drop in leptin levels will cause you to eat more food than you normally would because your brain doesn't get the signal that you are full.  In theory, a 20% drop in leptin levels should lead to an increased consumption of between 350-500 cals per day for an average male(1); this approximates a 30-45lbs weight gain per year.  Since most of the studies are done with calories held constant under laboratory conditions, we can only guesstimate as to the amount of weight these levels of leptin could generate.

People with insulin resistance and type 2 diabetes tend to have leptin resistance, a situation where leptin levels are high, but the brain doesn't respond to it.  Leptin signaling is affected by insulin resistance and cells that are constantly bombarded by both of these hormones tend to downregulate receptors to them on their cell membrane.  This leads to constantly high circulating levels of both insulin and leptin which is highly inflammatory and compounds the problem of systemic inflammation even further.  Since the cells in the hypothalamus that regulate appetite are not listening to the signal from leptin, these people get the same effect as sleep deprived people do.  It's not that they are always hungry, it's that they don't know when to stop eating because the communication system that sends that signal is malfunctioning.

Sleep also affects many other aspects of your health that impact your ability to lose weight.  A single night of sleep deprivation has been shown to induce insulin resistance in multiple pathways (2).  Other studies have shown reduced insulin sensitivity(3, 4) as well as significant increases in the stress hormones epinepherine and norepinepherine (3) during periods of sleep deprivation ranging from 7 to 14 days.  In the shorter study, researchers looked at what happened at a genetic level during 7 days of sleep restriction.  The researchers designed the study in a way that would emulate real world conditions in the Western world.  During the sleep restricted portion of the study participants slept an average of 5.7 hours per night for a week while in the sleep sufficient portion of the study the participants slept an average of 8.5 hours per night for a week.  The sleep deprivation duration is highly comparable to real world conditions as 30% of American workers indicate they sleep 6 hours or less per night and many night shift workers get less(5).

In this study, there were 711 genes expressed differently during sleep restriction compared to sufficient sleep(4).  These genes were involved in sleep regulation and circadian rhythm, immune system/inflammatory response, metabolism, and the stress response.  In addition, oxidative stress increased in the sleep deprived state as did insulin resistance.  In the sleep deprived state, all of these genes were differentially expressed in a way that would negatively impact health and your ability to lose weight, including increased triglyceride levels.  Recall from the last bog that triglyceride levels are important as high triglyceride levels in the blood are indicative of a reduced ability to break down fat for energy, your primary goal when trying to lose weight.  So how does stress play in to this and how can understanding the stress response help you lose weight?

The Autonomic Nervous System

Your stress response is handled by a part of your nervous system called the Autonomic Nervous System (ANS).  Your ANS has 2 branches, the sympathetic and the parasympathetic.  The sympathetic branch of the ANS is responsible for the fight or flight response while the parasympathetic branch is responsible for rest and digest.  Your ANS basically partitions your resources to the more needed processes based on how you perceive your situation.  When you perceive a situation as stressful or you send signals to your body that indicate stress, the autonomic nervous system increases sympathetic activity which causes blood to flow away from organs of digestion and to your muscles so that you can respond to the stressor.  In addition, heart rate and blood pressure increase as well as respiration rate.  When a stressor is resolved or you begin to send signals to your body that the stressor is over, parasympathetic activity increases and heat rate, blood pressure, and breathing rate decline back to normal and blood flows back to the organs of digestion so you can recover from the stress.

Unfortunately, we are in a society that is stressful 24/7/365.  The stress doesn't need to be physical either, how you perceive the situation is just as important.  Worrying about bills, getting a job, passing finals, and breaking up with a significant other may not warrant a physiological change that partitions resources to fighting or fleeing, but that's precisely what happens whether the stress is real or perceived.  This is because the amygdala, the emotional center of your brain, has a direct connection to the hypothalamus.   In addition to regulating most every process in your body including appetite, the hypothalamus initiates the stress response by increasing sympathetic nervous system activity.  Over time, chronic activation of the sympathetic nervous system can lead to digestive issues as well as depressed immune function as the body constantly tries to respond to a stress that is never there.  This can lead to big problems because if you cannot digest or absorb your food properly, the vital nutrients your body needs to function properly will not get to your cells.

In addition, a chronically activated stress response prevents you from relaxing and falling asleep, which further impairs you ability to enter a parasympathetic state.  Forget trying to lose weight, at this point your health is probably deteriorating pretty rapidly and you need to hold on to everything you've got to make sure you survive.  Your body doesn't know that the late rent check isn't going to kill you, it perceives it as a life or death situation regardless.  A body under this kind of stress will not budge if you are trying to lose weight.

The question now becomes, "What activities will get me in to this situation and which activities will get me out?"  To answer the first question, the biggest contributor is probably poor stress management.  Not dealing with stress is a terrible way of trying to deal with it as it never goes away and that is the tack most people take.  Other frequent contributors to this state are poor sleep, binge drinking, high caffeine consumption, over-exercising, having a job where you have little control and high or low demand, a long commute to work, and poor nutrient quality in the diet.  Things that help you get out of this situation include dealing with stress, getting 8 hours of quality sleep a night, meditation, tai chi, yoga, stretching, massage, getting proper nutrition, laughing often, and trying not to put yourself in to stressful situations.  One thing I've found to be very helpful for people who have long commutes to work is to listen to stand up comedy on the way to work.

In our program we utilize a stress bank account where you have withdrawals (Stressors) and deposits (De-stressors).  Finding a balance that works for you is key in helping you learn how to lose weight.  Making sure every withdrawal is matched with a deposit will go a long way in helping you achieve your weight loss goals.

Conclusion

All of the variables we have discussed up to this point that are important in teaching you how to lose weight will impact your body's stress response system in some way.  One of the best ways to make sure your body is recovering from stress and not tipping toward too much sympathetic nervous system activity is to get adequate, high quality sleep.  Doing this will help regulate your appetite, allow you to deal with the stressors you encounter every day, and provide the optimal internal environment to help you lose weight.

In the part 7 of this series found here, I will discuss exercise and it's role in how to lose weight.

Genetic pathways involved in meditation discovered...again

Meditation has been shown in numerous studies to be very beneficial for reducing stress, helping you lose weight, and improving your health.  I am personally a big fan of mindfulness meditation and have seen numerous improvement since I began practicing.  A recent study conducted in Massachussets and published in the journal PLOS ONE has identified the genetic pathways through which relaxation triggers these physiological responses in the body.

The study identified several genetic pathways important to health that were changed acutely during bouts of practicing the relaxation response and over an 8 week course.  Participants practiced a relaxation response sequence that included diaphragmatic breathing, mantra repetition, and mindfulness meditation.  Practicing the relaxation response increased expression of genes related to energy production, mitochondrial function, insulin sensitivity, and telomere length.  Genes that were suppressed were genes involved in inflammation as well as the stress response(1).  The 6 of you who read my blog may recall that mitochondrial dysfunction, inflammation, and oxidative stress are a large part of the generalized disease state that leads to diseases such as Cancer, Type 2 Diabetes, Cardiovascular disease, Alzheimer's disease, and Parkinson's disease.  Telomere length is thought to be a good biomarker of aging and is reduced by high levels of inflammation and oxidative stress.

In addition to the acute changes seen within individuals, people who are considered long time practitioners of the relaxation response had even greater improvement in these genetic pathways.  People who practiced of yoga, meditation, and repetitive prayer for over 4 years were considered long time practitioners.  This study builds on earlier findings of the same authors from 2008 that found over 2200 differentially expressed genes between long term practitioners of the relaxation response compared to non-practicing controls and over 1500 genes differentially expressed between people who underwent an 8 week relaxation response course compared to controls(2).  The differentially expressed genetic pathways were similar between the 2 studies.  The results of the newer study are more intriguing as they identify genetic pathways within individuals that change as a result of practicing the relaxation response rather than genetic changes between people who practice the relaxation response and those that don't.


Mindfulness meditation is a good way to begin the practice of mindfulness, a way to respond to situations and crises without activating the stress response.  These studies indicate that practicing the relaxation response on a regular basis provides multiple benefits to your health. We live in a world that activates our stress response 24/7 with little time for relaxation.  Taking 20 minutes per day to practice yoga, mindfulness meditation, or any other activity that initiates the relaxation response can prove to be very beneficial to your health and happiness by both preventing disease as well as reducing stress.

Feel fat, depressed and unhealthy? Get off your tookus!

If you're like most people, you spend your entire day at a desk and 3-4 hours a week at a gym trying to combat the negative effects associated with sitting at that desk.  As time has gone on, you've probably also noticed a reduced ability to maintain your body weight as well as increased risk markers for cardiovascular disease and other chronic diseases.  Even when you double up the amount of time you exercise per week for your New Years' resolution your results get worse each year, leading to year over year increases in fat mass.  The reason this happens is not because you don't exercise enough, it's because you spend too much time sitting.  Sedentary behavior leads to modified genetic expression that promotes fat gain and cardiovascular disease, and no amount of exercise at a gym will prevent that.  When you look at the grand scheme of things, even if you exercise intensely for 16 hours a week that still leaves 152 hours per week where the wrong genes are turned on.  Don't believe it?  Let's take a look at some of the research.

High levels of sedentary behavior are associated with the metabolic syndrome, independent of other factors related to the metabolic syndrome including moderate to vigorous physical activity(Alcohol intake, smoking status, age, gender, diabetes and heart disease)(1, 2).  This means that getting physical activity via exercise did not compensate for the amount of time spent being sedentary.  The amount of sedentary time also has a strong positive relationship with triglyceride levels as well as waist circumference and waist to hip ratio.  High levels of sedentary time also lead to higher circulating levels of insulin(3, 4, 5, 6, 7, 8), impaired glucose clearance(3, 7, 8)  and impaired fatty acid metabolism(5, 7, 8).  While a couple of these studies were done with people on multiple days of bed rest and therefore not directly comparable to people sitting at a desk day in and day out, most of these changes with insulin action and glucose appear to be a result of changes in localized gene expression due to a lack of muscular contraction(7).  In fact, as discussed in Part 2a of my 3 part series "Myths, Metabolism, and Appetite" (Part 2a), it may actually be whether or not the leg is loaded, regardless of muscular contraction.  Unloading one leg while still allowing movement of that leg for 48 hours leads to altered genetic expression that increases protein breakdown and anti-oxidant pathways (Indicating increased oxidative stress) while reducing mitochondrial metabolism with no change in gene expression in the other leg(9).  This reduction is mitochondrial metabolism is probably the mechanism by which fatty acid metabolism is reduced during sedentary periods.  These changes persisted even after 24 hours of reloading the leg.

When we look at who is most affected negatively by sedentary behavior from an insulin sensitivity perspective, it appears that healthy people are more negatively impacted than people prone to Type 2 Diabetes (T2D).  In a study that looked at bed rest and changes in insulin sensitivity with healthy people as well as people with first degree relatives with T2D (FDR)and those with low birth weight, two risk factors for T2D, the healthy subjects experienced a greater drop in insulin sensitivity (5).  The authors hypothesize that this effect is due to the other two groups already having some degree of insulin resistance. In another study comparing insulin sensitivity changes in healthy subjects to FDR, whole body insulin sensitivity declined in both groups but hepatic (Liver) insulin sensitivity declined only in the FDR group.  This is interesting because as discussed in "Myths, Metabolism, and Appetite", people who are prone to T2D and FDR of T2D have fewer type I fibers and a higher proportion of type IIx muscle fibers.  This is, in part, a gene environment interaction.

While the more oxidative (Fat burning) type I fibers have not been shown to convert to other fiber types, the more glycolytic (Glucose burning) type IIa and IIx fibers tend to convert back and forth based on recruitment of said fibers.  Lack of use causes IIa fibers to convert to IIx fibers which are more insulin resistant while regular recruitment of IIx fibers causes them to convert to IIa fibers.  In people with a higher percentage of type II vs. type I muscle fiber types that also do not recruit these fibers regularly, most will become insulin resistant as more of their musculature converts to the insulin resistant type IIx fibers.  People with this genotype probably have to participate in regular strength training to recruit the insulin resistant IIx fibers enough so that they convert to the less insulin resistant IIa fibers, particularly if they intend to consume a high carbohydrate diet.  Coincidentally, converting IIx fibers to IIa fibers allows these people to store more muscle glycogen.  Emptying out these glycogen stores with regular, intense strength training will provide a larger storage compartment for ingested carbohydrate and delay hepatic insulin resistance.  Ironically enough, people with this genotype tend to be the better power sport athletes so it seems that modern life is just not compatible with this genotype.  My guess is they would also have been the best hunters which could indicate why such a high percentage of the population is prone to T2D from an evolutionary perspective.

Another interesting aspect of sedentary behavior is it's effects on lipoprotein lipase(LPL) activity.  LPL is an enzyme responsible for triglyceride breakdown.  Reduced LPL activity leads to higher blood triglycerides via a reduced ability to metabolize fat.  Obviously conditions that lead to a reduction in LPL activity are not ideal, especially if one of your goals is to reduce body fat.  Sedentary behavior has been shown to dramatically lower LPL activity (6, 7) in the muscles of the leg and reducing sedentary behavior has been shown to have a greater effect on increasing LPL activity than does adding vigorous physical activity (7).  This increase in LPL activity makes sense because the muscle fiber type associated with physical activity of lower intensities is the type I fibers that tend to rely more on fat as a substrate.  As the intensity of your exercise increases, so does the utilization of glucose as fuel to power the type II fiber types during that activity.  During both active and passive recovery there appears to be a switch to the type I fibers and a greater reliance on fat as fuel, perhaps to spare glucose for future intense activity.

Other genes and pathways associated with health are positively affected by breaking up periods of inactivity.  One study identified 75 different genes differentially expressed during periods of inactivity vs. periods of activity used to break up inactive periods (8).  Many of these genes are involved in processes that are known risk factors for cardiovascular disease.  Breaking up periods of inactivity with periods of physical activity for 2 minutes every 20 minutes positively affected the expression of genes associated with carbohydrate metabolism, antioxidant pathways and anti-inflammatory pathways.  Another study found breaking up periods of inactivity improved postprandial insulin and glucose concentrations when compared to a completely sedentary condition(9).  While we have focused much of our attention on the localized effect of sedentary behavior on muscles and to a lesser extent the liver, there also appears to be a significant negative impact on the brain.

Increased sympathetic nervous system activity is a widely known symptom of obesity and T2D.  The autonomic nervous system is in charge of regulating mostly involuntary processes and has two branches.  The parasympathetic branch is responsible for rest and digest while the sympathetic nervous system is responsible for the fight or flight response.  People with increased sympathetic nervous system activity have a problem getting out of stress mode, in other words they are in a constant state of stress.  Research indicates that this increased sympathetic activity may be mediated by dysfunction in a part of the brain called the rostral ventrolateral medulla (RVLM)(10).  The RVLM is the primary part of the brain involved in regulating sympathetic nervous system activity.  Physical inactivity may have wide-ranging negative effects on the RVLM and this could explain the detrimental effects of sedentary behavior on measures of cardiovascular disease regulated by the autonomic nervous system such as hypertension.  It is not known at this point if the difference between sedentary and active people is due to a negative effect of being sedentary, a positive effect of being active, or a combined effect of the two.

As you can see, being in a seated position for prolonged periods is a significant factor in poor health and an inability to metabolize fat.  While insulin sensitivity and blood glucose utilization are two big factors impacting both, these are not the only considerations.  The data suggests that sitting for long periods of time is terrible for your health and no amount of exercise at the gym can attenuate the bad effects of sitting.  These effects may expand beyond the physical changes happening in the muscles and more than likely has deleterious effects on the brain.


EDIT: After I wrote this I found a new randomized clinical trial that looked at 3 groups (sedentary, sedentary+1 hour of intense exercise, and a group that spent half the time being sedentary and the other half standing or doing low intensity activity).  Guess who "won".  :)

Check it out.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0055542