 By Michael Stanclift, ND
Since the 1950s we’ve associated HDL cholesterol with being a positive for our health, and to a large extent, that’s true.1-6 However, more recent studies show us that elevated HDL cholesterol can actually be cause for concern.7,8 So what do we think is going on here? Well, first we have to look at what we’re actually measuring when we look at HDL and why we have assumed that was protective for our cardiovascular systems. For years I taught patients that they can remember the “H” in HDL means that’s the “healthy” cholesterol. While this is mostly a good rule of thumb, the HDL letters actually stand for high-density lipoproteins. High-density lipoproteins are like tiny little garbage trucks that take excess cholesterol out of our system so we can get rid of what we don’t need. And when we measure HDL cholesterol, we’re basically looking at how much “garbage” (cholesterol) is inside those little trucks. It would make sense that the more garbage we find, the more we would assume the trucks are picking up. Unfortunately, this is making a lot of assumptions based on just one finding. We’re assuming that we have enough garbage trucks, that everything on them is working, and that they’ll be dumping that garbage as soon as they get to the landfill (our livers). As you might suspect, those aren’t always the case. Sometimes our HDL particles contain a lot of cholesterol because there are just not that many little garbage trucks to handle all the cholesterol that needs to be transferred.9 Our HDL garbage trucks may also be loaded with cholesterol because they just aren’t unloading it well, which is akin to them driving around full and not picking up more garbage—not useful.10 So what we really want to know when we look at HDL and use that to predict cardiovascular health, is how much healthy HDL function does the patient have? This has been a tricky measure to pin down, but researchers and laboratories are looking to create tests that will give us a clear indication of healthy HDL function and bring that to us as patients. There are a few advanced tests available that can help give indications of our HDL function, but they still need more refinement.9 You’re probably thinking, “Are there ideal HDL levels? When should I seek more investigation?” We do have some indications of ideal levels that suggest our HDL is likely functioning well. One study found the following ideal HDL ranges:9
If your HDL levels fall within these ranges, it’s likely functioning as it should, protecting your cardiovascular system and cleaning up other various things your body no longer needs.9 These ranges show us that there is likely an upper limit to what is healthy and ideal and that we might need to rethink the “more is always better” axiom we’ve followed for decades. References: 1. Barr DP et al. Am J Med. 1951;11(4):480-493. 2. Gordon T et al. Am J Med. 1977;62(5):707-714. 3. Castelli WP et al. JAMA. 1986;256(20):2835-2838. 4. Cullen P et al. Circulation. 1997;96(7):2128-2136. 5. Sharrett AR et al. Circulation. 2001;104(10):1108-1113. 6. Di Angelantonio E et al. JAMA. 2009;302(18):1993-2000 7. Madsen CM et al. Eur Heart J. 2017;38:2478-2486 8. Hamer M et al. Arterioscler Thromb Vasc Biol. 2018;38(3):669-672. 9. Khera AV et al. Circulation. 2017;135(25):2494-2504. 10. Hancock-Cerutti W et al. Molecules. 2021;26(22):6862.
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 Feeling off? An unbalanced gut microbial community, also known as dysbiosis, can wreak havoc on your health. Your gut is home to around 100 trillion microbes, and most of these little critters are good for you.1 However, not all microbes provide the same health benefits. When potentially harmful bacteria have stronger effects than your good bacteria, it can negatively affect your health.
Here are 7 signs that your gut could use some love: Acne Has your skin been suffering from breakouts? An unbalanced gut might be the culprit. Recent studies have revealed a link between reduced bacterial diversity in the human gut and acne.2 Acne affects up to 50 million people in the United States and is the nation’s most common skin condition.3 What can you do to fight back against stubborn blemishes? Take a close look at your diet. Research has identified a link between the Standard American Diet (SAD) and acne.2 An overabundance of saturated fats, dairy products, and refined carbohydrates leaves Americans undernourished and can contribute to the development of blemishes.2 Omega-3 fatty acids are also in short supply in the SAD; supplementation with omega-3s has been shown to help reduce acne.4 Mood Feeling down? The bacteria living in your gut could be partially to blame. You’ve probably heard of the gut-brain connection; many studies have shown a relationship between mood and the gut.5 Via the vagus nerves, your thoughts and moods send signals to your digestive tract (and immune system) and vice versa.6 Recent studies suggest that a high-quality probiotic may help to improve mood and cognition.7-10 GI upset Too many trips to the porcelain throne? Losing friends to flatulence? Confounded by occasional constipation? These annoying symptoms could be signs of dysbiosis.11 To address these issues, a good place to start is to look at your medications and supplements to see if any may cause occasional diarrhea or constipation. Additionally, an elimination diet can be a good way to help determine if certain foods might be contributing to your symptoms. Your poop could be telling you a lot about your health, so keeping tabs on your bathroom visits is important. Immune system 70% of your immune system resides in your gut.12 A healthy balance of gut bacteria helps support a sufficient immune response. Sleep Are you counting sheep by the thousands, yet sleep is still elusive? The critters living in your gut could be partially to blame. A recent study showed that better and longer sleep is associated with microbiome diversity.13 Sugar cravings If you often find yourself craving sugary treats, this could be partially due to the microbes in your gut.14 For example, the bacteria in your gut may signal that they would like a bacon maple doughnut, even though you planned to have a salad instead. The most effective way to turn down the volume on the signals for sugary snacks? Starve those nasty bugs by changing up your daily diet. You can improve your guts microbiome by favoring vegetables, fruits, and fermented foods. Over time the cravings can diminish. Weight fluctuations Are you struggling to maintain a healthy weight? The bacteria in your gut could be a major player. Everyone’s microbiome is unique—made up of various strains of bacteria and protozoa (a group of single-celled microorganisms)—some of these gut dwellers have been shown to influence weight and even overall health. If you are experiencing sudden weight loss or unusual changes in your bowel habits, you should contact your healthcare practitioner. 7 ways to improve gut health Diet The more diverse your diet, the more diverse your microbiome! Eat the rainbow by loading up on a variety of different-colored fruits and vegetables, whole grains, and lean protein sources like fish and legumes. Another great way to support your gut is by eating fermented foods. Building a rich microbiome is a fantastic way to care for your health and immune system. Additionally, here are 5 foods to reduce to support your gut health. Probiotics High-quality probiotics can be a fantastic way to support your gut health. When you have a rich and diverse “forest” of good bacteria, the harmful bacteria are crowded out. This increase of good bacteria and the resulting reduction in harmful bacteria can improve your digestion and ability to better absorb macronutrients and micronutrients. Two important things to remember when selecting a probiotic: 1. Different strains for different gains, meaning different probiotic strains support specific health goals. 2. Not all probiotics are created equal. Here are six things to look for in a probiotic. Prebiotics Remember to feed your good bacteria! The good bacteria in your gut live on prebiotics. Prebiotics resist digestion so that they can reach the good bacteria living in your colon. Your good bacteria then ferment (eat) the prebiotics. So, probiotics and prebiotics go together like…well, probiotics and prebiotics! Supplements Many supplements are formulated to support a healthy gut and a strong digestive tract. Some great options are glutamine, inner leaf aloe, and zinc-carnosine. Additionally, recent studies have shown the benefits of vitamins C, B2 (or riboflavin), and D on the digestive tract and microbiota of the human gut.15-17 Exercise Need another reason to exercise? Studies have shown that exercise can increase microbiota diversity within the gut.18 So find your favorite way to break a sweat and get moving. Your gut will thank you! Developing a yoga practice may be a great place to start, as studies have shown that yoga has proven benefits for relieving intestinal distress.19-20 Hydrate Drink up; the gut’s mucosal lining is 98% water!21 Water not only helps to expel toxins through urine and stool, but it also helps to prevent occasional constipation. It’s important to support the mucosal lining of your gut; this lining helps shield your gut’s inner epithelial walls from undesirable microbes.21 Relax The gut and brain are in constant contact via the vagus nerves. Relaxation has been found to positively impact gut health.22 If you think your gut may be the source of your symptoms or just needs some love, reach out to your healthcare practitioner to create a plan of action to reach your best gut health. Unusual GI symptoms can be a sign of a more serious health concern. References
 High-density lipoproteins (HDL) are also known as “good” cholesterol. These particles help to remove cholesterol from the body by carrying it from the rest of the body to the liver, where it’s eliminated. There are a number of ways to help keep your HDL levels in the optimal zone, including exercising, quitting smoking, and taking supplements. There are also certain foods that, in correlation with exercise, can help to raise your HDL levels (and/or improve the ratio of your HDL to LDL levels). What do these foods have in common? High in healthy fats: Foods such as fatty fish, nuts, and seeds are great dietary sources of omega-3 fatty acids. Omega-3s are known for their heart-healthy benefits, but they also have the power to raise HDL levels.3,4 High in antioxidants: Known for the role they play in supporting a healthy immune system, antioxidants help to protect our bodies from the damage caused by oxidative stress. Foods high in antioxidants such as berries, grapes, and green tea have an added benefit: A higher antioxidant level is associated with improved HDL numbers.5 HDL is actually an antioxidant itself, helping to prevent the oxidation of lipids on LDL particles and helping to remove free radicals.6,7 So which foods should you add to your next grocery list?  ConclusionSo if your healthcare practitioner has suggested you increase your HDL levels to help optimize your health, consider adding one or more of these foods to your daily diet!
References: 1. Zhou Q et al. Int J Environ Res Public Health. 2015;12(5):4726-4738. 2. Brown L et al. Am J Clin Nutr. 1999;69(1):30-42. 3. Franceschini G et al. Metabolism. 1991;40(12):1283-1286. 4. Yanai H et al. J Clin Med Res. 2018;10(4):281-289. 5. Kim K et al. Nutrients. 2016;8(1):15. 6. Xepapadaki E et al.. Angiology. 2020;71(2): 112-121. 7. Brites F et al. BBA Clinical. 2017;8:66-77.  Many of us have learned to “trust our gut.” But if we ask most people what our digestive tract is for, they’ll probably explain it as a way of absorbing nutrients and disposing of waste. So where do phrases such as “trusting our gut” or “unable to stomach the results” come from? It turns out there is a two-way street between our digestive organs and our brains. What we eat and the state of our digestive tract can have a profound impact on our moods and behaviors. And probably unsurprisingly at this point, our gut microbiome is also involved.
Our vagus nerves, which control much of our “rest and digest” response, make a direct connection from our brains to our digestive tracts. Incidentally, these nerves also innervate our heart and communicate with our immune systems.1 These nerves help our brains communicate to our stomachs to start releasing stomach acid and digestive enzymes, and they carry signals from our digestive organs that tell our brains whether we’re hungry or full.1 But there’s a whole lot more to the story than these basic logistical messages. Our thoughts and moods are sending signals to our digestive tract (and immune system) and vice versa.1 Have you ever felt nausea from a stressful situation or lost your appetite from bad news? That message was carried from your brain to digestive tract via your vagus nerve.2 What might be news is that the situation in your digestion can also send signals to your brain.2 Is your digestive system reacting with something you ate? That signal is conveyed to your brain and can color the rest of your day or night.2 And to add another layer of complexity, the bacteria and other organisms in our gut can make or simulate neuroactive molecules like gamma-aminobutyric acid (GABA), melatonin, and serotonin.2 As you may know, these substances can make a big impact on our mood and how alert we feel. And stress can change the number of healthy bacteria (such as lactobacilli) in our guts and weaken the digestive tract and blood-brain barriers—letting molecules and even bacteria in that would be excluded under normal conditions.2,3 Conversely, consuming some probiotic species can improve our mood.2 This is all to say, everything is connected. I’ve seen many patients with digestive troubles (myself included) who’ve been told by someone, “It’s all in your head.” This is an oversimplified message, because stress and emotions absolutely play a role in digestive health, and the opposite is also true. Likewise, many patients who come in for issues with their mood have related concerns in their digestion that must be addressed before they see significant progress. Often when it comes to health, the symptoms can lead to the root of the problem, but only when you understand the connections. References:
 Did you know that the majority of your immune system is in your gut?1 Picture a lush, harmonious rainforest teeming with diverse forms of life; this is what a healthy gut should look like at a microbial level. With more than 1,000 microbial species, most of which are bacteria, your gut’s microbiome makes up an essential part of your immune system.2 The good bacteria in your gut protect you from pathogenic invaders and keep harmful bacteria from growing out of control. The good bacteria that live in your gut are an essential part of your body’s microbiome. Here are 10 of the best ways to increase your good gut bacteria.
1. Eat whole foods The human body is not meant to run on food-like substances; diet matters! Eating processed foods and refined sugars starves the good bacteria in your gut, allowing harmful bacteria to grow out of control, also known as dysbiosis.3,4 Instead of filling up on processed foods, eat the rainbow. Choosing to eat a wide variety of whole high-fiber foods feeds your good bacteria and, in turn, nourishes your microbiome. Choosing organic produce is also a great way to add good bacteria to your gut’s ecosystem.5 By keeping your good bacteria strong and healthy, they can keep you healthy too. 2. Eat fermented foods The creation of fermented foods dates back thousands of years, as far as 10,000 BCE, with the advent of yogurt; the health benefits of yogurt are described in Ayurvedic scripts from 6,000 BCE.6 Fermented foods are a great way to support your health by adding good bacteria to your gut’s population of roughly 100 trillion bacteria and microbes. Here are some tasty options for adding fermented foods to your daily diet:
Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”7 Choosing a high-quality clinically supported probiotic is a great way to introduce some new friends to your gut. Different strains of probiotics offer different health benefits; here are six things to look for in a probiotic. 4. Feed your good bacteria Now that you’ve loaded up on good bacteria from probiotic foods, it’s time to feed your new friends! Probiotics and prebiotics go together like, well, probiotics and prebiotics! Prebiotics are fibers that can resist the digestive process; once prebiotics reach the colon, they are “eaten” (selectively fermented) by specific strains of friendly gut bacteria.8,9 Here are some whole foods filled with prebiotics to feed your microscopic friends:10
Research shows a relationship between sleep and diversity within the gut microbiome.11 Consistent, uninterrupted sleep of between seven to nine hours per night has been shown to have a positive correlation to bacterial strains related to good health.12,13 6. Get moving Consistent exercise results in increased good bacteria. In a six-week study, exercise was shown to increase the numbers of certain strains of good bacteria.14 However, when followed by a six-week sedentary period, the increase of microbiota returned to baseline, so it’s important to get moving and stay moving.14 7. Destress Stress has been shown to have a negative impact on gut health. Heightened stress levels can trigger an increase in bad/pathogenic bacteria, crowding out good bacteria.15,16 Try these six simple ways to reduce stress. 8. Get some vitamin D A 2019 study found that skin exposure to UVB light positively impacts the diversity and composition of the human microbiome.17 Vitamin D supplementation also has positive impact on the gut’s microbiome by increasing bacterial diversity and richness.”18,19 9. Take it easy on the cocktails It’s well known that red wine can support good health, but too much alcohol has been shown to have a negative impact on good gut bacteria.20,21 The CDC 2020-2025 guidelines recommend one drink or less in a day for women and two drinks or less in a day for men.22 The CDC guidelines also caution against beginning drinking for possible health benefits and advise that “drinking less is better for health than drinking more.”22,23 The health benefits of red wine likely stem from polyphenols from the grape skins present in the wine-making process.24-27 Polyphenols are complex compounds found in fruits and vegetables that protect plants from pathogens and UV radiation; these compounds act as an antioxidant and as a prebiotic in the human body.28,29 Plenty of foods are packed with polyphenols, such as:30
Smoking causes a decrease in microbiome diversity; smoking withdrawal has been found to increase gut microbial diversity.31 Quitting smoking is a great way to show your little critters some love.31 All of these are great ways to help increase the friendly bugs working hard in your gut. Which will you try first? References: 1. Vighi G et al. Allergy and the gastrointestinal system. Clin Exp Immunol. 2008;153 Suppl 1(Suppl 1):3-6. 2. Wang W et al. Gut microbiota and allogeneic transplantation. J Transl Med. 2015;13:275. 3. Gagliardi A et al. Rebuilding the gut microbiota ecosystem. Int J Environ Res Public Health. 2018;15(8):1679. 4. Di Rienzi SC et al. Adaptation of the gut microbiota to modern dietary sugars and sweeteners. Adv Nutr. 2020;11(3):616-629. 5. Blum WEH et al. Does soil contribute to the human gut microbiome? Microorganisms. 2019;7(9):287. 6. Fisberg M et al. History of yogurt and current patterns of consumption. Nutr Rev. 2015;73 Suppl 1:4-7. 7. Hill C et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol. 2014;11(8):506-514. 8. Charalampopoulos D et al. Prebiotics in foods. Curr Opin Biotechnol. 2012;23(2):187-191. 9. Gibson GR et al. Expert consensus document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus statement on the definition and scope of prebiotics. Nat Rev Gastroenterol Hepatol. 2017;14(8):491-502. 10. Jovanovic-Malinovska R et al. Oligosaccharide profile in fruits and vegetables as sources of prebiotics and functional foods. Int J Food Prop. 2014;17(5):949-965. 11. Smith RP et al. Gut microbiome diversity is associated with sleep physiology in humans. PLoS One. 2019;14(10):e0222394. 12. Fei N et al. Gut microbiota alterations in response to sleep length among African-origin adults. PLoS One. 2021;16(9):e0255323. 13. Bowers SJ et al. Repeated sleep disruption in mice leads to persistent shifts in the fecal microbiome and metabolome. PLoS One. 2020;15(2):e0229001. 14. Mailing LJ et al. Exercise and the gut microbiome: a review of the evidence, potential mechanisms, and implications for human health. Exerc Sport Sci Rev. 2019;47(2):75-85. 15. Zeng MY et al. Mechanisms of inflammation-driven bacterial dysbiosis in the gut. Mucosal Immunol. 2017;10(1):18-26. 16. Kiecolt-Glaser JK et al. Modulation of cellular immunity in medical students. J Behav Med. 1986;9:5–21. 17. Bosman ES et al. Skin exposure to narrow band ultraviolet (UVB) light modulates the human intestinal microbiome. Front Microbiol. 2019;10:2410. 18. Bashir M et al. Effects of high doses of vitamin D3 on mucosa-associated gut microbiome vary between regions of the human gastrointestinal tract. Eur J Nutr. 2016;55(4):1479-1489. 19. Waterhouse M et al. Vitamin D and the gut microbiome: a systematic review of in vivo studies. Eur J Nutr. 2019;58(7):2895-2910. 20. Zhang X et al. Alcohol-induced changes in the gut microbiome and metabolome of rhesus macaques. Psychopharmacology. 2019;236(5):1531-1544. 21. Dubinkina VB et al. Links of gut microbiota composition with alcohol dependence syndrome and alcoholic liver disease. Microbiome. 2017;5(1):141. 22. https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm. Accessed September 21, 2021. 23. https://www.dietaryguidelines.gov/sites/default/files/202012/Dietary_Guidelines_for_Americans_2020-2025.pdf. Accessed September 21, 2021. 24. https://journalsblog.gastro.org/is-red-wine-consumption-good-for-your-intestinal-microbiome/. Accessed September 21, 2021. 25. https://www.winespectator.com/articles/understanding-wine-polyphenols-health-benefits. Accessed September 21, 2021. 26. Wiciński M et al. The influence of polyphenol compounds on human gastrointestinal tract microbiota. Nutrients. 2020;12(2):350. 27. Cavallini G et al. Resveratrol requires red wine polyphenols for optimum antioxidant activity. J Nutr Health Aging. 2016;20(5):540-545. 28. Pandey KB et al. Plant polyphenols as dietary antioxidants in human health and disease. Oxid Med Cell Longev. 2009;2(5):270-278. 29. Nazzaro F et al. Polyphenols, the new frontiers of prebiotics. Adv Food Nutr Res. 2020;94:35-89. 30. Yang J et al. Polyphenols in foods. Nutri Today. 2016;51(6):290-300. 31. Capurso G et al. The interaction between smoking, alcohol and the gut microbiome. Best Pract Res Clin Gastroenterol. 2017;31(5):579-588.  By Michael Stanclift, ND The rich orange color of turmeric is a signature of this powerfully healthy Indian spice. Even if you don’t dig the flavour of it in food, you might take turmeric in one of its many supplement forms for health benefits. Curcuma longa is the Latin name for turmeric and also hints at the name of the most talked about molecule in it, curcumin. Many people use “turmeric” and “curcumin” interchangeably, but surprisingly there isn’t that much curcumin in turmeric—curcumin makes up only about 3% of dried turmeric.1 But when we’re talking about the health benefits of turmeric, we’re usually really referring to its famous derivative, curcumin, which is the most studied component. So why has this orange molecule become the darling of healthy living? Curcumin offers a host of health perks, is safe, and is well-tolerated by nearly every patient I’ve recommended it to. Many of the effects essentially boil down to curcumin’s ability to function as an antioxidant or balance the immune response to cellular injury.2 It can improve markers of oxidative stress and increase circulating antioxidants, such as superoxide dismutase, sometimes referred to as SOD.2 Curcumin can block the activation of NF-κB, which is involved in the immune response and can lead to undesirable effects.2 So how are these effects meaningful? Here are some of the research-backed ways I’ve utilized curcumin with the patients I’ve seen:
Before you get started There are a few things you should know about curcumin before you run out and start taking it. First, curcumin isn’t very well absorbed, so it is often combined with other natural substances to help improve absorption. I have used it in formulations where it is combined with a black pepper extract (piperine), which can increase the availability about 20 times, and a fenugreek extract, which can increase the availability about 45 times.2,6 The second thing to know is that while curcumin has a great safety record, there have been cases of people taking a curcumin supplement experiencing liver injury.7,8,9 There’s some speculation that the effect may have come from another ingredient, not the curcumin, and many of the products involved contained piperine, the black pepper extract.7,9,10 In response to these concerns, I found a 90-day study of healthy volunteers who were investigated for signs of toxicity when the subjects were given highly bioavailable curcumin (with fenugreek extract).11 With this formulation no adverse effects were noted in the study, and liver enzymes remained within the normal range.11 There are two morals to this story: Always look for manufacturers with a solid reputation and transparent quality testing for their products, and seek the guidance of an experienced healthcare provider to ensure you’re taking the proper precautions and monitoring. In healthy individuals, doses between 150-1,500 mg have been studied and appear to be beneficial, well-tolerated, and safe.5 The European Food Safety Authority (EFSA) is a bit more conservative and established an acceptable daily intake (ADI) of curcumin at 3 mg/kg/day.9 For readers in the United States, that translates to roughly 1.36 mg/lb/day or a dose equivalent to about 205 mg/day of curcumin per day for a 150-pound person. Turmeric, along with its most active component curcumin, is clinically versatile and offers a wide range of health benefits. These qualities make it an attractive candidate to include in your healthy lifestyle. Ask your healthcare provider if you might benefit from turmeric or curcumin! References:
By Cassie I. Story, RDN
What is vitamin B12? Vitamin B12 is a water-soluble vitamin that plays an important role in neurological and hematological functions.1 The majority of bodily cells require vitamin B12, especially ones that undergo rapid turnover like red blood cells (RBC).2 Vitamin B12 is also involved in DNA synthesis and methylation of RNA, as well as Phase I detoxification.1,3 Perhaps one of its most important roles is in relationship to the nervous system and its need for the formation of the myelin sheath, which is found around nerve cells.2 In fact, long-term vitamin B12 deficiency-induced neuropathy can damage nerve cells to the point of irreversible neurologic damage.2 What food sources are rich in vitamin B12?Foods rich in vitamin B12 are primarily from animal sources including liver, oysters, poultry, fish, eggs.2 Some fermented foods like miso and tempeh also contain vitamin B12. However, plant sources of vitamin B12 are likely unavailable for absorption by humans—so special care should be taken by people who avoid or do not consume animal products.2 Absorption considerations In order for food-based vitamin B12 to be absorbed, it must first interact with hydrochloric acid (HCl) and gastric protease in the stomach. These substrates allow vitamin B12 to be released from the protein it is bound to and then to be combined with intrinsic factor (IF), which is secreted by the parietal cells in the stomach. The combined vitamin B12-IF complex travels through the gastrointestinal (GI) tract for absorption in the distal ileum. It is well-established that HCl and IF production decline with age, and certain medications (proton pump inhibitors, metformin) have been found to reduce vitamin B12 absorption in the gut.2,4 Supplementation with vitamin B12 in its free form, or combined with IF, may be more beneficial in preventing or treating a deficiency.2 Bodily storage As vitamin B12 is stored in the liver in high amounts, with estimates being 3-5 milligrams, the majority of individuals are not at high risk for a deficiency.2 Situations in which individuals have difficulty absorbing vitamin B12, such as malabsorptive disorders, lack or decline in the production of HCl or IF, low levels of hepatic storage, or dietary insufficiency, particularly for those who follow a strict vegan diet, are at higher risk of deficiency.1 Typically, there are three causes for a potential vitamin B12 deficiency. These include:1
What happens with a vitamin B12 deficiency? Nutritional deficiency is the main cause for low hemoglobin and red blood cells (RBCs).2 A reduction of hemoglobin in the blood can eventually lead to anemia, a condition that can affect day-to-day living by impacting energy levels.2 Macrocytic anemia can result from low levels of vitamin B12 and presents with typical signs of anemia like pallor and fatigue.1 Jaundice can also be present as a result of impaired RBC formation.1 Certain medications can negatively impact vitamin B12 status, including contraceptive pills. Oral contraception can impact B12 status, without typically producing the above symptoms or neurological damage.3 Some medications have been shown to deplete vitamin B12 including antibiotics, anticonvulsants, metformin, and proton pump inhibitors.2 Diagnosing deficiency Serum vitamin B12 is a standard marker used to evaluate deficiency; however, this may miss 30-50% of vitamin B12 deficiencies in certain people, including those with a history of GI or bariatric surgery.5 For this reason, serum methylmalonic acid (MMA) is the preferred method for assessment and also helps to distinguish between vitamin B12 and folate deficiencies.2,5 Additional markers can include intrinsic factor antibodies (IFAB) and parietal cell antibodies. Differential diagnosis of vitamin B12 and folate deficiencies lie in the measurement of MMA. If both MMA and homocysteine are elevated and vitamin B12 is depressed, this indicates a vitamin B12 deficiency. Alternatively, if homocysteine is elevated but MMA is within normal limits, this may indicate a folate deficiency.1 Physical signs and symptoms of deficiencyIt is estimated that 75-90% of individuals who present with a vitamin B12 deficiency experience neurologic disorders.2 Neurological symptoms present in vitamin B12 deficiency may include peripheral neuropathy, decreased reflexes, ataxia, vibratory sense loss, dementia, psychosis, and altered mood.1,6 Paradoxically, while vitamin B12 deficiency can cause fatigue, it also may induce insomnia.2 Other chief complaints may include glossitis, diarrhea, and headaches.1 In a 24-month randomized and double-blind intervention study that included 168 elderly individuals with mild cognitive impairment, oral supplementation of vitamin B12, folic acid, and vitamin B6 slowed the progression of brain atrophy and the reduction of cognitive performance by 53%.7 How much vitamin B12 is recommended?The common dosage range for treating vitamin B12 deficiency with supplements is 500-2,000 mcg per day and is available as cyanocobalamin or methylcobalamin, which is the active form. Methylcobalamin may be preferred especially for individuals with certain genetic polymorphisms, increased oxidative stress, or digestive conditions of any kind.2 Common repletion recommendations:2,5
When to take and what to take it with? Taking vitamin B12 early in the day with the presence of other B vitamins including folate and possibly calcium is recommended. Avoid taking with alcohol and antibiotics.3 ConclusionAwareness and treatment of vitamin B12 deficiency are important to ensure that individuals are not impacted by its potentially permanent damaging effects to neurological health, as well as to ensure overall health and wellbeing and expected energy levels for daily living. Check with your healthcare practitioner to see if you should be tested for deficiency and how much you should be supplementing with daily. References: 1. Ankar A et al. Vitamin B12 Deficiency. StatPearls. Treasure Island, FL: StatPearls Publishing, 2021. 2. Mahan L, Escott-Stump S. Krause’s Food, Nutrition, and Diet Therapy 10th edition. Philadelphia, PA: W.B. Saunders Company, 2000. 3. Mortimore D. Nutritional Healing. Boston, MA. Element Books Limited, 1999. 4. Miller JW. Adv Nutr. 2018;9(4):511S-518S. 5. Parrott J et al. SOARD. 2016;12:955-959. 6. Shils M et al. Modern Nutrition in Health and Disease. Vol 10th edition. Baltimore, MD: Lippincott Williams and Wilkins, 2006. 7. Gröber U et al. Nutrients. 2013;12:5031-5045.  Add These Detoxifying Foods to Your Shopping List
Detox is a hot topic nowadays. Many detox programs promise to cleanse your body harmful compounds, and others tout weight loss and additional health benefits. Unfortunately, many of these detox methods involve a major dietary overhaul or giving up solid foods altogether, which may actually be harmful to your body.1 Because your body is in constant detox mode, you can encourage this process, correctly and effectively, by simply eating the right foods. Scientific research has found that the nutrients, enzymes, and antioxidants found in certain whole foods can help support the liver’s detoxification pathways, prevent the buildup of toxins, and support overall health.2-4 Chemicals and toxins are everywhere, but your body is built to fight back. Here are six of your top nutritional allies: 1. Cruciferous vegetables & leafy greens Spinach, broccoli, and Brussels sprouts are among the folate- and chlorophyll-richgreens that support the body’s detoxification process by helping to detoxifythe blood and cleanse the intestines.2,4-7 All the more reason to go green! Broccoli deserves some special attention for its high concentrations of glucoraphanin, which is converted in the body to sulforaphane—an active compound associated with many positive health benefits, including its role in inducing phase II detoxification enzymes and support for overall liver health.8-10 2. Turmeric Used in many anti-inflammatory and detoxifying recipes, turmeric contains a powerful substance called curcumin, a polyphenol with anti-inflammatory and antibacterial properties. Science has found curcumin to play a role in modulating cellular response to oxidative stress—demonstrating hepaprotective and therapeutic effects on liver health.11,12 3. Sesame Commonly used in bread products, oils, and dressings, sesame is flowering plant that maybe beneficial for detox. Sulfur-containing amino acids methionine and cysteine—both of which are found at high levels in sesame—are precursors to the production ofglutathione, a key antioxidant in the detoxification process.4 4. Beets These pretty-colored veggies contain betanin, which can help repair liver cells and help support detoxification processes in the liver.13,14 It’s also great for digestion. Tell toxic chemicals to “beet” it! 5. Guacamole No party spread is complete without it! Avocado has high concentrations of the antioxidant glutathione, which has been found to neutralize free radicals to support and protect the liver—i.e., your detoxification powerhouse.4,15,16 Why guacamole? Avocado in this form often uses other healthful ingredients, like cilantro. Also known as coriander, cilantro contains oils with antibacterial, antifungal, and antioxidative properties.17 Pass the guac, please. 6. Garlic Alongside its knack for warding off vampires, garlic may be beneficial for clearing out toxins. The sulfur-containing compound allicin, which gives garlic its unique and strong-smelling aroma, may enhance antioxidation and detoxification capabilities18,19 and has also demonstrated hepatoprotective effects against heavy metals in the liver.20 Incorporating more of these foods into your diet can help support detox processes. Add them to your shopping list today! References:
Submitted by the Metagenics Marketing Team  By Molly Knudsen, MS, RDN
There’s no doubt that antioxidants are good for health. Antioxidants have been in the public spotlight since the 1990s and have only gained attention over the years, basically reaching celebrity status. And that status has not wavered, especially as their role in immune health becomes increasingly known. Antioxidants and antioxidant-rich foods continue to trend and make headlines, most recently in the forms of matcha/green tea drinks, acai bowls, golden milk, or just good ol’ fashioned fresh fruits and vegetables. Antioxidants are here to stay not only because they’re found in delicious foods, but they also play a vital role in health by protecting the body against oxidative stress.1 What is oxidative stress? Everyone’s heard of oxidative stress, but what exactly does that refer to? Oxidative stress occurs from damage caused by free radicals. Free radicals are unstable molecules that have lost an electron from either normal body processes like metabolism, reactions due to exercise, or from external sources like cigarette smoke, pollutants, or radiation.1 Now electrons don’t like to be alone. They like to be in pairs. So do free radicals suck it up and leave one of their electrons unpaired? Nope. They steal an electron from another healthy molecule, turning that molecule into another free radical and, if excessive, wreak havoc in the body and its defense system. Immune cells are particularly vulnerable to oxidative stress because of the type of fat (polyunsaturated) that they have in their membrane.2 So high amounts of oxidative stress over time can be especially detrimental to immune system. What are antioxidants? Antioxidants are the heroes that can break this cycle. And there’s not just one antioxidant. Antioxidants refer to a whole class of molecules (including certain vitamins, minerals, compounds found in plants, and some compounds formed in the body) that share the same goal of protecting the body and the immune system against oxidative stress.2 But different foods contain different antioxidants, and each antioxidant has its own unique way of supporting that goal. 6 antioxidants for oxidative stress protection + immune health 1. Vitamin C Vitamin C is a powerful antioxidant that also contributes to immunity. It works by readily giving up one of its electrons to free radicals, thereby protecting important molecules like proteins, fats, and carbohydrates from damage.3 Vitamin C is a water-soluble vitamin, which means storage in the body is limited, and consistent intake of this nutrient is vital. Research shows that not getting enough vitamin C can impact immunity by weakening the body’s defense system.3 Vitamin C is found in many fruits and vegetables, including strawberries, bell peppers, citrus, kiwi, and broccoli. The benefits of vitamin C’s antioxidant capabilities are more than just internal. Benefits are also seen when a concentrated source of this antioxidant is applied to the skin. For example, topical vitamin C serums are often recommended by dermatologists and estheticians to help protect the skin from sunlight and address hyperpigmentation.4 2. Epigallocatechin 3-gallate (EGCG) Green tea is easily, and unofficially, considered one of the world’s healthiest foods, and the presence of EGCG is one reason for this drink’s reputation. EGCG is the most abundant, potent, and researched polyphenolic antioxidant found in green tea leaves.5 It has been shown to protect against damage caused by free radicals.5 Drinking green tea is a great way to reap the benefits of EGCG and other nutrients found in tea leaves, or it’s also available as an extract in nutritional supplements. If you choose to drink green tea, it’s important to remember that water preparation matters. Using hot water to steep green tea not only preserves, but it also encourages more antioxidant activity compared to using cold water, as hot water may be better at extracting polyphenols from the leaves.5 3. Glutathione Glutathione is a powerful antioxidant that the body actually makes internally from three amino acids (AKA building blocks of protein): cysteine, glutamate, and glycine.6 Not only does this antioxidant protect the body against oxidative stress, it also supports healthy liver detoxification processes.7 Glutathione levels naturally decrease with age, and lower glutathione levels in the body are associated with poorer health.8 Since it takes all three of those amino acids to form glutathione, ensuring that the body has adequate levels of all three is vital. Cysteine is the difficult one. It’s considered the “rate-limiting” step in this equation, since it’s usually the one in short supply, and glutathione can’t be formed without it.6 Cysteine contains sulfur, so foods like unprocessed meat, garlic, and asparagus are great choices to support cysteine levels. Like cysteine, the compound N-acetylcysteine (found in supplements and often labeled NAC) can also be used to support the body’s glutathione levels.6 4. Curcumin Curcumin is the yellow pigment and considered the active ingredient in the spice turmeric. In the culinary world, turmeric is best known for playing the leading role in curries as well as in golden milk. Studies show that curcumin has been shown to improve markers of oxidative stress, act as a free radical scavenger, and assist with other antioxidant processes in the body.9 Curcumin isn’t very bioavailable, so your body isn’t able to fully capture the benefits when consumed on its own or just as turmeric.9 But adding other spices or herbs like black pepper or fenugreek can significantly increase your body’s ability to utilize curcumin.9 5. Vitamin E Vitamin E is a fat-soluble vitamin, meaning it’s best absorbed with fat. It acts as an antioxidant by stopping the production of free radicals from forming when fat is oxidized, or burned.10 Vitamin E is found in nuts and seeds (almonds, sunflower seeds, and hazelnuts) as well as green leafy vegetables. Vitamin E also plays a role in heart, eye, and cognitive health.10 6. Quercetin Quercetin is one of the most well-studied flavonoids, or plant compounds, typically found in onions, kale, broccoli, apples, and tea. Quercetin acts as a free radical-scavenging antioxidant, helps inhibit oxidative stress, and supports a healthy immune response.11 What’s the bottom line? Antioxidants are a crucial part to any healthful diet. They help protect the body from damage caused by oxidative stress and support immune function. There are many more antioxidants that are beneficial to health than those listed here. The best way to ensure that you’re getting enough antioxidants from the diet and supporting the antioxidants the body makes on its own is to consume a diet high in plants like fruits, vegetables, nuts, seeds, and legumes. References
 By Melissa Blake, ND
When it comes to building a healthy immune system, we often hear about diet and exercise, but unfortunately less often about the importance of sleep. But, when it comes to the immune system, sleep is a crucial component. Researchers around the world continue to discover the numerous benefits of our nightly slumber. Sleep is when the body and the mind have a chance to rest and repair on a cellular level, and without enough of it, or enough quality sleep, one’s health can begin to suffer.1 Disrupted sleep is a major contributor to hormone imbalances, skin issues, weight gain, and even a weakened immune system.1-4 Whether you’re not sleeping well due to stress, your schedule, or another factor, prioritizing sleep is a key component to a healthy immune system.1 The sleep debt cost Most likely everyone can relate to the immediate impact of a sleepless night. Even getting just a little less sleep than one needs or is used to can contribute to confusion, weakness, muscle pain, and changes in appetite.2-4 The long-term consequences of neglecting sleep are even more serious. A regular lack of sleep increases the risk of cardiovascular issues, weight gain, and compromised immune function.4,5 Correlation between sleep & immune health Driven by a circadian rhythm, messengers called cytokines impact the state of the immune system and also contribute to sleep-wake patterns.1 While we are sleeping, cytokines instruct immune cells to work hard at repairing damage, clearing toxins, and defending us against illness.1 This might be one reason why we feel more tired and require more rest when we are sick. It’s during sleep that the immune system is most active and focused on recovery and developing immune memory.1 A good night’s rest is also key for improving the function of immune cells known as T cells, a type of immune cell that fights against pathogens such as viruses.6 A German study found that in people who slept adequately the night before, T cells were better able to attach to their targets, including virus-infected cells, than in the T cells of those who stayed up all night.7 The findings highlight one of many immune-supportive effects of sleep. Conclusion Habits such as a consistent routine, including regular bed and wake times, as well as exposure to natural sunlight within an hour of waking are small, simple changes people can make in order to get a better night’s sleep while improving their body’s circadian health. Even going to bed just 10 minutes earlier can have a profound effect on how you feel, so give it a try starting tonight—your immune system will thank you. This is the first in a three-part series on circadian health. For more information on sleep and other general wellness topics, please visit the Metagenics blog. References:
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