“I’m addicted to sugar.” We’ve all heard or thought this before. Considering the American palate for highly processed, overly sweetened foods and the ubiquitous nature of sugar in advertising, we see evidence of a concerning shift. Sugar’s role in the American diet has moved beyond a character actor and into a starring role. Further, as discussed in the previous post, Sugar. How Much Is Too Much?, we consume far more sugar than is recommended for our health. But the question remains—are we addicted? More please: How sugar affects the brain While an ICD-10 code for “sugar addiction,” has yet to be established, an increasing body of research tells us that sugar has addictive effects on the brain.1,2 Like sex and drugs, consuming sugar stimulates the release of dopamine, a neurotransmitter that gives us a sense of euphoria and controls the reward and pleasure centers in the brain. But what may have evolved as a survival mechanism has gone rogue. The caveman sweet tooth From an anthropological perspective, we are hard-wired for sweetness. The pleasing taste of sweet foods was a conditioned reward, one which could increase early man’s survival odds. In times of food scarcity, a preference for more nutritionally dense foods might have provided the energy required to continue the hunt, outrun a predator, or simply avoid starvation. Flash forward a few hundred thousand years, and sugar is exponentially more abundant. Consistent intake of concentrated sugar can lead to changes in the brain’s dopamine receptors. Similar to increased drug or alcohol tolerance, over time, more sugar is needed for the same “high.” Cookies and cocaine So, the more you eat, the more you want. But, as for being “addictive” per se, animal studies have shown sugar consumption to have drug-like effects. These include sugar-related bingeing, craving, tolerance, and withdrawal. In fact, according to a Connecticut College study, Oreo cookies cause more neural activation in the brains of rats than cocaine.3 Taking control For many individuals, the only way to stop over consuming sugar is to stop the cravings. But the only way to end the cravings is to stop feeding them with sugar. So, in addition to cutting out the obvious forms of sugar—candy, baked goods, etc.—it is important to be aware of the less obvious forms of sugar in your diet. Over the course of a day, small quantities can add up, keep your cravings alive, and thwart your efforts to take control of sugar. So become a sugar sleuth. Here are five tips to get you started. 5 Tips for Identifying Added Sugars1. Beware of marketing geared toward dieters
2. Read ingredient labels, especially the first three ingredients
3. Beware of alternate forms and names for sugar
The journey to a healthy relationship with sugar starts with awareness. Watch for the next post in this series, which will feature strategies for taking control of sugar. References
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We sat down with Joel Evans, MD to talk about Functional Medicine options for common women’s health issues. This is the first in a series.
Before we get started, can you tell me about your background? My background really is one of a conventionally trained OB-GYN. As I became interested in helping my patients in every way I could, it became clear to me that all I was trained in simply wasn’t enough. The best example of this was a 26-year-old woman who I had the misfortune of diagnosing with breast cancer. She asked: Does it matter what I eat? The answer I gave was, “I don’t know; ask your oncologist.” Her oncologist was very well known, trained at Harvard, and the answer came back: “It doesn’t matter what you eat.” She asked me if I believed that, and I said, “Let’s find out for sure. Let’s have you meet with a nutritionist.” She met with a nutritionist, who said you must avoid all sugar; sugar goes directly to cancer cells. I went to the medical library to do some research on sugar and cancer. I was shocked to discover that there were over 10,000 papers on cancer and sugar! It was at that point that I realized that there’s more to taking care of people than is taught in medical school. That’s when I learned about Functional Medicine and met Jeff Bland and started speaking for Metagenics way, way back in 2002 or 2003. What kinds of patients do you typically see? I see patients that I’ve seen forever as an OB-GYN who come to me for GYN care. Then I see patients that come to me because they want a Functional Medicine doctor. I also see the most complicated issues that are referred to me by my colleagues and healthcare practitioners that have been through IFM that know that I have a level of expertise that justifies the referral. The patients you said you’ve seen forever, do you help guide them into the Functional Medicine realm? Or are they just there for their usual visits? I always try to guide them into the Functional Medicine realm. When I do their routine blood work, it is far more expansive than that ordered by a traditional doctor. I look for the subtleties in thyroid function. I look for subtleties in adrenal function. I ask probing questions like, How’s your mood? How’s your energy? How are you sleeping? By asking those broader questions about issues that most OB-GYNs don’t inquire, I can then target the blood work to address them. When I go over the results, my patients are getting Functional Medicine care without knowing the term. Are they open to that? Most are open to that. There are very few, maybe 2 or 3% that aren’t. The vast majority are, which is why they refer their friends and relatives to see me. I’m able to help them in all areas of their health. How would treatment for fibroids and endometriosis differ from traditional medicine to lifestyle medicine? For example, what tests do you use, and can you manage these conditions with lifestyle adjustments?This is a big question to answer! The treatments in conventional medicine for fibroids and endometriosis are treatments that most patients don’t want. If fibroids are diagnosed during a routine exam, and there are no symptoms, the conventional treatment is to do nothing. Most patients aren’t happy with that. From a Functional Medicine perspective, there are a lot of things that we can do to prevent them from growing and becoming symptomatic. Rarely do you find endometriosis without symptoms other than if you’re doing a pelvic exam and you feel a cyst, get an ultrasound on the cyst, and find out that it has qualities that are consistent with endometriosis. In that case, the only conventional interventions are birth control pills or surgery to get that cyst removed and see if there are other endometriosis lesions in the pelvis, where they can be destroyed with laser or electrocautery. If patients have symptoms of fibroids, it can be a feeling of fullness, it can be abnormal bleeding, or it can be pelvic pain. There really are no long-lasting conventional treatments for fibroids other than some type of surgical procedure done by radiologists where they block the blood flow to the uterus or block the blood flow to the fibroids and the fibroids shrink. What I do, the Functional Medicine approach, is totally different. I looked at the underlying driver of fibroid and endometriosis growth, and that has to do with estrogen. The Functional Medicine approach ensures there is not too much estrogen coming into, or being produced, by the body and that estrogen is being eliminated properly. What are the sources of estrogen entering the body?It can be from foreign substances, so we can be taking chemicals in, compounds that become or behave like estrogen—those are called xeno-estrogens—that’s why eating organic is so important. We can also be drinking estrogen from our water. They have found estrogens from medications in the water. The other way we can have too much estrogen is that we can be producing too much. For example, we can make too much estrogen through an ovarian cyst. Visceral adipose tissue produces estrogen. In addition, we know the enzyme that makes estrogen, aromatase, is actually inside of endometriosis tissue and inside uterine fibroids. Anything that stimulates aromatase will produce more estrogen. Two direct stimulators of aromatase are insulin and inflammatory prostaglandins. Therefore, the Functional Medicine approach includes normalizing insulin levels and reducing inflammation. Another thing to do is look at how the gut functions. If there are unhealthy bacteria in the microbiome, they can produce an enzyme called beta-glucuronidase that leads to reabsorption of estrogen from the intestine. We have to make sure that we move our bowels regularly, because if there’s constipation, that leads to increased estrogen absorption. We also have to make sure our liver is functioning well, that our cytochrome P450 detoxification enzymes are functioning well because estrogen is eliminated through those pathways. You have a special interest in hereditary breast and ovarian cancer. What kind of risk assessment and prevention tools do you use with your patients?There are standard questions that are put out by National Cancer Institute and the National Institute of Health that we use to find out if patients are at increased risk for BRCA. Then there are other questions that we ask. Dense breasts put a woman at increased risk for breast cancer. I also look at risk factors for other hereditary cancer syndromes, such as Lynch syndrome, where women are at increased risk of colon and gynecologic cancer. I also look for other, nongenetic reasons patients might be at increased risk for breast cancer, like being overweight, having increased adipose tissue, elevated insulin levels, or even being under stress. I then also do a test called BREVAGen™, which can give patients a five-year risk analysis of breast cancer. That’s what’s called a genomewide association study. By looking at the gene frequency of approximately 77 genes, they can come up with a very accurate five-year risk of breast cancer. That means they are candidates for risk reduction medications in addition to a thorough Functional Medicine breast cancer risk reduction protocol. Your Brain on DHA What is DHA? Docosahexaenoic acid (DHA) is a long-chain omega-3 fatty acid—the most abundant of all the fatty acids most commonly found in the brain and eyes. But like many essential nutrients, DHA’s importance is often overlooked, and many Americans fall short of the recommended daily allowance (RDA) outlined by the US Department of Health.1,2 With all the cognitive, and other, benefits DHA has to offer, ensuring you get enough through your daily dietary intake is truly a no-brainer. What are the benefits? Not only does DHA account for over 50 percent of omega-3 fatty acids in the brain, it also turns on your brain’s growth hormone, known as the brain-derived neurotrophic factor (BDNF). This helps support the survival and function of existing neurons and also encourages new neurons and synapses to grow.3,4 Unfortunately, BDNF circulation slows down with age and can be stunted by stress and other lifestyle factors.5 That’s why upping your DHA is so important. Although DHA is essential at every age, it’s especially crucial during three particular stages of life: Pregnancy DHA can be helpful for baby’s development as well as mom’s recovery. A study showed that mothers who supplemented with omega-3s during pregnancy saw their children score higher on intelligence tests due to enhanced cognitive performance.6 For some mothers, pregnancy also takes a temporary toll on cognitive functioning and memory. Colloquially, it’s called “baby brain,” and it’s likely due to hormonal changes and the stressors placed on a woman’s body to meet the increased needs of her unborn baby. According to research, pregnancy can sometimes shrink brain tissue and cause long-term changes to brain structure.7,8 Recovery from pregnancy-induced brain changes can take years, but increased dietary intake of DHA has been studied to help support the regrowth of cells along the way, as well as promote healthy brain development in the baby.9 Early childhood Babies and young children are growing every day, so it’s hard to understate the importance of DHA on brain development during this tender season of life.9 In fact, higher levels of DHA are associated with improved learning skills, while DHA deficiency in children has been linked to cognitive and learning disorders.10 That’s why making sure babies and toddlers get their fair share (500-700 mg daily)2 is a vital part of early brain development. Older adulthood The benefits of DHA are enormously promising for older adults looking to keep their brains sharp and healthy. In a study of over 1,500 men and women over the age of 65, those with the lowest levels of DHA had significantly lower brain volumes than those with higher DHA levels and scored lower on tests measuring both memory and abstract thinking skills.11 On the flip side, studies show higher levels of DHA in the body (1,600 mg RDA for those age 51 and older)2 have also been associated with a decreased risk for brain-related chronic illness.11,12 DHA & gray matter Our brains consist partly of something called “gray matter” (neural tissue that makes up a large amount of the central nervous system). Recent studies have supported a link between intelligence and the amount of gray matter in particular parts of the brain, which shrinks steadily in the years following adolescence. Though we naturally lose some brain volume over time, a higher intake of DHA is positively associated with gray matter volume and better cognitive function, even as we age.12 Where can I get it? You can get some of your DHA in foods like fatty fish (salmon, mackerel, tuna, herring, and sardines) as well as flaxseed, chia seeds, and walnuts. But for vegans and vegetarians, as well as those with nut allergies, obtaining DHA through diet alone can be a challenge. It’s also important to be mindful of how often you eat certain kinds of fish due to high mercury content. Supplementing with fish oils, a mainstay in many supplement regimens, can help fill in the gaps and give you the support you need for positive brain and cognitive development.1 There are many things to look out for when choosing a fish oil supplement, so keep these tips in mind while you shop. This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues. References:
Words matter
Words can be used to allay or contribute to unwarranted fears. Often one hears phrases such as “whole-food” versus “synthetic” dietary supplements. What’s the difference? Let’s begin with basic terminology.
Some examples: Vitamin CL-ascorbic acid is the naturally occurring form of vitamin C as found in many foods, including fruits such as oranges or cherries or plants such as rose hips. Each whole, unprocessed food that contains vitamin C also contains a unique blend of additional nutrients. No two foods will have vitamin C mixed with the exact same mixture of additional nutrients. There is no single “natural” vitamin C blend, and the additional nutrients do not change the biochemistry of the vitamin C itself. While humans have lost the ability to endogenously synthesize vitamin C, certain mammals such as cows and sheep retain this ability. These animals produce vitamin C by a synthetic process--chemical synthesis from simple sugar. The vitamin C synthesized by these animals is not biochemically different than the vitamin C found in their food. Vitamin C, as L-ascorbic acid, is natural vitamin C—regardless of endogenous chemical synthesis by an animal, chemically synthesized by the whole food, or synthesized for use in a dietary supplement. Omega-3 fatty acidsOmega-3 oils as used in supplements are found in any number of forms (triglyceride, resterified triglyceride, phospholipid, emulsified, ethyl ester, free-fatty acid). While there may be minor bio availability differences among these forms, they are all forms of EPA/DHA synthesized from a natural source: no longer whole foods,being separated from the remainder of the nutrients found in fish (flesh, protein), but still starting from naturally occurring sources of EPA and DHA. Algal EPA and DHA are similar. While synthesized by certain microorganisms (certain Schizochytrium sp.) Algal EPA and DHA are created through synthesis of naturally occurring EPA and DHA by these microorganisms. The human bodyThe human body is also a complex chemical factory, making or chemically synthesizing nutrients for use by the body. Proteins are prime examples. Humans do not absorb whole proteins from the diet; we digest them first (“degradation of a complex compound”), breaking proteins down to smaller peptides and free amino acids which then need to be synthesized (a “union of chemical elements”) into various other proteins, often structurally different from the food the individual amino acids came from. Further, the body chemically manufactures any number of nutrients from simpler compounds; glutamine and EPA/DHA are two examples of internal chemical synthesis. Practically speaking, certain amino acids such as glutamine and certain fats (e.g.: EPA, DHA, GLA, arachidonic acid) would be considered synthetic, as they are “the union of chemical elements” converted by the body either into a more complex structure or degraded to a simpler one (fats are naturally elongated or shortened and hydrogenated or dehydrogenated). What is the takeaway? No one would consider nutrients chemically synthesized by the body as being synthetic or artificial. The discerning practitioner and discerning patient (consumer) need to look beyond words. Dig deeper to understand the concepts. If anyone says, “Hey, that’s synthetic,” or “We have whole-food nutrients,” that should raise a big caution.
This entry was posted in General Wellness and tagged Mark Kaye, Omega-3s, Vitamin C, Whole Foods on February 8, 2019 by Mark Kaye. Methods to Help Manage Healthy Estrogen Balance
Hormonal balance is complicated. As women, we have a constant ebb and flow of hormones in our bodies that can greatly affect how we feel from day to day. Not only that, these hormones (estrogen, progesterone, and testosterone) work synergistically in the body to keep things running smoothly and hinge on a delicate balance that can easily be disrupted by lifestyle habits and environmental exposures. When that happens, we tend to feel, well, not quite right. Estrogen dominance is the most common type of hormone imbalance—characterized by frequent headaches, mood swings and anxiety, bloating and weight gain, irregular periods, trouble sleeping, unexplained fatigue, worsened PMS symptoms, and more.1 Some of these symptoms may sound familiar to you. Maybe you’ve already been checked for estrogen dominance or hormonal imbalance. The good news is, there are a few things you can do to help manage estrogen dominance—starting today.
Living with estrogen dominance does not have to be a lifelong challenge. With these complementary methods, you can limit your exposure to xenoestrogens and help regulate your body’s natural hormonal balance. If you have not had your hormone levels checked and show signs of estrogen dominance, please visit your healthcare practitioner. *These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.References:
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Certain persons, considered experts, may disagree with one or more of the foregoing statements, but the same are deemed, nevertheless, to be based on sound and reliable authority. No such statements shall be construed as a claim or representation as to Metagenics products, that they are offered for the diagnosis, cure, mitigation, treatment or prevention of any disease. PAIA Manual |