Dietary Confusion Part 1: Making Sense of Different Diets

With titles from A to Z, there are hundreds of diet plans and the media headlines are full of tips on “this diet” or “that diet”.  The medical literature banters back and forth about the benefits and risks of “low carb” versus “low fat” versus “high protein” as we hyper-analyze measurements such as good cholesterol, bad cholesterol, insulin, glucose, weight and blood pressure.  But which diets really work, what do they have in common, and which ones promote good health? 

On my bookshelf sit about 30 books on various diets which I have read over the years, including The Atkins, HCG, Hormone, Jenny-Craig, Mediterranean, NutriSystem, Paleo, Ornish, Pritikin, South Beach, Weight-Watchers, and Zone diets, just to name a few….  Each diet has it’s own “claim to fame”, and there are some common-sense threads that they all share, with a few of them making recent medical news.

Well Known Diets

The Atkins diet promotes weight loss by severely limiting carbohydrates, which are the “ready to burn” food source that converts quickly to glucose, and any glucose that is not burned for energy gets stored as fat.  By eliminating carbohydrates from the diet, the body naturally breaks down stored fat into chemicals called “ketones” which are burned for energy.  Ketones suppress appetite, which also leads to less calorie intake.  In the short term, the Atkins diet usually works for weight loss, but there is much controversy over the long-term health effects.

The South-Beach Diet is a “heart-friendly” version similar to the Atkins diet, but it makes a distinction between good and bad carbohydrates, and between good and bad fats.  Similar to Atkins, reducing carbs is key, but mostly the high-glycemic carbs that so quickly breakdown to glucose.  Unlike the Atkins plan, only healthy fats are allowed.

The Pritikin and the Ornish diets are both centered on a low-fat diet.  As with the South-Beach diet there is a distinction between good and bad carbs or fats.  The Ornish program in particular emphasizes the diet as part of a bigger program including exercise, stress relief, and healthy social connections.  Dr. Ornish has published numerous articles on the success of his program in reversing heart disease, and has succeeded in getting insurances such as Medicare to actually pay for qualifying patients to go through his “intensive cardiac rehabilitation” program.

The Paleo diet, also known as the “caveman” diet, is based on the idea of eating similar to our distant Paleolithic hunter-gatherer ancestors, focusing on a diet that includes wild game, fish, nuts, roots, fruits and vegetables.  Excluded are foods that came into our diet after the age of agriculture and domestication of animals – namely grains, legumes, and dairy.   Loren Cordain, PhD, Colorado State University professor and author of “The Paleo Diet” says even though grains and dairy seem healthful, our "genome has not really adapted to these foods, which can cause inflammation at the cellular level and promote disease.”

The Mediterranean Diet... even the name inspires a vision of warm breezes, crystal blue waters, and fresh healthy foods.  Rich in plant foods and healthy fats the diet has shown some of the best health benefits of any in numerous studies.  The focus is on locally available and fresh seasonal foods, relying heavily on unprocessed, whole plant foods such as fruits and vegetables, beans, whole grains, nuts, olives, and olive oil along with some cheese, yogurt, fish, poultry, eggs, and wine.

Several diet plans emphasize the role of hormones in proper metabolism.   I enjoyed The Hormone Diet as a great review of how many hormones, such as thyroid, cortisol, and the sex hormones, impact metabolism.  This plan emphasizes low-allergenic natural foods, and takes readers through a 3-step program that starts with a detox diet, all the while pointing out that balancing hormones is key to good metabolism and weight loss.

The Zone diet is geared toward eating a balance of foods that lower inflammation and lower insulin levels.  Author, Dr. Sears, recommends lower carbohydrate intake and some protein at every meal in order to blunt the fat storage hormone called insulin, and encourage more of the fat breakdown hormone called glucagon.  The focus is that we think of food not as "a source of calories but as a control system for hormones."

Calorie Control Programs

The Jenny Craig diet has been around since the 1980s and centers on calorie control with pre-packaged meals being the focus during the initial phases of the diet.  Exercise and lifestyle are also emphasized in the formal programs.  About the only limitation in food type is limiting high-glycemic carbs. 

NutriSystems goes back to the 1970s and provides a pre-packaged food system that takes convenience to a new level by shipping complete microwavable meal plans for a month.  Again, calorie control is the focus, and the food ingredients are generally healthy, being low in salt, mostly low-glycemic good carbs, low fat, healthy protein, and high-fiber. 

Starting in the 1960s, one of the oldest and most well known diets is Weight Watchers.  As stated on their website it was based on the idea of “changing habits and getting support and encouragement from people who cared” and “the belief that the best way to control weight is to change bad eating habits”.  The program allows most any food and focuses on calorie control using a point system that gives certain foods certain points with a limit on how many points one can eat in a given day, thus leading to an overall method of encouraging the choice of more of the healthier low calorie low point foods.

The HCG diet has been wildly popular in recent years although it has been around since the 1950s.  It is an aggressive weight loss program that centers on using the HCG hormone, normally made during pregnancy, to help the body readily breakdown stubborn fat deposits.  Not a long-term plan, this diet is more about shedding pounds.  Eating a very restricted calorie diet of normal meats, fruits and vegetables, while injecting the HCG hormone, dieters don’t get hungry and usually lose up to a pound per day.  This diet should be done with medical supervision.

With the above overview of some of the most well-known diet plans you may be better informed, but still a bit confused about which one to follow.  In “Dietary Confusion, part two” I will condense the lot of these into what I consider the most successful plan that will help you lose weight, promote good health and feel your best.

FREE SEMINARS

“Supplements:  Why You Need Them and How to Choose Them”

Monday, April 1^st at 6pm, at the IMC

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Monday, April 15^th, at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.

Calcium: Too Much of a Good Thing?

Millions of Americans take calcium supplements in an effort to prevent thinning of the bones, but recent research is showing that extra calcium is not all that helpful in preventing fractures and may increase the risk of heart disease.  It seems that the extra calcium is not ending up in bone but rather settling in the arteries.

Calcium and Fractures

Despite being advised to take calcium for strong bones, there is scant evidence that it does any good unless one is markedly deficient in the first place.  In February 2013 the US Preventative Task Force stated “the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women or in men”. 

A 1997 study in women over the age of 65 showed no relationship between dietary calcium intake and fracture rate, while taking extra calcium actually led to more fractures!  (Cumming 1997)  On the other hand, some studies that examine elderly patients, such as those in nursing homes, have found that calcium supplements with vitamin D help increase bone density.

Calcium and the Heart

Three recent studies have caused alarm over the issue of calcium and heart disease.  First, from 2013 Journal of the American Medical Association (Xiao 2013) comes the conclusion that  “suggests that high intake of supplemental calcium is associated with an excess risk of cardiovascular disease death in men but not in women.”

Second, from the European Prospective Investigation into Cancer and Nutrition study (Li 2012), “increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise heart attack risk, should be taken with caution.”

And from the British Medical Journal (Bolland 2010) results show “Calcium supplements are associated with an increased risk of myocardial infarction.  As calcium supplements are widely used these modest increases in risk of cardiovascular disease might translate into a large burden of disease in the population.  A reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”

A reanalysis of data from the 2002 Women’s Health Initiative showed “the increased risk of cardiovascular events appeared largely due to calcium supplements” (Bolland 2011).

How to Build Strong Bones

Thought of only as the rigid framework that supports the body, bones actually do much more and are a big player in many metabolic and hormonal systems.  Bone is a complex, and constantly remodeling organ, that requires far more than just calcium for good health.  Strong bones are a combination of both building strong bones, especially in our youth, and preserving bone while aging.       

Think of bone as being similar to a concrete wall – with concrete and the internal metal scaffolding called rebar.  Concrete is very hard, but brittle.  The rebar gives a concrete wall its tensile strength to prevent cracking under pressure.  Similarly, calcium is like the concrete while a delicate internal structure similar to rebar is what gives bone its real strength to prevent breaking.  This internal bone scaffolding is called the “matrix”.

Mature bone is made up from proteins and minerals.  About 60% of bone, by weight, is mineral, namely calcium and phosphorus.  The remaining 40% is the bone matrix and water.  The matrix is made up of proteins called collagen, which forms strong tissues throughout the body, including bone, tendons, cartilage and even skin.  In the bone matrix, collagen serves as the “rebar” scaffolding upon which minerals are laid down in an orderly fashion.  The precise patterns of bone matrix are oriented to reflect the external forces placed upon it, thus creating bones with elegant and logical patterns of matrix that provide the strength and flexibility to resist breakage.

Hormones play the largest role in turning on the machinery to either build or break down bone.  Estrogen, progesterone, testosterone, and growth hormone play the major role in stimulating the growth of new bone and/or slowing bone breakdown.  Other hormones such as parathyroid, thyroid, or the stress hormone cortisol, can cause bone to breakdown when present in excess.

Many nutrients play a role in the creation of a strong bone matrix and the proper deposition of calcium onto the matrix.  The process of bone formation requires an adequate and constant supply of minerals, such as calcium, magnesium, phosphorus, and potassium. 

Vitamin D is necessary for the body to absorb dietary calcium from the intestine.  Vitamin C, also known as ascorbic acid, is essential for the formation of the collagen matrix.  Studies show that vitamin C contributes to increased bone mineral density by improving markers of bone turnover.  A bone specific protein called “osteocalcin” is responsible for binding calcium into a strong matrix that helps give strength and Vitamin K is necessary for the osteocalcin to function properly. 

Vitamin K also protects against the build up of calcium in arteries by activating a protein in the artery wall that helps prevent calcium build up.  The Rotterdam Heart Study showed that adequate vitamin K, particularly the K2 subtype, lowered the risk of heart disease and calcification in the major arteries.

Other vitamins and minerals needed for metabolic processes related to bone include manganese, copper, boron, iron, zinc, Vitamin A and Vitamin B.

A Bone Health Plan

For strong bones, first start with good gut health and nutrition.  Get plenty of high quality protein, and fruits and vegetables that are rich in nutrients and anti-oxidants.  If you don’t get at least 800 mg/day of calcium in your diet, then taking a low dose calcium supplement makes sense, but don’t take more than necessary.  Of note, healthy bacteria that inhabit the gut make most of the beneficial Vitamin K2.  Taking a probiotic is an easy way to replenish beneficial gut bacteria.

Studies show that most Americans are deficient in Vitamin D and K2, and that supplementing helps build stronger bones and prevent fractures.  The only way to insure you have adequate Vitamin D is to get a blood test – then take enough to get ideal blood levels.  Recent reports consider a healthy Vitamin D level to be >50 nmol/L but many experts consider 70-100 nmol/L to be ideal.  Vitamin D3 is the type normally made in the skin and is recognized as the best form to supplement.  Vitamin K2 intake of at least 45 mcg/day appears adequate for bone and artery health.  A good quality multi-vitamin will insure adequate amounts of the other vitamin and mineral co-factors.

One of the most powerful tools to help keep strong bone is hormone replacement therapy or HRT, for both men and women.  This is a contentious area of practice but the evidence just keeps growing that shows HRT prevents disease, including osteoporosis, and that bioidentical HRT is the most safe and effective treatment.   Similarly, treating hormone imbalances, such as high cortisol or low thyroid is critical for bone health.

Last, remember exercise builds strong bones.  Not so much the aerobic type such as walking, but more so the strength building exercises that build strong muscles.  Core exercises and activities such as yoga are particularly helpful. 

FREE SEMINARS

“Supplements:  Why You Need Them and How to Choose Them”

Monday, April 1^st at 6pm, at the IMC

“Cleanse and Detox for Great Health”

Monday, April 15^th, at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.

Are Your Foods Killing You?

Believe it or not most of us have varying degrees of health problems caused by the foods we eat.  Food intolerances or allergies can lead to many common symptoms and diseases, and surprisingly many foods we think of as healthy are common culprits.  Moreover, these foods are often ones we frequently eat. 

When I say “allergies”, most people, including doctors, think of the originally described hypersensitivity reaction that involves the “immediate” immune reaction.  This is an obvious reaction such as getting stung by a bee and noting immediate swelling and redness or eating something that causes immediate swelling in the throat or generalized itching.  This reaction is mediated by an antibody called IgE and the release of histamine, which causes blood vessels to swell and leak, leading to the familiar symptoms such as hives or hayfever.  Common skin tests or serum RAST testing for allergies will test for this reaction.

In actuality there are three other immune reactions, one of which takes 12-72 hours to really get going after a trigger is encountered.  The main antibody in this immune reaction is called IgG and it can be tested in a blood sample.  We refer to these food allergies as “intolerances” or “sensitivities” but this is semantics – they are in fact hypersensitivity reactions that stimulate an abnormal immune system response.  I call them “delayed food allergies”.

The most common symptoms caused by delayed food allergies are brain fog, fatigue, nasal congestion, indigestion, gas, bloating, diarrhea, rashes and joint aches.  We also see mood changes such as depression, anxiety or attention-deficit or hyperactivity.  Even weight gain is caused by food allergies – patients commonly lose 10-20 pounds within a few months of removing certain foods from their diet.

Another amazing result of food allergies is their connection to diseases, particularly autoimmune diseases.  We now know that in order to get certain autoimmune diseases, such as Hashimoto’s Thyroiditis, Type-1 Diabetes, or Lupus, you pretty much have to have the right genetics.  But not everyone with the right genetics will get these diseases.  You must also have a “trigger” that causes an abnormal immune response, which will then overwhelm and confuse the regulating part of your immune system, allowing the appearance of antibodies that begin attacking your own body.

Probably most of the time the trigger for autoimmune disease begins in the gut, and most of that is food allergy related.  Other known triggers for autoimmune disease include “leaky” gut, bacterial imbalances in the gut, chronic infections, chemical toxins or heavy metal build-up, hormone imbalances and stress.  If you can find and remove the trigger in time, you can reverse the disease!

Some foods can literally cause holes in gut lining, known as “leaky gut”, which will allow large proteins and toxins to leak from the gut into the bloodstream causing an immune reaction.  Foods such as the nightshade family (e.g. tomatoes, peppers, potatoes) can cause “leaky gut” due to breakdown of the proteins that hold gut cells together.  Other food families such as chickpeas (Cicer arietinum), soya beans (Glycine max), lucerne (alfalfa) sprouts (Medicago sativa) and varieties of Phaseolus vulgaris (navy beans, haricot beans, kidney beans) contain “saponins” which can also cause leaky gut by literally punching holes in the gut wall.

The most common delayed food allergies are to wheat, dairy, egg, corn, soy, sugar and yeast.  Any food can be an allergen, but these top the list.  One can simply eliminate these foods from their diet and see if they feel better.  This is called an “elimination diet”.  After a month or two of eliminating possible allergic foods, a “food challenge” is then done by reintroducing the foods, one at a time, for several days to see if any symptoms return.  Careful tracking of symptoms during the challenge phase is critical in sorting out which foods are really causing problems.

Celiac disease is an autoimmune disease that is triggered by gluten, a protein found in wheat, barley and rye.  With exposure to gluten, the immune system begins making antibodies that attack and destroy the muscle lining in the gut, leading to serious problems with malabsorption and leaky gut.  Celiac disease is the most well known food allergy syndrome and the link between a food and autoimmune disease serves as a model for other food / autoimmune connections.

The best way to determine if you have food allergies is to get a blood test for IgG antibodies to foods.  But don’t bother using just any old lab for food allergy testing.  At last count I have used 12 labs during two decades of doing food allergy testing and I’ve come to the conclusion that not all labs can do delayed food allergy testing!

I’ve spent thousands of dollars out of my pocket to do “blinded” testing of various labs and I’ve busted many with lack of reproducible results.  Most labs I have tested with the same blood sent with one vial as the real patient’s blood and another as a “fake” patient and found the results quite different.  The common labs that accept insurance do not do delayed food allergy testing well – I’ve tried dozens of times with each of them without clinical success. 

My favorite lab for food allergy testing is Immunolabs (www.immunolabs.com).  They have been doing only food allergy tests for over 35 years, are the most accurate, and their follow up literature and technical help are unsurpassed.  You can go online and take a symptom questionnaire to see if you might have food allergies.  The cost is $175 for the basic 88-food panel, $355 for the 154-food panel, and we often add specific reflex tests for gluten allergy, celiac disease and Candida overgrowth.

Having provided food allergy testing for over almost 20 years I continue to be amazed at the outcomes with the elimination of food allergens.  In recent years we test 3 to 4 people each and every week, and I’d estimate 70 to 80% of all patients tested report positive results, with at least 20 to 30% reporting “amazing” results.  For many it was the key to helping them lose weight, cure a chronic illness or markedly improve how they feel.

Food allergy testing is easy and I recommend it to everyone.  We’ve seen hundreds of patients undergo amazing recoveries after years of struggling to find an answer to their health problems.  Our special food allergy program involves testing with follow up medical and nutritional counseling.  Call the clinic at 245-6911 if you would like more information or to get tested.

INSET

FREE SEMINAR

“Food Allergies and Intestinal Health”

Monday, March 18^th at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.

Heal Thy Gut

Intestinal Health Relies on Good Bacteria

A healthy gut, populated with beneficial bacteria, is a key to great health.  At first blush it makes little sense what a bunch of microbes and the intestine have to do with autoimmune diseases, urinary infections, sinus infections, bronchitis, asthma, allergies, many types of skin rashes, and more.  But it’s true that the interaction of a healthy gut with our immune system is the cause, and the cure, for many common ailments.

Bacteria and Immune Function

Consider first that the largest part of the immune system surrounds the gut.  The “gut associated lymphoid tissue” (GALT) provides about 80% of the infection fighting white blood cells called lymphocytes.  This lymphocyte arsenal includes immune system controllers called T cells, antibody producing B cells, and stealth defenders called natural killer cells.

Second, there are over a trillion bacteria that live in our intestinal tract – more than all the cells in our body – and these bacteria have evolved with us over the eons.  They are not just passengers on this journey through life, but rather they are active participants in our overall health.  They depend on certain nutrients and behaviors that have been forged over thousands of years.  If we do right by them, they will support and modulate our immune system, defend against infections, help break down our food, generate essential vitamins, metabolize hormones and bile acids, supply the intestine with energy, and stimulate the normal motility of the intestine.

The normal functioning gut wall “teaches” the immune system how to behave, and the system is profoundly influenced by what is in the gut and what gets through the gut wall.  A normal immune system relies on a normal gut.  It starts at birth with the “inoculation” of bacteria during passage through the birth canal and is further supported through breast-feeding.  During the first few years of life the ingestion of bacteria on food, dirt, and other “normal” things continues to instruct the immune system about tolerance.  We can’t simply attack everything that is foreign and have to learn a certain amount of tolerance.

Leaky Gut

The complex relationship between the beneficial bacteria and our immune system begins inside the gut.  The lining of the intestine is covered with a “biofilm” of mucus and beneficial bacteria, much like a screen filter, providing a first line of defense against abnormal invaders.  Below this filter lie block-shaped epithelial cells that are bound together by “tight junctions” providing very specific regulation of what is allowed to pass between the cells.   

The term “leaky gut” refers to damaged tight junctions allowing substances inside the gut to pass freely into the GALT.  Leaky gut is well researched and we know that it can be caused by infections such as rotavirus or salmonella, medications such as ibuprofen, aspirin, steroids, or antibiotics, as well as nicotine and alcohol.  Certain beneficial bacteria protect and repair the tight junctions.

With a total surface area of about 500 square yards, the intestine forms the largest interface between our system and the outside world.  The gut lining is in constant contact with potential immune stimulators such as foodstuffs, toxins, microbes, parasites and allergens.  Every single substance that passes through the gut wall is carefully “presented” to the immune system and undergoes a thorough identification process.  Remember we have tolerance though and the immune system does not generate an attack on everything that comes through the gut wall. 

Here’s where it starts to make more sense how a healthy gut can cure diseases in other parts of the body…  The GALT is part of a larger network of immune systems that also include the NALT and BALT (nasal and bronchial associated lymphoid tissue) and primitive immune cells called “mast cells” which form the first line of defense being located throughout the skin, respiratory tract and the gut.  The key here is that the immune cells from the GALT roam throughout the body and when they are activated they will disturb the other systems, leading to impaired defenses (e.g. bronchitis, sinusitis) or hypersensitive defenses (e.g. allergies, asthma, hives).  Imbalances in the T-helper immune cells can lead to autoimmune diseases (overactive T-helper 1) or allergies (overactive T-helper 2).

Healing the Gut

The good news is that the different layers of function in the gut wall can be analyzed and repaired.  A combination of simple tests can uncover problems in the gut interior, gut wall, and the immune system.  Stool tests reveal the status of enzymes, good and bad bacteria, parasites, digestive residues, and inflammatory markers.  A simple urine test can detect leaky gut.  Blood tests can show immune system activation and diagnose immediate or delayed food allergies.  Imbalances in the different branches of the immune system, namely T-helper 1 or 2, can be measured and treated to restore balance. 

Probiotics (pro + life) are live microorganisms which are administered into our system to confer a health benefit.  We are learning that the hundreds of different species of beneficial bacteria do different things in the body.  Some repair tight junctions and some prevent infections such as rotavirus, while others help digestion and aid in treating conditions such as irritable bowel syndrome.  Specific strains are known to stimulate gut defenses and protective immune responses.

When supplementing probiotics it is important to get a broad spectrum of bacteria and to get the product from a reputable company.  My favorite is the routinely prescribed “Multi-Probiotic” from Douglas Labs.  Other good brands include Jarrow, Enzymatic Therapy, PB8 and Therlac.  Depending on the condition we routinely prescribe a dose of 5 to 50 billion organisms daily.

Prebiotics are nondigestible nutrients that nourish and support the beneficial bacteria.  Sometimes known as fermentable fiber, prebiotics include short or long chains of carbohydrates.  The main types are inulin and fructooligosaccharides (FOS), and are found in foods such as Jerusalem artichoke, onion, garlic, bananas and asparagus.  For healing leaky gut we use amino-acid based formulas containing L-Glutamine, such as “Intestamine” from Douglas Labs.

With a holistic view of the intestinal-immune interaction, disturbances in the various communication systems can be identified and repaired.  Welsh poet George Herbert said it well, “Take all that is given whether wealth, love or language, nothing comes by mistake and with good digestion all can be turned to health.”

INSET

FREE SEMINAR

“Food Allergies and Intestinal Health”

Monday, March 18^th at 6pm, at the IMC

RSVP at 245-6911

Bio

Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine.  He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions.  He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com).  Call 245-6911 for an appointment or more information.