Functional Medicine meeting Announcement 11-17-2015

I hope that you can attend our next Functional Medicine Discussion Group meeting on Tuesday November 17 at 6:30 on the Prevention and Reversal of Alzheimer’s Disease, and other Neurological Problems. Metagenics will again be sponsoring some food.
Degenerative brain diseases, like Alzheimer’s Disease (AD), are on the rise today, especially in women. What do we know about these and what can we do about them?  One thing we know is that diabetics have a much higher rate of AD, and in fact some experts refer to AD as Type III diabetes. The literature shows a connection between sugar intake and insulin resistance and AD.  Muscle cell insulin resistance leads to brain cell insulin resistance and this leads to the inability to get the sugar into the brain cells (neurons) and eventually neuronal death.

But insulin resistance is certainly not the only factor in degenerative brain conditions.  Dr. Dale Bredesen from UCLA lays out a series of possible underlying factors, including vitamin D levels, B vitamins, zinc/copper ratio, antioxidants, DHA, hormones, inflammation, heavy metal toxicities, exercise, sleep, and stress in the attached paper.   Please also listen to the mp3 of him being interviewed by Dr. Bland on the February 2015 Functional Medicine Update.

I have also attached a recent paper on how Taurine leads to regeneration of brain cells in rats.  Other good sources to read if you have time (ha, ha!) are Dr. Perlmutter’s Grain Brain, Brain Maker, Chapter 14 of Dr. Perlmutter’s The Better Brain Book, and Why Isn’t My Brain Working by Datis Kharrazian.  In Grain Brain, Dr. Perlmutter talks about the relationship between gluten and casein proteins and increased intestinal permeability and AD.  Leaky gut can lead to leaky brain. You might want to look at this Mercola article about Perlmutter’s writings, including a short interview with Dr. Perlmutter:

http://articles.mercola.com/sites/articles/archive/2013/09/29/dr-perlmutter-gluten.aspx

***I hate to keep changing the dates, but I have decided to move our December meeting to Thursday Dec 10 in order to accomodate Dr. Lise Alschuler, who has agreed to join us from Arizona by Skype.  The topic will be antioxidants and cancer and Dr. Alschuler is one of the top cancer experts in the country and the author of The Definitive Guide to Cancer.  I have not used Skype before, but I’m curious to see how it will work.

***I asked Jeffrey Bland’s company to give our group members a discount if we wanted to subscribe to Dr. Bland’s monthly audiotape series, Functional Medicine Update and Linda Blodgett said that we could have free access till the end of the year!  Linda said “Please have anyone who is interested send me an email with their mailing address and email address that they will want to use for logging into their online account that I will establish for them.  I will email them the information they will need to access their new FMU account.” Send the email to: lindablodgett@jeffreybland.com

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Functional Medicine meeting summary 10-22-2015

If you didn’t attend last night’s Functional Medicine Discussion Group, you missed a good one. We discussed differences between Crohn’s disease and Ulcerative Colitis and some of the diets that are commonly recommended by dieticians for inflammatory bowel disease (IBD), including the elemental diet, the specific carbohydrate diet, and the FODMAP diet.  Dr. Marc Wishingrad, a conventional Gastroenterologist who specializes in IBD, gave his informed input on the topic, including how some of the pharmaceuticals work and the side effects. It was a real treat to have Marc join us.

Group member RD Lauren Cornell gave us a great case history of how she successfully handled a patient with Crohn’s Disease, who is now doing well and is off the meds. I also weighed in with my own case history of one of my patients who has Crohn’s and has responded extremely well to a nutrition based program. We both utilize UltrainflamX 360 in our protocals, as well as probiotics and various other nutritional supplements, including fish oils.  Adam Banning from Metagenics gave us some of the scientific basis of the newly redesigned UltraInflamX 360 (no longer has fructose and a specialized form of curcumin, instead of turmeric) and their new SPM active product for the second phase of inflammation. We also had a vigorous discussion of food allergy testing with Dr. James, Dr. Toulon, and myself weighing in on the benefits of IgG and IgA testing, with input from Dr. Wishingrad about why immunologists don’t think this form of testing is valid.  Metagenics once again treated us to some great, healthy food, this time from True Foods. You should really make our next meeting in November on Tuesday the 17th. Since a number of members have been having trouble getting there by 6, we have decided to change the time to 6:30. But try to get there a little early and you’ll have the best food choices. I will send an email in the next few weeks with the topic and a few papers to read.
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Functional Medicine meeting announcement 10-22-2015

Our next discussion Functional Medicine Discussion Group meeting is on Thursday, October 22nd at 6 pm and our topic will be Inflammatory Bowel Disease.  I am very excited that we will be discussing a GI topic, the foundation for functional medicine.  I am pleased to note that a respected gastroenterologist in Santa Monica, Dr. Marc Wishingrad, has agreed to join us.  Please email or call if you will be able to attend so that i can get a head count. As usual, Metagenics, our sponsor, will be providing us with some healthy food.

As you probably know, Inflammatory Bowel Disease (IBD) refers to chronic inflammatory conditions that involve both the small and large intestines and affect approximately 1.4 million people in the US.  The two most common categories of IBD are Ulcerative Colitis (UC) and Crohn’s Disease (Cr) and as you know, these conditions can be incredibly difficult to manage.  

Registered Dietician Lauren Cornell has a practice specialty on GI disorders and has taught about nutrition and IBD and she has offered to start the discussion with an overview of some of the most effective dietary regimens and supplements that may help manage both UC and Cr.  Among the dietary regimens that have been found to be effective for patients in the literature with UC and Cr are the elemental diet, the specific carbohydrate diet, the anti-inflammatory diet, a low fiber diet, an elimination diet, and the low FODMAP diet.  Among supplements that have been found to have documented benefit to some patients are the following:  1. Probiotics, 2. Prebiotics, 3. Fish Oil, 4. Curcumin, 5. Glutamine, 6. Vitamin D, and 7. Boswellia, among others. If anyone else would like to present a case study, that would be great.

I’ve attached a couple of papers. One is an overview on natural therapies for IBD and the other is on the low FODMAP diet for Crohn’s, my personal favorite dietary approach.  Another good thing to read would be the chapter in the Integrative Gastroenterology book edited by Gerard Mullin, “Alternative approaches to the patient with inflammatory bowel disease.” published by Oxford in 2011.

I’ve been asked to change the dates of the November and the December meetings, since the dates are too close to the holidays, so I propose that we switch them to Tuesday November 17 and Thursday December 17.  Is that o.k. with most of us? Feel free to pass the invite on to any of your colleagues who are interested in functional medicine or send me their email.

inflammatory-bowel-disease-summary
 fodmap-hypothesis
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Functional Medicine meeting summary 9-29-2015

We had a fun meeting last night, discussing whether dietary cholesterol and saturated fats contribute to heart disease.  We were all generally in agreement that the current research supports the concept that while saturated fat is not as evil as once believed, it would be better not to have too much animal fat in the diet and it is best replaced with healthier fats, like nuts, avocados, and olive oil. On the other hand, a few eggs per week and some grass fed butter can be part of a healthy diet, if consumed in moderation.  Recent studies point to the fact that when subjects are instructed to reduce saturated fats in their diets, they tend to substitute carbs, and often refined carbs. They end up no better or even worse off. But if they replace the saturated fats with polyunsaturated oil, monounsaturated oil, and omega 3 fats, they reduce their risk for cardiovascular disease. It was nice to have Dr. Howard Elkin, an integrative cardiologist, to provide us with his informed insights. Interestingly, we never got to discuss coconut and palm oil, the two vegetable sources of saturated fat. That can be a topic for a future discussion.

We welcome new attendees, Dr. Howard Elkin, cardiologist, Dr. Eric Dahlstrom, DC, LAc, and Lauren Cornell, RD, along with previous attendees, Dorothy Bernet, RD, Dr. Olga Popel, rheumatologist, and Dr. Denise Weisner, LAc. Thanks also to Metagenics for some fabulous sushi dinner and to Adam Banning for sharing some interesting information with us.  I will be sending out an email next week on the topic for our next discussion group Thursday, October 22 at 6 pm. The topic will be GI related and I will be asking for a few attendees to present a case study.
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Functional Medicine meeting announcement 9-29-2015

I hope that you can join our next exciting discussion of functional medicine on Tues Sept 29 at 6 pm with some healthy food sponsored by Metagenics. Please let me know via email or phone if you will be able to attend.

The topic for the next Functional Medicine Discussion Group is: Does dietary cholesterol and saturated fat intake contribute to cardiovascular disease?

For many years we advised our patients to avoid saturated fat and cholesterol in their diet, since they were linked with increased LDL cholesterol, which would increase cardiovascular disease risk. This would mean avoiding butter, cheese, egg yolks, red meat, poultry skin, whole fat dairy, etc.  In recent years, studies have not found as clear a link between dietary cholesterol or saturated fat intake with heart disease.  For example, the study by Mozaffarian in 2004 (1)  found no relation between saturated fat intake and heart disease in postmenopausal women. Similarly, a meta-analysis published in 2010 by Siri-Tarino found that the intake of saturated fat was not associated with an increased risk of heard CHD, stroke, or CVD.(2)

Jonny Bowden and Stephen Sinatra in The Great Cholesterol Myth (2012) pointed out the problems with the Diet-Heart Hypothesis first p8ut forth by Ancel Keys back in the 1950s, who claimed to have found a clear link between dietary fat intake and heart disease after examining epidemiological data from various countries around the world. Looking at the chart below, it’s hard to see how you could draw a straight line connecting the dots:

Inline image
http://rawfoodsos.files.wordpress.com/2011/12/yerushalmy_hilleboe_22_countries.jpg

Nina Teicholz in The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet published in 2014 made this case in even more exhausting detail that saturated fat intake was not the cause of heart disease.  The problem she argued is the carbohydrate and trans fat intake.  Teicholz and other practitioners who promote the Paleo or Primal nutrition approaches often argue that saturated fats do not contribute to cardiovascular disease and it is fine to eat plenty of eggs, butter, cheese, red meat, bacon, coconut oil, etc., though it is often recommended that we choose meat that has been grass fed and not farmed and butter that is from grass fed cows.  They recommend avoiding commercial seed oils (vegetable oils) other than olive oil.

Is this position correct?  Do we simply tell our patients to consume as much saturated fat and cholesterol as they like and not worry about it, even those with elevated LDL or coronary artery disease?  Recently, several papers have been published that review the evidence linking dietary cholesterol and saturated fat with cardiovascular disease risk.  Dr. Mozaffarian concludes that a review of the evidence demonstrates that consuming polyunsaturated fatty acids (vegetable oils) in place of saturated fats significantly reduces coronary heart disease. (paper attached)  The review by Berger et al. on dietary cholesterol concludes that intervention studies did show a relationship between dietary cholesterol and increased total cholesterol, LDL, and HDL levels, but only when high levels of dietary cholesterol were used (500-1400 mg/day).  Dr. Eckel in his accompanying editorial suggests “when ordering an omelet, why not order an egg white omelet with plenty of vegetables, lean meat, and spices, rather than one with 600 mg cholesterol?”

Please look at the attached papers before the next discussion group on September 29

References:
1. Mozaffarian D, et al. Dietary fats, carbohydrate, and progression of coronary atherosclerosis in postmenopausal wome. Am J Clin Nutr 2004; 80: 1175-1184
2. Siri-Taurino PW, Sun Qi, Hu FB, et al. Meta-anlysis of propective cohort studies evaluating the association of saturated fat with cdardiovascular disease. Am J Clin Nutr 2010; 91:535-46.
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Functional Medicine meeting summary 8-27-2015

We had a nice discussion last night on the alkaline ash theory of osteoporosis and we all agreed that the research does not support recommending an alkaline diet for promoting  bone health.  We were treated to some sushi by Metagenics.  After I was informed that September 22 was the start of a Jewish holiday, we decided to change the date of the next Functional Medicine discussion group to Tuesday September 29.  I will send another email with the topic and some articles to look at prior to the next discussion. I hope that you can join us.

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Larger Lunch, Smaller Dinner, Better for Weight Loss

It is common in US culture for people to consume their largest, most calorie rich meal for dinner, once they are done with work.  However, this may not be as good for your health as when you consume more calories at lunch or breakfast lose-weight-healthyand fewer calories at dinner.  A study reported in a paper in the American Journal of Clinical Nutrition found that without changing total calories, eating your larger meal at lunch and a smaller meal at dinner resulted in significantly more weight loss and better control with blood sugar.(1)  It is common for health professionals and  nutritionists to recommend eating a smaller meal in the evening because you will be doing less activity and not burning off the calories. But other research seems to indicate that what matters is how many calories are consumed during the day, not when those calories are consumed.  This new study lends evidence that eating a smaller dinner is helpful.

This research confirms that overweight and obese women who consumed a larger meal at lunch and a smaller meal at dinner lost  12 lbs, 9 oz (5.7 kilograms) as compared to 9 lbs, 7 oz (4.3 kg) for those who consumed a larger dinner.  Overweight and obese women who followed the larger lunch strategy saw greater decreases both in the fasting insulin levels and the HOMA-IR, a measure of insulin resistance.  This strategy of consuming a smaller dinner and a larger lunch appears to be effective both for weight loss and weight management as well as for blood sugar control and prevention of diabetes.  This study did not include patients who have diabetes, though other research indicates that this type of strategy may be effective for diabetics as well.(2)

 

References:

1. Madjd A, Taylor MA, Delavari A, et al. Beneficial effect of high energy intake at lunch rather than dinner on weight loss in healthy obese women in weight-loss program: a randomized clinical trial. AJCN. 2016;104:982-9.

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079942/

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Fish Oil for Concussion and Brain Injury

The aggressive use of omega 3 fish oil after a traumatic brain injury may be very beneficial.  There are several cases of patients who have suffered severe brain trauma being given high dosages–up to 20,000 mg per day of EPA and DHA–recovered much more quickly and to a larger extent than expected.

Traumatic brain injury (TBI) occurs after “a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.” In the US there are over 3.5 million TBIs annually with approximately 52,000 deaths. Traumatic brain injury is a clinical challenge and there are not really any effective treatment options. What is needed is an effective treatment strategy that can target neuroprotection, neuroinflammation, and neuroregeneration. Omega-3 fatty acids from fish oil may offer an effective approach. There is a growing body of strong pre-clinical evidence and clinical experience that suggests that larger dosages of fish oil, esp. if taken soon after an injury, can provide the optimal nutritional foundation for recovery and repair of the brain from TBI and concussion. Fish oil is incredibly safe and easy to consume through either capsules, liquid or even through feeding tubes.  There are virtually no side effects, unlike most pharmaceutical interventions, with the exception that there is a slight blood thinning effect.  However, for it to become standard mainstream treatment for a head injury, conventional medicine needs to overcome its inherent bias against nutritional, non-pharmacological therapies–sorry Big Pharma.

We know that the brain and the nerve cells are largely composed of fats and proteins and the types of fats that you eat affect the structural composition of the brain and neuronal cell membranes. Due to increased consumption of omega 6 fats in the modern diet from soybean oil and other commercial seed oils, omega 6 fats have displaced omega 3 fats like DHA from neuronal cell membranes. Omega 6 oils tend to lead to inflammation, whereas omega 3 fats tend to reduce inflammation. In addition, incorporation of mega 6 fats into these neuronal cell membranes reduces “cell permeability and synaptic membrane fluidity”. Therefore, having more omega 3 fats makes the brain function better by improving neuronal transmission of signals.  This new omega protocol for recovery from concussion and brain injury is already being used by  a number of University and professional sports teams.

Lewis MD. Concussions, Traumatic Brain Injury, and the Innovative Use of Omega-3s. Journal of the American College of Nutrition. 2016;35(5): 469-475.
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