An energetic approach to restoring gut function: Part 1.

Let’s kick this blog off with a question as to whether or not an energetic approach to restoring  gut function is useful when compared to over analysis? Let me clarify, that I have had my fair share of success stories with a reduced and diagnostic approach to improving gut health. Just like I have also had my fair share of kickbacks from the laboratory for recommending their tests. At one point I was using nearly 200 stool tests per year and making a little cash on the side. Many of the tests worked in isolating some specific disturbance to their gut bacteria, presence of a parasite or elevation of putrefied fatty acids. A ‘cleansing’ diet was promoted and a few supplements for good measure created some short term change whilst the client was in my care.

But here’s why the long-term approach to that type of assessment and treatment may not be the best response. A standard functional medicine approach  after spending quite a lot of cash on an integrated stool test is using the 4 R approach.

Remove (offending parties)- spend money on supplements

Restore function- spend money on supplements

Re-inoculate – spend money on nice expensive probiotics

Repair gut lining- spend money on supplements

Regurgitate. Ok the 5th one is mine but no supplements needed.

By taking this approach, an important question is not asked of the individual. Why is this person experiencing an overgrowth of bacteria/SIBO, parasitic infection, endotoxin overgrowth, inflammation and degradation of the bowel lining? I like to think that it is not because of the easy kickbacks FM practitioners are getting for the lab tests and supplements they recommend? So what is the persons level of biological energy and immune system function that allows their digestive system to get in such a state. We know there are some usual suspects. Food, stress or alcohol perhaps?

The typical gastrointestinal complaints people came to me with, were bloating, excess gas, constipation or irritated loose stools combined with poor energy. It was Ilya Mechnikov who originally stated that death starts in the bowel or colon and there’s’ certainly many degenerative and inflammatory conditions that appear at the last stop to poopy central. But is the bowel the main driver of this dysfunction? Many of the symptoms that I recalled earlier are also key symptoms of an energetic and perhaps a thyroid dysfunction. So instead of reaching for our drastic 4 R protocol with an expensive poo test lets consider the following.

 The likes of Broda Barnes and Ray Peat have highlighted how a lack of energy, either from a low or inappropriate food intake or a dysfunctional hypothalamic-pituitary-adrenal-thyroid axis can be evaluated by assessing body temperature and the combination of pulse. Additional information on Thyroid and TSH evaluation can be found here.

Most people are aware that when they get stressed or exercise, blood is shunted away from the digestive system to the periphery and other working tissues. Even the concept of high Adreno-corticotrophic hormone (ACTH), cortico releasing hormone (CRH) and adrenal production of cortisol is becoming common place in work and gym environments alike. These hormones suppress thyroid hormone and the energy compound ATP that provide energy for tissues.

It’s also well known that low energy states create tight painful muscles that are difficult to relax and one might be able to apply that line of thought to the smooth muscle tissues that regulate bowel contractility. Therefore a low energy state that does not allow for adequate energy production will not allow adequate digestion and bowel function to occur. Cold hands and feet can be a symptom of not eating enough carbohydrate and protein.

If the cold hands and feet, low body temperature, fatigue, constipation don’t resolve from eating energy rich meals that contain plenty of fruit and contains little of the foods that promote the bowel irritants histamine and serotonin (nuts, seeds, vegetable oils, grains, gluten free products, beans and pulses). Then, often factors that influence the hormones such as thyroid, estrogen and progesterone may need a deeper consideration.

I drafted a little flow chart that will be helpful for some quick strategies on what might be happening but what I would like to focus on the low energy state that might have its source from a food or hormone factor or perhaps both. Instead of using a strategy like the 4 R approach, these simple questions can help guide you to understanding whether it is the foods that you eat or an energetic factor that could be causing your digestive system to suffer. It’s not a complete algorithm but it does offer some simple solutions that have helped plenty of people resolve digestion and energy issues.

Foot note: I haven’t needed a stool test with a client for over 4 years now following this chart.

 

In part 2 I will elaborate on foods and basic supplements that can be used to resolve most long standing digestive issues and understanding other hormone actions that create digestive discord.

References:

Lokaj, J., & John, C. (2008). [Ilya Ilich Metchnikov and Paul Ehrlich: 1908 Nobel Prize winners for their research on immunity]. Epidemiologie, Mikrobiologie, Imunologie : Casopis Spolecnosti pro Epidemiologii a Mikrobiologii Ceské Lékarské Spolecnosti J.E. Purkyne, 57(4), 119–24. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19069024

Peat, R. (1997). From PMS to Menopause: Female Hormones in context.

Peat, R. (2006). Autonomic Systems. Retrieved from raypeat.com/articles/other/autonomic-systems.shtml

Health, Thyroid and TSH.

Increasingly health is defined by a bunch of arbitrary numbers. High cholesterol? That’s not normal take a pill. Low iron? Here take this iron supplement. In Ivan Illich’s book, Limits to Medicine- Medical Nemesis, Illich makes the reader fully aware of his disdain of medical check ups –

” The medicalisation of prevention thus becomes another major symptom of social iatrogenesis. It tends to transform personal responsibility for my future into my management by some agency.”

Instead of heavily reliant systems on numbers and markers. Should we not look to improve qualitative and quantitative pairings to get a better picture of health and improve outcomes? The last ten weeks of my life have been wrapped up in a post graduate diploma in endocrinology. Getting a better picture of how clinicians tackle complex areas has been a rewarding but at the same time frustrating area of study.

Sometimes the questioning has been a down the lines of – This patient has this endocrine feature, what are the medication used, which medications interfere, what surgical options can be pursued and what is the follow up? What is frustrating for me is there is little effort to understand why? Why? Why Donald why? Diet, stress and environmental aspects of hormonal health are often forgotten about, because the goal of getting that client back into the window of numerical health takes priority. But what if we took a better look at the why? Might it not yield better long-term outcomes for the patient?

I have a special interest in thyroid function, motivated by the writings of Ray Peat, Broda Barnes, Mark Starr and others. There’s a significant amount of work discrediting the role of combined T4/T3 therapy and in particular natural desiccated thyroid (NDT). In many endocrine textbooks the elevation of the active form of thyroid hormone, T3 was elevated significantly post NDT treatment.

A confounding factor in this assumption was based upon a previously incorrect conversion which can still be found in endocrine textbooks stating that 1mg of NDT was equivalent to 1ug of LT-4. There is recent evidence available showing a patient preference for NDT, which showed improved outcomes to weight loss, energy, happiness, sleep and memory (Hoang, Olsen, Mai, Clyde, & Shakir, 2013).

A reliance on TSH, T3 and T4 levels alone may be ineffective at analysing the effectiveness of combination therapy in comparison to synthetic monotherapy treatment of hypothyroidism. Additionally this study highlights the inaccuracy of the assumed conversion of 1mg: 1ug. Using more accurate 3rd generation TSH assays yields a suggested ratio of 1.47 mg’s to 1ug. This may explain the lack of effectiveness in previously conducted trials and the conclusion that increased transient T3 levels were decided as unacceptable. NDT in many cases may offer a better solution than synthetic thyroid hormone after all

Potential mechanisms of improvement may also lie in the actions of T1 and T2 and assumptions based solely on TSH, T3 and T4 may not explain the benefits recorded in this and other studies.     Thyroid pic

Another pitfall of number reliance is well known in the reference of thyroid stimulating hormone (TSH). TSH is considered the gold standard for hypothyroid diagnosis but its limitations have become increasingly prevalent due to its production via the stimulating centers from TRH (thyroid releasing hormone) from the hypothalamus and then TSH from the pituitary, if a problem exists at the periphery the likelihood of getting an accurate assessment is diminished. A normal TSH reading is defined as 0.4-4.5 mU/L but generally many Doctors do not consider someone hypothyroid unless they present with a TSH over 4 mU/L.

Increasingly some Doctors are becoming aware of the reduction of hypothyroid symptoms when TSH is kept below 1mU/L and some evidence suggests that even at 0.5 mU/L (lowered but suppressed) is ideal to ensure that hypothyroid symptoms are decreased (Pantalone & Nasr, 2010).

Me? I am going to go back and contradict myself and say that numbers are useful. The basal temperature test with a cheap thermometer, as championed by Broda Barnes still suggests a good window of function of the thyroid test. 36.5 to 37 degrees is considered normal and reflects a well functioning metabolism. Couple that with a pulse rate test and you can also get a good indication of cortisol. So I am not against the numbers. I just think we need to ask better questions before we accept them as absolutes.

References:

Hoang, T. D., Olsen, C. H., Mai, V. Q., Clyde, P. W., & Shakir, M. K. M. (2013). Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: A randomized, double-blind, crossover study. Journal of Clinical Endocrinology and Metabolism, 98(5), 1982–1990. http://doi.org/10.1210/jc.2012-4107

Illich, I. Limits to Medicine – Medical Nemesis. Marion Boyars. 1976.

Pantalone, K. M., & Nasr, C. (2010). Approach to a low tsh level: Patience is a virtue. Cleveland Clinic Journal of Medicine. http://doi.org/10.3949/ccjm.77a.10056

 

Adrenal fatigue or reductionist thinking? Part 2: Restoration of metabolic processes

adrenal Restoration of metabolic process- lowering the adrenal load.

Sugar, fat and other mal-aligned  factors.

Saturated fat is bad for you, so they said but it clearly wasn’t. Now it’s sugars turn. Sugar causes diabetes, cancer and many other modern conditions, if you are to believe many of the memes on social media. Well no, it doesn’t. Cancer for example is usually created from a specific defect to the respiratory apparatus of the cell. In English that means part of the cell that utilises oxygen. Sugar or Sucrose whose primary constituents are both Fructose and Glucose are readily available carbohydrates and the brain/central nervous system require plenty. Have you ever noticed that brain fog creep in when on that low carb diet? The reason? Restricted carbohydrates  equals reduced cognitive process’s. Yes we can generate glucose via oxidation of fat, in the form of ketosis and you can also break down protein to generate glucose too, but these methods are less than efficient forms of energy generation and long-term utilisation of these systems is not ideal.

Sugar produces energy and when processed with oxygen is much more efficient than glycolysis or energy production without oxygen (anaerobic). In those who have damaged metabolism, there is a reliance on the production of energy in this manner, lactic acid is often produced even at rest. Therefore trying to exercise at intense levels poses a problem for those with both adrenal and metabolic issues.

Give the body what it needs?  Got cravings? You know those ones where you are dying for some food, starchy carbohydrates, a sugary drink? There are no demons at work here, just a simple case of biology, carbohydrates are a primary fuel source for the body. Want to avoid coming crashing down? Avoid having 3 big meals a day and maintain blood sugar levels by eating frequently. Some do better than others but allowing 4-6 meals a day and noting how you feel is a step in the right direction. Maintaining a body temperature of 37 degrees and a pulse rate of 70-85 beats per minute is ideal. This has been well documented in the work of thyroid researcher Broda Barnes and the work of Ray Peat PhD.

Eating readily available carbohydrates such as ripe digestible fruits, protein and saturated fats (in the right amounts) such as coconut oil help to maintain blood sugar levels throughout the day without the resultant elevations in cortisol, which affect adrenal regulation issues.

Stressful situations often warrant the use of supplements such as Vitamins A, B6, C, magnesium and potassium. In particular sugary foods, which should include fruit, maple syrup and honey are ideal choices to diminish the stress response (even table sugar could play a therapeutic role in lowering stress).

Salt is also a powerful anti-stress compound. During stress sodium is often passed more rapidly from the body. Sodium spares magnesium. If you drink too much water the level of sodium excretion increases, which further decreases available magnesium. The research on lowering salt intake is inconclusive but what is known, is that when a low sodium state exists, aldosterone, a hormone that is used to regulate both salt and blood pressure elevates in response. It would come as no surprise that in a low adrenal state, feeling dizzy when moving from seated to standing exits due to poor blood pressure regulation. Craving salt is a mechanism to improve such a situation.

The current mind set regarding exercise and wellbeing is

Increased exercise + Low carb and raw foods = Health

And in the short term, markers suggest that this could be favourable. So how do you tell if this working for you long term? The monitoring of both pulse and body temperature give a great insight into optimal biological function. Here are some of the symptoms, which combine both compromised cortisol and thyroid function.

  • Cold hands, feet and nose
  • Energy crashes
  • Poor wound healing
  • Poor sleep
  • Fatigue
  • Constipation or alternation between constipation and diarrheoa
  • Weight gain
  • Bloating
  • Skin issues
  • Low libido

In reality:

Intense exercise + low carb/raw food diets= compromised metabolism.

Historically in many, changing both the way you eat and completing more exercise may have worked previously, but as you push the markers of exercising more and eating less or certainly eating foods that do not support your activities. You may see many of those symptoms above start to creep into your daily life. There’s no doubt that eating well and exercising are productive pursuits for optimal body function. However for many the lines are blurred as to what actually is a healthy diet.  Consumption of large amounts of grains, margarine and low fat foods were being touted as healthy a decade or two earlier, now look at the research condemning that approach. The following information seems to be heading a similar route.

For the health conscious exerciser today a diet high in raw green vegetables, green juices, seeds nuts, fish oils, low carb, low starch seems to be the zeitgeist but is it that healthy? From a biological perspective the answer would be no. Eating these foods over a long period of time not only increases the stress response but may actually damage how our body’s cells actually function. Increasing available energy from easily digestible foods helps to assimilate energy for production. In contrast foods such as many raw green vegetables, nuts, seeds and vegetable oils, not only irritate the bowel, sit and accumulate bacteria damaging the intestinal lining, but also provide less than optimal nutrition, which will lower metabolic rate.

Moving is important, no doubt, but exercising to within an inch of total fatigue can be detrimental, especially so when dealing with issues related to both adrenal and metabolic based issues. Finding the right type of exercise and even stepping back and focusing on exercise that doesn’t produce high levels of lactic acid, causes hyperventilation and the loss of carbon dioxide should be considered in the short term. The goal of improving metabolic function, restoring deep sleep and raising energy should always predominate over the loss of body fat reduction. It’s a tricky issue to get your head around for some, but when you start to feel great again. You’ll understand why.

Adrenal Fatigue or Reductionist Thinking?

adrenal

 

Here is the first part of my article, which published in the May 2014, Womens Health and Fitness Magazine.

Adrenal fatigue or reductionist thinking?

Often, being given a distinct diagnoses that can relate to modern living can   make sense to us, a modern condition that makes sense of the hectic lifestyle and the symptoms that we have been experiencing. Over the last decade there has been much literature on a so  called ‘Adrenal fatigue’, whose symptoms are wide reaching from fatigue, digestive dysfunction, weight and sleep issues.

Walther Canon and Hans Seyle, probably the most prominent  scientists to study and interpret the mechanics behind, adrenaline, cortisol and the stress response, showed that when  rats were exposed to high levels of stress, they developed issues such as ulcers, intestinal bleeding and then finally death. The common suggested auto immune diseases that are becoming more prevalent, such as intestinal hyper-permeability or leaky gut can therefore be interpreted as symptoms of chronic stressors.

The premise of adrenal fatigue works something along these lines.

  • You are exposed to stress
  • You produce stress hormones (Alarm phase)
  • Your body returns to normal
  • You become stressed again on a regular basis
  • You enter the adaptation phase
  • You constantly maintain the stress response through permanent exposure
  • The adrenal glands become exhausted
  • Suggestion that you have adrenal fatigue or exhaustion phase

There are many problems with this interpretation and deduction of adrenal fatigue, and how many practitioners treat this reductionist diagnosis.  If your adrenals were truly fatigued, you may not actually be with us anymore and ultimately be dead. Cortisol which is produced by the adrenal glands, is the primary hormone that directs immune function, inflammation and is involved in virtually all aspects of body function. Certainly the terms hypocortisolemia, too little cortisol and hyper, too much cortisol make sense, and that is what a typical adrenal stress test tells us. Are we producing too much or not enough cortisol , on that particular day, based around a suggested norm?

Cortisol does go up and down, and probably outside of suggested arbitrary norms especially if you experience or engage in the following:

  • Excessive physiological or structural stress, intense exercise without adequate rest.
  • Psychological stress
  • Diet or fail to eat enough calories, eating too much may also contribute over time
  • Eat a so called healthy diet based upon current guidelines
  • Fail to get adequate sleep.
  • Chronic exposure to environmental pollutants

The longer one stays in a state of chronic stress the more compromised all aspects of body function become. This can ultimately result in hormone, immune and metabolic systems dysfunction.

The positives from treating the aspects of adrenal fatigue are a compliance of those suffering from the suggested condition, to address aspects of why they have got to this current state of affairs. Overworking, too much or too little exercise, not enough sleep and psychological stress recognition can be aspects that can be changed with great effect.

To create effective change, should we not consider other aspects of function that would treat the root cause, rather than plaster over the symptom? Lets take a look at the cross over between symptoms of both adrenal and thyroid dysfunction, which have roots in energy and digestion. You may start to notice that there are many symptoms that you may experience a mixture of both and to highlight adrenal fatigue alone is problematic. The thyroid gland supports energetic process’s and when this becomes compromised we call on the adrenal glands to act in a supporting role. Addressing energy, metabolism and digestion, should be the target of any lifestyle or therapeutic interventions.

Adrenal symptoms Thyroid symptoms
Fatigue

Difficulty sleeping

Low blood pressure

Clenching teeth

Dizzyness

Arthritic issues

Crave salt

Sweats a lot

Allergies

Weakness

Afternoon crash

Need to wear sunglasses

Anxiety

Weight gain or loss

Difficult to lose or gain weight

Nervousness/anxiety

Constipation

Hair loss

Poor energy/fatigue

Feel cold hands and feet

Mentally sluggish

Morning headaches

Seasonal sadness

Poor sleep

 

 

 

 

However treating adrenal fatigue in isolation with adaptogenic herbs, restriction of sugar and other stimulants as is often the case, may be unwarranted and most importantly ineffective in resolving these issues. Treating any system in isolation is reductionist and often gives you at best, reductionist results. The complex interaction of the Hypothalamus-Pituitary-Adrenal-Thyroid-Gonadal axis is a system that helps our body manage many global aspects of our body’s function and therefore addressing adrenal balance leaves a gaping hole in your treatment strategy. Consider that the adrenals and in particular cortisol production can be a slave to the your environment, nutrition, exercise and other lifestyle choices. Take stock, address what may be affecting your stress hormone production, If these factors can be changed do so. Stress is a double-edged sword. We need a certain amount of stress to improve our physiological function. Constant exposure to stress decreases our biological state.

Raising biological wholeness such as energy levels, cognition and increasing balance throughout the hormonal system can give much better results than focusing on the adrenals. Remember that the adrenals and ultimately cortisol production elevate in response to, what you eat, or fail to eat, the environment, psychological and physiological stress. All of these aspects are changeable.  In the next article I suggest some strategies that can be used to improve energy and lower adrenal stress.