The real cause of Obesity

The real cause of Obesity

A few weeks ago, I went to Leura to attend a 3 hour seminar on obesity, held by Metagenics. It was a great turn out from practitioners from Sydney, Canberra as well as the Blue Mountains and Central West.

In Australia, it is estimated that by the year 2025, there will be more obese
(BMI >30) people than people in the healthy weight range (BMI 20-25). Currently 63% of Australians are overweight or obese.

Why is this so important? Obesity is a medical issue in terms of the potential health implications. The more fat mass a person carries the greater risk of chronic disease:

  • Cardiovascular disease
  • Diabetes
  • Cancer
  • Sleep apnoea
  • Mood disorders
  • Neurological diseases

Even modest amounts of weight loss (5-10% reduction) leads to dramatic improvements in health. The Diabetes Prevention Program showed that losing 5.5% of body weight over 2.8 years, decreases the risk of getting diabetes (from a pre-diabetic situation) by 48%. (1)

Obesity relates to our brains – they drive what we eat. We are hardwired to seek out more calories and remain less active, so we have ample supplies for the lean times. But in 2018 with food available 24/7 the lean times don’t come.

Body weight regulation is under UNCONSCIOUS homeostatic control – similar to blood pressure, blood sugar and pH regulation. The body weight our body likes to maintain is called the “body weight set point”. There is a 2-6kg fluctuation around this point. (2)

Our body weight set point is developed around the age of 20y, around 24y in some males. This body weight set point goes up in our 50s and as we then get older, this starts to drop. If there is obesity in childhood, the body weight set point will be set higher at an earlier stage.

Our brains control the energy we use. For example, in a group of obese people who had 20% weight loss, they were inclined NOT to move MORE than obese people who had lost 10%.

So, the gut-brain connection rears up again – in animal studies, inflammation in the brain (in particular the hypothalamus) precedes obesity. What drives inflammation? A high fat and high sugar diet. Eating food triggers dopamine release, a neurotransmitter, which activates reward, motivation and learning centres in the brain. The more calorie dense a food is, the more dopamine is released. (3)

Studies show that obese people demonstrate higher reward centre activation in the brain compared with lean controls. (4)

What are some of the real causes of obesity in 2018?

  • We are eating more than we have historically – calorie intake is 425 kcal/day higher
  • The body weight set point is reset so there is a 20% increase in energy intake (2)

So, what can we do to lower the set-point?

  • Have a diet with low to moderate palatability (tastiness)
  • Eat adequate protein
  • Restrict fat OR carbohydrate
  • Have diet breaks (time off restricted eating, to prevent metabolic adaption and give a psychological boost)
  • Ensure adequate good quality sleep
  • Maintain good levels of physical activity

Having a buddy when focusing on weight loss has been shown to be very beneficial for accountability, psychological support and better outcomes.

Watch out with the upcoming holiday season….much of weight gained through the year happens during the smallest window. Research shows that annually 52% of weight gain occurs over the holiday season, which is only 12% of the year. Lots of hyper-palatable (very tasty) food is consumed/over-consumed, which has been found to drive up the set-point. (5)

References:

  1. Diabetes Prevention Program Outcomes Study. Lancet. 2009 14;374:1677-86
  2. Obesity Pathogenesis: An Endocrine Society Scientific Statement. Endocrine Rev. 2017 1;38:267-296
  3. The gut-brain dopamine axis: a regulatory system for caloric intake. Physiol Behav 2012 6;106:394-9
  4. Widespread reward-system activation in obese women in response to pictures of high-calorie foods. Neuroimage 2008 41:636-47
  5. Defence of body weight depends on dietary composition and palatability in rats with diet-induced obesity. Am J Physiol Regul Integr Comp Physiol. 2002 282:R46-54
What stool testing do we do at Braid Health?

What stool testing do we do at Braid Health?

In order to really understand the health of the gut, we do advanced lab testing. The test is comprehensive and gives a picture of the good and not-so-good bugs (the microbiome) who are living in the bowels, as well as detailed information on digestion, the immune system and inflammation.

The test we use at Braid Health is the GIMAP, a comprehensive stool test which uses DNA PCR analysis to identify the little critters on board.

“More than ever before, we are keenly aware of the health benefits or disease risks brought about by the microorganisms that inhabit the human body. Culture techniques, previously the standard, left up to 50% of bacterial species virtually invisible. Because most of the bacteria of the GI tract are anaerobes (survive in no-oxygen surroundings), culture-based methods cannot cultivate them which leaves a large blind spot for clinicians when trying to diagnose the source of infection.”

Quote from the GIMAP website

The turnaround for testing is quick. Samples have to be sent to the USA by Fedex for express shipping, then lab results are usually ready 6 days after the sample has arrived.

Who would benefit from GIMAP testing?
People with symptoms of:

  • Inflammatory Bowel Disease (IBD)
  • Irritable Bowel Syndrome (IBS)
  • Autoimmune Disease
  • Acute and Chronic Gastroenteritis
  • SIBO (small intestinal bacterial overgrowth
  • Suspected H. pylori infection
  • Fungal or Yeast infections
  • Bacterial and Parasitic infections
  • Viral pathogens
  • Intestinal permeability

Here is an example of a report.

Here is a video I made to use the test kit correctly.

Overall this is a very thorough test and I often use it with clients of Braid Health. Cost of this testing is around $535 (including shipping). If you have any queries about the GIMAP please let me know.

Perimenopause and Menopause

Perimenopause and Menopause

Women’s health is a very important topic every day.

By far the majority of the clients I see at Braid Health are women and there is nearly always a hormonal overlay to optimising their health, whatever stage they are in their lives.

So what exactly is the menopause?

It’s the cessation of menstruation, the life phase that begins 1 year after the last period. The age of most women starting menopause is 45-55 years.

And have you heard about the perimenopause?

This can be a time between 2-12 years before menopause, when hormones and fluctuating like a rollercoaster. Symptoms can include heavy periods, hot flushes and insomnia and these can start from age 35. About 20% of women will experience the dramatic rollercoaster ride!

So what hormones are we talking about here?

Firstly oestrogen, a very important hormone that affects multiple areas in our bodies from brain to gut to breasts and of course our reproductive organs. It has multiple functions including:

  • Increase in metabolic rate
  • Improves insulin sensitivity
  • Regulates body temperature
  • Maintains muscles
  • Improves sleep
  • Anti-inflammatory

And secondly there is progesterone, which prepares and sustains a woman’s body for pregnancy. Generally as ovulation stops, the progesterone level drops more rapidly than oestrogen and it is this imbalance in hormones which causes symptoms.
Other functions of progesterone include:

  • Neuroprotective calming effect
  • Eases anxiety
  • Supports immune system
  • Smooths skin and improves hair growth

Have you come across the “Grandmother theory”?
We are genetically programmed to stop reproduction relatively young to dedicate time to dependants and their offspring. Other mammals are not programmed this way. Orca whales are the only other species to undergo menopause.

Some suggestions that may help with symptoms in the perimenopause include:

  • Managing stress. Aim for good sleep and self care routine
  • Reduce alcohol intake. Alcohol impairs healthy metabolism of oestrogen, and lowers progesterone and the calming action it has on the brain
  • Keep track of your cycles with a perimenopause diary. Here is one to try out: cemcor.ubc.ca
Alzheimer’s can be reversed!

Alzheimer’s can be reversed!

I am so keen to share with you the knowledge that Alzheimer’s disease can be reversed! This was not something ever taught to me during my medical school or specialist training. In my more recent studies I have learnt about the work of Dr Dale Bredesen who has developed the first programme to prevent and reverse the cognitive decline of dementia. He has written an excellent book “The End of Alzheimer’s” and presents many examples of reversing mild cognitive impairment.

We now know that there are changes happening in the brain 10-20 years before symptoms start. Often people feel absolutely fine, then start noticing difficulty recognising and remembering faces, or getting more tired later in the day to do mentally challenging tasks. Other changes an individual or loved one may notice could be a decreased interest in reading or an inability to follow or engage in complex conversation. Sometimes words can be mixed up using a completely wrong word in a sentence. Early physical signs include a change in walking/gait, where someone might make more noise when they are walking, shuffling their feet and taking shorter steps.

Optimising brain health is something dear to me as my wonderful father has Alzheimer’s disease with moderate cognitive impairment. I have seen him slowly decline in communication, energy and endurance, getting lost in new or familiar places, and a slowing and shuffling of his gait. Fortunately he has remained positive and warm-hearted during these challenging times. He is supported by my amazing mother and some additional home help. Mum encourages him to do the concise crossword with her, go for at least a daily walk with her and catch up with friends on a regular basis.

So some of the lifestyle areas to address when looking to reverse Alzheimer’s include:

  • Diet:
    • Avoid all sugars which cause inflammation in the body.
    • Avoid gluten which is inflammatory to 80% of the population and can cause intestinal permeability.
    • Eat a wide variety of colourful fruit and vegetables every day. Aim for a 1, 2, 3 plan: 1 veggie at brekkie, 2 with lunch, 3 at dinner.
    • Ensure you have a 12h gap between meals overnight.
    • Avoid fatty fried foods which have Advanced Glycation End products – these get stuck in the end of tiny capillaries (blood vessels) and can induce AD.
  • Sleep: Aim for 7-8h sleep per night. This is essential for the brain to clear out any debris and be ready for the next day ahead. Lack of sleep = debris build up.
  • Stress: address your stress is one of the most important areas to target. Low-grade chronic stress is terrible for our systems. We were designed to have short bursts of stress that stopped. Work on up-regulating your Rest-and-Digest system (Parasympathetic Nervous System):
    • Sit down to eat
    • Take 3 deep breaths before you start
    • Chew your food well
    • Chill out after a meal
    • Hum, sing, laugh or gargle to stimulate your vagus nerve
  • Dental health: Brush your teeth 3 times a day. Dental health is related to the risk of AD. Mid-life tooth loss and lack of brushing teeth increases risk of AD. See your dentist regularly to check on dental hygiene and conditions like periodontitis.

If you know of someone who would benefit from this information, please share it so they can improve their brain health. As always, if you have a question please email me directly or contact my rooms if you would like to book an appointment.

What is IF? 12/12, 8/16, 5:2….(it’s not a maths class!)

What is IF? 12/12, 8/16, 5:2….(it’s not a maths class!)

This post is all about Intermittent Fasting. What it is, all the different ways you can do it and the possible health benefits.
[Medical Disclaimer: this pattern of eating may not be suitable for everyone.
Please review with your medical practitioner before embarking on a change in your intake is advised. People who should NOT fast include pregnant and breastfeeding women, people under the age of 18y, underweight people and people with anorexia.]

Intermittent Fasting is essentially giving your digestive system and body a break from the work of digestion. Did you know it takes 10% of your daily energy to digest the food you eat? So by having a break from grazing or even three meals a day, a common benefit from intermittent fasting is increased energy!

So how might it look if you are Intermittent Fasting? Well there are lots of different ways to do this.

  • A great place to start is the 12/12 routine where there is a 12 hour window of fasting, for example 7pm to 7am. Aim for your last meal to be 3 hours before you lie down to sleep.
  • For a bit more of a stretch between meals you could increase the fasting window to 14 or 16 hours, with a 10 or 8 hour feeding window, respectively. Personally, I prefer to do these days while I’m at work rather than at home, and the time passes by quickly. Before I know it, 12.30pm rolls around and it’s lunchtime and my first meal of the day.
  • So what’s 5:2 you may ask? This is based on normal dietary intake on 5 days a week with reduced intake (around a third of normal) on 2 days a week as presented by Dr Michael Mosley.

There are multiple purported benefits for our bodies from fasting. Some of these include:

  • Mental clarity and concentration
  • Weight loss
  • Lowering of blood insulin and glucose levels
  • Increased energy
  • Improved fat burning
  • Cellular cleansing (potential). The Nobel Prize in Medicine 2016 was awarded for this discovery

What do you do during the fasting period when you’re awake?

  • Stay hydrated
  • Drinking black tea or coffee is fine (adding milk or sugar requires digestion and breaks the fast)
  • Stay busy
  • Don’t overeat after the fasting period has ended

So over to you – have you ever fasted before? Fasting (not starvation) as a dietary intervention has been practiced since ancient times. I encourage you to consider this health strategy that can save you time and money!

Remember medical review prior to changing your intake is recommended.

What is your brain up to when you’re sleeping?

What is your brain up to when you’re sleeping?

Have you ever thought what your “grey-stuff” does when you’re in a deep slumber?

There’s a lot that goes on when we are asleep….and guess what? It’s really important for good health!

I’m really passionate about empowering you to achieve good health and sleep is the number 1 medicine I recommend. Above what you eat, how you manage your stress and how much you exercise, sleep is top dog.

Numerous functions of the brain are restored by, and depend upon, sleep. We have different stages of sleep – NREM (light and deep) and REM – and they all offer different brain benefits at different times of night.

Memory: sleep has proven itself time and again as a memory aid: both before learning, to prepare for making new memories and after learning, to cement those memories and prevent forgetting.

In my brain-injury rehabilitation clinic, I am always checking in on sleep with my clients, who often are challenged with short term memory. Good sleep patterns (including daytime naps in the recovery phase) are very important for brain recovery.

Creativity: at nighttime your sleeping brain creates a theatre, making connections between vast stores of information. This all happens during REM sleep in our dreaming state. These connections would never occur during wakefulness.

Cellular cleaning: while we are sleeping, metabolic debris is removed by the exceptional support team of our neurons – the glymphatic system. It is important to remove unwanted metabolic products from the areas surrounding hard working neurons, so the brain can work better the next day. This may even link with the development of Alzheimer’s disease. Amyloid protein is a poisonous element associated with AD and is usually cleared out at night. In mouse experiments depriving mice of NREM sleep, there is an immediate increase in amyloid deposits within the brain. Another way of saying this is “wakefulness is low-level brain damage, while sleep is neurological sanitation”.
Quote from Why we sleep by Matthew Walker (a fantastic read!).

Getting too little sleep across the adult lifespan will significantly raise your risk of developing Alzheimer’s disease. This has been reported in numerous epidemiological studies, and two anecdotal cases include Ronald Reagan and Margaret Thatcher. Two heads of state who appeared proud and were certainly vocal about sleeping only 4-5 hours a night. They both went on to develop the ruthless disease.

So what can you do to help your brain while you’re sleeping?

  • Prioritise sleep! Aim for 7-8 hours per night
  • Develop an evening routine to wind down
  • Turn off screens 1-2 hours before bed
  • Keep your bedroom cool
  • Remove any blue-light emitting devices from your bedroom:
    • phone, alarm clock/radio, TV
Could you have a leaky blood-brain barrier?

Could you have a leaky blood-brain barrier?

We can often take our health, including that of our brain, for granted. In order to keep our body humming along, there are a huge number of body systems our brain oversees – hormones, digestion and muscles to name a few.

Sadly, conditions of the brain are rampant in society nowadays.

Why is this the case? There are often several underlying factors including inflammation, gut microbial imbalance and toxins. In functional medicine, we look for the root cause(s).

I have presented webinars on the gut-brain connection before, and now research is finding a leaky gut can be associated with a leaky brain, or the protective blood-brain barrier (BBB).

Dr Alessio Fasano [MD, chief of pediatric gastroenterology and nutrition at MassGeneral Hospital for Children, Boston, Massachusetts], has worked extensively on the role of gluten and intestinal permeability. His research has shown how gluten stimulates the production of zonulin, and zonulin makes the bowel hyperpermeable, which allows proteins access to the bloodstream, where they might normally have been excluded. More importantly, what Dr. Fasano’s research has revealed is that the same mechanism is involved—gluten-stimulating zonulin—in increasing the permeability of the blood–brain barrier. While clinicians may be concerned about patients having leaky bowels, I can promise that having a leaky brain is certainly of much more concern. A compelling finding in his work is that 100% of humans have this gluten-zonulin signalling cascade to some degree.

So when we have leaky blood-brain barrier, larger molecules fit through the membrane than should usually get through. This leads to brain inflammation (cytokine model of cognitive function), and can be associated with depression, anxiety, brain fog and auto-immune brain conditions. Medications for example anti-depressants are often ineffective where there is brain inflammation because the underlying reason for brain inflammation has not been addressed.

So if you think you have brain inflammation, what can you do?

  1. Avoid brain zappers – sugar, highly processed foods, preservatives, artificial sweeteners. High blood sugar increases the risk of cognitive dysfunction (thinking problems) as well as shrinkage of the brain. Trial 2-4 weeks off gluten and see if you experience any difference in brain fog or mental energy.
  2. Manage stress – mindfulness, yoga, tai chi can all mitigate the effects of stress. Acute stress can increase leakiness of the blood-brain barrier.
  3. Exercise – aerobic exercise increases Brain Derived Neurotrophic Factor (BDNF) which promotes the health of the brain and nerve cells.
  4. Consider a functional medicine approach to brain health. Comprehensive testing for brain health includes markers such as homocysteine, a marker of detoxification, and HbA1C. This is a marker of sugar attaching to a protein over the past three months. If this marker is raised, it is likely other proteins are also becoming glycated. This in turn increases free radical production and oxidative stress in the body. This marker is well researched in monitoring the risk of Alzheimer’s Disease. The empowering part is that you have control on your HbA1C level – it depends on the foods you choose to eat.
  5. Look into the health of your microbiome. In clinic I often test the gut-brain axis through a stool test as an unhealthy gut can lead to an unhealthy brain. In particular bacterial imbalance or yeast overgrowth can have neurological implications. A good diversity of gut bacteria including Lactobacillus and Bifidobacterium species is important for good mental health.

References: 
Perlmutter D. Rethinking Dietary Approaches for Brain Health. Alt Comp Therap 2014;20:2.
Fasano A. Zonulin and its regulation of intestinal barrier function: The biological door to inflammation, autoimmunity, and cancer. Physiol Rev 2011;91:151–175.
Enzinger C, Fazekas F, Matthews PM, et al. Risk factors for progression of brain atrophy in aging: Six-year follow-up of normal subjects. Neurology 2005;64:1704–1711.

Women’s brains just ain’t the same

Women’s brains just ain’t the same

Concussion in Females
Women show signs of concussion later and for longer than men (3 weeks to 6 months for women).
Women concuss at a higher rate than men, differently to men and they recover differently. Hormones and the musculoskeletal structure of women’s necks may explain the differences in outcomes to men.

What are signs of concussion (or mild traumatic brain injury (mTBI):

  • Dizziness and or vertigo
  • Headache
  • Confusion
  • Fatigue
  • Fuzzy or blurred vision
  • Nausea or vomiting
  • Sensitivity to noise or light
  • Irritability
  • Sleeping more or less than usual.

The Research:

  • Females sustain more concussions at a higher rate than their male counterparts
  • Report a higher number and more severe symptoms than males
  • Women have longer recovery periods than males.

A woman will know more men than women who have concussions and may judge her own recovery by the male experience.

And IF her recovery spans more than a few weeks….

  • Depression
  • Isolation
  • Self-doubt
  • Anxiety
  • can occur with significant impact on her day to day functioning, at home and at work.

One of the experts on the Pink Concussions research panel, Angela Colantonio, PhD, professor and director of the Rehabilitation Sciences Institute at the University of Toronto in Canada, conducted a study, published in the Journal of Women’s Health, to see if menstrual functioning, fertility, and pregnancies were affected after a woman receives a mTBI. She and her colleagues found that 68 percent of the 104 observed women experienced irregular menstrual cycles after their injury as well as lower mental health and function.

What are the main causes of concussion in women:

  1. Sports
  2. Motor vehicle accidents
  3. Military
  4. Domestic Violence
  5. Falls in the elderly

Stats on concussion in females

Female basketball: 1 out of 2 collisions results in concussion.
Female Soccer: 1 out of 2 headers results in concussion.
30% Concussions from something other than sports – eg gym class.

Remember HEAD BUMPS:

    • Headache
    • Eye trouble
    • Abnormal behaviour
    • Dizziness
    • Balance dysfunction
    • Unsteady on feet
    • Memory impaired
    • Poor concentration
    • Something’s not right.
  • Seek urgent medical assistance if any of the above occur.

For more information you may enjoy Love your Brain – a great online resource for individuals, family or friends following a brain injury.

Metabolic Syndrome – What is it? Will I get it?

Metabolic Syndrome – What is it? Will I get it?

It is estimated that 25% of the world’s adult population has Metabolic Syndrome (Met Sy) (1). This is a very common syndrome and I want to empower you to take a preventative approach to minimise your risks of developing Met Sy.

Essentially it represents 5 variables which increase “cardiometabolic risk”.

  • Obesity (BMI >30)
  • Raised fasting glucose (blood sugar)
  • High triglycerides
  • Low high density lipoprotein (HDL)
  • High blood pressure

Fundamentally central obesity (apple shape) is associated with insulin resistance. This means cells are not responding to insulin as they usually do, moving glucose from the blood stream into cells. When there is excess insulin secreted from the pancreas:

  • Excess glucose (sugar) is stored as fat and energy levels drop
  • Testosterone and cholesterol levels increase
  • Fat burning is reduced and diabetes risk increases

In obesity, the extra fat causes inflammation, can result in high blood pressure, clotting and adverse blood fat profiles. It acts like a metabolic organ of it’s own, producing inflammatory factors that affect whole body health.

So what action steps can you take to decrease your risks of metabolic syndrome?

  • Exercise more
  • Lose weight – between 5-10% weight loss can increase HDL and reduce blood pressure and blood sugar levels
  • Avoid trans fats – these are not recognised by the body – commonly found in baked goods eg pastries and deep fried foods.
  • Cut back on refined carbohydrates or processed foods
  • Stop smoking
  • Alcohol in moderation – no more than 1 drink per day for women and 2 drinks per day for men is recommended.

Metabolic Syndrome and Mental illness

The incidence of obesity and Met Sy in people with mental illness compared with the general population is:

  • More than two times higher in women
  • Almost twice as high in men

This reflects the brain effects of vascular and hormonal changes with metabolic syndrome (2)

At Braid Health, we take a preventative and proactive approach to health. Metabolic Syndrome is a condition we look out for in our clients and routinely do comprehensive blood panels and detailed functional pathology testing. We aim to empower our clients through education, discussion and implications of results of testing, and use science-based approaches to optimise their health.

Who to test and when?

  • Asymptomatic men >45y
  • Asymptomatic women >55y
  • In Maori, Pacific and Indo-Asian people start 10 years ie
    • asymptomatic men >35y
    • asymptomatic women >45y
  • If there are multiple risk factors begin 10 years earlier.
    • Long term steroid or antipsychotic treatment
    • BMI>30 or BMI >27 for Indo-Asian people
    • Family history  of early onset type 2 diabetes
    • Personal history of gestational diabetes mellitus
    • Ischaemic heart disease (heart attack or angina) (3)

References:
1. Anagnostis P et al 2009
2. Allison et al 2009
3. http://www.bpac.org.nz/BPJ/2012/February/hbA1c.aspx

Really Lame Sleep….due to Restless Legs Syndrome

Really Lame Sleep….due to Restless Legs Syndrome

So you may have heard of Restless Legs Syndrome….a neurological condition where someone has compulsion to move their limbs in order to feel relief. It most often happens in the evening or at night and can contribute to insomnia or poor sleep (sometimes without the individual realising this). Sometimes it is the bed partner who is most acutely aware of the restless legs!

Research over the past 20 years has suggested some of the causative factors at play include a lack of iron specifically in the brain, excess neurotransmitter activity during the day (dopamine in particular), and genetics.

When considering why someone may have a deficiency (lack) of iron in their brain, we would look into the following areas:

  • What is their iron intake (food diary)?
  • How well are they digesting their food?
  • How well are they absorbing the iron in their food? Is there any competition for iron absorption in the gut….think microbes who often take iron before the human cells get access to it.

Restless Legs Syndrome can also be confused with leg cramps at night which can be due to common causes such as dehydration, lack of magnesium or potassium.

Finally ensuring an individual has a strong and balanced immune system is key (remember 70% of the immune system is in the gut) and stress management is very important to address in this area. Raised cortisol (from the adrenal glands), due to stress can suppress the immune system.

Please share this article if you know someone with restless legs. https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/restless-legs-syndrome/what-is-rls/causes.html