Archive for tag: nutrition

Chiropractic and Obesity

Hello, everyone. These three-day weekends are the best. This weekend was perfect for work and play. Half of the weekend the weather was horrible, perfect for studying, and the other half was gorgeous, perfect for some daytime bar action. I took full advantage of both aspects of the weekend.

This week, I thought I'd share an essay I wrote on the obesity situation in our country and possible complimentary treatments that we as alternative medicine practitioners could offer our prospective patients. This is just my take on the situation and treatment I believe could help, so please take it with a grain of salt, and if anyone has any questions or comments, please shoot them my way.

Obesity: A multifactorial disease in need of a multifactorial treatment.

The most serious threat to public health in the United States today can easily be attributed to chronic illness and health problems either wholly or partially caused by diet. The estimated number of deaths linked to obesity in the United States is 280,184 per year. Sixty-five percent of adults 20 years of age or older are considered either overweight or obese. The leading cause of mortality in our country is cardiovascular disease (38.5% of all deaths). Cancer is the second leading cause of death in America (25% of all deaths), one-third of which are ascribable to nutritional factors and obesity (1). How has our society succumbed to this modifiable risk factor of obesity? More importantly, how can we combat this issue?

The first step in attacking this epidemic is to realize that there is no one "magic bullet" to cure the overweight person. It has been proven time after time, that monotherapies are not effective. Obesity is a multifactorial disease in need of multifactorial treatment. There are a slew of inherent barriers to weight loss and controlling appetite. The most important of these road blocks to health being the instinctual drive to eat, hypothalamic inflammation, and regulation of satiation hormones.

Chiropractic care and its philosophy of treating the whole person, provides a unique and effective avenue in the world of weight management. As a physician, one of our roles will be to use education as a key component of treatment. We must relate to our patients that overeating is instinctual, because historically, food was a scarce commodity. Our genome has not had the time to adapt to the fact that food is readily available to us.

Evolutionobesity2

In the time of our ancestors, the hunter-gatherers, the meal they were eating could have very well been their last. The body therefore creates a set point of weight over time to preserve itself. In the obese, this set point is set at an increased weight (1-2). This method was advantageous to the lean person in an environment where food is scarce and physical activity was needed to produce a meal. In society today, where over-processed fast food is so readily available and little if any physical activity is required to gather, weight gain isn't that surprising. Educating our patients to the fact that weight management is an active process should be the first step in treatment.

Education provides a solid base from which to build a healthier society. The next tier of treatment is aimed to combat the postprandial inflammation that occurs in the hypothalamus. It has been studied and published, that systemic, and hypothalamic inflammation can affect key neuronal systems that govern energy homeostasis, and defend the level of body weight (3). Seventy-two percent of the total daily energy consumed by an average American consists of dairy, cereals, refined sugars, refined vegetable oils and alcohol (1). These dietary choices translate to release of the amino acid, arachidonic acid during their digestion, which leads to the advent of inflammation in the body. This global inflammation leads to disruption of satiety mechanism, via insulin/leptin resistance, so people feel hungry even if they overeat (3). Diet modification is key in this component of treatment.

A Paleo-Mediterranean diet has been shown to satiate as well as keep levels of inflammatory mediators at a minimum (5). This proposed diet, takes the best of the "Paleo" and Mediterranean" style diets, with emphasis on fresh whole fruits, vegetables (raw or minimally cooked), omega-3-rich lean meats, seeds, olive oil, red wine in moderation, and the avoidance of starchy foods. This diet has been consistently associated with improvements in insulin sensitivity and reductions of cardiovascular disease, diabetes, and cancer (5). Foods included in this diet provide the patient with adequate nutrients, anti-inflammatories, anti-oxidants, as well as favorably modifies gut microbiota. By providing our bodies with the whole foods it needs, in a form that it is genetically equipped to process, health and obesity is ours to control.

As much as our diets promote obesity, our mood contributes just as much. Stress and lack of sleep promote increased ghrelin release from the stomach (4). Ghrelin is a hormone that has the ability to up-regulate appetite and down-regulate satiety by decreasing insulin release. In order to fight back against ghrelin, it is imperative to have patients get six to nine hours of sleep a night (4), and manage their stress preferably with exercise, or meditation.

A country composed of healthier people is a very attainable goal, but it requires work by all parties. Managing this public health issue will be effective if a multifactorial approach is used to attack it. By educating our patients that they will have an innate drive to overeat that they will have to overcome, providing them with adequate anti-inflammatory diet options, and helping them overcome stress and sleep deprivation, the obesity epidemic in our country could be controlled. Weight gain and a healthy lifestyle are modifiable risk factors that can be used to save over 250,000 lives per year (1).

References:

  1. Loren Cordain, S Boyd Eaton, Anthony Sebastian, Neil Mann, Staffan Lindeberg, Bruce A Watkins, James H O'Keefe, and Janette Brand-Miller."Origins and evolution of the Western diet: health implications for the 21st century". American Journal of Clinical Nutrition2005; 81:341-54.
  2. Sumithram P et al. "Long-term persistence of hormonal adaptations to weight loss". New Eng J Med. 2011.
  3. Wisse BE, Schwartz MW. "Does hypothalamic inflammation cause obesity?" Cell Metab. 2009; 10:241-42.
  4. Lisa Morselli, Rachel Leproult, Marcella Balbo, Karine Spiegel. " Role of sleep duration in the regulation of glucose metabolism and appetite". Endocr Dev. 2010; 17:11-21.
  5. Vasquez, A. "Integrative Rheumatology. Concepts, Perspectives, Algorithms, and Protocols. 2nd edition. 2007; 90-92.

I hope everyone has a great week, and enjoyed the essay. If nothing else, maybe it will give you something to consider with future patients.

Catch ya on the flip side,
Dex

Giving Thanks

Good morning and welcome back. I hope everyone's long Thanksgiving weekend helped as much as mine did. I needed a little break to gas the engine back up for finals. The weekend was full of good food, good people and good times.

Thursday could not have been better. I have to give thanks for my family. They've always been there to support me in any way I needed, as well being excellent cooks and putting on a heck of a Thanksgiving feast.

2011-11-28_shakers

The Florida State Seminoles also deserve some praise after getting a big win against the Florida Gators on their home field, Saturday. It's the second straight season the Noles beat the Gators, and the first time since 2003, that we've gone undefeated to all the teams in the state of Florida--not too shabby!

We may celebrate the holidays a little differently down here in Florida than in Illinois. The weather is beautiful this time of year, and we tend to be outside as much as we can. If you're a dork like me, then you would realize more sun = more vitamin D! Yes, my brother and cousins made fun of me on Thursday after spitting off some facts about vitamin D and its numerous health benefits. Being that I didn't get to finish my rant then, I'll take the time now to give shed some light (pun intended) on this unsung hero.

Vitamin D

There is almost no population of people studied thus far that maintains an average vitamin D level above 36ng/mL, with the normal physiological range being 32-100ng/mL. I believe these levels are as low as they are because people aren't given the proper education on D's benefits and dosing. Vitamin D is unique because it functions as a hormone rather than a vitamin. Vitamin D has as many mechanisms of actions in the body as the 1,000 human genes it regulates.

Research has shown that doses as low as 2,000 IU per day of D may produce enough of the naturally occurring antibiotic cathelicidin to cure common viral respiratory infections such as influenza and the common cold. So maybe taking some more vitamin D, may be an option rather than taking a flu shot each year (just a thought)? The common cold and the flu aren't the only things vitamin D is good for.

Research has proven that Vitamin D supplementation can be beneficial in managing conditions such as hypertension, osteoporosis, osteoarthritis, MS, depression, type 2 diabetes, musculoskeletal pain, and it can even prevent insulin-dependent diabetes. In a recent study, a total of 341 out of 360 subjects suffering from chronic lower back pain were completely relieved from supplementing with vitamin D for 3 months.

The current upper limit of Vitamin D supplementation set by the Institute of Medicine is 4000 IU a day. This is simply not enough; research has shown that 4,000 IU/day of D has no effect on calcium levels in the serum or urine. Our optimum serum D levels should be in the range of 32-100 ng/mL. We could achieve this by supplementation of 4,000-10,000 IU/day.

How vitamin D is absorbed and utilized by each person is different, and dosing is therefore no different. A good rule of thumb for vitamin D dosing is: If you are under 110 lbs., you may want to supplement with 5,000 IU/day; if over 110 lbs., 10,000 IU/day. I know 10,000 IU sounds like a ton of supplement, but in reality 10,000 IU only equals 0.25mg.

Feels good to get that off my chest finally. I hope everyone has a killer week, and start studying, if you haven't already, for finals start next week.

Take care,
Dex