Are you Sensitive to Gluten?

Why did you give up Gluten?

Is it really necessary to remove gluten entirely from your diet? Gluten is a protein complex largely found in wheat, barley and rye and is composed of strands of gliadin and glutenin. 

It is particularly useful in baked goods as it is structurally amenable to water absorption and enables entrapment of air to create a moist, airy food product.  It also provides flavor.  As such, bakers are inclined to adjust the gluten content of baked goods to improve taste and texture.  This has led to the adulteration of breads that are traditionally dry and dense with added wheat gluten.  This modification has now produced rye breads and black breads that have the texture of an airy, moist white bread.   In and of itself, gluten is a perfectly healthy source of protein.  However, it is not the only nutritious component of whole grains.  Whole grains also contain a bran layer and a germ layer.  The bran layer contains fiber, B vitamins and other trace minerals while the germ layer is a nutrient-rich core containing vitamin E, B vitamins and polyunsaturated fatty acids. Unfortunately, these nutrient dense layers are removed from whole grains to get to the structurally useful endosperm where gluten is located.

 

Makers of processed foods have no practical use for the much healthier bran and germ layers of whole grains so they practically have been eliminated from the Standard American Diet (SAD).  The gluten-containing endosperm, on the other hand, is such a large component of the SAD diet that it is consumed in quantities that have exceeded its health benefit.  It is known that food sensitivities may be created by over-consumption of the same products, resulting in lack of adequacy, balance and variety.  Over the past few decades we have over-indulged on gluten-containing products to the point that we no longer have the capacity to completely digest what was once a perfectly healthy protein.  Gluten intolerance is not to be confused with Celiac disease, an adverse immunological response to gliadin that leads to autoimmune destruction of the small intestine.

As a result of a bona fide sensitivity to gluten or Celiac disease many consumers have removed whole grains from their diets and so are missing out on their many health benefits.  Let’s start with the bran layer.  The fiber in bran directly improves colon health, is beneficial to healthy gut bacteria and lowers plasma cholesterol levels using a mechanism that is free of the side-effects common to pharmaceutical agents.  B vitamins, in both the bran and germ layers, function as co-factors that are critical for cellular activity.  Additional benefits of the germ layer exceed that of any other food category.  The germ layer contains a plethora of antioxidants including vitamin E which is so deficient in the SAD diet, along with heart-healthy fats.

I commend David Perlmutter, author of Grain Brain, for bringing to our attention the many ways that gluten adversely effects our health and leads to cognitive decline.  However, it is somewhat concerning that we have over-interpreted his message and removed whole grains from our diets entirely.  I did a little deep dive to see what Dr. Perlmutter is eating himself.  Although he subscribes to a ketogenic diet (high protein, low carb) he does allow himself 50-100 g of carbohydrates per day.  This includes consumption of amaranth, buckwheat, rice (brown, white, wild), millet, quinoa, sorghum, teff and certified gluten-free oats.  These grains are just as healthy, if not more so, than whole wheat and provide a perfectly sound alternative for those with gluten sensitivity.  More information about the benefits of these gluten-free whole grains may be found on the Whole Grains Council website, http://wholegrainscouncil.org.

Nutrition and Dementia

The Role of Nutrition in Dementia Prevention and Management

Sponsored by the Sackler Institute for Nutrition Science

Hosted by the New York Academy of Sciences
26-27-March-2015
& World Trade Center, New York, NY
#NutrDementia

Day 1 of the New York Academy of Sciences Symposium on Nutrition and Dementia left me bursting at the seams with a newfound understanding of how nutrient status dictates cognitive health. First, I’d like to begin this summary by expressing my appreciation to the Sackler Institute and Nestlé Health Science center for their commitment to identifying Nutrient gaps that affect early childhood development and aging. 

Dr. Irwin Rosenberg, from Tufts University, was the first speaker to point out the inverse relationship between homocysteine levels, which are regulated by B vitamins, and cerebrovascular disease.  This introductory presentation laid the groundwork for the presentations by David Smith and Helga Refsum who showed that B vitamin supplementation (folate, B6 and B12) reduce the rate of brain atrophy by lowering total homocysteine levels.  Although B12 and folate rely on one another for metabolism this effect is largely driven by B12 levels.  The reason why media outlets reported that a large-scale clinical trial showed that B vitamins do not prevent dementia was due to a gross misinterpretation of the data.  In order for the data to be significant baseline levels of B vitamins need to be measured because those who have normal levels will not show any brain changes if treated with B vitamins.  Also, the study was conducted with an inappropriate patient population that did not meet suitable inclusion criteria. Finally, Dementia was not an assessment outcome for the study, only cognitive function.

I must admit that I was unmoved by Gary Gibson’s discussion of how reduction of the mitochondrial alpha-ketoglutarate- dehydrogenase complex (KGDHC) correlates with diminished mental performance, but was very intrigued by the correlation between thiamine (vitamin B1) levels and Alzheimer’s disease (AD).  Thiamine deficiency, which leads to impaired glucose metabolism, can be treated with Benfotiamine, a synthetic S-acyl derivative of thiamine (vitamin B1).  This theme was further elaborated by Dr. Stephen Cunnane who reported that glucose hypometabolism may be abrogated by following a ketogenic diet where ketone bodies may be used as a source of energy for the brain.

Given my own personal interest in the Microbiome I was quite intrigued by Kirsten Tillisch’s assertion that decreased Microbiota diversity correlates with aging.  As such, it may be possible to reverse cognitive decline by increasing Microbiota diversity.  The observation that anxiety and depression decrease when given probiotics supports this hypothesis.

Richard Wurtman was not a speaker at the symposium but certainly piqued my interest by calling the audience’s attention to a product called Souvenaid®, an elemental product, largely consisting of uridine, choline and Omega-3 fatty acids, that has been shown to promote synaptogenesis, thus reversing the synapse loss seen in AD.  This product is currently available in Europe but not in the US.

The data presented by Cédric Annweiler to support the role of vitamin D in cognitive function were rather weak but were supported by Katherine Tucker who shared a list of published studies to show vitamin D levels correlate with reduced incidence of dementia, AD and stroke.  Dr. Tucker cited the outcome of a Boston-Puerto Rican Health Study that provided support for the roles of vitamin B6, Omega-3 fatty acids and vitamin D in improving cognitive abilities.  High sugar consumption and reduced fruit and vegetable consumption correlate with cognitive impairment.

The final presentation of the day, presented by Dr. Martha Clare Morris, was reviewed in the Health Section of the a number of media outlets.  Based on the unique nutritional needs of those at risk for cognitive decline, Dr. Morris compared the benefits of a “Mind” diet, designed to improve cognitive function, with a Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet.  While all three diets improved cognitive function, the Mind diet was significantly better than the other two.  The Mind diet consists of the following foods:

·         Three servings of whole grains every day

·         A salad and one other vegetable every day

·         A single glass of wine every day

·         Mostly nuts as snacks

·         Beans every other day

·         Poultry twice a week

·         Berries twice a week

·         Fish once a week

·         Olive oil as the primary oil used in meal preparation

The following foods should be avoided:

·         Red meats

·         No more than one tablespoon of butter or margarine per day

·         Less than a serving a week of cheese, fried or fast food

·         No fruits beyond blueberries and perhaps strawberries

·         No pastries or sweets, may be replaced with a teaspoon of jam per week

A subsequent blog will be posted shortly to review Day 2 of the Symposium.

Nutrigenomics-How Your Diet Impacts Your Genes

YOUR GENES DO NOT DEFINE YOUR HEALTH

Your risk factors for adverse health conditions are largely dictated by the health of your mother during pregnancy.  Your Mother’s diet and lifestyle, along with everything that she was exposed to shortly before and during pregnancy, have a significant impact on your long-term health.  Under or over-consumption of macro- and micro-nutrients, and anything else with the potential to modify DNA, have genetic consequences that will likely last a number of generations.  While this exposure increases your risk for disease you have the power to control that risk. 

Knowing your health history puts you in the driver’s seat.  If you have an increased risk for any metabolic disease including obesity, hypertension, atherosclerosis and diabetes then it would be prudent to carefully manage your diet by consuming fewer processed foods and less sugar, and by eating more fruits and vegetables.  Increased consumption of fiber is correlated with a reduced risk for atherosclerosis since it lowers cholesterol levels.  You may also ask your physician or nutritionist for a nutrient blood test to see if you are lacking any critical micronutrients such as Vitamin D and iron.  If cancer runs in your family then it may be prudent to refrain from smoking and drinking alcohol.  There are many other cancer protective factors that can also be incorporated in to your lifestyle:  Physical activity has been shown to protect you from cancers of the breast, colon, rectum and endometrium.  Consumption of fruits and vegetables reduces risk for esophageal, lung, mouth, pharynx and stomach cancers.  Foods containing dietary fiber reduce the risk of colon and rectal cancer.

A well-informed expectant mother is encouraged to take prenatal vitamins to ensure adequate iron levels for healthy blood, and folate to ensure proper neural tube development of the baby.  An under developed spinal cord is an extreme outcome of folate deficiency.  Folate is a B vitamin that helps to regulate embryonic and fetal nerve cell formation.  Deficiency of both folate and Vitamin B12 are known to prevent special chemical modifications of your DNA that drive the expression of health regulating proteins.  Although this deficiency may not always manifest as a neural tube defect it may impact health in other, less obvious ways.  These deficiency outcomes may be reversed in future generations through proper diet.

Knowledge is the key to your health.  Research institutes committed to furthering our understanding of how our diet impacts gene expression include the Center of Excellence for Nutritional Genomics (CENG) at the University of California, Davis and North Carolina Research Campus (NCRC).  Both institutions are spearheading research efforts to understand how nutrients, plant phytochemicals, the environment and lifestyle choices impact brain and fetal development, cancer, diabetes, obesity, heart disease, fatty liver and other metabolic disorders.

 

*The content of this blog was derived, in part, from Nutrition Concepts and Controversies 13th Edition.  Editors:  Sizer and Whitney

 

Dog Food Considerations

WHAT ARE YOU FEEDING YOUR DOG?

I recently hosted a Healthy Gut workshop this past weekend.  While I was explaining to the audience the importance of a low pH (~2.0) in the human stomach it brought to mind something I learned from my former pharmacology brethren regarding pharmacokinetics.  The acidic conditions in our stomach serve a number of critical purposes.  First and foremost, it aids in digestion of the food that we eat.  Second, it provides an antiseptic environment to prevent the growth of unwanted microbes. 

I then reminded my audience that unlike humans, the pH in the stomach of a dog is much higher, anywhere between pH 4 to 6.  As a result, dogs have a much harder time digesting any food that they are not accustomed to.  A reputable dog food is specially formulated to be compatible with the unique environment of the dog gut.  When you bring Spot home for the first time you may have to try a few food formulas before you find one that agrees with your pet, but once you find the right brand, stick with it.

Feeding your dog human food may titillate his taste buds but you are sure to wreak havoc on his stomach and immune system.  He simply does not have the digestive conditions compatible for metabolizing food that was not specifically made for a dog.  So what happens when your pet eats something that is not on the doggie menu?  Regurgitation and runny poop may be acute symptoms but you are setting your pet up for a lifetime of chronic disease.  Humans who subscribe to the Standard American Diet (SAD) of processed and sugar-laden foods put themselves at risk for a host of metabolic and inflammatory diseases including Diabetes and even Rheumatoid Arthritis.  Dogs who are constantly fed people food or poor quality dog food are at risk for the same conditions.  A poorly formulated diet will ultimately lead to destruction of the immune system which is a major contributing factor to allergic disease.   Not only is the rate of allergic disease exploding in children and adults, it is also showing up in dogs at an alarming rate.  …and the cause is exactly the same.

Clean Eating with the Tower Garden

Grow Your Own Food Using Aeroponic Gardening

Aeroponics is a unique and increasingly popular gardening technique.  The reason why it is appealing is because it is soil-less and therefore, amenable to a vertical irrigation design.  In an aeroponic garden, the plants can be suspended in a Tower-like apparatus where the water softly trickles on to the roots.  This, in turn, promotes improved air circulation which expedites plant growth.  This horticulture technology is so simple and efficient that it is sanctioned by NASA and you may have even noticed it in the Living with the Land attraction at Disneyworld.

 As part of a Healthcare initiative to promote clean eating I have been traveling among school and civic communities to tout the benefits of growing your own fruits, vegetables and herbs using aeroponic gardening. This growing method is extremely efficient because it uses far less water and space than any other methodology and the plants are as clean and organic as they can get.  I personally, don’t even wash the food that I harvest from my garden and just about any edible plant can be grown including cantaloupe and watermelon, but excluding root vegetables. 

One variety of this gardening system, The Tower Garden®, comes with a conveniently proportioned food tonic consisting of the same minerals that you find in soil, along with organic Nitrogen sources.  It requires minimal maintenance other than adding water to the trough when it gets low, adding food tonic every two weeks or so, and harvesting, which ensures continued growth.

 Recently, I set up a Tower Garden® with the students and Physical Education teacher at St. John the Apostle school in Clark, New Jersey.  The garden was initially set up outdoors but recently was moved to one of the Science classrooms for the winter where the plants are still growing like gang-busters.  These students are not only learning about the benefits of growing your own food but also acquiring an appreciation of the science behind Aeroponic gardening.

Cholesterol and Statins

What you should know about cholesterol and statins

A friend of mine stopped by the office the other day.  She shared that she was concerned that her total cholesterol was ~ 210 and her doctor wanted to put her on a Statin. I have known this friend for many years and was disappointed that the Doctor who made this suggestion did not bother to ask her a few probing Health History questions.  My friend swims for one hour 4-5 times per week, and she had done so for many decades.  Needless to say, she is at a healthy weight and has a heathy blood pressure, which she has enjoyed her entire life.  Furthermore, her HDL level is an enviable 64, likely due to all that swimming.  May I remind you that HDL (aka High-Density Lipoprotein) is the good cholesterol.  It functions like a vacuum (think H for Hoover) removing LDL from the blood and transporting it to the liver where is can be reprocessed. I am very happy to see the tide shifting on what is considered a healthy cholesterol level but am disturbed by the blithe manner in which prescriptions for statins are still written.

I have no doubt that Michael Brown and Joseph Goldstein truly deserved to win that Nobel Prize for showing a correlation between plasma cholesterol and atherosclerosis.  I even wrote my dissertation on Cholesterol biosynthesis (and was tongue-tied during my thesis defense when a professor asked me if I thought that drinking red wine could lower cholesterol levels-a provocative concept in the early 90s).  Based on my own research I can tell you that statins are life-saving medicines for those who are genetically pre-disposed to high cholesterol levels.  This would include individuals who have heterozygous or homozygous mutations in the gene that codes for LDL-receptors.   These are cell surface proteins that remove LDL from the blood and target LDL for degradation. 

But there is a lot that we have yet to understand about the complete mechanism of statins.  They do indeed function to inhibit cholesterol biosynthesis, and to stimulate the synthesis of LDL receptors, but what exactly leads to the decrease in mortality?  Other agents that lower cholesterol through different mechanisms, such as Niacin or Zetia, do not show the same clinical outcomes.  It has been reported that statins have anti-inflammatory properties (Curr Pharm Des. 2012;18(11):1519-30) and so prevent heart disease. Good news for those who present with symptoms for Metabolic disease, but what about my friend who lacks even a single risk factor? 

In order for statins to do their magic they need to penetrate the liver where cholesterol synthesis takes place.  Among the many adverse side effects caused by statins, damage to the liver is one of the more concerning.  Other unpleasant side effects include muscle pain and weakness (myalgia), disturbed sleep and neurological deficiencies such as memory loss and confusion.  The chemical properties of statins are uniquely designed so that they do not penetrate the blood-brain-barrier.  That’s a good thing because your brain needs cholesterol to function properly.  However, I suspect that certain individuals lack this barrier function (leaky brain) and may exhibit memory loss as a result of reduced cholesterol levels in the brain.

If you are certain that you are not a candidate for atherosclerosis, owing to a healthy lifestyle, but are concerned about your plasma cholesterol levels, then add more fiber to your diet.  The average adult should be consuming 20-30 g of fiber per day.  Fiber has natural cholesterol lowering properties and is found in whole grains, fruits and vegetables.  My personal preference is to focus on fruits and vegetables as the 1000’s of phytonutrients found in this food group have many, wonderful anti-inflammatory properties. You might also want to increase consumption of fresh fish or take an Omega-3 fatty acid supplement.  Omega-3 fatty acids, which are NOT synthesized by the body like cholesterol, will improve the health of all of your cells, in the brain and heart in particular…with NO side effects.

A Balanced Understanding of Vaccination

Why do we live so long?  If you question the value of vaccines then please read this:

In 1800 the average lifespan was about 30 years old.  By 1900 that number increased to 47 but by the turn of the 21^th century life expectancy increased to a whopping 77.  What were the primary contributors to this increase in longevity?  We may thank the advent of antiseptics, antibiotics, and vaccines.  Modern medicine has not nearly had the impact on human health as these fortuitous discoveries.

Prior to the discovery of antiseptics entire generations were wiped out by plagues that likely, were caused by infectious agents such as influenza, cholera and typhus.  Alexander Fleming’s discovery of Penicillin, and the introduction of the first Small Pox vaccine by Edward Jenner, ultimately vanquished the kiss of death for those impacted by these bacterial and viral infections.  This blog will largely focus on current concerns regarding vaccination.  Efficacy and outcomes of antibiotic use will be addressed in a future blog. 

The first vaccination campaigns were met with broad cooperation.  Young people today may be amused by the depiction of Polio in the movie Forest Gump but make no mistake, a Polio infection is no laughing matter.  Poliomyelitis is a disease caused by infection with the poliovirus that initially presents with minor symptoms such as fever and headache but ultimately, may lead to complete muscle paralysis.  During an outbreak in the early 1950’s iron lungs were used to help the infected breathe.   The discovery of a vaccine that could irradiate this infection was met with global support and as result, Polio is almost completely eradicated.

So what exactly is propelling our fear of vaccines?  It appears that after many decades of reduced bacterial and viral infection our immune systems have let down their guard.  Our killer T cells and natural killer cells simply are not the stealth fighters that they used to be.  Although we are no longer susceptible to infectious disease we are MORE prone to immunological and immune-based diseases such as allergies and asthma, along with inflammatory bowel diseases, rheumatoid arthritis, psoriasis, and even Multiple Sclerosis (MS).  Lately, I have noticed a perceptible uptick in diagnosis of Lupus (aka Lupus erythematosus), an autoimmune disease caused by a hyperactive immune system that attacks normal, healthy tissues.  These diseases tend to be chronic, and not as pronounced as infectious disease, but diagnosis rates are growing at an alarming rate with no abatement in sight.

During the fledgling days of vaccination campaigns our immune systems were primed to respond exactly as predicted to vaccine exposure.  Almost every individual immediately mounted an active immune response that would prevent future infection upon viral exposure.  However, as our immunity has evolved so has our response to vaccines.  This is particularly apparent in infants whose developing immune systems are largely dictated by the health of the Mother.  If Mommy does not pass on a healthy immunity to baby then some infants with undiagnosed immune deficiencies may respond adversely to a vaccination.  The response may be triggered by the vaccine itself or by a non-active ingredient, both of which are perceived as foreign.

This relatively recent observation calls for more research to better understand the biological response to vaccines so that we can conclusively demonstrate cause and effect.  It would be a pity to see even a minor reversal in viral infection rates due to our lack of understanding of Immune Biology.  I fully empathize with parents concerned about adverse events related to vaccination.  These are not trivial yet are not fully understood.

In the meantime, I would like to emphasize the benefits of vaccination for those with a healthy immune system.  The herd immunity theory dictates that the more healthy people that are vaccinated the less likely the unvaccinated people will become infected.   Furthermore, it is important to keep in mind that response to new viral infections will be very different from what we have seen in the past.  Once new infections become increasingly more common, our response to these infections may not mirror what we have seen in the previous century.  So many people, baby-boomers in particular, remember acquiring measles, mumps and chicken pox and thinking-no big deal.  Since viral infections, other than influenza, are a relatively rare occurrence, we have no idea how the current immune system will respond.  If the current response to influenza* is any indication, then a new round of viral infections will not be pleasant.  Keep in mind also, that in the previous century most Moms stayed home and took care of their sick family.  Today, these exposed Moms and Dads will return to work possibly carrying infection to their place of employment.  Managing outbreaks is sure to be a challenge.

So what is the solution to vaccination?  As a healthy adult and parent I fully endorse vaccination of myself and my family.  The very young, the very old and the immunocompromised deserve special consideration while we support research to understand the root cause of adverse outcomes of vaccination.

* The CDC estimates that from the 1976-1977 season to the 2006-2007 flu season, flu-associated deaths in the US ranged from a low of about 3,000 to a high of about 49,000 people.