Pharmaceutical medications help millions of Americans cope with clinical symptoms every day, but most are not without side effects. In fact, the side effects of a medication are often worse than the original condition according to many patients.
One reason for this is that prescription drugs very often cause nutrient depletions, which manifest clinically in very significant ways. A classic example is coenzyme Q10 deficiency caused by statin medications. Statins block an enzyme that affects cholesterol production, but the same enzyme is needed to manufacture the important antioxidant coenzyme Q10, which is a key nutrient needed for cellular energy metabolism proper heart function. So if you block this enzyme (called HMG-CoA reductase for hydroxyl-3-methylglutaryl coenzyme A, (which is why statins are known generically as HMG-CoA reductase inhibitors), you may lower cholesterol, but as a consequence you may cause a coenzyme Q10 deficiency, which can manifest as low energy and muscle pain.
Why is this so common? The reason is simple – the pharmaceutical approach is fundamentally different from the nutrient repletion approach in that medications alter or interrupt metabolic pathways to achieve a clinical result while nutrient repletion supports or helps maintain the optimal function of a metabolic pathway to achieve balance.
In general, medications are palliative in that they focus often on the relief of symptoms. Conversely, nutrient repletion is curative and the goal is optimal cellular function of which a side effect is relief of symptoms.
This is not to say that medications have no place in health, but they do have a role in nutrient depletion which can cause the unpleasant and dangerous side effects. Especially in the age of polypharmacy – when people take more than one medication simultaneously (including over the counter meds) – nutrient depletions caused by drugs deserve a closer look.
Here are some examples of how medications can deplete micronutrients:
Adding to the problem is that fact research on drug-induced nutrient depletions is comparatively sparse compared to the giant funding allotted to pharmaceutical development and testing. In addition, there is a lag time between the market introduction of a blockbuster drug and potential nutrient depletion-induced side effect data.
An example of this is research in the past decade that implicates antacids (proton-pump inhibitors) as a causative factor in cardiac events due to their tendency to deplete magnesium. The strong link between PPI use and arrhythmias (irregular heartbeat) may be caused by magnesium depletion, which may also explain an increased risk in bone fractures for people on long-term PPI use according to the FDA. Although research on PPI-induced magnesium deficiency emerged in the last few years, PPIs have been widely used in the market since 1990.
In some cases, the research on drug-induced nutrient depletions may not emerge for many years after a drug is widely accepted into the market.
If you are taking a medication, have your micronutrient levels tested today.
By Kathy J. Shattler, BS, MS, RDN
SParkinson’s disease is an irreversible neurological disorder resulting from lowered levels of the neurotransmitter, dopamine, at the basal ganglia of the brain and typically results in trembling, rigidity, slowness of gain, insomnia, incoordination, constipation, cognitive decline and other systemic symptoms. Approximately 1.5 million people in the US have Parkinson’s syndrome. There is no cure, only symptomatic relief of which L-Dopa, the precursor to dopamine and product of tyrosine metabolism, is administered along with other supportive medications such as anti-depressants or MAO Inhibitors.
Although there is a strong genetic component to Parkinson’s Disease (PD), only about 10% are truly genetic. The remainder of the cases are thought to be results of long-term exposure to manganese, lead, iron, pesticides, herbicides, contaminated well water or even medications such as major tranquilizers and benzodiazepines. Other predisposing factors are head trauma/injury, high intake of red meat and heme iron, low caffeine intakes (in women, but not men), & vitamin D deficiency (but not directly). Genetic aberrations in how iron is handled have been found with alterations in transferrin and the hemochromatosis gene meaning that iron metabolism is deregulated which may account for the iron deposits found in the brains of PD patients.
Neuroprotection is being studied as a means of protecting the nervous system and brain from the ravages of PD as L-Dopa, the primary treatment of choice, grows less effective as time wears on. Nutritionists are looking at dietary factors that can prevent oxidation, provide neuroprotection and offer supportive functions where the metabolic pathways have become ineffectual. (1)
The Role of Macronutrients
Macronutrients refers to proteins, fats, carbohydrates and fibers in the diet. The amounts, types and distribution of each of these nutrients play a key supportive and therapeutic role in the nutritional treatment of PD. If an overall diet plan were to be chosen, the Mediterranean Diet eating plan would be the template for any dietary modifications since it is consistently favored in the literature as a preventative dietary approach for PD.
L-Dopa, the major therapeutic treatment for PD, competes with the amino acids from protein fragments for absorption. Consequently, low protein diets, either .5g/kg or a straight 40 g protein diet, are therapeutically recommended to enhance the effectiveness of L-Dopa absorption at its lowest possible dose for the longest period of time possible. The protein limit prior to the last meal of the day is 7 grams according to one study (2). Generally, protein loads are advised for the evening meal with mostly carbohydrates, fiber, fats and fluids throughout the day. This means the daily diet should consist of fruits, vegetables, some grains, water, juice, limited nuts and nut butter and low protein medical foods. While dairy is important, do not take it with medications or within 40 minutes after L-Dopa as it, too, contains proteins.
Fats are classified as either saturated, polyunsaturated or monounsaturated. Early studies in rats showed a detrimental effect of total fat on PD progression. Later studies in humans showed more of a negative relationship to animal fats in PD progression. Saturated fat theoretically alters the cell membrane adversely affecting the lipid membrane and promoting oxidative stress. (2)
Neuroprotection has been found with diets high in polyunsaturated fats(PUFA), particularly with the omega-3 fatty acids. It has also been consistently shown that diets high in PUFA and low in saturated fats reduce the risk of PD and protect from the toxic effects of neurotoxins.
Saturated fats, found abundantly in meats, are loaded with the “heme” protein, a protein some PD patients are genetically programmed not to metabolize correctly, thus aggravating symptoms and possibly accounting for the negative associations between meat consumption and PD development. (2)
Carbohydrates may play a more positive role in decreasing progression of PD. Carbohydrates are full of polyphenols, fibers and increase the release of insulin-induced dopamine in the brain. Since a high consumption of carbohydrates is not necessarily beneficial for everyone, particularly those with diabetes, emphasis should be placed on fiber containing carbohydrates rather than simple sugars.
Constipation is a common complaint in patients with PD as is adequate fluid intake. Getting enough fiber will help to avoid constipation and straining, but an increase should be gradual to avoid gas and bloating and should be accompanied by an intake of 8-10 glasses of fluids per day. Twenty-five grams of fiber a day is the current daily recommendation.
Some nutrients have been identified to have a supportive role in PD preventing oxidation and neurodegeneration thus delaying or mitigating symptoms associated with the demise associated with this disorder.
Omega 3 Fatty Acids
Omega 3's have proven to be a protective factor in many neurodegenerative diseases. (2) Oral administration of docosahexaenoic acid (DHA), an omega 3 fatty acid, increases dopaminergic neurotransmission, synaptic membrane formation as well as the density of dendrite spines. In the first study of its kind, DHA supplementation in rats was shown to have neurorestorative and disease-modifying properties. (3) Supplements of 1,000 mg of DHA/EPA omega 3 fatty acids may be supportive in the prevention of the ravages of PD.
Of all supplements studied, only fish oil (a source of omega 3’s and coenzyme Q10 showed significant associations with PD progression. (4)
Both folic acid and B12 have commonly been supplemented in PD. Both are known to lower the neurotoxin homocysteine and are often low in PD patients.
Patients on L-Dopa must frequently limit their B6 intake to 15 mg so as to not interfere with L-Dopa.
Coenzyme Q10 is a naturally occurring, fat-soluble, vitamin-like enzyme found in a variety of foods and synthesized in the body. At levels of 300,600 and 1200 mg/day over a six-month period, patients showed decreasing symptoms over placebo with the best effects achieved at the 1200 mg supplementation level.(5,6)
While black tea is a no-no due to its high manganese level, green tea has shown beneficial effects at about 3 cups per day. Green tea has both anti-oxidant and anti-inflammatory properties and has been shown to have neuroprotective qualities (7). It is thought that the polyphenols and, specifically, epigallocatechin gallate (EGCG), a catechin, are responsible for the beneficial effects.
Melatonin is a hormone synthesized by several tissues other than the pineal gland in the brain that exerts neuroprotective, anti-inflammatory, antioxidant and regulatory effects on the body. Melatonin has been shown to improve motor derangement, non—motor symptoms, sleep and anxiety disorders as well as improving memory and decreasing depression in PD patients. Current research suggests its use in preventing the neurodegeneration in PD. (8) Melatonin is also known to decrease homocysteine, a chemical that is neurotoxic to dopaminergic neurons in PD patients and is a known cardiovascular risk indicator (9).
Because, theoretically, melatonin can cause a decrease in dopamine secretion, it is suggested that therapy begin low and slow at 1 mg in the evening before bed and increasing up to 5 mg if tolerated.
All patients with PD should have their vitamin D checked and repleted if low. Much debate exists over the optimum blood level of this pro-hormone, but its importance in multiple system disease management can no longer be questioned. Since the intake of milk and vitamin D fortified products is often low in PD patients, supplementation is often needed and required for optimum prevention of future neurological demise. Repletion therapy involves high doses of 10,000 IU/day for 5 days per week for six weeks and then retest. Maintenance dose can be anywhere from 400 - 1000 IU/day after repletion therapy.
Additional Supportive Practices
In cases of heavy metal poisoning, eating foods high in sulfur may assist the detoxification process. Foods such as onions, garlic, and foods high in water soluble fibers from guar gum, pectin, oats, oat bran and psyllium seeds. Maintaining a high antioxidant intake of vitamin C and bioflavonoids from vegetables and fruits are helpful as well as lowering meat intake.
In the initial stages of PD, caloric restriction of up to 25% of estimated needs may help alleviate some symptoms, but over time weight loss and adequate caloric intake become of paramount importance to prevent malnutrition. Hydration and choking may become issues of concern. Food may then need to be blenderized and ways to increase calories may need to be implemented to prevent excess weight loss. A weight loss of greater than 10% in six months is high risk for malnutrition and should be addressed by a Dietitian.
Multivitamins with added iron or manganese should be avoided. Caffeine is acceptable and may provide some benefit to brain and energy function. Kava kava, Ephedra, Ma Huang, Ginseng and St. Johns Wort should be avoided as should cooking in aluminum pans.
PD is not curable, but is manageable through diet and medications. Education of the patient and caregivers is of paramount importance in working with the prescribed diet and medications.
1. Agim ZS, Cannon JR. Dietary factors in the etiology of Parkinson’s Disease. Biomed Research International. 2015; http://dx.doi.org/10.1155/2015/672838.
2. Perez-Pardo P, Kliest T, Dodiya HB, et al. The gut-brain axis in Parkinson’s disease: possibilities for food-based therapies. European Journal of Pharmacology. 2017; 817:86-87. http.//dx.doi.org/10.1016/j.ejphar.2017.05.042.
3. Seidl S E, Santiago JA, Bilyk H, Potashkin J.A. The emerging role of nutrition in Parkinson’s disease. Frontiers in aging neuroscience. 2014; 6(36):1-14. Doi.10.3389/fnagi.2014.00036.
4. Pardo P, deJong E, Broersen L M, et al. Promising neurorestorative and gastrointestinal dysfunction after symptom development in the mouse model. Frontiers in Aging Neuroscience. 2017;9(57): 1-12.doi:10.3389/fnagi.2017. 00057.
5.Mischley LK, Lau RC, Bennett RD. Role of diet and nutritional supplements in Parkinson’s disease progression. Oxidative Medicine and Cellular Longevity. 2017. https://doi.org/10.115512017/6405278.
6. Pizzorno JE, Murray MT, Joiner-Bey H, eds. Parkinson’s Disease. In: The Clinician’s Handbook of natural Medicine. 3rd ed St. Louis, Missouri: Elsevier Press; 2016:749-765.
7. Pinto NB, Alexandre B, Neves KR, et al. Neuroprotective properties from Camellia sinensis (Green Tea) and is main bioactive components, epicatechin and epigallocatechin gallate, in the 6-OHDA model of Parkinson’s disease. Evidence based complementary and Alternative Medicine 2015. http://dx.doiorg/10.1155/2015/161092.
8. Mack, JM, Schamne MG, Samoaio Tb, et al. Melatoninergic system in Parkinson’s disease from neuroprotection. Oxidative Medicine and Cellular Longevity. 2016:1-31.
9. Paul R, Phukan BC, Thenmozhi AJ, et al. Melatonin protects against behavioral deficits, dopamine loss and oxidative stress in homocysteine model of Parkinson’s disease. Life Sciences. 2018; 192:238-245. https://doi.org/10.1016/jlfs.2017.11.016.
See also 'The Art and Science of Aromatherapy' featured article in Sivana East by KathyShattler: https://blog.sivanaspirit.com/eo-sc-art-and-science-of-aromatherapy/
Are One-A-Days the Way to Go as We Get Older?
According to the National Center for Health Statistics, 70% of Americans over the age of 60 take at least one supplement and 29% take four or more. As busy practitioners have we lost sight of the needs of aging adults and just recommend a one-a-day to cover all our nutritional bases or is it the lack of knowledge on the part of the consumer buying the one-a-day thinking that a multivitamin surely will take the place of hot cooked meals, or, is it a combination of both?
The overuse of multivitamins indiscriminately in the elderly may not harm, may help, but also may become a problem. The problems are that many seniors are on multiple medications and the nutrients in a multivitamin may cause a drug-nutrient interaction, nutrients may be present in excess of recommended amounts or may contain other compounds not needed. Those taking coumadin are to be consistent in vitamin K intake but may be inconsistent taking their vitamin K containing multis. Or, the multivitamin may contain Ginkgo Biloba, an herb which may interact with blood pressure medications causing pressure to drop. The multi may contain more than the recommended amount of nutrients throwing off lab tests or, in the case of vitamin A, being stored up to toxic levels over time.
Surely, if a multivitamin is purchased it should carry a seal of approval, not contain more than the recommended daily levels of nutrients and be appropriate for age at a minimum.
So, what nutrients are of greatest concern as we grow older?
We are especially interested that as we grow older that we get adequate calories since the tendency is to cook fewer meals, grab something quick, and for many, income is an issue. Malnutrition in the elderly is becoming more predominant just as obesity can be an issue (as well as a form of malnutrition). Achieving caloric balance in the different phases of ageing can be a struggle for many due to multiple factors such as immobility, arthritis, lack of transportation or declining mental status.
Protein needs which are set at .8g/kg when younger may rise to 1.2 g/kg after age 50 to prevent some of the decline in muscle mass with the normal ageing process. Losing even 10% of muscle mass negatively affects the immune system.
It is well known that fiber is too low in our population in general and it further declines as we get older. The median intake of fiber is 13.6 grams per day when it should be closer to 25 grams per day. In fact, recent studies show an increase of 4.3 healthspan years for every 10 g fiber/1000 calories.
While we are discussing fiber, it seems like a good time to talk about fluids which tend to run low in our older diets. Why? One reason is that we lose some of our thirst sensations that would normally remind us to drink. It is especially important to drink 8 glasses of fluid per day when increasing fiber to avoid constipation and to avoid dehydration.
What about vitamins or minerals?
Vitamin D is typically low in ageing as it tends to be in the general population. As we age the skin becomes less elastic and its ability to absorb the vitamin D producing rays is impaired. The less vitamin D in our system the less calcium is absorbed and the weaker our bones can become. It is important to get 800-1000 IUs per day from either vitamin D fortified cereals/milk/seafood or a supplement.
Calcium is also often low due to an age-related decline in the lactase enzyme with a subsequent inability to break down lactose. Drinking milk or consuming dairy, both high in the milk sugar, lactose, begins to cause gas, diarrhea or bloating resulting in a decrease in consumption. This can be prevented by drinking milk treated with the lactase enzyme called Lactaid or taking a digestive enzyme prior to eating dairy. One should try to get their calcium needs met through diet if possible since calcium supplementation may cause kidney stones, arterial deposits or drug interactions. Vitamin D will also help increase the absorption of the calcium eaten. A calcium intake of 800 mg/day is generally adequate.
Vitamin B12, found in meats and mostly animal products, also tends to run low in our “tea and toast” dieters. In addition, the absorption of B12 decreases in the ageing process. Since a low level of B12 may cause anemia and eventually nerve damage or even dementia, identification of a deficiency and treatment of any low levels should be implemented promptly.
Folic Acid is a nutrient of concern for some and will cause similar anemia problems as does B12 deficiency. Treatment with folate may mask vitamin B12 deficiencies. Tomato juice, green vegetables, fortified grains (cereals, breads) are good sources of this nutrient.
Potassium tends to run low in our older population primarily due to lack of fruits and vegetables. Potassium is important in regulating blood pressure and is not commonly found in multivitamins.
Are there nutrients to limit more as we age?
Sodium guidelines are to reduce sodium to less than 2300 mg until age 50 when we are to limit sodium to 1500 mg/day. Be sure to read labels as sodium is in many processed and snack foods. Just one teaspoon of salt contains 2,000 mg of pure sodium, so put down the salt shaker. Salt, or sodium, can cause a rise in blood pressure and or/water retention. High blood pressure is a concern when we age and especially since the guidelines have been lowered to 130/80 as the cut-off for diagnosing hypertension.
We can see that taking a multivitamin does not address calories, protein fiber or water. It doesn’t limit sodium or increase potassium. Multivitamins do not contain enough calcium for one day and calcium frequently interacts with other minerals in a multi. Remember, calcium really should be obtained from food anyway. Nutrients that can be met with a vitamin include B12, Vitamin D, folic acid.
Overall, improving one’s dietary intake seems to be the best choice as we grow older if we are to support optimum healthspan. If dietary needs cannot be met by diet, the diet should be assessed and supplemented with the nutrients that are missing taking care not to over-supplement past the recommended dietary daily intakes recommendations (check the RDI on the label).
Supplemental nutrients need to be taken separately from medications, sometimes by many hours. So, being familiar with potential drug-nutrient interactions are also key to maintaining optimal healthspan. Make supplements your ally, not your saboteur.
Will taking a multi-vitamin hurt you? Probably not. But first, take a look at how you can improve your nutritional intake or have a Dietitian help you. You deserve to feel the best you can feel as you get older, don't you?
See blog 6/6 on The Art of Aromatherapy at:
Becoming leaner, building endurance and decreasing body fat while maintaining optimal health has become the goal for many whether you are a weekend warrior or a top athlete.
Sports nutrition is about providing the body with the best fuel at just the right time for the chosen activity type and the performance goals you have set for yourself. Unfortunately, this field is riddled with mis-information, money-making hypes and a preying on an unsuspecting public.
For the most part, eating a diet rich in the colors from fresh vegetables, fruits, whole grains and lean proteins form the basics of a healthy sports nutrition diet. Indeed, many of the molecules that enhance performance come directly from the food we eat and it is possible just by changing the way we eat to perform better with greater endurance and energy.
“Everyone is an athlete. The only difference is that some of us are in training, and some are not. “George Sheehan
The ‘glycogen paradigm” is a manner of thought regarding the utilization of the maximum amount of muscle sugar storage as a maximal way to increase training intensity, accelerate recovery, and improve performance. However, there is a direct negative association between glycogen storage and fat burning. Some studies have even shown that exercise done in a glycogen-depleted state may have more benefits for increasing fat loss thus changing body composition.
So, what are the top performing sports supplements today?
1. Nitrates and Nitric Oxide
Nitrates are the conjugate base of nitric oxide which is really the topic of this discussion. Dietary nitrate may be found in various leafy vegetables, especially beets, luncheon meats (not recommended) and drinking water. Nitrite and water are converted in the body to nitric oxide, which could reduce hypertension. Anti-hypertensive diets, such as the DASH diet, typically contain high levels of nitrates, which are first reduced to nitrite in the saliva, as detected in saliva testing, prior to forming nitric oxide.
Research has shown that dietary nitrate supplementation delivers positive results when testing endurance exercise performance. Nitrates are potent vasodilators and regulators of blood flow, particularly to areas of the body with poor oxygenation. Nitrate molecules protect the lining of blood vessels and aides in blood pressure reduction, protection of the kidneys and shows promising pseudovitamin like effects, some important in exercise physiology.
Reduction of fatigue when using continuous muscle control
Increase in cardiovascular health
Increase in anaerobic capacity
Reduction in oxygenation cost of exercise
Sources: Beet root and beet root juice, turnips, spinach, rocket, leafy green citrulline, arginine (caution with this as due to dependence on oxygen decreasing nitric oxide signaling under hypoxic states leading to a state of nitrate tolerance)
Targeted Exercises (examples only): Anaerobic running, hockey, rugby, rowing, CrossFit training, high intensity cycling, 5-30 minute burst activities
.1-.2mmol/kg (6.4 – 12.9 mglkg)
440 mg – 870 mg for weight 150 pounds
580-1160 mg for weight levels of 200 pounds
730-1450 mg for weights greater than 250 pounds
2 g of amaranth can increase nitrates for up to 8 hours
Longer supplementation periods are less effective with trained athletes than those in training.
Optimal nitrate intake can generally be obtained from foodstuffs from a healthy diet for exercise training support shooting for about 8.2 mmol/day.
This amino acid is considered a medical food and is used as such in many metabolic disorders primarily due to its involvement in the urea cycle and the inhibition of the buildup of ammonia. It is also produced in the body – 90% of its production comes from the metabolism of glutamate and 10% from arginine although its use as supplement by itself is common. Citrulline has been found to increase the muscle ATP efficiency similar to those effects observed from nitrous oxide and with arginine supplementation.
Prevents ammonia accumulation thus prolonging exercise endurance
Decreases time muscles are sore and intensity of pain
Reduces fatigue from long exercises/work-outs
Augments release of Growth Hormone
Sources: watermelon, musk melons, bitter melons, squashes, gourds, cucumbers, pumpkins
3 g kg/day
6 gram increases nitric oxide
Glutathione taken in conjunction with L-citrulline more effective at sustaining high levels of nitric oxide than L-citrulline alone.
Considered to be a safe.
3. Betaine Anhydrous (not hydrochloride)
Betaine occurs naturally in the body as a result of the metabolism of choline. It is also useful in the metabolism of homocysteine, a chemical notoriously present in heart disease. Betaine also acts as a methyl donor in the formation of creatine leading to the possibility that it may improve athletic performance, increase tolerance and cardiac function in those with heart failure as well as enhancing oxygen consumption on exertion.
Potential Effective for:
Resistance Training Enhancement
Reduces fatigue in untrained but not trained subjects
Sources: beets, whole grains, spinach, liver, eggs, seafood
2.5 g/day for two weeks with resistance training
4. Branched Chain Amino Acids (BCAA)
Branched chain amino acids consist of 3 amino acids, leucine, lysine and valine. While BCAA supplementation may be useful for gaining skeletal muscle and look defined are especially helpful for maintaining mass while on a calorie-deficit diet. They're particularly useful for bodybuilding competitors who take their physiques to the lean extreme.
Although dieting down makes you look awesome onstage, on the beach, and to your friends, it can also take a chunk out of your muscle mass.
Preventing muscle breakdown during bed rest or injury recovery
Preventing muscle break down during intense exercise
Sources: BCAA Supplementation
Targeted Exercise; Intense, competitive sports, cycling, skiing
2 g +.5 g arginine may increase maximal oxygen consumption according to some studies
25-65 mg/kg body weight in general
For enhanced performance, .2 g/kg before and .2 g/kg after exercise
Creatine is a well-known, well researched molecule that can rapidly produce energy to support cellular functions. Higher levels of creatine are thought to enhance ATP short energy bursts.
Increase in strength or “power”
Reduction of time to reach peak torque
Increase in muscle weight and hydration
Sources: Supplementation, red lean meat. For every one lb. of red meat 2 grams of creatine can be found.
Target exercise: Muscle building, weight lifting, endurance exercises, sprinting, cycling, power lifting
Dosage: Loading dose protocols usually used.
.3 gm /kg for 5-7 days and then .03 /kg for 3 weeks up to training event
Some take 5 gram daily.
Potential side effects: nausea, vomiting, cramping, diarrhea
Evidence for body composition changes is lacking for most of these supplements and food extracts despite conflicting and contradictory data claims. Evidence for increasing endurance and time to exhaustion look far more promising than do the effects on body composition changes. Also, these studies help us put into perspective that many fitness benefits seen are seen in those athletes who are in training and not already in the trained state thus enhancing motivation to become more fit.
These supplements and food resources look promising as we look ahead to becoming a more “fit” generation while developing the energy to reach those fitness goals. This, indirectly, will change our body composition by increasing muscle mass through exercise and decreasing body fat as we burn excess calories.
McMahon N, Leveritt, M, Pavey. T."The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis" in "Sports Medicine", 2016. doi:10.1007/s40279-016-0617-7
Teta J. Sports Nutrition: In: Pizzorno J, Murray T, eds, Textbook of Natural Medicine, 4th Edition. Elsevier Press; 2012:542-542.
Jones, AM. Dietary nitrate Supplementation and exercise Performance. Sports Med. 2014:44(1); S35-36.
Examine.com. Supplement Goals Reference Guide. 2018. Online subscription.
Beta Anhydrous; Creatine; Natural Medicines for Improving Performance. In: Natural Medicines Database in Dietitians in Integrative and Functional Medicine. Somerville MA: Therapeutic Research center. Accessed 4/1/18. Available from: https://naturalmedicines.therapeutic research.com. Subscription required to view.
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Aging is a multifactorial process that affects all lifeforms beginning at birth. Research into methods to extend life began decades ago with lower life forms such as yeast, nematodes, mice and continued for decades on differing species including non-human primates with each study showing positive life extending properties associated with calorie restriction (CR). The search for a “new age” Tree of Life or Fountain of Youth treatment continued with renewed energy until an advanced definition was formed for applying this search to humans. Since the quality of life with the absence of age-related diseases is a goal of human life extension as well as adding years onto those years free of disease, a new term was given to the outcome of human longevity research, “healthspan” (1).
What is CRON?
CRON, or calorie-restricted-optimal-nutrient diet is an acronym for a diet developed by Roy and Lisa Walford after participation in the “Biosphere 2” project in 1991-92. (2) Proponents of this diet believe that most people have a “set-point” weight that they will gravitate to when eating normally that is determined by genetics and childhood habits. Evidence for this theory was never proven.
Proponents of this diet also believe that sticking to about 10-15% under this “set-point” is one indicator of diet effectiveness, an indicator that is certainly lacking determination of quality of diet or adequacy of nutrients.
Walford’s original Biosphere 2 diet contained 10% fat calories, 1 gm/protein/kg body weight and was almost totally vegetarian. Furthermore, the study was not long-term but lasted 6 months. The diet was supplemented with 50% of the RDI for multivitamins and minerals plus 100% of vitamin D, vitamin B12, folic acid, vitamin E and vitamin C. Foods were nutrient dense and claimed to be low glycemic index. There were 8 subjects in his study group. (2)
The CRON diet is typically started by improving the quality of nutrient intake first by incorporating nutrient dense, lower calorie foods into the diet rather than by restricting calories. General changes are recommended first such as cutting out sugar, white flour and eating more fresh fruits and vegetables. Omega-3 fatty acids are encouraged. Decreasing weight/percent body fat to a healthy BMI should be done slowly at a rate of 2% per month for overweight individuals and 1% for others. Special guidelines exist for pregnancy, the elderly, those in growth cycles, and other “at risk” groups.A typical restriction percentage from assessed needs is 20%, although calculations for the restriction seem to differ depending on source.
Risks of the CRON diet plan
Risks of the diet first and foremost are malnutrition and eating disorders. After that comes a possible loss of libido, feeling cold, reduced bone mass, hunger or food obsession, menstrual irregularity, or rapid weight loss more than recommended by the CRON plan.
What are cellular biomarkers for aging?
To examine a therapy for effectiveness, we need to know what we are looking for. To slow down the aging process the treatment should do one or more of the following functions…the more functions it can perform, the stronger the treatment. The following mechanisms are associated with aging and to increase healthspan a therapy must positively affect the following: (1)
· Telomere shortening or erosion
· Genetic changes such as the breakdown of genes and the emergence of genetic disease tendencies
· Stem cell depletion
· Cellular aging
· Mitochondria dysfunction
· An instability in the genome
· Proteostasis imbalance related to an imbalance in the biological pathways of protein homeostasis within and without the cell. It is a key process related to successful aging without disease
· Impaired nutrient sensing, i.e. The cells ability to sense the presence of glucose or other nutrients so that nutrient-specific molecules essential for metabolism and life can be produced
· Abnormal cell to cell communication
Impact of CRON on cellular markers of aging
This is where the review of studies on the outcome of the CRON diet get interesting, contradictory, inconclusive, poorly defined, poorly designed and easily misinterpreted. First, there seems to be no standard reference base for calorie restriction or how the CR is determined. Quality of the diet was not a consistently studied or addressed variable. The amount and type of protein in the diet was generally not addressed. The number of subjects in the studies were frequently small and/or predominantly male. (4-9)
The reported impact of CRON on healthspan has been the following: lowering of cholesterol, blood pressure, blood glucose and total leukocyte count (2); a reduction in fat mass and overall adiposity (3); prevention of increase in BMI after an athlete retires (5); prevention of age related heart muscle changes resulting in better blood pressure control (7); a promising adjunct to cancer therapy (8).
In addition to calorie restriction, one of the mechanisms proposed for the CRON diet’s positive effects on healthspan is the limited amount of the amino acid methionine found in many follower’s diets. Also, the composition of the protein load correlated with age is another variable to consider. A lower protein intake has been associated with lower mortality up until the age of 65 and then the reverse becomes true according to some studies. The same relationship exists for the composition of the protein load. A primarily vegetarian diet is associated with lower mortality up until age 65-70 and the correlation disappears. (8)
Other mechanisms identified to date associated with CR include activation of the SIRT 1 biochemical pathway, the decline in growth hormone and growth hormone receptors, a reduction in fasting blood sugar thus potentially impacting diabetes expression, and a reduction in IGF-1 (7,8).
A novel and controversial study recently published by Tomiyama and his team set out to measure telomere length in CRON society members who had been following Walford’s diet for a mean of ten years. The surprising result was that the telomere length was statistically significantly shorter in Walford’s CRON group than in the control group.
Delayed immune aging was also not proven which recalls Walford’s low total lymphocyte counts (TLC) in his study which dropped from a normal range to a level sub-normal indicative of a possible nutritional deficiency. (6) Tomiyama’ s study has its shortcomings as the number of subjects was small, predominantly male and older than 50. However, it is one of the few studies available that measure telomere length after a significant time on the CRON diet. The conclusions, which, admittedly must be approached with caution, are disturbingly different than expected.
Application of research
All in all, there have been relatively few human studies on the effects of the CRON diet in its original form on biomarkers of aging. No real longevity or healthspan conclusions can be drawn from these studies on caloric restriction relative to healthspan at this point.
It is clear that future studies need to look at a larger sample size of differing age groups and an even distribution between male and female. A consistent percentage or calculation for caloric restriction should be used across all studies. A standardized supplement regime should be used with subjects and controls. Diet records need to be computer analyzed for nutrient content, distribution of macronutrients, protein content relative to needs, type of protein consumed and the amount of methionine eaten.
Outcome measures should address those elements associated with aging and aging related disease variables which should be clearly defined in the study methodology.
In summary, the CRON diet seems to be a restrictive form of lifestyle that few can follow safely and justifies the scientific search for caloric restriction mimetics, or nutraceuticals /pharmaceuticals that can mimic the effects that we see in caloric restriction in other species in our human species to slow down the ravages associated with the aging process. Right now, our most promising nutraceutical for this mimetic is Resveratrol.
More studies are needed on the effects of the CRON diet on biomarkers of healthspan and until then the risks seems to outweigh the benefits for humans.
1. Pica A, Pesce V, et al. Does eating less make you live longer? Clinical Investigations in Aging. 2017; 12:1887-1902.
2. Walford R, Harris S, et al. The calorically restricted low-fat nutrient dense diet in Biosphere 2 significantly lowers blood glucose, total leukocyte count, cholesterol and blood pressure in humans. Proceedings of the National Academy of Sciences. 1992;89(23):11533-37.
3. Das S, Roberes SB, et al. Body composition changes in the Comprehensive Assessment of Long Term Effects of reducing intake of energy (CALERIE)-2 study: a 2-year randomized controlled trial of calorie restriction in non-obese humans. Am J of Clin Nutr. 2017; 105:913-27.
4. Jain S, Sing SN. Calorie restriction – an approach towards obesity management. J. Nutr Disorders Ther.2015; S1:006.
5. Czerwinska M, Holowko J et al. Caloric Restriction Diet (CR Diet) or Mediterranean Diet (MD)-which is better choice for former athletes? Central European J of Sports Medicine and Science. 2018;13(1);23-35.
6. Tomiyama A, Milush J, et al. Long-term calorie restriction in humans is not associated with indices of delayed immunological aging: A descriptive study. 2017. 147-156.
7. Meyer T, Kavacs S, et al. Long -term caloric restriction ameliorates the decline in diastolic function in humans. J of the American College of Cardiology. 2006;47(2):388-402.
8. Levine M, Suaz J. Low protein intake is associated with a major reduction in IGF-1, cancer and overall mortality in the 65 and younger but not older population. Cell Metab. 2014; 9(3):407-417.
9. Kopeina GS, Senichkin VV, et al. Caloric restriction – a promising anti-cancer approach from molecular mechanisms to clinical trials. Biochimica et Biophysica Acta. 2017; 1867: 29-41.
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Tunes for Tranquility
Music has been used throughout the centuries to create “environments” which alter in some way or other, consciousness. Music sets the “mood” of the occasion. Or, think about the music we use to celebrate holidays, to worship by, to have fun by. Music is an important part of our culture, our religions, our history and now, as we are discovering and putting to use, healing.
Let’s take a closer look at binaural music and examine what science has to say about popular claims linking these tunes with tranquility. Science has termed the musical perception that occurs when listening to this “healing” music as binaural beats. Reason? In order for the beats to create the desired change in the individual and promote a feeling of “tranquility”, two different beats need to be played, a different beat in each ear and each frequency below 1500 Hz. A binaural beat is an auditory illusion created when one ear perceives a frequency lower than 1500 Hz and the other ear perceives another yet different frequency also lower than 1500 Hz. The auditory illusion is that the listener, when presented with the two different frequencies, perceives a third tone. This third tone is called the binaural beat, a beat heard in your mind when TWO beats in different ears stimulate brain neurons.
Research findings have demonstrated that music or auditory stimulation can affect immune function, relaxation, mood and stress control and that such changes are centrally/ neurologically based with the exact mechanism still unknown. The following states of awareness have been observed, measured and/or reported after using binaural beats:
· Feelings of Tranquility
· An Increase in Vigilance
· Better Memory
· Reduction of Anxiety Levels
· Reduction in Pain
· Increase in Creativity
· Decrease in Mood Dysregulation
So, What Does This Mean for Me?
For the general, stressed out fatigued public, binaural beats represent a way to take a tranquility break that doesn’t cost a fortune. For the more focused, it represents a life-saver for problems that adversely impact their lives, such as trait anxiety – anxiety that is just part of your personality, not situational like you just went through a divorce, but there all the time 24 hours a day, 7 days a week. It is an alternative or adjunct to pills that may be the first effective treatment an individual has ever tried.
How to Use Binaural Beats
Get a good set of headphones. The better the headphones, the better the experience.
1. You don’t need to buy anything. Plug your headphones into your desktop, your laptop, your tablet and go to YOU TUBE.
2. Search for Binaural Beats.
3. Choose one that looks appropriate to your needs.
4. Plug in and focus on the music; 30 minutes seems reasonable, but everyone is individual.
5. You will become increasingly aware of your surroundings when the video stops.
Although research continues, using music to promote tranquility seems like a wonderful, easy way to relax while creating positive change within. Binaural Beats can be a tool to be used daily to take back control over our health, our happiness, and to cement our goals within reach.
Choose any one or combination of tools to break the plateau:
*Meal Plan Adjustments - Use the Calorie Restricted Optimum Nutrients Diet ( CRON)
*Journals: weigh, measure everything that is eaten
Pay attention to emotional cues and whether hunger is driving your appetite
*Begin an Intermittent-Fasting Meal Plan (not for diabetes)
*Change your workout routine-frequency/interval/duration
*Use sprint interval training
*Do resistance training first, then cardio
* Add balancing activities – yoga, tai chi, meditation
*Add Themogenic Aides:
*Green Tea (synergetic with quercetin, fish oil, caffeine)
* Add hot chili peppers and turmeric to foods
* Assure adequate vitamin D
* Resveratrol use- 150 mg/ day
* Bitter orange supplement
Weight-loss plateaus are discouraging and temporarily halt the weight loss process due to the drop in metabolic rate. The trick is to increase the metabolic rate through a combination of foods and/or supplements to break the plateau, then resume the scheduled nutritional program and back off on the plateau interventions.
Any and all changes to your current nutritional plan should be made in conjunction with your health care provider. This is not an attempt to diagnose or treat any disease or illness.
Adapted from the Weight Loss Program “Synergetics” by Kathryn Shattler, MS, RDN
New blog posted on Hematopoiesis, Aging and Anemia on my Wellness Center Site at:https://nutritionalsynergywellnesscenter.wordpress.com/2018/02/25/hematopoiesis-aging-and-anemias/
B-12 Deficiency – A New Player in Chronic Illnesses - Hyperlipidemia, Diabetes, Neuropathy and Gestational Diabetes
Feeling sluggish, fatigued and you can’t blame your thyroid – what do you do? Now, there is an alternative reason and a treatment for it . . . before it’s too late.
The association between fatigue and low B-12 is not a new concept. What is new is how many chronic illnesses B12 deficiency is found in, the widening scope of a problem not necessarily identifiable by a common lab test and very rarely treated. The effects of the deficiency, such as dementia or neuropathy, may become permanent.
In late 2015 Vitamin B-12 deficiency was highlighted again as an ever growing safety threat to our population’s health, longevity and quality of life. It had come to light that the consequences of B12 deficiency may be far more profound than anyone has yet to imagine.
Studies came to light showing that Metformin, a drug commonly used with Type 2 Diabetes and Polycystic Ovary Syndrome, causes B12 deficiency and independently contributes to the development of peripheral neuropathy. Only 60 % of the diabetic subjects had any symptoms. Bottom line? Long term treatment with metformin yields approximately a 19% reduction in vitamin B12 levels resulting in a 5% greater heart wrecking homocysteine level.
Furthermore, vitamin B12 deficiency does not always show up in the typical lab work. A metabolite called methylmalonic acid must be measured.
That isn’t the end of the story. It makes one wonder how much vitamin deficiencies are involved with chronic disease. A deeper look at B12 deficiencies show that B12 deficiency is associated with high blood fats, hyperlipidemias in individuals with diabetes on or off metformin. The relationship is so strong that in 2014 there was a discussion of automatic screening for B-12 deficiency be done on all individuals with diabetes and a pill be developed that combined metformin with B12. This has been brought up again in 2018 as a resounding problem without a workable solution in place.
If that isn’t bad enough, low B12 has been found in those who are obese and have gestational diabetes. A deficiency during pregnancy can affect the baby’s growth and development not to mention cognitive development.
Is it out of line to start questioning just how much vitamin and nutrient deficiencies contribute to our chronic diseases? That medications given to alleviate problems create more serious nutritional problems? That the nutritional deficiencies created, or already present but not looked, for are at the bottom of many problems?
The time to address the medical nutritional needs of patients is urgent, neglected and has come to the forefront of the nation’s attention.
Lack of movement and unhealthy food choices are thought to be the main causes of obesity, but when looking deeper into the unconscious aspect of being fat, it is no secret that a more hidden agenda exists. . . often not spoken of, not dared to think about even. Let’s start this part of the transformation journey by being honest with ourselves, to dare to confront the sabotages, to finding oneself and then not losing that person again.
Unmet emotional (and spiritual) longings are recurrently filled by food – looking deeper, it may even be our “comfort food” or the food that always made us feel better as kids. Our mind in its ultimate judgement feels empty, lonely, starved for affection or belonging recurrently and unconsciously even telling our bodies to turn to food to gain some feeling of being “full”. Food eventually becomes a learned substitution for every need in our lives, including how to deal with stress, emptiness, despair. Stress comes with its own sad story of fat hormones and carbohydrate intolerances which may lead to sleep issues. Lack of adequate sleep, in turn, contributes to “fatness.”
Is it reasonable to expect that any effective weight loss program should address an awareness that successful obtainment of the physical goal of achieving permanent weight loss, body shape change, mental image transformation requires that a plan emphasizing replacement strategy needs to be in place? This plan could address such things as:
Humans are emotional creatures and there is no denying basic instincts such as finding community, love, pleasure and happiness. Unlike our land and sea mammals driven biologically to reproduce and survive, humans have an expansive consciousness with the freewill to choose how they want to live, eat and love.
It can be argued that over the years families have changed thus giving birth to an entire generation with predominantly negative health behaviors. If a child grows up eating fast food and drinking soda in replacement for water and nutritionally balanced meals, the child will grow up into an adult that passes these behaviors and unhealthy ways of coping down into his/her family.
Underlying causes of many cases of resistant obesity are driven from the emotions, which then becomes an addiction caused from the release of hormones in the body. Many food chemists design food to become addictive which, in turn, plays into the role of overeating. It’s a vicious cycle that takes time to retrain the body and brain. Even food commercials stimulate the production of insulin, not a very helpful tool in assisting food addicted individuals from responding to a physical stimulus. Essentially, our environment is not set up to help those who struggle with these issues.
In ancient Japanese beliefs, one’s midpoint is called theHara, or “sea of energy.” Combined with the Harais a pocket of etheric energy calledtan tien. In alchemist’s texts, Taoists refer to the Hara as the “cauldron” as this is the area for digestion and assimilation of food. Those with an energy blockage have issues feeling full or satisfied due to a lack oftan tien. The same concept is true withmanipuraas the naval chakra in Yogic texts as it represents our digestive fire. The fire in our constitution balances the heat and energy produced in the body. When unbalanced stomach problems arise, this can affect the clarity of the psyche. Thus, there is a deep connection between the mind and the gut, between emotions and food.
A frequent complaint in weight management is the problem of abdominal obesity, or belly fat. Biology on fat storage plays a roll, but gynoid or abdominal obesity is often the easiest to gain and the hardest to lose. And, abdominal girth represents metabolic disaster. Abdominal fat is now referred to medically as “sick fat.”
For many struggling with weight find they have “lost” their power somewhere on their journey in life. Many keep giving their power away to their boss, spouse, children, friend or anyone who needs their service. Those who have power, but still struggle emotionally are stuck in belief systems that they can’t be or look a certain way. This, too, is linked subconsciously to being powerless.
Another common emotional scenario are those who have been verbally, physically or sexually abused in their past. Emotional burdens from these life experiences are likely to lead one to fall into negative eating habits. There seems to be an underlying sense of shame or the need to be unattractive to others bound up in their actions.
People struggle with weight for many reasons, but those who are not emotionally stable often seek fulfillment and validation through overeating. Those who “MUST eat their ice cream everyday” have connected a certain food with a certain feeling. Why is this connection to a certain food that important? Questions like these must be asked and answered with a plan.
A truly balanced person never has a biological urge to “need” a certain food every day for survival. Power must be balanced. Those who have excess or too little power often abuse their personal strength, or use their power to compensate for something else lacking in their life. Not everybody has emotional baggage, but for many emotions run deeply buried allowing others to control our life instead of ourselves.
Breaking free from tangled emotions that interfere with balance and control in one’s life is an evolution to embrace with awareness. That awareness is achieved by allowing oneself to experience an emotion, deal with it and then letting it go. Awareness means knowing that food does not equal being loved nor does it take away the pain not dealt with and buried. The essence of breaking free means you have room to fill your heart and soul with other more positive emotions and food no longer must be part of the emotional baggage.
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