functional medicine and nutritional genomics - American Association ...

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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS obese children had increased carotid intimal thickness. Special Note: Gluten, Inflammation and Obesity Another growing problem is gluten intolerance or celiac disease, which triggers systemic inflammation and has been linked to autoimmune diseases, mood disorders, cancer, and cardiovascular mortality. In a recent study comparing blood samples taken from a cohort of 10,000 people 50 years ago to a modern cohort of 10,000, researchers found a 400 percent increase in celiac disease based on antibody testing (tissue transglutaminase). lxv In a 30-year study of over 30,000 people, hidden gluten sensitivity, even without biopsy proven celiac, was shown to increase risk of death by 35 to 75 percent, mostly from cardiovascular and cancer mortality, both known to be driven by inflammation. lxvi Damage to the gastrointestinal tract and impaired intestinal permeability from overuse of antibiotics, NSAID’s, and proton pump inhibitors and H2 blockers, combined with our low-fiber, high-sugar diet, combined with genetic alternations in gliadin proteins lxvii leads to the development of celiac disease and gluten intolerance or sensitivity and the resultant inflammation. Other Factors Driving Chronic Inflammation: Infections, Toxins, Stress, Sedentary Lifestyle, Nutrient Deficiencies Chronic infections can also trigger inflammation and cause persistent weight gain. New studies show that chronic infections, such as adenovirus, may be linked to obesity and insulin resistance. lxviii The increasing load of persistent organic pollutants (like PCBs and pesticides) and heavy metals (such as arsenic, mercury, and lead) has been linked to both diabetes lxix and insulin resistance, lxx in part through increased cytokine production. Chronic stress is yet another cause of chronic inflammation. lxxi Lack of regular exercise promotes low-grade inflammation while regular exercise reduces inflammation. lxxii Low-level nutrient and antioxidant deficiencies promote inflammation. Taking a multivitamin and 48 mineral supplement is as effective for lowering inflammation as is statin medication, at less expense with fewer side effects. lxxiii Digestive Dysfunction Metabolic dysfunction and insulin resistance has recently been linked to disturbances in intestinal ecology or the microbiome. lxxiv Shifts from our Paleolithic diet to a highly processed, high-sugar, high-fat, low-fiber diet has dramatically altered gut microflora. When the microflora is altered, the homeodynamic balance shifts from symbiosis—a mutually beneficial relationship to dysbiosis—a harmful interaction between microflora and host. These altered flora create metabolic endotoxemia through an increase bacterial endotoxins or lipopolysaccharides (LPS) binding to lymphocytes releasing tumor necrosis factor alpha (TNF-�) which blocks the PPAR (peroxisome proliferator activated receptor) family of nuclear receptors that control inflammation, insulin sensitivity and mitochondrial function. This triggers a cascade of inflammation, insulin resistance, and weight gain. lxxv Improving diet quality and normalizing gut flora with probiotics can reduce the burden of systemic inflammation. Toxic Burden and Impaired Detoxification Environmental toxins interfere with glucose and lipid metabolism and cause insulin resistance. lxxvi In 2006, scientists at Harvard School of Public Health found that rates of obesity in infants less than six months old have risen 73 percent since 1980. The Environmental Working Group study found the average newborn has 287 chemicals in the umbilical cord blood, 217 of which are neurotoxic. lxxvii Bisphenol A, a petrochemical that lines water bottles and canned food containers, increases a person’s risk of diabetes, heart disease, and abnormal liver function. lxxviii Data from the government’s National Health and Nutrition Examination Survey 1999-2002 found a very striking correlation between blood levels of six common persistent organic pollutants (petrochemical toxins) and diabetes. lxxix Those people who had the highest levels of pollutants in 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS their blood had a dramatically higher risk of diabetes. Studies of Air Force veterans of the Vietnam War found that those who had been exposed to Agent Orange (dioxin) had a much higher risk of diabetes. lxxx Environmental toxins alter normal thermodynamics making weight regulation simply a matter of calories in/calories out obsolete. New evidence shows that weight gain can occur in the absence of excess calorie intake. Rats given toxic chemicals gained weight and increased their fat storage without increased caloric intake or decreased exercise. In six months, these rats were 20 percent heavier and had 36 percent more body fat than rats unexposed to those chemicals. lxxxi A large population study published in Environmental Health found higher levels of organochlorine pesticides in diabetics. lxxxii Heavy metals such as mercury, lead, and arsenic also cause diabesity. Arsenic exposure increases the risk of diabetes. lxxxiii Toxins promote obesity through multiple welldocumented mechanisms. lxxxiv Toxins are PPARs (peroxisome proliferator-activated receptors) antagonists, receptors which regulate insulin sensitivity, inflammation and mitochondrial energetics. lxxxv Using new techniques of genetic and metabolic analysis, scientists have shown how toxins cause increases in glucose, cholesterol, and fatty liver. lxxxvi This opens a whole new area of potential treatment for diabetes and obesity. A comprehensive detoxification program for petrochemical and heavy metal toxins can be an effective addition to the treatment of diabesity. Mitochondrial and Redox Dysfunction Obesity and diabetes is linked to defects in mitochondrial function lxxxvii and oxidative stress. lxxxviii Even thin otherwise healthy first-degree relatives of diabetics have mitochondria that are 50 percent less active than those of people without a family history of diabetes. lxxxix Impaired mitochondrial function and oxidative stress results from calorie-rich, high-sugar, nutrient- and antioxidant-poor foods. Toxins, infections, and any 49 inflammatory trigger further damage mitochondria through increasing oxidative stress, which alters gene expression that drives insulin resistance. A plant based, low glycemic load, phytonutrient rich, nutrient dense diet enhances mitochondrial function and reduces oxidative stress. HIT or highintensity interval training also significantly improves mitochondrial function and leads to enhanced weight loss and improved cellular metabolism. xc Newer treatments are also being developed to address mitochondrial dysfunction, including one based on resveratrol, the antioxidant compound in red grapes. Resveratrol affects mitochondrial health through its impact on a master class of genes called sirtuins that regulate insulin sensitivity and mitochondrial function and helps reverse diabetes and increase longevity. xci Calorie restriction also helps improve mitochondrial function. xcii However, modifying lifestyle, engaging in interval training and exercise, eating a nutrientdense diet, and appropriate use of dietary supplements can enhance mitochondrial function and reduce oxidative stress. xciii Psychosocial/Spiritual Imbalances Stress promotes central obesity, xciv insulin resistance and diabetes through elevations of cortisol, insulin and cytokines. Mice bred to be obese and diabetic had improved metabolic function and lost weight through adrenalectomy, not an optimum strategy for weight loss. xcv However stress management including relaxation therapies, meditation, breathing exercises, yoga, xcvi group support, biofeedback, massage, exercise, saunas, dancing and laughing reduce the stress response and help normalize adrenal function and neuroendocrine signaling. Depression and diabetes are linked xcvii and may be interactive. A comprehensive psycho-spiritual approach to obesity is necessary. Obesity and diabesity is a complex, multi-factorial, multi-gene disorder embedded within a complex psycho-social-cultural fabric. Systematic attention, review and treatment of each factor and 2012
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