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Understanding the following, traditional Chinese medicine utilizes herbal medicines as well as various mind and body practices, such as acupuncture and tai chi, in order to treat or prevent numerous health issues. Traditional Chinese medicine, or TCM, originated in ancient China and has evolved over thousands of years. TCM has been primarily used as a complementary health approach along with other alternative treatment options like chiropractic care. Like TCM, chiropractic care is an alternative healthcare approach focused on the diagnosis, treatment and prevention of a variety of injuries and conditions of the musculoskeletal and nervous system, with an emphasis on manual manipulations and adjustments of the spine. As a doctor of chiropractic, or DC, TCM can also be offered to treat various types of injuries and conditions.
On a personal note, integrative TCM conservative therapies have been utilized to help treat symptoms of low back pain due to lumbar disc herniation, or LDH. Disc material from a ruptured or herniated disc in the lumbar spine can irritate or compress one or several of the nerves found in the lower spine. Pressure along the sciatic nerve can cause symptoms of sciatica, such as pain and discomfort, burning and tingling sensations, and numbness which may radiate from the buttocks into the leg and occasionally, down to the foot.�A randomized controlled trial was conducted in order to measure the outcomes of traditional Chinese medicine for low back pain due to LDH. The results have been recorded below.
Abstract
Low back pain due to lumbar disc herniation (LDH) is very common in clinic. This randomized controlled trial was designed to investigate the effects of integrative TCM conservative therapy for low back pain due to LDH. A total of 408 patients with low back pain due to LDH were randomly assigned to an experimental group with integrative TCM therapy and a control group with normal conservative treatment by the ratio of 3?:?1. The primary outcome was the pain by the visual analogue scale (VAS). The secondary outcome was the low back functional activities by Chinese Short Form Oswestry Disability Index (C-SFODI). Immediately after treatment, patients in the experimental group experienced significant improvements in VAS and C-SFODI compared with the control group (between-group difference in mean change from baseline, ?16.62 points, P < 0.001 in VAS; ?15.55 points, P < 0.001 in C-SFODI). The difference remained at one-month followup, but it is only significant in C-SFODI at six-month followup (?7.68 points, P < 0.001). No serious adverse events were observed. These findings suggest that integrative TCM therapy may be a beneficial complementary and alternative therapy for patients with low back pain due to LDH.
Introduction
Lumbar disc herniation (LDH) is a common disease and a major contributing factor of low back pain. Although many studies have confirmed that surgery is more effective for LDH, conservative therapies have also been recognized for their therapeutic efficacy. Considering the fact that 20% of patients still have pain after surgery, 7% to 15% of surgical patients may have failed back surgery syndrome, and some patients are scared of surgery, conservative treatment is still one of the primary means for LDH.
In China, TCM is one of the main conservative treatments for LDH. Previous studies have confirmed that some TCM therapies have certain effects on low back pain due to LDH. These include acupuncture, oral administration of Chinese medicine, external application of Chinese medicine, Chinese Tuina (massage), and TCM-characteristic functional exercise. Clinically, these therapeutic methods are not used alone but often in combination. Recently, the clinical pathway of treating LDH with integrative TCM therapy has attracted attention. The Shi’s Traumatology Medical Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine is well recognized for its long-term commitment to the research on conservative treatment for LDH, coupled with a package protocol for LDH. However, high-quality research evidence is needed to support the effectiveness of the protocol.
This clinical trial aims to study the efficacy and safety of integrative TCM therapy for LDH and thus confirm its clinical effect.
Materials and Methods
Design
We conducted a multicenter, randomized controlled trial to evaluate the effectiveness of integrative TCM conservative treatment for patients with low back pain due to LDH. Patients were randomly assigned to an experimental group and a control group by the ratio of 3?:?1 using computer-generated numbers. The randomized treatment assignments were sealed in opaque envelopes and opened individually for each patient who agreed to be in the study. The nurse, who had no role in the design and conduct of the study, prepared the envelopes. Patients in the experimental group were treated with integrative TCM therapy once a day, for two weeks, whereas patients in the control group were treated with a two-week normal conservative intervention. At baseline, immediately after treatment, one and six months after treatment, visual analogue scale (VAS) and the Chinese Short Form Oswestry Disability Index (C-SFODI) were used as outcome assessment. This trial is registered in Chinese Clinical Trial Registry (No. ChiCTR-TRC-11001343).
Subjects
Patients were recruited from Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Ruijin Hospital Affiliated to Shanghai Jiaotong University, and Yueyang Integrative Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between January 2011 and August 2012.
Inclusion criteria: (1) aging 20�60 years; (2) having low back pain due to LDH (MRI scan confirmed lumbar disk herniation) and ruling out other relevant ongoing pathologies such as fractures, lumbar spondylolisthesis, tumor, osteoporosis, or infection; (3) willing to participate in this study and signing the informed consent.
Exclusion criteria: (1) having other pain syndromes; (2) experiencing a history of spinal surgery; (3) having neurological disease; (4) having psychiatric disease; (5) having serious chronic diseases that could interfere with the outcomes (e.g., cardiovascular disease, rheumatoid arthritis, epilepsy, or other disqualifying conditions); (6) scared of acupuncture; (7) pregnant or planning to become pregnant during the study; (8) having other diseases that the researchers believe is not suitable for the study.
Treatment
Experimental Group
Patients in the experimental group receive a two-week integrative TCM treatment. They were further divided into three subgroups (according to the duration from initial low back pain to getting treatment) for different treatment methods: acute stage (0�14 days), subacute stage (15�30 days), and chronic stage (>30 days).
Acute stage: (1) Electroacupuncture + (2) Chinese herbal injection (Salvia miltiorrhiza injection) + (3) external plaster (Compound Redbud Injury-healing Cataplasms); Subacute stag: (1) Chinese Tuina (massage) + (2) hot compress using Chinese medicine + (3) external plaster (Compound Redbud Injury-healing Cataplasms); Chronic stage: (1) TCM functional exercise + (2) external plaster (Compound Redbud Injury-healing Cataplasms).
Treatment Parameters
Electroacupuncture. Points: bilateral Dachangshu (BL 25) and Baihuanshu (BL 30).
Method: Insert the needles (the sterile, disposable needles, 0.3 � 75?mm, manufactured by Suzhou Medical Supplies Factory Co., Ltd.) 2.5 to 2.8?cun. Upon De Qi (needling sensation), connect the needles with the electroacupuncture device (Model: G6805-II, manufactured by Guangzhou KangMai Medical Devices Co., Ltd.), using a continuous wave, an electrical stimulation pulse wave of approximately 0.6?ms and a frequency of 20?Hz. The treatment was conducted once every day, 30?min for each treatment.
Main ingredients: Zi Jing Pi (Cortex Cercis Chinensis), Huang Jing Zi (Negundo Chastetree Fruit), Da Huang (Radix et Rhizoma Rhei), Chuan Xiong (Rhizoma Chuanxiong), Tian Nan Xing (Rhizoma Arisaematis), and Ma Qian Zi (Semen Strychni).
Functions: Circulates blood, resolves stasis, eliminates swelling, and alleviates pain.
Method: Apply the cataplasms to the most painful area, one plaster each time, once a day.
Chinese Herbal Injection. Salvia miltiorrhiza injection (Approval no. Z51021303, manufactured by Sichuan ShengHe Pharmaceutical Co., Ltd.).
The main ingredient of the injection is Salvia root P.E. It acts to circulate blood and resolve stasis.
Method: Intravenous dripping of 20?mL salvia miltiorrhiza injection and 250 mL 5% glucose, once a day.
Hot Compress Using Chinese Medicine. Ingredients: 20?g of Cang Zhu (Rhizoma Atractylodis), Qin Jiao (Radix Gentianae Macrophyllae), Sang Zhi (Ramulus Mori), Mu Gua (Fructus Chaenomelis), Hong Hua (Flos Carthami), Chuan Xiong (Rhizoma Chuanxiong), Hai Feng Teng (Caulis Piperis Kadsurae) and Lei Gong Teng (Radix Tripterygii Wilfordii), respectively. All herbs were provided by Shanghai Hongqiao Pharmaceutical Co., Ltd. and have been tested and qualified.
Method: Place the previous medicinal into a gauze bag, decoct with water for 20?mins and take it out. After the temperature cooled to 40~45�C, apply the back to the affected low back area for 30�40 minutes, once a day. The hot compress can help circulate blood and resolve stasis.
TCM Functional Exercise. The exercise is known as �Fei Yan Shi� (literally meaning �the flying swallow style�) in Chinese.
Method: Ask the patient to take a prone position, extend both hands backwards, lift the chest and lower limbs off the bed using the abdomen as a pivot, and then relax. Conduct this exercise once a day and repeat 4-5 times each time.
Functions: Strengthens the power of back muscles, increases the stability of the spine, and thus prevents relapses.
Chinese Tuina (Massage). Ask the patient to take a prone position and find the tenderness spots on the low back. Then apply gun-rolling (10?min), Anrou-pressing and kneading (10?min), and Tanbo-plucking (5?min) manipulation to the tenderness spots and surrounding areas. Conclude with oblique pulling manipulation of the low back. Conduct the treatment once a day.
Functions: Relaxes spasm of the low back muscles and adjusts lumbar subluxation.
After one week TCM treatment, if the patient’s lower back pain without any relief or even aggravated, the prescription of pain medication was adjusted according to clinical guidelines, detailed records the type and dose of pain medication taken by patients, and the patient was identified as no effect.
Control Group
Patients in the control group receive a two-week normal conservative treatment. Intervention measures include three sections, (1) health education. The patients were invited to receive LDH health education twice a week in outpatient; the health education was designed exclusively to inform patients about the natural course of their illness and the expectation of successful recovery, irrespective of the initial intensity of their pain, educate patients to avoid some bad habits that aggravate the disease, such as a sitting position for a long time and carrying heavy loads, and encourage patients to participate in social activities. (2) Rest: in addition to the normal sleep, the patients need to rest in bed for at least 1-2 hours a day. (3) Pain medication or physical therapy: after one week health education, if the patient’s lower back pain without any relief or even aggravated, the prescription of pain medication was adjusted according to clinical guidelines, detailed records the type and dose of pain medication taken by patients. And if the patients do not want to take pain medication, then the patients were referred to a physiotherapist.
Measurements
All outcomes were assessed by observers unaware of the grouping, at baseline (M1), immediately after the last intervention (M2). The followup included the assessments at one month (M3) and six months (M4) after the last intervention.
The primary outcome measure was the change in pain by the visual analogue scale (VAS), scores range 0 to 100, and a higher score indicates a greater pain, 0 means no pain, and 100 means intolerable pain.
The secondary outcome measure was the change in the Chinese Short Form Oswestry Disability Index (C-SFODI), range 0 to 100%. The C-SFODI consists of nine questions, which come from Oswestry Disability Index (ODI); omit the sex life question in Section??8, because this question is always unacceptable by Chinese. The C-SFODI calculation formula is actual cumulative score/45 � 100%, with higher percentage indicating more severe functional disability. And the study has shown that the C-SFODI has good reliability and validity.
Statistical Analysis
Our pretrial power calculation indicated that 81 patients in experimental group were required to detect a difference in pain relief based on the preliminary experiment data at a significant level of 5% (a two-sided t-test) with 80% power. In anticipation of a 20% attrition rate, we sought 102 patients at least in experimental group. Taking into account the poor effect of control therapy, 102 patients were included in the control group.
Between-group difference at baseline was analyzed using independent-samples t-test or Chi-square test. Changes in continuous measures were analyzed by analysis of variance (ANOVA). Effects were evaluated on an intention-to-treat basis (ITT), and participants who did not complete the followup period were considered not having any changes in scores. A two-sided P value of less than 0.05 indicated statistical significance. Results are presented as mean and standard deviation (SD) at M1 and as between-group difference with 95% confidence intervals (CI) at M2, M3, and M4.
Quality Control
Before the beginning of the study, all researchers have to receive protocol training. A clinic research coordinator (CRC) was employed to assist researchers in each center. A monitor was also appointed to ensure the quality of the research.
Dr. Alex Jimenez’s Insight
The above clinical trial focused on investigating the safety and effectiveness of TCM, or traditional Chinese medicine, for low back pain due to lumbar disc herniation as well as to confirm its clinical result. The participants of the research study with low back pain due to LDH were divided into two groups: the experimental group, which was treated with integrative TCM conservative therapy; and the control group, which was treated normal conservative treatment. The experimental group was then further divided into three subgroups. The details of each TCM treatment method used in the subgroups, including the name, ingredients, method and function of each, are described above. The outcomes were measured accordingly by observers unaware of the specific group divisions. The statistic results were properly analyzed by researchers who received protocol training before the start of the study.
Results
Between January 2011 and August 2012, a total of 480 patients with low back pain due to LDH were recruited, 72 were rejected due to exclusion criterions, and 408 eligible patients were randomly assigned in accordance with the ratio of 3?:?1 to the experimental group and the control group, 306 in the experimental group and 102 in the control group. Patients in the experimental group all completed a two-week treatment. In the control group, at the second week one patient in the control group was unwilling to continue to participate and withdrew his informed consent, and two patients took Fenbid (500?mg for each dose, 2 doses a day) since the pain worsened during treatment (Figure 1).
Figure 1: Screening, randomization, and completion evaluations from the baseline to six-month followup, LDH = lumbar disc herniation.
Baseline Characteristics of the Patients
Table 1 shows the baseline data for the 408 participants. The mean age of all patients is 45 years, and 51% were women. In terms of disease staging, experimental group and control group were comparable. And the baseline outcome including VAS scores and C-SFODI were also reasonably well balanced between experimental group and control group.
Table 1: Baseline characteristics of the study participants.
Improvement in the Primary Outcome
The changes in the primary outcomes from baseline to six-month followup are shown in Table 2 and Figure 2. Immediately after the intervention, two groups showed significant decrease in VAS than the baseline. And the experimental group showed a more significant decrease than the control group (?16.62 points [95% confidence interval {CI}, ?20.25 to ?12.98]; P < 0.001).
Figure 2: Mean changes of the primary and secondary outcomes. The means of outcomes are shown for the experimental group (diamond) and the control group (squares). Measurements were obtained at baseline (M1), immediately after the last intervention (M2).
Table 2: Changes in primary and secondary outcomes.
One month after intervention, two groups also had significantly greater reduction in VAS than the baseline. And again, the experimental group showed a more significant decrease than the control group (?6.37 points [95% CI, ?10.20 to ?2.54]; P = 0.001).
Six months after intervention, compared with the baseline, the changes in VAS remained significant in the experimental group and control group, but between-group difference was not significant (P = 0.091).
Improvement in the Secondary Outcome
Immediately after intervention, two groups had significant improvement in C-SFODI than the baseline, and the experimental group showed a more significant improvement than the control group (?15.55 points [95% CI, ?18.92 to ?12.18]; P < 0.001).
One month after intervention, two groups also had significant improvement in C-SFODI than the baseline. And again, the experimental group improved more (?11.37 points [95% CI, ?14.62 to ?8.11]; P < 0.001).
Six months after intervention, two groups also maintained significant improvement, and the experimental group showed superiority (?7.68 points [95% CI, ?11.42 to ?3.94]; P < 0.001).
Adverse Events
One patient in the experiment group had mild fainting during acupuncture, remission by bed rest, and then completed the remaining treatment. Two patients in the control group were given Fenbid orally due to aggravated low back pain. No other adverse events were noted in either experimental group or control group.
Discussion
Although the mechanism of low back pain caused by lumbar disc herniation (LDH) is still not very clear, the prevailing view is that low back pain due to LDH was found to occur not only in response to mechanical stimuli but also to chemical irritation around the nerve root sheath and sinuvertebral nerve.
Different TCM therapies have different advantages in the treatment of LDH. Pain is the main symptom in the acute stage of LDH; acupuncture has good analgesic effect on low back pain due to LDH. Lumbar dysfunction is the main symptom in the remission stage; Chinese massage has good effect on improving dysfunction. Oral Chinese herbal formulae, external use of Chinese medicine, and Chinese herbal injection also showed good effect in relieving pain and improving dysfunction caused by LDH. And one study also found that Salvia miltiorrhiza injection especially works better and faster for the acute stage when compared with mannitol. Although the mechanism of acupuncture, Chinese massage, and traditional Chinese herbs in the treatment of LDH remains unclear, it is generally agreed that these treatment methods play a role by increasing local blood circulation, relieving nerve root edema, and speeding up the metabolism of the local inflammatory mediators. In recovery stage of the disease, the major task is to strengthen the muscles of the waist and abdomen to prevent relapse, and TCM functional exercise has advantages in this regard and can subsequently increase the lumbar stability to prevent recurrence.
Treating LDH according to different stages has been more and more accepted. In China, LDH is mainly divided into three stages, including acute stage, subacute stage (or remission stage), and chronic stage (or recovery stage). Studies have proven that treating LDH according to different stages has obtained a good clinical effect. In addition, studies have also suggested that it can obtain a better effect than treatment without differentiating different stages.
The past 20 years of clinical practice have witnessed the safety of the treatment regimens used in this study. At the same time, its efficacy has been preliminarily confirmed; however, high quality research evidence is still needed. In the treatment regimens, different TCM therapies were selected according to the characteristics of different stages. Specifically, acupuncture and Chinese herbal injections were used in the acute stage for fast pain relief, Chinese Tuina (massage) and external application of Chinese medicine were used in the subacute stage for improvement of the lumbar functions, and low back muscle exercise was used in the chronic stage to increase the stability of the spine and prevent relapses.
In China, nonsurgical treatment of lumbar disc herniation mainly uses drugs, physical therapy, or TCM treatment. TCM treatment used in the experimental group has been used in clinical routine and is considered to have good clinical efficacy; the efficacy of conservative treatment used in the control group is considered very weak, usually as auxiliary treatment of other therapies. Ethics Committee considers that in order to maximize the protection of the interests of the patients, it is necessary to let the patients have more opportunity to receive TCM treatment, so in this research the sample size of the experimental group and the control group is 3?:?1.
The findings of this study have shown that immediately and one month after intervention, integrative TCM conservative treatment can significantly reduce the VAS scores and C-SFODI, and at six month after intervention, integrative TCM conservative treatment can also significantly reduce the C-SFODI, but two groups have no significant difference in reducing VAS score. VAS is an international general pain visual analog scale, and C-SFODI is the improved version of the ODI (Oswestry Disability Index), and it consists of 9 questions, a higher percentage indicating a more severe functional disability.
Regarding adverse events, one patient had mild fainting in the experiment group, two patients in the control group were given Fenbid oral due to low back pain aggravation, and no other adverse events were noted in either experimental group or control group. The mechanism of integrative TCM conservative treatment for LDH remains unclear, and it will be our future research orientation.
The main limitation of this study is the short followup time. As a result, we failed to conduct comprehensive evaluation regarding the long-term efficacy of integrative TCM conservative treatment for LDH.
Conclusions
This randomized controlled clinical trial provides reliable evidence regarding the effectiveness of integrative TCM conservative treatment for patients with low back pain due to lumbar disc herniation. A large sample of long-term followup is further needed for future research.
Conflict of Interests
No potential conflict of interests relevant to this study was reported.
Acknowledgments
This work is supported by the Key Discipline of TCM Orthopaedic and Traumatic of the Ministry of Education of the People’s Republic of China (100508); the Medical Key Project of Shanghai Science and Technology Commission (09411953400); the project of Shanghai Medical leading talent (041); the National Natural Science Foundation of China (81073114, 81001528); the National Key New Drugs Creation Project, innovative drug research and development technology platform (no. 2012ZX09303009-001); Shanghai University Innovation Team Construction Project of the Spine Disease of Traditional Chinese Medicine (2009-26).
In conclusion, with the measured outcomes and final results of the two groups of participants with low back pain due to lumbar disc herniation, the randomized controlled trial helped contribute valuable information regarding the safety and effectiveness, as well as the clinical effect of integrative TCM conservative therapy. Information referenced from the National Center for Biotechnology Information (NCBI). The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
Curated by Dr. Alex Jimenez
Additional Topics: Sciatica
Sciatica is referred to as a collection of symptoms rather than a single type of injury or condition. The symptoms are characterized as radiating pain, numbness and tingling sensations from the sciatic nerve in the lower back, down the buttocks and thighs and through one or both legs and into the feet. Sciatica is commonly the result of irritation, inflammation or compression of the largest nerve in the human body, generally due to a herniated disc or bone spur.
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Genetic: Integrative and functional medicine came to the forefront for many medical practitioners and patients alike when they
became dissatisfied with traditional medicine�s sole focus on what was considered �science-based� treatment approaches. Traditional medicine�s viewpoint of dealing with symptoms in isolation from the rest of a patient�s body, mind, and spirit can be too confining when it comes to certain conditions.
This evolution to a more function-centered approach as opposed to a disease-centered way of seeing the whole person has led to improved healthcare. It also looks at prevention, not simply illness and at living in a healthy state, not simply disease-free.
What Is Integrative & Functional Medicine?
Practitioners of integrative and functional medicine take into consideration genetic, environmental, and lifestyle issues when listening to their patients describe the symptoms plaguing them. Their inclusion of these issues makes the process more of a natural medicine approach.
With the dramatic increase in chronic illness conditions and the lack of training traditional physicians have in dealing with these conditions, the move into integrative and functional medicine is needed.
Many of these chronic illness conditions have a genetic component that, along with environmental and lifestyle factors, lead to serious limitations on people�s lives. This shows the importance of the individual biochemical and genetic aspects of each person on his or her health.
This other approach in medicine realizes the necessity of considering nutrition, exercise, diet, and genetics in evaluating and remediating chronic illness conditions. The use of genetic testing in integrative and functional medicine is one way to take all of these factors into account.
SNPs & Integrative & Functional Medicine
Upon completion of the mapping of the human genome, we know there are 20-25,000 genes in each genome. With this knowledge came the information that there are over 80 million variants in the human genome.
These variants are comprised in part of single nucleotide polymorphisms (SNPs) and deletions or insertions in the genome. It is these SNPs that provide significant health information to providers of integrative and functional medicine to prevent or alleviate chronic illness conditions.
Knowing the presence of and placement of SNPs through genetic point mutation testing allows evaluation of the susceptibility to develop many of the chronic illness conditions that affect people today. In addition, this kind of testing helps pinpoint relevant SNPs and their corresponding metabolic markers in individuals.
Testing of this kind provides targeted interventions through the use of traditional medicine approaches as well as supplementation through integrative and functional medicine approaches. Monitoring of individuals� progress is also made easier with genetic testing by measuring metabolic markers found in the original tests over a period of time.
Individual monitoring of this type is necessary when this kind of personalized intervention and supplementation is used. If there is an overload of either medications or supplementations, there can be an impact on the performance of metabolic processes that can lead to side effects. These side effects can influence functions and responses, such as the immune response.
Individual SNPs will determine how well medications and supplements are working.
Genetic Testing In Relation To Diet & Weight Loss
Integrative and functional medicine practitioners not only deal with illness, they also provide health and wellness evaluations. Current research has shown how important a role genetics plays in the prevention of many chronic health conditions.
Genetic testing can show vulnerabilities to conditions and suggest options for individuals. This kind of testing can also provide valuable information concerning how individuals can respond to different attempts to live more healthy lives.
Genetic testing has been shown to be effective in several areas: diet, eating behavior traits, nutritional needs, exercise, body and weight, and metabolic health. For each of these areas, there are certain genetic markers that can provide information regarding how genetics will affect each of these areas.
Diet
People are seemingly obsessed with weight. How to lose it and keep it off, how to re-distribute it to look more attractive. Professionals in integrative and functional medicine are approached regularly for help in this area.
Everyone knows it�s hard for some people to lose weight on any kind of diet, while others can lose weight any time they want. It�s not just due to lack of willpower that people don�t lose the weight they want. It may also be due to genetics.
Research has shown about 88 percent of people have bodies that resist burning fat through low-intensity exercise. Most people will gain weight if they eat almost any carbs (about 45 percent of people) or almost any fat (about 39 percent of people).
The reason for this is a diet and type of exercise matched to specific genotype lead to weight loss. These diets and exercise types are not the same for everyone.
For example, let�s look at adrenoceptor Beta 3 (ADRB3) with an SNP on rs4994. There are different variations of this gene. If you are either an AA or TT genotype, you have what is called a genetic privilege and just about any kind of exercise will work for you. On the other hand, if you don�t have either of these AA or TT genotypes, this is a genetic disprivilege and only a high-intensity type exercise will help you lose weight.
Further analysis of other genes and SNPs can tell you the type of diet, either low carb or low fat, that will work best for you. In fact, using a diet matched to your genetics can result in a loss of two and half times as much weight as a diet not matched to genetics.
In addition to choosing the right diet to lose weight, choosing the right diet may also help you avoid developing a chronic health condition. Research has shown diet to be implicated in many chronic illness conditions, so genetic testing to determine your specific vulnerability to illnesses and your response to particular foods may help prevent them.
Knowing your predisposition to illnesses can lead to targeted dietary and lifestyle changes that may modify any existing conditions and help prevent future developments. Future research may bring more information regarding bioavailable components in foods that can aid in alleviating health issues.
COMT & CYP19 Genes
Research has identified certain genes that work together and appear to show that some people retain fat regardless of, or in spite of, exercise.
In one study, researchers found two genes, COMT and CYP19 that appeared to be involved in patterns of fat loss and exercise. Having one CYP19 gene and variants of that gene did not affect fat, intra-abdominal fat, or total fat. However, having two of these genes seemed to be related to slightly more decrease in body mass index and significantly more decrease in total fat and percentage of body fat.
The researchers also found that having one genotype of the COMT gene and one copy of the CYP19 gene seemed related to significant loss of BMI, total fat, and percentage of body fat.
Why and how these genes and combinations work isn�t known yet. More research is needed to determine this. Other research suggests women with a specific CYP19 variant may also have increased levels of estradiol and estrone which may make it harder for them to lose fat through exercise.
Environmental Factors
Weight loss or gain is not solely at the mercy of your genetics however. A combination of genetics and environment is likely behind your success or failure regarding your weight loss attempts.
The thinking of professionals is divided on the subject of genetics versus environment/lifestyle choices. One set of these professionals regards environment to be the telling component. They point to the teaching over the years that food is a reward for good performance at anything. This, combined with constant reminders about food that are around us all the time, makes it hard for some people to lose weight and/or keep it off.
Others believe losing weight and keeping it off are more related to biological functions. They have found people to be metabolically different after losing up to ten percent of their body weight. Their brains also seem to respond to food differently. The emotional response to food is greater, but the brain regions that deal with food restraint are less active. This sets up the person to regain the weight lost.
Further research into why people lose weight and maintain that loss will be needed. Some of that research has to be on the genetic basis of weight loss.
Eating Behavior
Integrative and functional medicine practitioners view eating behavior as important for overall health.�These behaviors include snacking behavior, feelings of satiety, craving for sweets, desire for food or certain foods, and the disinhibition of eating.
Nutrigenetics and nutrigenomics are two new fields of study related to how genes affect our diet and how our diet affects genes, respectively. Obesity, cancer, and heart disease are three of the health conditions most investigated in these two new fields.
One study involving these new fields showed the bitter taste gene receptor hTAS2R38 to be involved in tasting glucosinolates, found in some fruits and vegetables. Three genotypes in this gene receptor have been identified: PAV/PAV, PAV/AVI, and AVI/AVI.
Those individuals with PAV/PAV are said to be supertasters. They are very sensitive to bitter tastes in some foods and in some man-made compounds used in research. People with PAV/AVI are considered medium tasters. They can taste bitter in the research compounds, but not as much as the supertasters. Individuals with AVI/AVI are labeled non-tasters. They don�t taste bitter in the research compounds.
While it�s difficult to completely understand why these differences occur, it does appear they can make a difference in people�s diets. It could be that people who taste bitter greatly or somewhat will avoid certain vegetables that contain this bitter taste. Vegetables like kale and broccoli have this taste.
In this way, genetics have a significant influence on eating behavior.
Research indicates taste is only one of the ways genetics affects eating behavior. Caloric intake, meal size, and frequency of eating also appear to be affected. People�s desire for fats, carbohydrates, or proteins also may be influenced by genetics.
Research has found apolipoprotein A-II (APOA2) to be implicated in this kind of desire. Three variants in this gene, TT, TC, and CC, have been isolated as factors affecting the choice of fats, carbs, and proteins. One study showed both men and women who had the recessive CC chose more fat and protein and fewer carbs than either of the T alleles. The CC group ate about 200 more calories than the other group and tended to develop obesity more frequently.
It appears that APOA2 may affect not only food choices but also feelings of satiety.
Nontasters seem to prefer and seek out fats and flavors, so dieting may be more difficult for them to stick with and lose weight. Supertasters, on the other hand, enjoy a variety of foods, especially those that are spicy and robust. This may help them with diets.
Understanding the factors that appear to influence eating behaviors has gained importance with the tremendous increase in obesity in the U.S. and around the world, along with diabetes and cardiovascular disease. Eating behavior must be seen as a complex inter-relationship among psychological, cultural, physical, and genetic factors that influence the choice of foods, the amount of food intake, caloric intake, and timing of meals.
Regulating Eating Behavior
Clearly, taste affects food choices as seen in the discussion above. Another of the bitter receptors, TAS2R5, may also assist in regulating eating behavior. Alcohol dependence has been associated with an SNP in this receptor, along with another receptor, TAS2R16. These research findings seem to indicate variants in the TAS2R gene to be associated with ingestive behavior.
Genetic influence over meal amounts, how often people eat, and the timing of meals is a new area of study and may involve digestive neuroendocrine hormones such as CCK, leptin, and ghrelin. Studies are underway investigating the effects of these hormones on pathways that influence eating behavior.
A gene with a strong association with the risk of obesity, FTO, appears to contribute to obesity by downregulating leptin production in adipocytes. Adiposity and satiety appear to be associated with a fairly common variant, rs9939609. One study showed the A allele of rs9939609 to influence post-meal feelings of satiety and possibly to influence the excess caloric intake seen in men and women with high BMIs.
A gene involved in the detoxification of nutrients during digestion, AKR1B10, also appears to play a role in influencing human eating behavior.
Nutritional Needs & Genetic Testing
Another area in which integrative and functional medicine practitioners use genetic testing is in�determining nutritional needs of their patients. As we have seen previously, genetic variants have an effect on taste and thus on nutrition. When people choose foods that �fit� their tastes but are short on nutrients, their health suffers. People also appear to have genetic responses to some supplements, such as some of the B vitamins and vitamin C.
The impact of nutrition is a lifetime factor, and practitioners of integrative and functional medicine evaluate nutritional needs closely. Any genetic variant that leads to abnormal nutritional requirements would likely be incompatible with survival. For example, miscarriage is more likely in a woman whose fetus has two alleles that negatively affect the use of any given nutrient than a woman whose fetus just has the common functional variants.
Several studies have isolated genes and alleles that affect nutrients and their utilization. For example, an SNP (Ala222Val) in the methylenetetrahydrofolate reductase (MTHFR) gene leads to a significant alteration in folate metabolism, increasing the risk of neural tube defects (NTDs) and cardiovascular disease, but lowering the risk of colon cancer. Increasing folate intake lowers the risks of developing serious health conditions.
Research has found other SNPs that alter homocysteine metabolism and folate uptake and transport. SNPs in enzymes that affect utilization and metabolism of vitamin B12 seem to be associated with NTDs and the possible development of Down syndrome and colon cancer.
SNPs in the vitamin D receptor may be associated with asthma in both children and adults. Lipid pathways, alcohol metabolism, and lactose metabolism appear to be affected by SNPs in other genes, also. A beneficial effect of these SNPs in the ancestors of certain ethnic groups or ancestral subpopulations may have been present, even though they tend to carry the risk of an adverse outcome today.
Environmental changes have been shown to bring a previously silent allele into a role as a disease allele. The aldolase B enzyme metabolizes fructose and was silent even with a high number of polymorphisms. In recent times, when fructose was added to foods as a sweetener, the polymorphisms began presenting as disease alleles.
Integrative and functional medicine professionals can use this information to guide their patients into more healthy lives.
Genetic Testing & Exercise
Integrative and functional medicine also uses genetic testing to determine the best types of exercise for different people and to explore the likelihood of injuries of several kinds in athletes. This latter area of research and clinical practice can help reduce the number and severity of athletic injuries for adult and child athletes.
While there have been some gene variants associated with athletic ability, none have been shown to be predictive to any degree. Research in this area is promising for decreasing serious injury in young athletes. But to date, little scientific information regarding a genetic variation in young athletes is available.
Genetic testing as a way of choosing which athlete to select for a particular sport is increasing. However, little evidence has been found to show it is more accurate than traditional ways of selecting candidates. The ethics of this kind of testing for young athletes has been brought into question.
ACE Genes
Two genes and the SNPs associated with them have been examined in several population samples and thus have robust findings. The ACE I/D polymorphism was first found to be associated with human performance several years ago. This gene is part of the renin-angiotensin system that controls blood pressure through its effect on the regulation of body fluid levels.
The ACE I allele lowers ACE activity in serum and tissue. The D allele increases ACE activity in serum and tissue. The ACE I/I genotype has been shown over and over again to indicate performance endurance and greater efficiency in exercise. The ACE DD genotype has been shown to indicate strength and power performance levels.
This ACE I/D genotype does not appear to have predictive ability in Kenyan athletes, suggesting the confounding influence of ethnicity or geography.
ACTN3 Gene
The ACTN3 is strongly associated with the protein alpha-actinin-3. This protein is involved exclusively in fast type II muscle fibers that are used in explosive activities. SNP R577X indicates a stop codon at position 577 rather than an arginine (R). An R allele puts athletes at an advantage in power sports. A study of the ACTN3 R577X variant in elite European athletes showed those in power event to be 50 percent less likely to have the XX variant and those involved in endurance events to be 1.88 times more likely to have the XX variant. For world-class endurance athletes, the odds of having the XX variant were 3.7 times larger when compared with lower-level athletes. It appears the ACTN3 gene is more important at the upper levels of sports.
While research shows the effects of the ACTN3 gene on athletic performance, especially in higher class athletes, the effects in the general population were negligible. It is unclear just what the association of this gene in the general population and choice of athletic activities in this population might be.
Resistance to injury and the ability to recover from injuries are also very important factors not only in professional sports but also for the general population. The emphasis on physical activity currently seen in the culture increases the risk of injury and the need for information regarding recovery.
Concussions and tendinopathies have been studied fairly extensively. Information on these two growing areas of injury among young athletes has been valuable for integrative and functional medicine specialists.
These two areas are important due to the long-lasting effects of both on young athletes. Research and clinical practice have shown the effects of concussion to linger into old age where they can increase the cognitive decline normally seen at that time of life.
APOE4 Gene
A better understanding of the genetic aspects of injury and recovery can help practitioners of integrative and functional medicine to both protect those young athletes at risk for injury and to better treat those who suffer injuries.
Regarding concussion, the gene most studied is APOE and its three alleles. The APOE e4 allele has been implicated in the development of Alzheimer�s Disease. This allele has been studied recently to determine its association, if any, with concussion risk and outcomes of traumatic brain injury. To date, the results are not clear.
Some findings have shown people with the e4 allele to have less favorable outcomes from traumatic brain injuries and boxers with this allele had higher chronic brain injury scores. These findings are consistent with e4 being a risk allele. However, one study of college athletes with the e4 allele did not find them to be more likely to suffer a concussion. Another study showed the e4 allele was not associated with poorer head trauma outcomes in children.
Another APOE variant, G-219T, has been linked with increased risk of concussion in athletes. Those athletes with the TT genotype compared to those with the GG genotype had a risk of concussion three times larger. A weak association was found in that same study between the tSer53Pro polymorphism in MAPT, the tau-protein encoding gene, and risk of concussion.
Collagen Genes, Integrative &Functional Medicine
Collagen is the primary component of tendons and ligaments, thus it is connected very closely with research into tendinopathies. It is no surprise that two variants in genes coding for collagen (COL1A1 and COL5A1) have been shown to suggest increased risk of injury to tendons. MMP3, a gene associated with connective tissue wound repair and the gene encoding TNC, an extracellular matrix protein, have also been implicated in increased risk of tendinopathies.
These are preliminary studies that need replication and further study to validate the findings.
Genetic Testing & Metabolic Health
Metabolic syndrome and metabolic health have been studied extensively due to metabolic syndrome being a major risk factor for the development of diabetes mellitus 1 and cardiovascular disease. Genetic and environmental factors interrelate in a complex fashion to bring about this condition. A cluster of metabolic abnormalities, including hypertension, dyslipidemia, abdominal obesity, insulin resistance, and impaired glucose tolerance make up metabolic syndrome.
All of the components of metabolic syndrome are highly heritable. Studies have shown links between metabolic syndrome and genes such as PPARg, adiponectin, CD36, and beta receptors.
There has been a considerable investigation into the heritability of metabolic syndrome. One study involved over 2,200 individuals in over 500 family groups. It was the first to identify major genes influencing metabolic syndrome.
Chromosome 3q27 was significantly linked to six factors involved in metabolic syndrome: weight, leptin, insulin, waist circumference, hip circumference, and insulin/glucose ratio. Chromosome 17p12 was strongly linked to plasma leptin levels.
Another study evaluated over 200 SNPs in 110 genes for their effects on coronary artery disease, highly implicated in metabolic syndrome. SNPs in eight of these genes showed association with metabolic syndrome: LDLR, GBE1, IL1R1, TGFB1, IL6, COL5A2, SELE and LIPC.
These genes are described below:
LDLR: Low Density Lipoprotein Receptor gene. It is strongly involved in the homeostasis of cholesterol. Hypercholesterolemia in families has been linked to mutations of this gene.
GBE1: Glycogen Branching Enzyme gene. It is involved in coding the glycogen branching enzyme which aids in glycogen synthesis. Branching of these chains allows a great number of glycosyl units to be stored in a molecule of glycogen.
IL1R1: Interleukin 1 Receptor, Type 1. Interleukin 1 is made up of two proteins, IL1-alpha and IL1-beta, and is a mediator of inflammation.
TGFB1: Transforming Growth Factor, Beta 1. This gene encodes the peptide involved in many functions in cells. Apoptosis may result due to dysregulation of the activation of this gene.
IL6: Interleukin 6 gene. It is a cytokine that regulates the immune response by activating a cell surface signaling assembly. Its production by neoplastic cells has been implicated in the growth of a number of cancers.
COL5A2: Collagen, Type V, Alpha 2. Mutations in the gene may bring on weakened connective tissue throughout the body.
SELE: Selectin E gene. May be involved in the pathogenesis of atherosclerosis.
Some of the more common inherited metabolic conditions include:
Lysosomal storage disorders. These can result in the buildup of toxic substances inside lysosomes in the cells.
Glycogen storage conditions. Sugar storage problems can lead to weakness, low blood sugar, and muscle pain.
Mitochondrial disorders: Can lead to muscle damage.
Peroxisomal disorders: Can lead to a buildup of toxic products of metabolism.
Metal metabolism disorders: Special proteins control levels of trace metals in the blood. A malfunction in these proteins caused by genetic metabolism disorders can lead to toxic levels of metals in the body.
Symptoms of genetic metabolism disorders include:
Low energy levels
Decreased appetite
Abdominal pain
Weight loss
Jaundice
Seizures
From this list of symptoms, it�s easy to see the relationship�of metabolic syndrome and adrenal fatigue. Practitioners of integrative and functional medicine will be faced with patients who present with adrenal fatigue and these similar symptoms. This makes it important for them to understand at least the basics behind Adrenal Fatigue Syndrome (AFS).
Adrenal Fatigue Syndrome
Feelings of fatigue and lethargy are presented more and more frequently in health care professionals� offices. Combined with concentration difficulties, sleep problems, inability to lose weight, feeling your brain is in a fog, fatigue, and lethargy may point to AFS as the basic issue.
AFS is a constellation of many nonspecific symptoms that can become debilitating. The onset of the symptoms is slow and can be missed by traditionally trained professionals.
The symptoms of AFS result from�the body�s normal response to stress�from any source. The hypothalamic-pituitary-adrenal (HPA) axis is set into motion, releasing hormones and other chemicals that are designed to deal with stress. At the end of the axis are the adrenal glands that secrete cortisol, the stress fighting hormone. The purpose of this hormone is to limit the effects of stress on the body.
In normal circumstances, once the stress ceases, the cortisol levels decline and the adrenals get a chance to recover. However, in our stress-filled culture, the stresses continue. This puts the demand on the adrenals at an extreme level. At some point, the adrenals are no longer able to secrete cortisol, which results in damage to the body from the effects of stress.
Levels of inflammation and an increased immune response results. Inflammation has been implicated in many chronic illness conditions. It is at this point that the body begins breaking down from the accumulation of symptoms such as fatigue, brain fog, insulin resistance, and increasing inflammation.
NeuroEndoMetabolic (NEM) Response
The traditional medical viewpoint of addressing individual symptoms and/or organs when working to alleviate illness conditions is simply too mechanistic. A more comprehensive viewpoint is needed in order to effectively deal with symptoms of AFS. The NEM model is such a viewpoint.
The model says it is important to consider organ systems operating in an interrelationship in which whatever affects one organ system affects others as well. In this regard, it is in line with�the integrative and functional medicine viewpoint.
The NEM model is a functional approach that looks at interactions between the individual�s environment and the gastrointestinal, endocrine, and metabolic organ systems, among others. This allows a healthcare practitioner to find the root causes, triggers, immediate causes, and genetic factors involved in a person�s illness condition.
This is a much more comprehensive approach to alleviating people�s symptoms and illness conditions.
Increasing and unrelenting stress is a part of our culture that is detrimental to the health of every individual. The metabolic component of the NEM model added to the neuroendocrine aspect helps professionals to see how localized organ-specific responses and systemic responses are necessary for successfully dealing with stress.
The metabolic component of our stress response is very subtle in the early stages. But the derangements of our metabolism worsen as time goes on and stress doesn�t stop. By the time the stress response reaches stage 3 or 4, these derangements can become debilitating. At the severe stage, they can lead to hypersensitivity to supplements and to paradoxical reactions.
Very significant and debilitating symptoms begin arising. Often, these lead the person to be bed-ridden due to their severity.
AFS & Genetics
A question integrative and functional medicine experts and those who suffer from AFS all want to know is: Can you inherit AFS?
Before answering that question, you need to understand even if you have a gene or several genes that are involved in a health condition like AFS, it doesn�t mean you will automatically get that condition. Before genes can do anything, either positive or negative, to your health, they have to get the signal to �switch on.�
One good thing about that signal is you have quite a bit of control over it. Scientists and researchers have discovered environment, choices you can make, exert significant control over whether genes are turned on or off. This is called gene expression.
Can you choose to switch specific genes on or off? That�s beyond us at this point. What you can do is make good lifestyle choices, good exercise choices, good diet choices and either activate or de-activate genes in this way. Genetic testing as seen in integrative and functional medicine practices is a way to determine your choices in many areas. Which diet works best for you and what exercises will best benefit you can be answered through this kind of testing.
Answering the specific question posed above, �Can you inherit AFS?�, is a complicated process.
Two genes with significant involvement in this answer are MTHFR and COMT. Both are involved with methylfolate. People with mutations in MTHFR don�t have enough methylfolate leading to less adrenaline because of interference in the methylation process. Methylation aids in the production of adrenaline and other hormones.
The other gene, COMT, is involved in the production of hormones and chemicals in the body. Low levels of methylfolate with this gene leads to lower levels of epinephrine and higher levels of norepinephrine.
The lack of methylfolate with both of these genes, especially MTHFR, leads to feelings of fatigue.
When your body is stricken by stress, both your adrenals and MTHFR are affected. This leads to the fatigue felt by those of you who suffer from AFS. The enzyme that produces dopamine and serotonin is also dependent on methylation to work right. Low levels of methylfolate can lead to low levels of both of these neurochemicals which can then lead to low energy and fatigue.
What Can You Do To Improve Energy Levels?
There are some things you can do to aid in increasing energy and improving the work of the two genes mentioned, MTHFR and COMT.
Balance your blood sugar levels by eating three or four small meals per day. These meals should include good grains like quinoa or rice, good carbs, and vegetables. You can add protein from fish or free-range chicken.
Supplements can help support your adrenal glands and the methylation process also. Vitamin B1, B2, and B6 will help. There are usually no side effects from vitamin B1, but if you should begin feeling any itching, notice any rashes, or have trouble breathing, contact your healthcare professional immediately.
Side effects from B2 are also rare. Very yellow urine will be seen, but this is not serious. If you do have any rashes, breathing trouble, or itching, contact your physician at once.
Taken in large doses for a long time, B6 can cause side effects. Headache, nausea, and drowsiness are enough to contact your healthcare professional at once.
Some people try taking methylfolate (5-MTHF), but this is a labor-intensive effort and could bring on some serious side effects if your body is not ready for it. If your body gets overwhelmed by the 5-MTHF, you can feel headaches, irritability, anxiety, and heart palpitations. Get medical help right away for these side effects.
Despite advance testing, it is important to remember that tests are simply data points of alert. A clinical decision should be made after a detailed consideration of the history and state of the body. A shotgun approach to treating abnormal laboratory values is a common clinical mistake and can lead to negative clinical outcomes.
Conclusion
The mapping of the human genome has provided an opportunity for researchers and clinicians alike to consider the roles genes play in health and wellness. Discovering the presence and effects of single nucleotide polymorphisms (SNPs) has increased not only our knowledge of how genes affect health, but also has given us tools to use in preventing and remediating many chronic illness conditions.
Integrative and functional medicine practitioners have been among the professionals to use this information in a practical sense. Whether AFS can be inherited is yet to be seen. Clinically, we do see a strong correlation from one generation to the next.
Genetic testing to examine the working of MTHFR and COMT may be of some help. Diet and supplements can also increase your chances of these two genes working correctly and alleviating some of the symptoms of AFS.
Because genetic testing is still in the very early phase of development, it is important to take all data points with the right perspective and refrain from treating abnormal laboratory numbers while the root cause of the problem can be masked.
� Copyright 2017 Michael Lam, M.D. All Rights Reserved.
Ketosis is a metabolic state where the liver takes proteins and fat and produces molecules to use for energy. Ketosis allows a starving person to survive for days (or even months). Some athletes see improvements while others feel miserable whenever they are in a condition that is ketogenic. Is a ketogenic diet right for you?
Ketogenic Diet and the Brain
Your brain is about 2 percent of your body mass, even though it requires approximately 20 percent of your basal metabolic rate, more if you are a thinker. Various parts of your brain use different amounts of glucose, and almost twice as much in the morning. You will need to fuel your mind more if you are using your mind working hard through the day and solving problems. If you’re working more on engine control, (state a skill involving precision or equilibrium), then you will use less glucose. Many people can attest to how much energy is used by the brain when challenged.
Although sugar is run off by our brains rather than fat, they are also able to run off of ketones as an alternate fuel source. People who market diets tend to be aware the simple fact that an increase in ketones improves repair and the healing of neurons and increases the neurotransmitter GABA. (GABA makes it possible to sleep. It’s also the main neurotransmitter that sleep drugs and antipsychotic drugs influence.) Due to the impact of ketones on the brain, a ketogenic diet can really help those with seizures. Of course, ketosis means you’re burning far more fat, (in the form of ketones), for energy compared to glucose, and also, for the most part, that’s usually great thing.
You won’t venture to some harmful diabetic ketosis amount as long as you are generating even only a tiny amount of insulin. So as long as you are not Type 2 or a Type 1, there is nothing to immediately worry about. However, to stay in a state of ketosis, you typically need to eat less than 50g of carbs per day if not less than that. In this state, the body’s functions are based on fat rather than glycogen, and the brain is based on ketones instead of glucose.
People wishing to achieve ketosis can not consume an excessive amount of protein. This means no more than 150g per day. Protein could be converted into glycogen and as it may have been mentioned before by professionals, this protein can also be used to make glucose and you would throw the body out of ketosis.
Ketones vs Glucose
So, should you attempt to achieve this ketogenic state? For many people, they need to do it at least to change their body from insulin resistance. Again, like most things, it is very individualized. If you’re severely resistant this might be your way out of it and about the road to health again.
Overall, most people could do much better, (significance become more fit and more healthy), eating less carbs. But when they don’t need to, some people have a tendency to go to the stress and extreme carbs. Many people also fear insulin because everything we read about obesity, cancer, and pretty much any disorder talks about insulin and inflammation. But remember it is all about making just the right amount. Insulin is not a bad guy, just too much of it is. If you don’t make insulin when you ought to be you’re really in a more dire situation than becoming insulin resistant.
It typically takes two to three weeks to really shift your body over to fat from using glucose as a main fuel source, which is with an extremely low carb, high fat diet plan. Merely tweaking your diet a little bit won’t do the job. You have to go to the more extreme for a few weeks, and after that you can add in some carbohydrates and determine how you react to them, mentally and physically. The nice thing about changing your body from sugar burning is that you also won’t convert back to being a sugar-burner if you consume too many carbs for a brief period of time.
Whether your want to be in ketosis or not is your choice, but you should be able to go days with no carbs (other than veggies) in your diet plan. Carbohydrates should generally only be consumed when you only want to eat them, like pizza, or anything you are into, or once you are training hard or extended.
Remember, even if you’re only eating about 2,000 calories per day then 100g of carbohydrates is only 20 percent of your diet plan. You’re getting the identical amount of protein and the fat is left by that around 60 percent, which is grams of fat. (Fat is 9 calories per gram; protein and carbohydrates are every 4 cals.) You are going to want some more carbs, if you are training hard. You’ll need some carbohydrates. If you’re trying to select a diet , training difficult or in any medium to high intensity for a period. Therefore, if you are going to try a diet do it in the off season when you are building a strong base or when you’re in a recovery interval in racing or training hard.
On a clinical note, many individuals perform well staying in ketosis for more than a month or two months, max. Health disorders and pain have been a result of being in a ketogenic condition for such a long time. The diet helps people progress mentally and physically, but it can turn on them, without proper understanding. Therefore, if you’re going to go keto, have a rest every few months or so, and see how you operate and feel in and out of ketosis.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Since ketones are a preferred fuel for the heart and the diaphragm, and because a state of ketosis may provide extreme focus and cognitive performance during difficult mental activities, a ketogenic diet can be extremely useful for endurance athletes such as triathletes, distance swimmers, cyclists, marathoners, ultra-runners, etc..
Problem is, there are not a ton of tools out there about how highly active people can really get into a state of ketosis.
In this guide, author, triathlete, and ketogenic expert extraordinaire Patricia Daly explains how to do things the ideal way. Patricia just finished writing an amazing publication called “Practical Keto Meal Plans For Endurance Athletes: Tips, Tricks And How To’s For Optimizing Performance Using A High Fat, Low Carb Meal Plan”, and she has a wealth of information on this topic.�So in this article, you’re going to get the top 10 mistakes low-carb athletes make.
Mistake #1: Being Scared of Fat
The ketogenic diet is quite different from other typical diets. The objective of your lifestyle is to teach the body to utilize ketone bodies rather than glucose as the primary source of energy. That is why the quantity is about 75 to 85+ percent of daily caloric consumption.
Quite simply, if you operate out quite a bit you probably eat about 2,900 calories a day, of which about 2,300 will come from fat should you follow a ketogenic diet. Fat contains 9 calories per gram, and you will eat 256g of fat daily, based on how much you train of course. To simplify this further: all your intake will be approximately 18 tablespoons, one tablespoon of olive oil, for example, weighs approximately 14g.
Mistake #2: Eating Too Much Protein
Another mistake novices make is to substitute most of the carbs they used to consume with protein instead of fat. This happen all of the time. The problem is that excess protein intake can result in gluconeogenesis, which is the conversion of amino acids to glucose. This is not what we need on a ketogenic diet, to the contrary, promote the creation of ketone bodies from fatty acids to keep glucose levels low.
A lot of men and women are amazed when they start weighing their food according to the proper meal plans and realize how small protein they actually must consume on a ketogenic dietplan. But fat is protein sparing, meaning that a high fat consumption is decreased with by your need for protein.
Mistake #3: Carbs Creeping In
Carbohydrates can quickly add up if you’re eager to get your veggies, herbs and spices in. They can in fact be found in products that you’d never think contained carbs.
Good examples are any processed foods, shop bought salad dressings, milk replacements (many almond and coconut milks have added sugar), tomato sauce, a few meats, such as duck confit, starchy vegetables and even herbal tea, to name only a few. Eating out can be challenging because most restaurants prefer to use dressings, sauces and dips that have added alternative or honey sources of sugar. It tastes nice but is not keto-friendly. Having strong, reliable information is key to carb restriction, especially in the first stages when metabolic alterations occur.
Mistake #4: Giving Up Too Early
The faster you enter nutritional ketosis, the more side effects you could suffer from initially. The metabolic changes may be striking because every single cell in the body wants to do the change from glucose. Insulin is influenced: Amounts return because of reduced consumption. Insulin allows the kidneys to hold on to sodium. If insulin is at a lower level, the body starts getting rid of excess sodium and also water.
This is why it’s so important to guarantee you add sufficient sodium to your diet and keep well hydrated, especially in the first few days of beginning to reduce carbohydrates. This will make certain that you don’t suffer from some of the symptoms of the dreaded “keto flu”: shivers, foggy mind, headaches or nausea are some of the possible symptoms. It is probably more appropriate to call them “carbohydrate withdrawal symptoms” because of the effects on hormonal and electrolyte balance.
Things that help to get over these initial obstacles are strong bone broth with good quality salt, a great deal of rest, no extreme exercise and plenty of mineral-rich water, e.g. San Pellegrino. However, the best advice I could give is to take things slowly and not to give up when you are feeling a bit off in the initial phases, provided you’ve done all of the suggested blood tests to exclude any underlying health issues before starting a ketogenic diet.
Mistake #5: Scared of the New; Eating the Same
Many people feel overwhelmed from the first phases of executing a low carb and ketogenic diet. And because they have very little experience with certain new foods, they still keep eating the same “safe” low-carb stuff. For instance bacon and eggs for breakfast and nuts for snacks.
Of course this means that you’re eating low carbohydrate but its often a first priority to always improve their wellness. And this is only possible using a healthy diet. Eating the same things over and over again is dull, it may set you up for having deficiencies and growing food intolerances. This happens quite frequently especially if you’re somewhat worried, your gut function is not optimal or if you’re using medications.
Food intolerances may have an effect not only on your stomach health by causing nausea, bloating, diarrhea, constipation or other symptoms, but also in your immune system. The best advice is to continue experimenting with new foods, even if they seem completely strange to you, such as (for example) chicken liver, that is way easier to find and prepare than you’d think. There is a wonderful recipe for each and every food.
Mistake #6: Eating Processed Foods
This is particularly common for people who have read about the Atkins diet and noticed the products that are sold online and in stores. Yes, they keep you inside the limits that you select and may make life easier but they are also full of artificial flavors, polydextrose, odor, sucralose and other artificial sweeteners that can mess with your psychological and physical health.
A rule of thumb: if you wouldn’t have the ability to bake or cook a meal depending on the components list (because you don’t recognize half of them or wouldn’t know where to buy them), then you should stay away from it. Hopefully, with a growing amount of research to verify the advantages of low carb and ketogenic diets there will be plenty of incentives for companies to create snacks based on real foods.
Mistake #7: Deficiency Of Planning (And Obsessing)
Both absence of preparation and obsessing too much could be stumbling stone. If you don’t plan you’re much more likely to “fail” and give up in your lifestyle modifications. You see, the challenge is that if you realize you haven’t got all you might not find them.
Some of the goods that are staples on a low carb or ketogenic diet like olive oil, olives, fatty fish or ghee can only be bought in health stores or on the internet. More and more supermarkets start to inventory them but this depends where you live. Planning makes it more easy to cook in bulk and save cash and time.
Evidently, it’s a different story for somebody who follows a ketogenic diet for medical reasons, for instance in the case of epilepsy, no mistakes could be made without a consequence and where the diet has to be nicely calculated. But occasionally people become stressed out about dietary modifications that they wake in the middle of the night and can not go back to sleep. They fear what their next meal could look like ketones could be further increased by them or what to eat on a vacation In cases like this, it’s time to choose a (big) step back, relax, try some recipes without weighing and counting and possibly give it another go after a couple of weeks with a great deal of preparation and support. Stressing about meals can cancel the positive effects of good nutrition out.
Mistake #8: Ignoring the Body’s Warning Signs
Trainers who obsess over dietary modifications can get caught up in measuring blood sugar and ketones, weighing their meals all the time, producing exact meal programs and they are able to get really scared of eating out where items are out of their hands. In experience, they are also likely candidates to ignore the warning signs of their body.
Please remember that you just know your body best and that no meal or instruction program can conquer your innate wisdom and intuition. Take warning signs since you have it in your head to adhere to a specific regime, and do not override them. Low carb and ketogenic diets are not for everybody and if you are feeling worse than before, even after getting over the first symptoms talked about before, then it is probably time to stop and reconsider.
Mistake #9: Social Pressure
Even years into following a ketogenic diet, many people get opinions from close friends and family regarding this specific nutritional plan and it can sometimes be difficult for individuals to follow their keto diet close when social pressure pushes them to eat a variety of foods outside of their meal plan.
Ketogenic diets are still very poorly known even by the medical profession. People don’t understand where a few treats are allowed in moderate quantities, that you can not follow the famous 80/20 rule. You are either in ketosis or you’re not.
Mistake #10: Bad Timing
And lastly, lets discuss when to start lowering your carbs or attempting to go into ketosis. Please don’t do it a week before your competition of the season or during a period when you’re super busy at the office.
The best period of the year to make key adjustments to lifestyle and diet is when you are “off season”. Another fantastic time is before a few preparatory competitions to build towards the most important race. That’s when you see how your body responds to intensity and if the diet doesn’t suit you, you have loads of time to make changes.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
Only about 5 to 10 percent of cancer is hereditary, although most cancer scientists have thought that cancer was a disease, states Dr D’Agostino.
A metabolic disorder is one that interrupts normal metabolism, the process of converting food to energy on a cellular level. The mitochondria create the energy that our cells will need to perform their job, and these are usually known as the powerhouses of the cells.
When carbohydrates (composed of glucose) are consumed, they cause the blood glucose levels to rise. The hormone insulin, responsible for regulating energy use, is secreted by the pancreas because it damages the structure of all proteins, as a high blood sugar concentration is toxic for human tissues.
Based on Dr Fettke, we could simply metabolise about one teaspoon (4 grams) of glucose at once and the remainder is stored in the liver and muscles as glycogen, or if this cannot happen, it’s stored as fat.
The longer carbs are ingested, the more glucose is produced, the more our body becomes resistant.
Insulin resistance occurs when the body does not respond to insulin properly. This results in increased blood glucose levels, which can not be saved in muscles or the liver must store it as fat, as discussed by Prof Noakes.
Relation of Insulin and Health
Insulin is consequently the fat storing hormone, which leads to an expanding waist. In case a high carb diet is followed, and if unchecked, it can cause obesity, metabolic syndrome (a combination of hypertension, obesity and hypertension) and to type 2 Diabetes.
The long-term impairment which occurs in Diabetes is because of the effect of always high blood glucose levels on a lot of different organs. If blood glucose levels are high, so too will insulin amounts be, and will consequently add to the damage.
“The more I read the more I’m convinced of the connection between diet and cancer. A lot hinges on stimulating factors involved in metabolism and cellular division, says Dr Gary Fettkesaid
In his study, Dr Elio Riboli notes the higher risk of late onset breast cancer, colon, rectum, endometrial, oesophageal and kidney disorders together with obesity. He explains the link between endometrial cancer and obesity: “Essentially, endometrial cancer is quite closely connected with oestrogen levels. So the tissue there is, the more oestrogens. So there are two outcomes. One is that in the obese, oestrogens are produced by the tissue, converts androgens to oestrogens. The second one is that down-regulating sex hormone binding globulin, insulin, makes oestrogen more bioavailable.
According to Dr Gary Fettke, in his lecture at the LCHF Convention before this season, cancer could be tied up with sugar metabolism. Cancer cells cannot use any additional fuel for growth, except for sugar. Without sugar they starve to death. This theory is based upon the Warburg effect, by Dr Otto Warburg, who won the 1931 Nobel Prize for discovering aerobic glycolysis – a flaw in subcutaneous sugar metabolism which diverts glucose away from energy production to cell development and causes fermentation of sugar. In other words, he discovered that cancer cells thrive on glucose and have mitochondria. Dr Gary Fettke also thinks that the problem with modern cancer treatment is that it ignores the glucose metabolism.
“We also haven’t fully recognised the institution of diet in the causation of cancer. The problem is sugar, especially fructose, refined fats and polyunsaturated seed oils. The modern diet is inflammatory and it generates masses of oxygen free radicals.”
Ketogenic Diet Health Benefits
A low carb, high fat Ketogenic diet (that is in nature the Banting diet, but with carb consumption below 25g per day) has successfully treated many different ailments like obesity, epilepsy, Diabetes, Alzheimer’s and cardiovascular disease. Dr Seyfried requires it a single metabolic procedure for a profusion of ailments that are distinct.
By maintaining carbs below 25g a day, your system moves from a carb burning state to a fat burning state. Ketones are formed when the liver for energy breaks down fatty acids. Ketosis is reached when ketones are formed through withdrawal of carbs within the body. These compounds are generated throughout metabolism — and are a sign that your body is presently using fat for energy. This process forces the body. Prof Noakes explains this in more detail in the Beginner Banting Online Program, in which you may find the tools to stick to a way of life.
“Virtually all the wholesome cells in our body have the metabolic versatility to utilize glucose, fat and ketones to survive, but cancer cells lack this metabolic versatility and require large quantities of sugar and can’t survive on ketones. Therefore by limiting carbohydrates, we could reduce insulin and glucose, and thus limit the key fuel for cancer cell growth.” Says Dr Seyfried. Dr Gary Fettke has a vested interest in this study as he had brain cancer 15 decades ago. He switched to a diet plan and shattered the cancer.
Prof Noakes says, “When fighting cancer, just the finest will do. Grass-fed beef, pasture-reared chickens, organic vegetables, etc.. Since hormones and tainted foods have been fed to animals, pesticides sprayed on veg and genetically modified soya and corn is routinely fed to cows and livestock, one must be dedicated to quality in order to avoid the dangers of the substances, highly carcinogenic independently.”
What to eat and drink on a Ketogenic diet
Animal protein
Saturated fat
Olive oil
Avocado
Above the ground vegetables
Water
What to avoid on a Ketogenic diet
Processed food
Fizzy drinks
Toxic oils
Processed meat
Fast food
Cancer Fighting Foods
Tomatoes: cooking enhances cancer-fighting and anti inflammatory properties. Lycopene was found to prevent cancer cell growth in a study in Cancer and Nutrition.
Chilli: capsaicin that gives chillies their powerful, spicy personality is anti-bacterial, anti-carcinogenic and anti-diabetic.
Cruciferous vegetables: such as cabbage, cauliflower, broccoli, spinach, Brussels sprouts and kale have powerful anti-carcinogens. Cabbage in particular contain anti-oxidants known to help protect against prostate, colon and breast cancers. Broccoli is the only one having a sizable quantity of sulforaphane, an especially potent chemical that boosts the body enzymes and flushes compounds out .
Mushrooms: include the amino acid ergothioneine, which is an anti-oxidant and an anti-inflammatory, it protects against free radicals and boosts the immune system.
Aubergine: that the epidermis is rich in anti-oxidants known as anthocyanins, which are believed to fight cancer, inflammation, aging and neurological diseases.
Turmeric: includes curcumin that’s a powerful anti-oxidant and anti inflammatory. According to Cancer Research UK, it seems to have the ability to kill cancer cells and stop more from growing. It’s the very best consequences on breast cancer, bowel cancer, stomach cancer and skin cancer cells.
Berries: the idea of berries as anticarcinogens began in the late 1980s, when it was discovered that berries, and specifically black peppers, comprised ellagic acid, which is believed to inhibited the genesis of tumours.
Garlic: belongs to the Allium class of bulb-shaped plants, which also includes onions, chives, leeks, and scallions. It’s an strong and excellent neutraliser of free radicals. It contains good levels of selenium and, in several studies, selenium has been shown to decrease cancers. Phytochemicals in garlic have been found to stop the formation of nitrosamines, carcinogens formed in the stomach.
In summary, from the evidence that we have collected from all of the various sources, it’s obvious to see that the link between diet and health is a serious one and that what we consume really has an impact in the long term. Dr D’Agostino goes as far as to state, “let food be thy medicine.”
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
The benefits that come from a ketogenic diet are much like those of any strict low-carb diet. The effect may be greater since protein is significantly more restricted. This raises ketones more, and reduces insulin (the fat-storing hormone).
Weight Loss
Turning your body to some fat-burning machine has clear benefits for weight loss. Fat burning is significantly increased while insulin, the hormone that focuses on fat-storing, drops considerably. This produces the perfect circumstances.
About 20 scientific research of the maximum category (RCTs) reveal that, compared to other diets, low-fat and ketogenic diets result in more effective weight reduction.
Reverse Type 2 Diabetes
A ketogenic diet is excellent for reversing type 2 diabetes, because it lowers blood-sugar levels as well as also helping to reverse the negative effect of elevated insulin levels from this condition.
Improved Mental Focus
Ketosis ends in a steady stream of gas (ketones) to the brain. And on a ketogenic diet you stay away from swings in blood glucose. This contributes to the experience of concentration and attention.
A lot of people use keto diets specifically for improved mental performance. Interestingly, there is a frequent misperception that eating a great deal of carbs6 is necessary for proper brain functioning. When ketones aren’t available but this is only true.
Following a couple of times (up to a week) of keto adaptation, through that people can experience some difficulty concentrating, have headaches and be easily irritated, both the human body and mind can run smoothly on ketones.
Inside this state, lots of men and women experience more energy and enhanced mental focus.
Increased physical endurance
Ketogenic diets may vastly increase your physical endurance, by giving you constant access to all of the energy of your own fat stores.
The body’s source of stored carbohydrates (glycogen) only lasts for a few hours of intense exercise, or less. But your fat stores hold sufficient energy to easily last for weeks or perhaps months.
When you’re accommodated to burning primarily carbs — like most individuals are now — that your fat stores aren’t readily accessible, and they can not fuel your brain. This results in needing to fill up by eating before, during and after exercise sessions that are longer. Or even simply to fuel your everyday activities and prevent “hanger” (hungry and irritable). On a ketogenic diet this dilemma is solved. As the body and brain can be fueled 24/7 from the stores that are powerful, you can keep going.
Whether you are competing in a bodily endurance event, or just trying to remain focused on reaching some other target, your body gets the fuel it needs to keep you going and going.
Two Problems
So how is it possible that the majority of people feel that carbohydrates are essential to do exercise? There are just two reasons. Not, and to unlock the power of ketogenic diets for bodily endurance rather suffer reduced performance, you’ll need:
Enough fluid and salt
Fourteen days of adaptation into burning fat — it does not happen immediately
Metabolic Syndrome
There are many studies demonstrating that low-carb diets improve markers of metabolic syndrome, such as blood lipids, insulin levels, HDL-cholesterol, LDL particle size and fasting blood sugar levels. Improvements have been demonstrated to be greater when carbs and protein are limited to some the point of becoming.
Epilepsy
The ketogenic diet is a proven medical therapy for epilepsy that’s been utilized since the 1920s. Traditionally it has been used in children with uncontrolled epilepsy despite drugs.
More recently it has also been tested successfully by adults with epilepsy, with similar good results. There are randomized controlled trials that demonstrate the potency of the ketogenic diet in seizures in patients with epilepsy.
Employing a ketogenic diet in epilepsy is that usually enables people to take less anti-epileptic drugs, while staying seizure-free. It is not uncommon to even be in a position to completely stop taking these drugs.
As a number of medications have side effects, such as nausea, reduced concentration, personality changes or even reduced IQ — being able to shoot less or no medications can be enormously beneficial.
More Prevalent Advantages
The advantages will be the most frequent ones. However there are many others that are potentially even more unexpected and, at least for some people, lifechanging.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
IFM's Find A Practitioner tool is the largest referral network in Functional Medicine, created to help patients locate Functional Medicine practitioners anywhere in the world. IFM Certified Practitioners are listed first in the search results, given their extensive education in Functional Medicine
People are seemingly obsessed with weight. How to lose it and keep it off, how to re-distribute it to look more attractive. Professionals in integrative and functional medicine are approached regularly for help in this area.
Research has identified certain genes that work together and appear to show that some people retain fat regardless of, or in spite of, exercise.
Integrative and functional medicine practitioners view eating behavior as important for overall health.�
Research indicates taste is only one of the ways genetics affects eating behavior. Caloric intake, meal size, and frequency of eating also appear to be affected. People�s desire for fats, carbohydrates, or proteins also may be influenced by genetics.
Integrative and functional medicine also uses genetic testing to determine the best types of exercise for different people and to explore the likelihood of injuries of several kinds in athletes. This latter area of research and clinical practice can help reduce the number and severity of athletic injuries for adult and child athletes.
The ACTN3 is strongly associated with the protein alpha-actinin-3. This protein is involved exclusively in fast type II muscle fibers that are used in explosive activities. SNP R577X indicates a stop codon at position 577 rather than an arginine (R). An R allele puts athletes at an advantage in power sports. A study of the ACTN3 R577X variant in elite European athletes showed those in power event to be 50 percent less likely to have the XX variant and those involved in endurance events to be 1.88 times more likely to have the XX variant. For world-class endurance athletes, the odds of having the XX variant were 3.7 times larger when compared with lower-level athletes. It appears the ACTN3 gene is more important at the upper levels of sports.
Metabolic syndrome and metabolic health have been studied extensively due to metabolic syndrome being a major risk factor for the development of diabetes mellitus 1 and cardiovascular disease. Genetic and environmental factors interrelate in a complex fashion to bring about this condition. A cluster of metabolic abnormalities, including hypertension, dyslipidemia, abdominal obesity, insulin resistance, and impaired glucose tolerance make up metabolic syndrome.
Feelings of fatigue and lethargy are presented more and more frequently in health care professionals� offices. Combined with concentration difficulties, sleep problems, inability to lose weight, feeling your brain is in a fog, fatigue, and lethargy may point to AFS as the basic issue.
Increasing and unrelenting stress is a part of our culture that is detrimental to the health of every individual. The metabolic component of the NEM model added to the neuroendocrine aspect helps professionals to see how localized organ-specific responses and systemic responses are necessary for successfully dealing with stress.
The mapping of the human genome has provided an opportunity for researchers and clinicians alike to consider the roles genes play in health and wellness. Discovering the presence and effects of single nucleotide polymorphisms (SNPs) has increased not only our knowledge of how genes affect health, but also has given us tools to use in preventing and remediating many chronic illness conditions.
