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10 Signs and Remedies for Thyroid Diseases | Wellness Clinic

10 Signs and Remedies for Thyroid Diseases | Wellness Clinic

It’s estimated that as many as 27 million people in the United States have a thyroid issue, such as Hashimoto’s thyroiditis or Graves’ disease, and half of them don’t have any concept that they do. An under-active thyroid, or hypothyroidism, accounts for approximately 90 percent of all thyroid imbalances.

 

What is the thyroid gland?

 

A butterfly-shaped gland in your neck’s center gland, the thyroid gland, is the master gland of metabolism. Your thyroid gland is inter-related with each system in the human body. If your thyroid isn’t running optimally, then neither are you.

 

10 Signs of an Underactive Thyroid:

 

  • Fatigue after sleeping 8 to 10 hours a night or having to take a rest daily
  • Weight gain or the inability to lose weight
  • Mood issues such as mood swings, anxiety, or depression
  • Hormone imbalances such as PMS, irregular periods, infertility, and reduced sex drive
  • Muscle pain, joint pain, carpal tunnel syndrome, or tendonitis
  • Cold hands and feet, feeling cold when others aren’t, or having a body temperature consistently under 98.5
  • Dry or cracking skin, brittle nails and excess hair loss
  • Constipation
  • Head issues like brain fog, poor concentration, or poor memory
  • Neck swelling, snoring, or hoarse voice

 

How Does the Thyroid Gland Function?

 

Thyroid hormone production is regulated by a feedback loop involving the hypothalamus, pituitary gland, and the thyroid gland. Hypothalamic thyrotropin-releasing hormone (TRH) stimulates pituitary thyrotropin (TSH) secretion and synthesis. In turn, TSH stimulates release and production of T4 and T3 in the thyroid gland. It signals that there’s enough thyroid hormone in flow and not to generate more, when T4 is generated.

 

About 85 percent of this hormone produced by our thyroid gland is T4, which is an inactive form of the hormone. Once T4 is made, a little quantity of it is converted. For complicate matters, T3 also gets converted to either Free T3 (FT3) or Reverse T3 (RT3). It is the Free T3 that actually matters in all of this, as it is the only hormone that could attach to a receptor and cause your metabolism to increase its production, keep you warm, keep your bowels moving, keep your mind working, along with keeping other hormones in check. Reverse T3’s part isn’t well known, however, healthcare professionals have seen it increase under intense stress and in people who have allergies.

 

And finally, Hashimoto’s thyroiditis, an autoimmune disease, is the most common form of hypothyroidism and its numbers are increasing annually. An autoimmune disorder is one in which your body turns on itself and begins to attack a certain organ or tissue believing it’s foreign. Many healthcare professionals regularly screen patients for autoimmune thyroid disease by ordering Thyroid Peroxidase Antibodies (TPOAb) and Thyroglobulin Antibodies (TgAb) tests.

 

Why is Hypothyroidism So Under Recognized?

 

Many symptoms of thyroid imbalance are vague and most doctors spend only a few minutes talking with patients to sort out the cause of the complaint. Most conventional doctors use just a couple of tests (TSH and T4) to display for problems. They aren’t assessing the thyroid gland, RT3 , or FT3.

 

Most traditional doctors utilize the ‘normal’ laboratory reference range as their guide only. Rather than listening to their patients symptoms, they use ‘optimal’ laboratory values and temperature as their guide.

 

Which laboratory tests are better to ascertain if you’ve got a thyroid problem?

 

Healthcare professionals may check the below panel on patients. Make sure your doctor does the same for you.

 

  • TSH
  • Free T4
  • Free T3
  • Reverse T3
  • Thyroid Peroxidase Antibodies (TPOAb)
  • Thyroglobulin Antibodies (TgAb)

 

What are the Optimal Laboratory Values for Thyroid Tests?

 

In various clinics, it has been discovered that the below list are the ranges in which many patients flourish. These may have been recordeded taking how patients are feeling into account and listening to their patients.

 

  • TSH 1-2 UIU/ML or lower (Armour or compounded T3 can artificially suppress TSH)
  • FT4 >1.1 NG/DL
  • FT3 > 3.2 PG/ML
  • RT3 less than a 10:1 ratio RT3:FT3
  • TPO — TgAb — < 4 IU/ML or negative

 

10 Things to Improve Thyroid Function

 

  • Be certain that you are carrying a high quality multivitamin with Iodine, Zinc, Selenium, Iron, Vitamin D, and B vitamins.
  • Also make sure that your multivitamin contains adequate levels of iodine to aid with the FT4 to FT3 conversion.
  • Go gluten-free. In case you have Hashimoto’s thyroiditis, try going entirely grain and legume.
  • Deal with your stress and support your adrenal glands. The adrenal glands and thyroid work hand and hand. It’s necessary to deal with anxiety using healing yoga and adaptogenic herbs, which support the adrenal glands.
  • Get 8 to 10 hours of sleep per night.
  • Possessing a biological dentist safely remove any amalgam fillings you may have.
  • Watch your intake of cruciferous vegetables. There is a bit of a disagreement.
  • Get fluoride, bromide, and chlorine from your diet and surroundings.
  • Heal your gut. A correctly functioning digestive tract (gut) is essential to good health.
  • Locate a functional medicine doctor and have them operate the above mentioned laboratory test and work with you to find out the root cause of the thyroid imbalance.

Reverse Chronic Illnesses So You Can Take Back Your Health

 

Are you ready to conquer your symptoms, regain your energy, and feel like yourself again? When you have Hashimoto’s, Graves’, or any of the hundreds of other autoimmune disorders, it’s important for you to know that you CAN reverse your affliction. Simply follow a healthcare professional’s advice and take back your health.

 

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.

 

blog picture of cartoon paperboy big news

 

TRENDING TOPIC: EXTRA EXTRA: About Chiropractic

 

 

Body Composition Evaluation: A Clinical Practice Tool

Body Composition Evaluation: A Clinical Practice Tool

Body Composition: Key Words

  • Fat-free mass
  • Fat mass
  • Undernutrition
  • Bioelectrical impedance analysis
  • Sarcopenic obesity
  • Drug toxicity

Abstract

Undernutrition is insufficiently detected in in- and outpatients, and this is likely to worsen during the next decades. The increased prevalence of obesity together with chronic illnesses associated with fat-free mass (FFM) loss will result in an increased prevalence of sarcopenic obesity. In patients with sarcopenic obesity, weight loss and the body mass index lack accuracy to detect FFM loss. FFM loss is related to increasing mortality, worse clinical outcomes, and impaired quality of life. In sarcopenic obesity and chronic diseases, body composition measurement with dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or computerized tomography quantifies the loss of FFM. It allows tailored nutritional support and disease-specific therapy and reduces the risk of drug toxicity. Body composition evaluation should be integrated into routine clinical practice for the initial assessment and sequential follow-up of nutritional status. It could allow objective, systematic, and early screening of undernutrition and promote the rational and early initiation of optimal nutritional support, thereby contributing to reducing malnutrition-induced morbidity, mortality, worsening of the quality of life, and global health care costs.

Introduction

man overweight 3D modelChronic undernutrition is characterized by a progressive reduction of the�fat-free mass (FFM) and fat mass (FM)�and �which has deleterious consequences on health. Undernutrition is insufficiently screened and treated in hospitalized or at-risk patients despite its high prevalence and negative impact on mortality, morbidity, length of stay (LOS), quality of life, and costs [1�4]. The risk of underestimating hospital undernutrition is likely to worsen in the next decades because of the increasing prevalence of overweight, obesity, and chronic diseases and the increased number of elderly subjects. These clinical conditions are associated with FFM loss (sarcopenia). Therefore, an increased number of patients with FFM loss and sarcopenic obesity will be seen in the future.

Sarcopenic obesity is associated with decreased survival and increased therapy toxicity in cancer patients [5�10], whereas FFM loss is related to decreased survival, a negative clinical outcome, increased health care costs [2], and impaired overall health, functional capacities, and quality of life [4�11]. Therefore, the detection and treatment of FFM loss is a major issue of public health and health costs [12].

Weight loss and the body mass index (BMI) lack sensitivity to detect FFM loss [13]. In this review, we support the systematic assessment of FFM with a method of body composition evaluation in order to improve the detection, management, and follow-up of undernutrition. Such an approach should in turn reduce the clinical and functional consequences of diseases in the setting of a cost- effective medico-economic approach (fig. 1). We discuss the main applications of body composition evaluation in clinical practice (fig. 2).

body composition fig 1

Fig. 1. Conceptualization of the expected impact of early use of body composition for the screening of fat-free loss and�under-nutrition in sarcopenic overweight and obese subjects. An increased prevalence of overweight and obesity is observed in all Western and emerging countries. Simultaneously, the aging of the population, the reduction of the level of physical activity, and the higher prevalence of chronic dis- eases and cancer increased the number of patients with or at risk of FFM impairment, i.e. sarcopenia. Thus, more patients are presenting with �sarcopenic over- weight or obesity�. In these patients, evaluation of nutritional status using anthropometric methods, i.e. weight loss and calculation of BMI, is not sensitive enough to detect FFM impairment. As a result, undernutrition is not detected, worsens, and negatively impacts morbidity, mortality, LOS, length of recovery, quality of life, and health care costs. On the contrary, in patients with �sarcopenic overweight or obesity�, early screening of undernutrition with a dedicated method of body composition evaluation would allow early initiation of nutritional support and, in turn, improvements of nutritional status and clinical outcome.

Rationale for a New Strategy for the Screening of Undernutrition

Screening of Undernutrition Is Insufficient

checklistAcademic societies encourage systematic screening of undernutrition at hospital admission and during the hospital stay [14]. The detection of undernutrition is generally based on measurements of weight and height, calculations of BMI, and the percentage of weight loss. Nevertheless, screening of undernutrition is infrequent in hospitalized or nutritionally at-risk ambulatory patients. For example, in France, surveys performed by the French Health Authority [15] indicate that: (i) weight alone, (ii) weight with BMI or percentage of weight loss, and (iii) weight, BMI,�and percentage of weight loss are reported in only 55, 30, and 8% of the hospitalized patients� records, respectively. Several issues, which could be improved by specific educational programs, explain the lack of implementation of nutritional screening in hospitals (table 1). In addition, the accuracy of the clinical screening of undernutrition could be limited at hospital admission. Indeed, patients with undernutrition may have the same BMI as sex- and age- matched healthy controls but a significantly decreased FFM hidden by an expansion of the FM and the total body water which can be measured by bioelectrical impedance analysis (BIA) [13]. This example illustrates that body composition evaluation allows a more accurate identification of FFM loss than body weight loss or BMI decrease. The lack of sensitivity and specificity of weight, BMI, and percentage of weight loss argue for the need for other methods to evaluate the nutritional status.

Changes in Patients� Profiles

patient consulting a doctorIn 2008, twelve and thirty percent of the worldwide adult population was obese or overweight; this is two times higher than in 1980 [16]. The prevalence of overweight and obesity is also increasing in hospitalized patients. A 10-year comparative survey performed in a European hospital showed an increase in patients� BMI, together with a shorter LOS [17]. The BMI increase masks undernutrition and FFM loss at hospital admission. The increased prevalence of obesity in an aging population has led to the recognition of a new nutritional entity: �sarcopenic obesity� [18]. Sarcopenic obesity is characterized by increased FM and reduced FFM with a normal or high body weight. The emergence of the concept of sarcopenic obesity will increase the number of situations associated with a lack of sensitivity of the calculations of BMI and�body weight change for the early detection of FFM loss. This supports a larger use of body composition evaluation for the assessment and follow-up of nutritional status in clinical practice (fig. 1).

body composition fig 2Fig. 2. Current and potential applications of body composition evaluation in clinical practice. The applications are indicated in the boxes, and the body composition methods that could be used for each application are indicated inside the circles. The most used application of body composition evaluation is the measurement of bone mineral density by DEXA for the diagnosis and management of osteoporosis. Although a low FFM is associated with worse clinical outcomes, FFM evaluation is not yet implemented enough in clinical practice. However, by allowing early detection of undernutrition, body composition evaluation could improve the clinical outcome. Body composition evaluation could also be used to follow up nutritional status, calculate energy needs, tailor nutritional support, and assess fluid changes during perioperative period and renal insufficiency. Recent evidence indicates that�a low FFM is associated with a higher toxicity of some chemo- therapy drugs in cancer patients. Thus, by allowing tailoring of the chemotherapy doses to the FFM in cancer patients, body com- position evaluation should improve the tolerance and the efficacy of chemotherapy. BIA, L3-targeted CT, and DEXA could be used for the assessment of nutritional status, the calculation of energy needs, and the tailoring of nutritional support and therapy. Further studies are warranted to validate BIA as an accurate method for fluid balance measurement. By integrating body composition evaluation into the management of different clinical conditions, all of these potential applications would lead to a better recognition of nutritional care by the medical community, the health care facilities, and the health authorities, as well as to an increase in the medico-economic benefits of the nutritional evaluation.

Body Composition Evaluation For The Assessment Of Nutritional Status

Body composition evaluation is a valuable technique to assess nutritional status. Firstly, it gives an evaluation of nutritional status through the assessment of FFM. Secondly, by measuring FFM and phase angle with BIA, it allows evaluation of the disease prognosis and outcome.

body composition table 1

body composition table 2Body Composition Techniques For FFM Measurement

Body composition evaluation allows measurement of the major body compartments: FFM (including bone mineral tissue), FM, and total body water. Table 2 shows indicative values of the body composition of a healthy subject weighing 70 kg. In several clinical situations, i.e. hospital admission, chronic obstructive pulmonary dis- ease (COPD) [21�23], dialysis [24�26], chronic heart failure [27], amyotrophic lateral sclerosis [28], cancer [5, 29], liver transplantation [30], nursing home residence [31], and Alzheimer�s disease [32], changes in body compartments are detected with the techniques of body composition evaluation. At hospital admission, body composition evaluation could be used for the detection of FFM loss and undernutrition. Indeed, FFM and the FFM index (FFMI) [FFM (kg)/height (m2)] measured by BIA are significantly lower in hospitalized patients (n = 995) than in age-, height-, and sex-matched controls (n = 995) [3]. Conversely, clinical tools of nutritional status assessment, such as BMI, subjective global assessment, or mini-nutritional assessment, are not accurate enough to estimate FFM loss and nutritional status [30, 32�34]. In 441 patients with non-small cell lung cancer, FFM loss deter- mined by computerized tomography (CT) was observed in each BMI category [7], and in young adults with all�types of cancer, an increase in FM together with a de- crease in FFM were reported [29]. These findings reveal the lack of sensitivity of BMI to detect FFM loss. More- over, the FFMI is a more sensitive determinant of LOS than a weight loss over 10% or a BMI below 20 [3]. In COPD, the assessment of FFM by BIA is a more sensitive method to detect undernutrition than anthropometry [33, 35]. BIA is also more accurate at assessing nutrition- al status in children with severe neurologic impairment than the measurement of skin fold thickness [36].

Body Composition For The Evaluation Of Prognosis & Clinical Outcome

FFM loss is correlated with survival in different clinical settings [5, 21�28, 37]. In patients with amyotrophic lateral sclerosis, an FM increase, but not an FFM in- crease, measured by BIA, was correlated with survival during the course of the disease [28]. The relation between body composition and mortality has not yet been demonstrated in the intensive care unit. The relation between body composition and mortality has been demonstrated with anthropometric methods, BIA, and CT. Measurement of the mid-arm muscle circumference is an easy tool to diagnose sarcopenia [38]. The mid-arm muscle circumference has been shown to be correlated with survival in patients with cirrhosis [39, 40], HIV infection [41], and COPD in a stronger way than BMI [42]. The relation between FFM loss and mortality has been extensively shown with BIA [21�28, 31, 37], which is the most used method. Recently, very interesting data suggest that CT could evaluate the disease prognosis in relation to muscle wasting. In obese cancer patients, sarcopenia as assessed by CT measurement of the total skeletal muscle cross-sectional area is an independent predictor of the survival of patients with bronchopulmonary [5, 7], gastrointestinal [5], and pancreatic cancers [6]. FFM assessed by measurement of the mid-thigh muscle cross- sectional area by CT is also predictive of mortality in COPD patients with severe chronic respiratory insufficiency [43]. In addition to mortality, a low FFMI at hospital admission is significantly associated with an in- creased LOS [3, 44]. A bicentric controlled population study performed in 1,717 hospitalized patients indicates that both loss of FFM and excess of FM negatively affect the LOS [44]. Patients with sarcopenic obesity are most at risk of increased LOS. This study also found that ex- cess FM reduces the sensitivity of BMI to detect nutritional depletion [44]. Together with the observation that the BMI of hospitalized patients has increased during the last decade [17], these findings suggest that FFM and�FFMI measurement should be used to evaluate nutritional status in hospitalized patients.

BIA measures the phase angle [45]. A low phase angle is related to survival in oncology [46�50], HIV infection/ AIDS [51], amyotrophic lateral sclerosis [52], geriatrics [53], peritoneal dialysis [54], and cirrhosis [55]. The phase angle threshold associated with reduced survival is variable: less than 2.5 degrees in amyotrophic lateral sclerosis patients [52], 3.5 degrees in geriatric patients [53], from less than 1.65 to 5.6 degrees in oncology patients [47�50], and 5.4 degrees in cirrhotic patients [55]. The phase angle is also associated with the severity of lymphopenia in AIDS [56], and with the risk of postoperative complications among gastrointestinal surgical patients [57]. The relation of phase angle with prognosis and disease severity reinforces the interest in using BIA for the clinical management of patients with chronic diseases at high risk of undernutrition and FFM loss.

In summary, FFM loss or a low phase angle is related to mortality in patients with chronic diseases, cancer (in- cluding obesity cancer patients), and elderly patients in long-stay facilities. A low FFM and an increased FM are associated with an increased LOS in adult hospitalized patients. The relation between FFM loss and clinical out- come is clearly shown in patients with sarcopenic obesity. In these patients, as the sensitivity of BMI for detecting FFM loss is strongly reduced, body composition evalua- tion appears to be the method of choice to detect under- nutrition in routine practice. Overall, the association between body composition, phase angle, and clinical outcome reinforces the pertinence of using a body com- position evaluation in clinical practice.

Which Technique Of Body Composition Evaluation Should Be Used For The Assessment Of Nutritional Status?

Numerous methods of body composition evaluation have been developed: anthropometry, including the 4-skinfold method [58], hydrodensitometry [58], in vivo neutron activation analysis [59], anthropogammametry from total body potassium-40 [60], nuclear magnetic resonance [61], dual-energy X-ray absorptiometry (DEXA) [62, 63], BIA [45, 64�66], and more recently CT [7, 43, 67]. DEXA, BIA, and CT appear to be the most convenient methods for clinical practice (fig. 2), while the other methods are reserved for scientific use.

Compared with other techniques of body composition evaluation, the lack of reproducibility and sensitivity of the 4-skinfold method limits its use for the accurate measurement of body composition in clinical practice [33,�34]. However, in patients with cirrhosis [39, 40], COPD [34], and HIV infection [41], measurement of the mid- arm muscle circumference could be used to assess sarcopenia and disease-related prognosis. DEXA allows non- invasive direct measurement of the three major components of body composition. The measurement of bone mineral tissue by DEXA is used in clinical practice for the diagnosis and follow-up of osteoporosis. As the clinical conditions complicated by osteoporosis are often associated with undernutrition, i.e. elderly women, patients with organ insufficiencies, COPD [68], inflammatory bowel diseases, and celiac disease, DEXA could be of the utmost interest for the follow-up of both osteoporosis and nutritional status. However, the combined evaluation of bone mineral density and nutritional status is difficult to implement in clinical practice because the reduced accessibility of DEXA makes it impossible to be performed in all nutritionally at-risk or malnourished patients. The principles and clinical utilization of BIA have been largely described in two ESPEN position papers [45, 66]. BIA is based on the capacity of hydrated tissues to conduct electrical energy. The measurement of total body impedance allows estimation of total body water by assuming that total body water is constant. From total body water, validated equations allow the calculation of FFM and FM [69], which are interpreted according to reference values [70]. BIA is the only technique which allows calculation of the phase angle, which is correlated with the prognosis of various diseases. BIA equations are valid for: COPD [65]; AIDS wasting [71]; heart, lung, and liver transplantation [72]; anorexia nervosa [73] patients, and elderly subjects [74]. However, no BIA-specific equations have been validated in patients with extreme BMI (less than 17 and higher than 33.8) and dehydration or fluid overload [45, 66]. Nevertheless, because of its simplicity, low cost, quickness of use at bedside, and high interoperator reproducibility, BIA appears to be the technique of choice for the systematic and repeated evaluation of FFM in clinical practice, particularly at hospital admission and in chronic diseases. Finally, through written and objective re- ports, the wider use of BIA should allow improvement of the traceability of nutritional evaluation and an increase in the recognition of nutritional care by the health authorities. Recently, several data have suggested that CT images targeted on the 3rd lumbar vertebra (L3) could strongly predict whole-body fat and FFM in cancer patients, as compared with DEXA [7, 67]. Interestingly, the evaluation of body composition by CT presents great practical significance due to its routine use in patient diagnosis, staging, and follow-up. L3-targeted CT images�evaluate FFM by measuring the muscle cross-sectional area from L3 to the iliac crest by use of Hounsfield unit (HU) thresholds (�29 to +150) [5, 7]. The muscles included in the calculation of the muscle cross-sectional area are psoas, paraspinal muscles (erector spinae, quadratus lumborum), and abdominal wall muscles (transversus abdominis, external and internal obliques, rectus ab- dominis) [6]. CT also provided detail on specific muscles, adipose tissues, and organs not provided by DEXA or BIA. L3-targeted CT images could be theoretically per- formed solely, since they result in X-ray exposition similar to that of a chest radiography.

In summary, DEXA, BIA, and L3-targeted CT images could all measure body composition accurately. The technique selection will depend on the clinical context, hard- ware, and knowledge availability. Body composition evaluation by DEXA should be performed in patients having a routine assessment of bone mineral density. Also, analysis of L3-targeted CT is the method of choice for body composition evaluation in cancer patients. Body composition evaluation should also be done for every abdominal CT performed in patients who are nutritionally at risk or undernourished. Because of its simplicity of use, BIA could be widely implemented as a method of body com- position evaluation and follow-up in a great number of hospitalized and ambulatory patients. Future research will aim to determine whether a routine evaluation of body composition would allow early detection of the in- creased FFM catabolism related to critical illness [75].

Body Composition Evaluation For The Calculation Of Energy Needs

vegetable-juicesThe evaluation of FFM could be used for the calculation of energy needs, thus allowing the optimization of nutritional intakes according to nutritional needs. This could be of great interest in specific situations, such as severe neurologic disability, overweight, and obesity. In 61 children with severe neurologic impairment and intellectual disability, an equation integrating body composition had good agreement with the doubly labeled water method. It gave a better estimation of energy expenditure than did the Schofield predictive equation [36]. However, in 9 anorexia nervosa patients with a mean BMI of 13.7, pre- diction formulas of resting energy expenditure including FFM did not allow accurate prediction of the resting energy expenditure measured by indirect calorimetry [76]. In overweight or obese patients, the muscle catabolism in response to inflammation was the same as that observed�in patients with normal BMI. Indeed, despite a higher BMI, the FFM of overweight or obese individuals is similar (or slightly increased) to that of patients with normal BMI. Thus, the use of actual weight for the assessment of the energy needs of obese patients would result in over- feeding and its related complications. Therefore, the ex- perts recommend the use of indirect calorimetry or calculation of the energy needs of overweight or obese patients as follows: 15 kcal/kg actual weight/day or 20�25 kcal/kg ideal weight/day [77, 78], although these predictive formulas could be inaccurate in some clinical conditions [79]. In a US prospective study conducted in 33 ICU medical and surgical ventilated ICU patients, daily measurement of the active cell mass (table 2) by BIA was used to assess the adequacy between energy/protein intakes and needs. In that study, nutritional support with 30 kcal/ kg actual body weight/day energy and 1.5 g/kg/day protein allowed stabilization of the active cell mass [75]. Thus, follow-up of FFM by BIA could help optimize nutritional intakes when indirect calorimetry cannot be performed.

In summary, the measurement of FFM should help ad- just the calculation of energy needs (expressed as kcal/kg FFM) and optimize nutritional support in critical cases other than anorexia nervosa.

Body Composition Evaluation For The Follow-Up & Tailoring Of Nutritional Support

towel different nutritionBody composition evaluation allows a qualitative assessment of body weight variations. The evaluation of body composition may help to document the efficiency of nutritional support during a patient�s follow-up of numerous clinical conditions, such as surgery [59], anorexia nervosa [76, 80], hematopoietic stem cell transplantation [81], COPD [82], ICU [83], lung transplantation [84], ulcerative colitis [59], Crohn�s disease [85], cancer [86, 87], HIV/AIDS [88], and acute stroke in elderly patients [89]. Body composition evaluation could be used for the follow-up of healthy elderly subjects [90]. Body composition evaluation allows characterization of the increase in body mass in terms of FFM and FM [81, 91]. After hematopoietic stem cell transplantation, the increase in BMI is the result of the increase in FM, but not of the increase in FFM [81]. Also, during recovery after an acute illness, weight gain 6 months after ICU discharge could be mostly related to an increase in FM (+7 kg) while FFM only increased by 2 kg; DEXA and air displacement plethysmography were used to measure the FM and FFM [91]. These two examples suggest that body composition evaluation could be helpful to decide the modification and/or the renewal of nutritional support. By identifying the patients gaining weight but reporting no or insufficient FFM, body composition evaluation could contribute to influencing the medical decision of continuing nutrition- al support that would have been stopped in the absence of body composition evaluation.

In summary, body composition evaluation is of the utmost interest for the follow-up of nutritional support and its impact on body compartments.

Body Composition Evaluation For Tailoring Medical Treatments

In clinical situations when weight and BMI do not reflect the FFM, the evaluation of body composition should be used to adapt drug doses to the FFM and/or FM absolute values in every patient. This point has been recently illustrated in oncology patients with sarcopenic obesity. FFM loss was determined by CT as described above. In cancer patients, some therapies could affect body com- position by inducing muscle wasting [92]. In patients with advanced renal cell carcinoma [92], sorafenib induces a significant 8% loss of skeletal muscular mass at 12 months. In turn, muscle wasting in patients with BMI less than 25 was significantly associated with sorafenib toxicity in patients with metastatic renal cancer [8]. In metastatic breast cancer patients receiving capecitabine treatment, and in patients with colorectal cancer receiving 5-fluorouracile, using the convention of dosing per unit of body surface area, FFM loss was the determinant of chemotherapy toxicity [9, 10] and time to tumor progression [10]. In colorectal cancer patients administered 5-fluoruracil, low FFM is a significant predictor of toxicity only in female patients [9]. The variation in toxicity between women and men may be partially explained by the fact that FFM was lower in females. Indeed, FFM rep- resents the distribution volume of most cytotoxic chemo- therapy drugs. In 2,115 cancer patients, the individual variations in FFM could change by up to three times the distribution volume of the chemotherapy drug per body area unit [5]. Thus, administering the same doses of chemotherapy drugs to a patient with a low FFM compared to a patient with a normal FFM would increase the risk of chemotherapy toxicity [5]. These data suggest that FFM loss could have a direct impact on the clinical outcome of cancer patients. Decreasing chemotherapy doses in case of FFM loss could contribute to improving cancer patients� prognosis through the improvement of the tolerance of chemotherapy. These findings justify the systematic evaluation of body composition in all cancer patients in order to detect FFM loss, tailor chemotherapy doses according to FFM values, and then improve the efficacy- tolerance and cost-efficiency ratios of the therapeutic strategies [93]. Body composition evaluation should also be used to tailor the doses of drugs which are calculated based on patients� weight, e.g. corticosteroids, immuno-suppressors (infliximab, azathioprine or methotrexate), or sedatives (propofol).

In summary, measurement of FFM should be implemented in cancer patients treated with chemotherapy. Clinical studies are needed to demonstrate the importance of measuring body composition in patients treated with other medical treatments.

Towards The Implementation Of Body Composition Evaluation In Clinical Practice

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News Letter

hypertension blood pressure pillsThe implementation of body composition evaluation in routine care presents a challenge for the next decades. Indeed the concomitant increases in elderly subjects and patients with chronic diseases and cancer, and in the prevalence of overweight and obesity in the population, will increase the number of patients nutritionally at risk or undernourished, particularly those with sarcopenic obesity. Body composition evaluation should be used to improve the screening of undernutrition in hospitalized patients. The results of body composition should be based on the same principle as BMI calculation, towards the systematic normalization for body height of FFM (FFMI) and FM [FM (kg)/height (m)2 = FM index] [94]. The results could be expressed according to previously de- scribed percentiles of healthy subjects [95, 96]. Body com- position evaluation should be performed at the different stages of the disease, during the course of treatments and the rehabilitation phase. Such repeated evaluations of body composition could allow assessment of the nutritional status, adjusting the calculation of energy needs as kilocalories/kilogram FFM, following the efficacy of nutritional support, and tailoring drug and nutritional therapies. BIA, L3-targeted CT, and DEXA represent the techniques of choice to evaluate body composition in clinical practice (fig. 2). In the setting of cost-effective and pragmatic use, these three techniques should be alternatively chosen. In cancer, undernourished, and nutritionally at-risk patients, an abdominal CT should be completed by the analysis of L3-targeted images for the evaluation of body composition.

In other situations, BIA appears to be the simplest most reproducible and less expensive method, while DEXA, if feasible, remains the reference method for clinical practice. By allowing earlier management of undernutrition, body composition evaluation can contribute to reducing malnutrition-induced morbidity and mortality, improving the quality of life and, as a consequence, increasing the medico-economic benefits (fig. 1). The latter needs to be demonstrated. Moreover, based on a more scientific approach, i.e. allowing for printing reports, objective initial assessment and follow-up of nutritional status, and the adjustment of drug doses, body composition evaluation would contribute to a better recognition of the activities related to nutritional evaluation and care by the medical community, health care facilities, and health authorities (fig. 2).

Conclusion

woman buying fresh organic vegetables

Screening of undernutrition is insufficient to allow for optimal nutrition care. This is in part due to the lack of sensitivity of BMI and weight loss for detecting FFM loss in patients with chronic diseases. Methods of body com- position evaluation allow a quantitative measurement of FFM changes during the course of disease and could be used to detect FFM loss in the setting of an objective, systematic, and early undernutrition screening. FFM loss is closely related to impaired clinical outcomes, survival, and quality of life, as well as increased therapy toxicity in cancer patients. Thus, body composition evaluation should be integrated into clinical practice for the initial assessment, sequential follow-up of nutritional status, and the tailoring of nutritional and disease-specific therapies. Body composition evaluation could contribute to strengthening the role and credibility of nutrition in the global medical management, reducing the negative impact of malnutrition on the clinical outcome and quality of life, thereby increasing the overall medico-economic benefits.

Acknowledgements

R. Thibault and C. Pichard are supported by research grants from the public foundation Nutrition 2000 Plus.

Disclosure Statement

Ronan Thibault and Claude Pichard declare no conflict of interest.

 

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Close Accordion
Excessive Weight Gain, Obesity, And Cancer

Excessive Weight Gain, Obesity, And Cancer

Opportunities For Clinical Intervention

Even though the effects of overweight and obesity on diabetes, cardiovascular disease, all-cause mortality, and other health outcomes are widely known, there is less awareness that overweight, obesity, and weight gain are associated with an increased risk of certain cancers. A recent review of more than 1000 studies concluded that sufficient evidence existed to link weight gain, overweight, and obesity with 13 cancers, including adenocarcinoma of the esophagus; cancers of the gastric cardia, colon and rectum, liver, gallbladder, pancreas, corpus uteri, ovary, kidney, and thyroid; postmenopausal female breast cancer; meningioma; and multiple myeloma.1�An 18-year follow-up of almost 93?000 women in the Nurses� Health Study revealed a dose-response association of weight gain and obesity with several cancers.2

Obesity Increase

obesity man eating oversized burger outside el paso txThe prevalence of obesity in the United States has been increasing for almost 50 years. Currently, more than two-thirds of adults and almost one-third of children and adolescents are overweight or obese. Youths who are obese are more likely to be obese as adults, compounding their risk for health consequences such as cardiovascular disease, diabetes, and cancer. Trends in many of the health consequences of overweight and obesity (such as type 2 diabetes and coronary heart disease) also are increasing, coinciding with prior trends in rates of obesity. Furthermore, the sequelae of these diseases are related to the severity of obesity in a dose-response fashion.2�It is therefore not surprising that obesity accounts for a significant portion of health care costs.

Cancers

obesity cancer-cells microsope el paso tx

A report released on October 3, 2017, by the US Centers for Disease Control and Prevention assessed the incidence of the 13 cancers associated with overweight and obesity in 2014 and the trends in these cancers over the 10-year period from 2005 to 2014.3�In 2014, more than 630?000 people were diagnosed as having a cancer associated with overweight and obesity, comprising more than 55% of all cancers diagnosed among women and 24% of cancers among men. Most notable was the finding that cancers related to overweight and obesity were increasingly diagnosed among younger people.

obesity man sits at beach el paso txFrom 2005 to 2014, there was a 1.4% annual increase in cancers related to overweight and obesity among individuals aged 20 to 49 years and a 0.4% increase in these cancers among individuals aged 50 to 64 years. For example, if cancer rates had stayed the same in 2014 as they were in 2005, there would have been 43?000 fewer cases of colorectal cancer but 33?000 more cases of other cancers related to overweight and obesity. Nearly half of all cancers in people younger than 65 years were associated with overweight and obesity. Overweight and obesity among younger people may exact a toll on individuals� health earlier in their lifetimes.2�Given the time lag between exposure to cancer risk factors and cancer diagnosis, the high prevalence of overweight and obesity among adults, children, and adolescents may forecast additional increases in the incidence of cancers related to overweight and obesity.

Clinical Intervention

obesity doctor in surgery room el paso tx

Since the release of the landmark 1964 surgeon general�s report on the health consequences of smoking, clinicians have counseled their patients to avoid tobacco and on methods to quit and provided referrals to effective programs to reduce their risk of chronic diseases including cancer. These efforts, coupled with comprehensive public health and policy approaches to reduce tobacco use, have been effective�cigarette smoking is at an all-time low. Similar efforts are warranted to prevent excessive weight gain and treat children, adolescents, and adults who are overweight or obese. Clinician referral to intense, multicomponent behavioral intervention programs to help patients with obesity lose weight can be an important starting point in improving a patient�s health and preventing diseases associatedwith obesity. The benefits of maintaining a healthy weight throughout life include improvements in a wide variety of health outcomes, including cancer. There is emerging but very preliminary data that some of these cancer benefits may be achieved following weight loss among people with overweight or obesity.4

The US Preventive Services Task Force (USPSTF)

obesity woman doctors office blood pressure taken el paso txThe US Preventive Services Task Force (USPSTF) recommends screening for obesity and intensive behavioral interventions delivered over 12 to 16 visits for adults and 26 or more visits for children and adolescents with obesity.5,6�Measuring patients� weight, height, and body mass index (BMI), consistent with USPSTF recommendations, and counseling patients about maintaining a healthy weight can establish a foundation for preventive care in clinical care settings. Scientific data continue to emerge about the negative health effects of weight gain, including an increased risk of cancer.1�Tracking patients� weight over time can identify those who could benefit from counseling and referral early and help them avoid additional weight gain. Yet less than half of primary care physicians regularly assess the BMI of their adult, child, and adolescent patients. Encouraging discussions about weight management in multiple health care settings, including physicians� offices, clinics, emergency departments, and hospitals, can provide multiple opportunities for patients and reinforce messages across contexts and care environments.

Weight Loss Programs

obesity young men working out in gym el paso txImplementation of clinical interventions, including screening, counseling, and referral, has major challenges. Since 2011, Medicare has covered behavioral counseling sessions for weight loss in primary care settings. However, the benefit has not been widely utilized.7�Whether the lack of utilization is a consequence of lack of clinician or patient knowledge or for other reasons remains uncertain. Few medical schools and residency programs provide adequate training in prevention and management of obesity or in understanding how to make referrals to such services. Obesity is a highly stigmatized condition; many clinicians find it difficult to initiate a conversation about obesity with patients, and some may inadvertently use alienating language when they do. Studies indicate that patients with obesity prefer the use of terms such as�unhealthy weight�or�increased BMI�rather than�overweight�or�obesity�and�improved nutrition and physical activity�rather than�diet and exercise.8�However, it is unknown if switching to these terms will lead to more effective behavioral counseling. Effective clinical decision support tools to measure BMI and guide physicians through referral and counseling interventions can provide clinicians needed support within the patient-clinician encounter. Inclusion of recently developed competencies for prevention and management of obesity into the curricula of health care professionals may improve their ability to deliver effective care. Because few primary care clinicians are trained in behavior change strategies like cognitive behavioral therapy or motivational interviewing, other trained health care professionals, such as nurses, pharmacists, psychologists, and dietitians could assist by providing counseling and appropriate referrals and help people manage their own health.

woman being tempted devil angel shoulder cake fruit obesity el paso txAchieving sustainable weight loss requires comprehensive strategies that support patients� efforts to make significant lifestyle changes. The availability of clinical and community programs and services to which to refer patients is critically important. Although such programs are available in some communities, there are gaps in availability. Furthermore, even when these programs are available, enhancing linkages between clinical and community care could improve patients� access. Linking community obesity prevention, weight management, and physical activity programs with clinical services can connect people to valuable prevention and intervention resources in the communities where they live, work, and play. Such linkages can give individuals the encouragement they need for the lifestyle changes that maintain or improve their health.

two men stomach cut out healthy obesity unhealthy el paso txThe high prevalence of overweight and obesity in the United States will continue to contribute to increases in health consequences related to obesity, including cancer. Nonetheless, cancer is not inevitable; it is possible that many cancers related to overweight and obesity could be prevented, and physicians have an important responsibility in educating patients and supporting patients� efforts to lead healthy lifestyles. It is important for all health care professionals to emphasize that along with quitting or avoiding tobacco, achieving and maintaining a healthy weight are also important for reducing the risk of cancer.

Targeting Obesity

Article Information

Greta M.�Massetti,�PhD1;�William H.�Dietz,�MD, PhD2;�Lisa C.�Richardson,�MD, MPH1

Author Affiliations

Corresponding Author:�Greta M. Massetti, PhD, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341 ([email protected]).

Conflict of Interest Disclosures:�All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflict of Interest. Dr Dietz reports receipt of scientific advisory board fees from Weight Watchers and consulting fees from RTI. No other disclosures were reported.

Disclaimer:�The findings and conclusions in this report are those of the authors and not necessarily the official position of the Centers for Disease Control and Prevention.

References

1. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K; International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer�viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794-798. PubMed Article

2. Zheng Y, Manson JE, Yuan C, et al. Associations of weight gain from early to middle adulthood with major health outcomes later in life. JAMA. 2017;318(3):255-269. PubMed Article

3. Steele CB, Thomas CC, Henley SJ, et al. Vital Signs: Trends in Incidence of Cancers Related to Overweight and Obesity�United States, 2005-2014. October 3, 2017. https://www.cdc.gov/mmwr/volumes/66/wr/mm6639e1.htm?s_cid=mm6639e1_w.

4. Byers T, Sedjo RL. Does intentional weight loss reduce cancer risk? Diabetes Obes Metab. 2011;13(12):1063-1072. PubMed Article

5. Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417-2426. PubMed Article

6. US Preventive Services Task Force. Final Recommendation Statement: Obesity in Adults: Screening and Management. December 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-adults-screening-and-management. Accessed September 21, 2017.

7. Batsis JA, Bynum JPW. Uptake of the centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988. PubMed Article

8. Puhl R, Peterson JL, Luedicke J. Motivating or stigmatizing? public perceptions of weight-related language used by health providers. Int J Obes (Lond). 2013;37(4):612-619. PubMed Article

Nutrition Counseling In A Clinical Practice

Nutrition Counseling In A Clinical Practice

Wellness Chiropractor, Dr. Alexander Jimenez takes a look at discussing nutrition with patients in a clinical setting.

How Clinicians Can Do Better

Despite overwhelming evidence that relatively small dietary changes can significantly improve health, clinicians seldom discuss nutrition with their patients. Poor nutritional intake and nutrition-related health conditions, such as cardiovascular disease (CVD), diabetes, obesity, hypertension, and many cancers, are highly prevalent in the United States,1 yet only 12% of office visits include counseling about diet.2 Even among high- risk patients with CVD, diabetes, or hyperlipidemia, only 1 in 5 receive nutrition counseling.2 It is likely that many patients receive most of their nutrition information from other, and often unreliable, sources.

These data may reflect the minimal training, time, and reimbursement allocated to nutrition counseling (and preventive services in general) in clinical practice.3 Most physicians and other health care professionals receive limited education on nutrition in medical school (or other professional schools) or in postgraduate training. Just 25% of medical schools offer a dedicated nutrition course, a decline since the status of nutrition education in US medical schools was first assessed in 1985, and few medical schools achieve the 30 hours of nutrition education recommended by the National Academy of Sciences.4 As a result, physicians report inadequate nutrition knowledge and low self-efficacy for counseling patients about diet.3 In addition, time pressures, especially in primary care, limit opportunities to counsel on nutrition or address preventive issues beyond patients� acute complaints. Lack of time is frequently cited as the greatest barrier to counseling on nutrition and obesity.3

Moreover, nutrition and behavioral counseling have traditionally been non-reimbursed services. Few state Medicaid programs cover nutrition or obesity counseling, and before 2012, Medicare explicitly excluded coverage for obesity counseling; although now a reimbursed service for Medicare beneficiaries, just 1% of eligible Medicare beneficiaries receive this counseling.5 Dietitian counseling is also excluded by Medicare, unless patients have diabetes or renal disease. Although the Affordable Care Act mandates coverage for services graded A or B by the US Preventive Services Task Force, including nutrition counseling for patients with CVD risk factors and obesity counseling for patients with a body mass index of 30 or greater, existing private health insurance benefits are in- consistent, and the covered services are often unclear to both clinicians and patients, thereby limiting use.

Furthermore, health behavior change counseling is often frustrating given the current food environment, in which less nutritious foods tend to be less expensive, larger portioned, more easily accessible, and more heavily marketed than healthier options, making patient adherence 6 to nutrition advice challenging. Conflicting and confusing nutrition messages from popular books, blogs, and other media further complicate patient decision making.

Despite these unfavorable trends, there has been progress in this area. The evidence base supporting the benefits of nutrition intervention and behavioral counseling is expanding. Renewed focus on nutrition education in health care professional training is being driven by both student demand and the health care system. Although time pressures and reimbursement remain impediments, incentives and reimbursement options for nutrition and behavioral counseling are growing, and value-based care and health care team approaches hold promise to better align time demands and incentives for long-term care management. Initiatives to integrate clinical care and community resources offer opportunities to leverage resources that alleviate the clinician�s time commitment. There is evidence of some success; for instance, the amount of sugar-sweetened beverages consumed by individuals in the United States has declined substantially over the past 10 years.7

Clinicians can take the following reasonable steps to include nutrition counseling into the flow of daily practice:

1. Start the conversation. Several short, validated screen- ing questionnaires are available to quickly assess need for nutrition counseling, such as the Starting the Conversation tool8 (Table). This approach can be efficiently used prior to seeing the patient at an appointment, either delivered by medical assistants as part of vital sign assessment or as prescreening paperwork for patients to complete online or in the waiting room.

2. Structure the encounter.�Using methods such as the �5 A�s� (assess, advise, agree, assist, arrange), which has been adapted from tobacco counseling. Motivational interviewing, which has documented efficacy in numerous behavior change settings, is particularly helpful to engage patients who are not yet committed or are hesitant to consider behavioral change.

3. Focus on small steps. Changing lifelong nutrition behaviors can seem overwhelming, but even exceedingly small shifts can have an effect (Table). For example, increasing fruit intake by just 1 serving per day has the estimated potential to reduce cardiovascular mortality risk by 8%, the equivalent of 60 000 fewer deaths annually in the United States and 1.6 million deaths globally.9 Other examples include reducing intake of sugar-sweetened beverages, fast food meals, processed meats, and sweets, while increasing vegetables, legumes, nuts, and whole grains. Emphasize to patients that every food choice is an opportunity to accrue benefits, and even small ones add up. Small substitutions still allow for �treats,� such as replacing potato chips and cheese dip with tortilla chips and salsa, the latter lowering trans fats and saturated fat and increasing whole grain and vegetable intake (Table).

4. Use available resources. Numerous extracurricular resources are readily available for clinicians. The Nutrition in Medicine program offers online, evidence-based nutrition education and tutorials for clinicians and an online, core nutrition curriculum for medical students. The Dietary Guidelines for Americans offers evidence- based and freely available nutrition guidance, tutorials, and tools for clinicians and patients alike. A companion website, Choose My Plate, offers nutrition and counseling advice for clinicians and handy resources for patients, including recently added videos with useful examples of small substitutions that patients will appreciate.

5. Do not do it all at once. Expecting to create long-term behavioral change during a single episode of care is a recipe for frustration and failure, for both the patient and clinician. Empowering and sup- porting patients is an ongoing process, not a 1-time curative event. Use a few minutes at the close of a patient visit to identify opportunities for future counseling, offer to serve as a resource, and be- gin a discussion and support that can be reinforced over time. Take solace in knowing that small initial steps can quickly improve health; for example, reducing trans fats at a single meal (eg, replacing baked goods with fruit or nuts or fried foods with non-fried alternatives) promptly improves endothelial function.10

6. Do not do it all alone.�The primary care physician need not be the sole clinician who provides nutrition counseling. Proactive use of physician extenders (eg, physician assistants, nurses, medical assistants, and health coaches) and referrals can alleviate much of the burden for the busy clinician. Receptionists can distribute assessment and screening questionnaires for patients to complete in the waiting room; medical assistants can document behavioral change progress while assessing vital signs; administrative staff can identify and con- tact patients who are overdue for interaction. Large practices may benefit from including nutrition or health coaches on staff. Referring to clinical specialists and community-based support programs can significantly extend the clinician�s reach.7 In addition to registered dietitians, numerous clinical and community resources are available and often covered by insurance plans. Board-certified obesity medicine specialists, certified diabetes educators, and physician nutrition specialists are available as referrals in many areas. Diabetes Prevention Program group counseling sessions are now covered by Medicare and available throughout communities, such as in many YMCA sites, and electronically.

Summary

Although there is no conclusive evidence that these steps will improve diet and health outcomes for patients, there is virtually no harm in counseling and the potential gains, especially at the population level, are substantial. Nutrition and health behavior change must become a core competency for virtually all physicians and any other health professionals working with patients who have or are at risk for nutrition-related chronic disease.

A Healthier You

 

Scott Kahan, MD, MPH Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and George Washington University School of Medicine, Washington, DC.

JoAnn E. Manson, MD, DrPH Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts; and Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.

ARTICLE INFORMATION
Published Online: September 7, 2017. doi:10.1001/jama.2017.10434 Conflict of Interest Disclosures: All authors have
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

REFERENCES

1. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62.
2. Office of Disease Prevention and Health Promotion. Healthy People 2020. https://www.healthypeople.gov/2020/data-search/Search-the-Data#srch=nutrition. Accessed January 23, 2017.
3. Kolasa KM, Rickett K. Barriers to providing nutrition counseling cited by physicians. Nutr Clin Pract. 2010;25(5):502-509.
4. Adams KM, Kohlmeier M, Zeisel SH. Nutrition education in U.S. medical schools: latest update of a national survey. Acad Med. 2010;85(9):1537-1542.
5. Batsis JA, Bynum JPW. Uptake of the Centers for Medicare and Medicaid obesity benefit: 2012-2013. Obesity (Silver Spring). 2016;24(9):1983-1988.
6. Kahan S, Cheskin LJ. Obesity and eating behaviors and behavior change. In: Kahan S, Gielen AC, Fagan PJ, Green LW, eds. Health Behavior Change in Populations. Baltimore, MD: Johns Hopkins University Press; 2014:chap 13.
7. Rehm CD, Pe�alvo JL, Afshin A, Mozaffarian D. Dietary intake among US adults, 1999-2012.JAMA. 2016;315(23):2542-2553.
8. Paxton AE, Strycker LA, Toobert DJ, Ammerman AS, Glasgow RE. Starting the conversation performance of a brief dietary assessment and intervention tool for health professionals. Am J Prev Med. 2011;40(1):67-71.
9. Mozaffarian D, Capewell S. United Nations� dietary policies to prevent cardiovascular disease. BMJ. 2011;343:d5747.
10. Williams MJA, Sutherland WHF, McCormick MP, de Jong SA, Walker RJ, Wilkins GT. Impaired endothelial function following a meal rich in used cooking fat.J Am Coll Cardiol. 1999;33(4):1050-1055

Keto Diet: Ketones vs Glucose for Brain Function | Advanced Nutrition

Keto Diet: Ketones vs Glucose for Brain Function | Advanced Nutrition

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.

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10 Common Ketogenic Diet Mistakes for Athletes | Advanced Fitness

10 Common Ketogenic Diet Mistakes for Athletes | Advanced Fitness

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.

blog picture of cartoon paperboy big news

 

TRENDING TOPIC: EXTRA EXTRA: New PUSH 24/7�? Fitness Center

 

 

Ketogenic Diet: Preventive for Insulin Resistance and Cancer? | Nutrition

Ketogenic Diet: Preventive for Insulin Resistance and Cancer? | Nutrition

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.

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