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Metabolic Syndrome and Chiropractic Body Wellness

Metabolic Syndrome and Chiropractic Body Wellness

Metabolic syndrome is the term for a group of risk factors like heart disease, diabetes, along with other health issues. The number of individuals dealing with the condition could be as high as 1 in 4. An individual can have one risk factor but most have several in combination. When there are three of these risk factors it becomes metabolic syndrome. The syndrome is a collection of conditions, that culminate in a correlative diagnosis. Risk factors/Symptoms include some or all of the following:
  • High blood pressure
  • High blood sugar
  • Increased triglycerides
  • Low HDL cholesterol
  • Obesity
11860 Vista Del Sol, Ste. 128 Metabolic Syndrome and Chiropractic Body Wellness
 
The disease can lead to:
  • Gastrointestinal distress
  • Insulin resistance
  • Heart attack
  • Stroke
  • Heart disease
If left untreated and continued poor life choices that include unhealthy diet, lack of physical activity/exercise, and habit formation an individual can die from complications of the syndrome. The condition requires clinical treatment and medical assistance, however, chiropractic has been seen as a viable way to help treat the syndrome.

Causes

The syndrome can have several causes that progress together:
  • Age the risk goes up as an individual gets older
  • Genetics and family history
  • Weight issues
  • Physical inactivity
  • Insulin resistance, a condition where the body can’t use insulin properly
  • The resistance can lead to high blood sugar levels
Individuals with metabolic syndrome tend to have excessive blood clotting and inflammation throughout the body. However, research has not shown whether these conditions cause the syndrome or worsen it.
 

Chiropractic

Chiropractic�s role is to stabilize the spine and the body. Too much weight leads to spinal dislocation and vertebral compression issues. This can lead to nerve impingement and disc problems. Even a small subluxation can turn into an extreme condition/s with widespread symptoms. Individuals that are overweight require a spinal realignment in order to gain proper stability. A chiropractor will administer corrective adjustments to generate the body’s natural healing process in the affected areas. Restoring the nerve pathways will promote better blood flow and nutrient delivery to and through the spine. Chiropractic will set the tone for a metabolic syndrome reversal. The second phase of treatment will look at diet and exercise. This serves a dual purpose of introducing proper nutrition to the body, encouraging weight loss, and conditioning the individual’s mindset for the lifestyle adjustments/changes. A healthy/balanced spine will help those with metabolic syndrome get a proper foothold on turning their poor lifestyle into a healthy one.
11860 Vista Del Sol, Ste. 128 Metabolic Syndrome and Chiropractic Body Wellness
 

Reversal

The syndrome can be reversed with the right treatment approach. Usually, this begins with weight loss. Once the weight begins to reduce the secondary benefits kick in. This includes a reduction in blood pressure and a decrease in triglycerides. Once an individual’s spine is stable, they will then be educated on how to adapt and apply a long-term plan to maintain healthy habits for diet, physical activity, sleep, and stress relief strategies. As chiropractors focus on whole-body wellness, treatment plans will also look at: Remember, the spine is the root of the body. The key to wellness is total body balance. All-natural chiropractic medicine can help achieve optimal health.
 

Weight Loss Doctor of Chiropractic


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Samson, Susan L, and Alan J Garber. �Metabolic syndrome.��Endocrinology and metabolism clinics of North America�vol. 43,1 (2014): 1-23. doi:10.1016/j.ecl.2013.09.009
Functional Neurology: Obesity and Thyroid Dysfunction

Functional Neurology: Obesity and Thyroid Dysfunction

The endocrine system is made up of a collection of glands that release hormones that regulate a variety of bodily functions, including metabolism. The thyroid gland is a large, butterfly-shaped organ found in the center of the neck. The thyroid gland secretes three hormones, known as triiodothyronine (T3), thyroxine (T4), and calcitonin, in response to stimulation from the pituitary gland which secretes a compound, known as the thyroid-stimulating hormone (TSH). However, if the thyroid gland produces too little or too many hormones, it can ultimately cause a variety of health issues, including obesity. �

 

According to the American Association of Clinical Endocrinologists, approximately 27 million people in the United States have thyroid dysfunction. Healthcare professionals found a connection between diabetes and thyroid dysfunction. People with obesity and diabetes have an increased risk of developing thyroid dysfunction compared with the healthy population. Because the thyroid gland regulates metabolism, thyroid dysfunction can cause various metabolic health issues. Thyroid dysfunction can frequently occur due to iodine deficiency, autoimmune diseases, and surgery. �

 

How Thyroid Dysfunction Can Cause Obesity

 

Research studies demonstrated that thyroid dysfunction can ultimately lead to obesity. Understanding the connection between obesity and thyroid dysfunction can help reduce the risk of developing a variety of other health issues, including cancer. Thyroid dysfunction is associated with changes in body weight and composition, temperature, and energy. In a recent research study, 27,097 participants above 40 years of age with a body mass index (BMI) of at least 30.0 kg/m2, scientists found that thyroid dysfunction was associated with a higher BMI and an increased risk of developing obesity. �

 

Thyroid-stimulating hormone (TSH) levels are higher in people with obesity, according to research studies. Scientists also demonstrated that TSH levels appear to be closely associated with the degree of obesity and BMI. Surprisingly, research studies also found increased T3 levels in participants with obesity. Progressive fat accumulation was associated with an increase in TSH and T3 levels, regardless of insulin resistance and metabolic parameters. The ratio between T3 and T4 was also associated with both BMI and waist circumference in people with obesity, according to the research studies. �

 

Although people with obesity have increased TSH levels, their TSH receptors are frequently less expressed compared with healthy people. The reduced TSH receptor expression can ultimately cause thyroid dysfunction, further increasing TSH and T3 levels. Fortunately, healthcare professionals demonstrated that weight loss can help regulate thyroid function. Thyroid dysfunction can be reversed following weight loss due to diet and lifestyle modifications or surgery. Weight loss can also cause a considerable reduction in both TSH and T3. The decrease in T3 levels during weight loss can also increase energy. �

 

According to research studies, reduced T3 levels can make it difficult to maintain or promote weight loss. Evidence suggesting that TSH and T3 levels increase in people with obesity while TSH and T3 levels are reduced during weight loss supports the hypothesis that changes in thyroid function in people with obesity may be reversible through weight loss. However, it’s frequently challenging to identify participants with obesity who are only affected by mild thyroid dysfunction. Healthcare professionals should suspect thyroid dysfunction in people with obesity that also have increased TSH levels. �

 

Healthcare professionals determined that evaluating the thyroid gland using ultrasound may not necessarily help diagnose possible thyroid dysfunction in people with obesity. As a matter of fact, the moderate increase in TSH levels is frequently associated with an increase in thyroid volume and hypoechogenicity, or the reduced response of an organ using ultrasound, with an ultrasound pattern that suggests Hashimoto thyroiditis. Furthermore, the increased hypoechogenicity in people with obesity is associated with increased cytokines and other inflammatory markers produced by adipose tissue. �

 

The increased cytokines and inflammatory markers can ultimately increase TSH levels, increasing the size of the thyroid and leading to vasodilatation and increased thyroid vessel permeability with increased parenchymal inhibition of the thyroid gland which may be responsible for the hypoechogenicity with ultrasound. Average TSH was demonstrated to be higher in people with obesity compared with healthy people. It is essential to understand that�an ultrasound pattern suggesting Hashimoto thyroiditis may also suggest autoimmune diseases associated with thyroid dysfunction and obesity. �

 

Dr. Alex Jimenez Insights Image

The endocrine system is made up of a collection of glands, such as the thyroid gland, which release several different types of hormones that regulate a variety of bodily functions, including metabolism. The thyroid gland is a large, butterfly-shaped organ found in the center of the neck and it plays a fundamental role in the secretion of three hormones, including triiodothyronine (T3), thyroxine (T4), and calcitonin, following stimulation from the pituitary gland, which secretes a compound known as the thyroid-stimulating hormone (TSH). However, thyroid dysfunction can ultimately cause a variety of health issues, including obesity. According to the American Association of Clinical Endocrinologists, approximately 27 million people in the United States have thyroid dysfunction. Because the thyroid gland regulates metabolism, thyroid dysfunction can also cause various metabolic health issues. Thyroid dysfunction can frequently occur due to iodine deficiency, autoimmune diseases, and surgery, according to research studies. Scientists demonstrated a connection between thyroid dysfunction and obesity. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The endocrine system is made up of a collection of glands that release hormones that regulate a variety of bodily functions, including metabolism. The thyroid gland is a large, butterfly-shaped organ found in the center of the neck. The thyroid gland secretes three hormones, known as triiodothyronine (T3), thyroxine (T4), and calcitonin, in response to stimulation from the pituitary gland which secretes a compound, known as thyroid-stimulating hormone (TSH). However, if the thyroid gland produces too little or too many hormones, it can ultimately cause a variety of health issues, including obesity. �

 

According to the American Association of Clinical Endocrinologists, approximately 27 million people in the United States have thyroid dysfunction. Healthcare professionals found a connection between diabetes and thyroid dysfunction. People with obesity and diabetes have an increased risk of developing thyroid dysfunction compared with the healthy population. Because the thyroid gland regulates metabolism, thyroid dysfunction can cause various metabolic health issues. Thyroid dysfunction can frequently occur due to iodine deficiency, autoimmune diseases, and surgery. �

 

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.�

 

Curated by Dr. Alex Jimenez �

 

References:

  1. Doheny, Kathleen. �Does Underactive Thyroid Lead To Weight Gain-Or Vice-Versa?� EndocrineWeb, 16 Dec. 2019, www.endocrineweb.com/news/obesity/55275-does-underactive-thyroid-lead-weight-gain-vice-versa.
  2. Biondi, Bernadette. �Thyroid and Obesity: An Intriguing Relationship.� OUP Academic, Oxford University Press, 1 Aug. 2010, academic.oup.com/jcem/article/95/8/3614/2596481.
  3. Jacques, Jacqueline. �The Role of Your Thyroid in Metabolism and Weight Control.� Obesity Action Coalition, 2009, www.obesityaction.org/community/article-library/the-role-of-your-thyroid-in-metabolism-and-weight-control/.

Additional Topic Discussion: Chronic Pain

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance. �

 

 


 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention. �

 

Food Sensitivity for the IgG & IgA Immune Response

Food Sensitivity Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate health issues associated with a variety of food sensitivities and intolerances. The Food Sensitivity ZoomerTM is an array of 180 commonly consumed food antigens that offers very specific antibody-to-antigen recognition. This panel measures an individual�s IgG and IgA sensitivity to food antigens. Being able to test IgA antibodies provides additional information to foods that may be causing mucosal damage. Additionally, this test is ideal for patients who might be suffering from delayed reactions to certain foods. Utilizing an antibody-based food sensitivity test can help prioritize the necessary foods to eliminate and create a customized diet plan around the patient�s specific needs. �

 

Gut Zoomer for Small Intestinal Bacterial Overgrowth (SIBO)

Gut Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate gut health associated with small intestinal bacterial overgrowth (SIBO). The Vibrant Gut ZoomerTM offers a report that includes dietary recommendations and other natural supplementation like prebiotics, probiotics, and polyphenols. The gut microbiome is mainly found in the large intestine and it has more than 1000 species of bacteria that play a fundamental role in the human body, from shaping the immune system and affecting the metabolism of nutrients to strengthening the intestinal mucosal barrier (gut-barrier). It is essential to understand how the number of bacteria that symbiotically live in the human gastrointestinal (GI) tract influences gut health because imbalances in the gut microbiome may ultimately lead to gastrointestinal (GI) tract symptoms, skin conditions, autoimmune disorders, immune system imbalances, and multiple inflammatory disorders. �

 


Dunwoody Labs: Comprehensive Stool with Parasitology | El Paso, TX Chiropractor


GI-MAP: GI Microbial Assay Plus | El Paso, TX Chiropractor


 

Formulas for Methylation Support

Xymogen Formulas - El Paso, TX

 

XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call our office in order for us to assign a doctor consultation for immediate access.

 

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download

 

* All of the above XYMOGEN policies remain strictly in force.

 


 

 


 

Modern Integrated Medicine

The National University of Health Sciences is an institution that offers a variety of rewarding professions to attendees. Students can practice their passion for helping other people achieve overall health and wellness through the institution’s mission. The National University of Health Sciences prepares students to become leaders in the forefront of modern integrated medicine, including chiropractic care. Students have an opportunity to gain unparalleled experience at the National University of Health Sciences to help restore the natural integrity of the patient and define the future of modern integrated medicine. �

 

 

Functional Neurology: What You Need to Know About Obesity and Depression

Functional Neurology: What You Need to Know About Obesity and Depression

Doctors understand that people with depression can experience weight gain and over time, it may eventually lead to obesity if left untreated. Depression is also associated with poor eating habits, overeating, and a more sedentary lifestyle. According to the Centers for Disease Control and Prevention (CDC), approximately 43 percent of people with depression have excess weight or obesity. In a 2002 research study, scientists found that children with depression had an increased risk of suffering from obesity. In the following article, we will discuss what you need to know about obesity and depression. �

Understanding Obesity and Depression

Mental health issues, such as anxiety and depression, are associated with obesity. A 2010 research study found that about 55 percent of people with obesity had an increased risk of developing depression and other mental health issues compared to “healthy” people. Moreover, obesity can also cause a variety of other health issues, including joint pain, hypertension, and diabetes, among others. Anxiety, by way of instance, can also ultimately cause depression and obesity. Scientists believe that stress can make people turn to food as a coping mechanism. This can eventually lead to excess weight gain and obesity. �

 

Scientists were once hesitant to connect obesity and depression, however, further evidence from numerous research studies has demonstrated that excess weight or obesity can cause a variety of mental health issues like anxiety and depression. Many doctors utilize a multi-pronged treatment approach to help improve a patient’s mental and physical health. Scientists still don’t quite understand how obesity is closely associated with depression but it is clear that there’s a connection between obesity and depression. Furthermore, research studies demonstrated that mental health issues may also cause obesity. �

 

The Connection Between Obesity and Depression

Obesity and depression, as well as any other mental health issues, are can also cause a variety of other health issues if left untreated, including chronic pain, coronary heart disease, hypertension, sleep problems, and diabetes. Fortunately, all of these health issues can be properly diagnosed, treated, and prevented by following a proper treatment program. Treating the underlying source of a patient’s depression, by way of instance, may help restore their energy in order to help them participate in exercise and physical activities. Engaging in exercise and physical activities may, in turn, help patients lose weight. �

 

Dietary and lifestyle modifications can also be utilized to help treat a variety of mental and physical health issues, including obesity and depression. It’s essential to seek immediate medical attention from qualified and experienced doctors who can help guide patients in the right direction. If you’ve ever experienced any of the following red-flags, symptoms, or side-effects, including loss of all interest in regular activities that you used to enjoy, an inability to get up from bed or leave your house, abnormal sleep patterns, feeling tired or fatigued, and weight gain, talk to your doctor about what you can do. �

 

Dealing with Obesity and Depression

A strategic treatment plan for obesity and depression can ultimately be different, however, several methods and techniques can also help improve the underlying source of the other health issue. You can reduce your risk of developing obesity and depression by following proper nutritional or dietary guidelines and engaging in exercise or physical activities. Participating in exercise or physical activities is a great way to naturally help boost endorphins as well as neurotransmitters like dopamine and serotonin that help boost and balance mood, ultimately helping you lose weight and feel better. �

 

Research studies demonstrated that engaging in exercise or physical activities at least once per week can have a considerable effect on symptoms of depression. Doctors also understand that when you have depression, finding the motivation to participate in exercise or physical activities can be challenging. Doctors recommend taking small steps, such as engaging in 10 minutes of exercise or physical activities every day, may help people get in the habit of participating in exercise or physical activities. Talk to your doctor about the right amount of exercise or physical activity that you should do. �

 

Talking to a therapist or psychologist is a well-known treatment approach for a variety of mental and physical health issues. From anxiety and depression to excess weight and obesity, a therapist or psychiatrist can help you process the emotional factors that may be causing the underlying source of your health issues. They can also help you embrace changes that will help you improve your quality of life. Following a strategic treatment plan and always being honest with your healthcare professional may ultimately help improve obesity and depression as well as any symptoms, side-effects, and complications. �

 

Obesity and depression are well-known health issues that need long-term care and attention. It�s essential to talk to your doctor regardless of whether you�re following your strategic treatment plan. Being honest about what you are and aren�t doing is the only way for your doctor to understand and help with your underlying health issues. Your doctor is your best resource for information and they�ll work with you to find the best treatment for your needs, help you create a healthier lifestyle, and hold you accountable for the changes you seek. People with obesity and depression can ultimately restore their wellness. �

 

Dr. Alex Jimenez Insights Image

Research studies demonstrated that obesity is associated with mental health issues like anxiety and depression. Doctors understand that people with depression can experience weight gain and over time, it may eventually lead to obesity if left untreated. Depression is also associated with poor eating habits, overeating, and a more sedentary lifestyle. According to the Centers for Disease Control and Prevention (CDC), approximately 43 percent of people with depression have excess weight or obesity. In a 2002 research study, scientists found that children with depression had an increased risk of suffering from obesity. In the following article, we will discuss what you need to know about obesity and depression, including the connection between obesity and depression as well as dealing with these mental and physical health issues, among others. Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

Doctors understand that people with depression can experience weight gain and over time, it may eventually lead to obesity if left untreated. Depression is also associated with poor eating habits, overeating, and a more sedentary lifestyle. According to the Centers for Disease Control and Prevention (CDC), approximately 43 percent of people with depression have excess weight or obesity. In a 2002 research study, scientists found that children with depression had an increased risk of suffering from obesity. In the article above, we will ultimately discuss what you need to know about obesity and depression. �

 

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.�

 

Curated by Dr. Alex Jimenez �

 

References:

  • Holland, Kimberly. �Are Obesity and Depression Related? And 9 Other FAQs.� Healthline, Healthline Media, 11 May 2018, www.healthline.com/health/depression/obesity-and-depression.

 


 

Neurotransmitter Assessment Form

Neurotransmitter Assessment Form AE260 (1)

 

The following Neurotransmitter Assessment Form can be filled out and presented to Dr. Alex Jimenez. The following symptoms listed on this form are not intended to be utilized as a diagnosis of any type of disease, condition, or any other type of health issue. �

 


 

Additional Topic Discussion: Chronic Pain

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance. �

 

 


 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention. �

 

Food Sensitivity for the IgG & IgA Immune Response

Food Sensitivity Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate health issues associated with a variety of food sensitivities and intolerances. The Food Sensitivity ZoomerTM is an array of 180 commonly consumed food antigens that offers very specific antibody-to-antigen recognition. This panel measures an individual�s IgG and IgA sensitivity to food antigens. Being able to test IgA antibodies provides additional information to foods that may be causing mucosal damage. Additionally, this test is ideal for patients who might be suffering from delayed reactions to certain foods. Utilizing an antibody-based food sensitivity test can help prioritize the necessary foods to eliminate and create a customized diet plan around the patient�s specific needs. �

 

Gut Zoomer for Small Intestinal Bacterial Overgrowth (SIBO)

Gut Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate gut health associated with small intestinal bacterial overgrowth (SIBO). The Vibrant Gut ZoomerTM offers a report that includes dietary recommendations and other natural supplementation like prebiotics, probiotics, and polyphenols. The gut microbiome is mainly found in the large intestine and it has more than 1000 species of bacteria that play a fundamental role in the human body, from shaping the immune system and affecting the metabolism of nutrients to strengthening the intestinal mucosal barrier (gut-barrier). It is essential to understand how the number of bacteria that symbiotically live in the human gastrointestinal (GI) tract influences gut health because imbalances in the gut microbiome may ultimately lead to gastrointestinal (GI) tract symptoms, skin conditions, autoimmune disorders, immune system imbalances, and multiple inflammatory disorders. �

 


Dunwoody Labs: Comprehensive Stool with Parasitology | El Paso, TX Chiropractor


GI-MAP: GI Microbial Assay Plus | El Paso, TX Chiropractor


 

Formulas for Methylation Support

Xymogen Formulas - El Paso, TX

XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

Please call our office in order for us to assign a doctor consultation for immediate access.

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download

 

* All of the above XYMOGEN policies remain strictly in force.

 


 

 


 

Modern Integrated Medicine

The National University of Health Sciences is an institution that offers a variety of rewarding professions to attendees. Students can practice their passion for helping other people achieve overall health and wellness through the institution’s mission. The National University of Health Sciences prepares students to become leaders in the forefront of modern integrated medicine, including chiropractic care. Students have an opportunity to gain unparalleled experience at the National University of Health Sciences to help restore the natural integrity of the patient and define the future of modern integrated medicine. �

 

 

Functional Neurology: How Obesity Can Affect Brain Health

Functional Neurology: How Obesity Can Affect Brain Health

Research studies demonstrated that brain health may ultimately be associated with obesity. Scientists also reported that obesity affects the overall size and function of the brain, as well as specifically altering certain neuronal circuits. By way of instance, a recent research study found a connection between smaller brain size and lower gray matter volume associated with obesity around the stomach region. Another research study also found that the prefrontal cortex, an essential area in the brain that plays a fundamental role in thinking, planning, and self-control, is less active in people with obesity.   Several other research studies have also found further evidence showing the connection between brain health and obesity. Dr. Ilona A. Dekkers, from the Leiden University Medical Center in the Netherlands, utilized MRI scans in several recent research studies to understand how obesity can affect the size and function of the brain. Dr. Dekkers reported lower gray matter volume in people with obesity. According to the research studies, people with obesity also had white matter volume changes in a variety of brain regions. In the following article, we will ultimately discuss how obesity can affect brain health.  

Obesity Can Change How You Look and Feel

Recent research studies demonstrated that obesity can affect brain health. Ranjana Mehta, an assistant professor of environmental and occupational health at the Texas A&M Health Science Center School of Public Health in College Station, Texas discussed how obesity doesn’t simply affect how you look and feel, it can affect your mental and physical health as well as cause a variety of brain health issues. Ranjana Mehta, who received funding from the National Institute on Aging to evaluate how obesity can affect brain health in older adults determined that obesity can affect brain structure and cause atrophy.  

Obesity Can Alter the Way You Move

People with obesity have to carry extra weight that can add stress and pressure on the joints, ultimately altering movement. Scientists utilized imaging methods and techniques to demonstrate how people with obesity often have to utilize more mental resources when walking, although they were still able to walk as well as healthy people. Moreover, research studies found that stress and pressure from carrying extra weight affected brain activity in people with obesity compared to healthy people. The additional mental burden associated with obesity may also cause individuals to become tired more quickly.  

Obesity Can Influence Your Memory

Obesity is associated with poor memory, often making it difficult to remember past events in young adults between 18 to 35 years of age, according to a research study published in the Quarterly Journal of Experimental Psychology. Further evidence also suggests that people with obesity experience memories in slightly less detail and/or less vividly compared to healthy people. Lucy Cheke, lead researcher and a lecturer in the department of psychology at the University of Cambridge in England discussed that memory can play a fundamental role in regulating what we eat and how we lose weight.  

Obesity Can Lead to Dementia and Alzheimer’s Disease

Other research studies demonstrated that obesity in people during their 40s, 50s, and even early 60s is associated with an increased risk of developing dementia and Alzheimer’s disease. According to Heather Snyder, senior director of medical and scientific operations at the Alzheimer’s Association, mid-life obesity is connected with an increased risk of developing dementia and Alzheimer’s disease over time with age. Scientists still don’t understand how obesity can cause dementia and Alzheimer’s disease, however, obesity can ultimately affect heart health which can play a fundamental role in brain health.  

Obesity Can Cause Depression

As previously mentioned, obesity can ultimately affect mental and physical health. Dr. Susan McElroy, chief research officer at the Lindner Center of HOPE, a private psychiatric facility in Mason, Ohio, who has also evaluated the connection between obesity and mental health issues described that obesity can cause depression. Scientists believe that just like obesity can cause major depression, it may also cause bipolar disorder. Furthermore, scientists believe that depression itself may, in turn, also cause obesity. McElroy suggests that obesity and depression both need to be addressed to make progress.  

Obesity Can Rewire the Pleasure-and-Reward Center

In a research study published in the Journal of Neuroscience, a region of the brain, known as the striatum, was demonstrated to be less active in people with obesity. The striatum plays a fundamental role in controlling the pleasure-and-reward center in the brain associated with the release of the neurotransmitter or chemical messenger known as dopamine. The release of dopamine we get from eating certain foods, such as foods that are high in sugars and fats, can have a dulling effect in people with obesity which scientists believe can cause a person to overeat to regain that fleeting sense of pleasure.   Dr. Alex Jimenez Insights Image
Research studies demonstrated that obesity may ultimately affect the brain. By way of instance, a recent research study found a connection between smaller brain size and lower gray matter volume associated with obesity. According to the research studies, people with obesity also had white matter volume changes in various brain regions. Several other research studies have also found further evidence showing the connection between obesity and brain health. In the following article, we will ultimately discuss how obesity can affect brain health, from changing how you look and feel to causing depression. Dr. Alex Jimenez D.C., C.C.S.T. Insight
 

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.�

  Curated by Dr. Alex Jimenez   References:
  • Sandoiu, Ana. �How Might Obesity Affect the Brain?� Medical News Today, MediLexicon International, 27 Apr. 2019, www.medicalnewstoday.com/articles/325054.php#1.
  • Wlassoff, Viatcheslav. �How Obesity Affects the Human Brain.� World of Psychology, World of Psychology Media, 8 July 2018, psychcentral.com/blog/how-obesity-affects-the-human-brain/.
  • Schroeder, Michael O. �6 Ways Obesity Can Weigh on the Brain.� U.S. News & World Report, U.S. News & World Report, 12 May 2016, health.usnews.com/wellness/slideshows/6-ways-obesity-can-weigh-on-the-brain.
 
 

Neurotransmitter Assessment Form

[wp-embedder-pack width=”100%” height=”1050px” download=”all” download-text=”” attachment_id=”52657″ /]   The following Neurotransmitter Assessment Form can be filled out and presented to Dr. Alex Jimenez. The following symptoms listed on this form are not intended to be utilized as a diagnosis of any type of disease, condition, or any other type of health issue.  
 

Additional Topic Discussion: Chronic Pain

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance.    
 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor   Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention.  

Food Sensitivity for the IgG & IgA Immune Response

Food Sensitivity Zoomer | El Paso, TX Chiropractor   Dr. Alex Jimenez utilizes a series of tests to help evaluate health issues associated with a variety of food sensitivities and intolerances. The Food Sensitivity ZoomerTM is an array of 180 commonly consumed food antigens that offers very specific antibody-to-antigen recognition. This panel measures an individual�s IgG and IgA sensitivity to food antigens. Being able to test IgA antibodies provides additional information to foods that may be causing mucosal damage. Additionally, this test is ideal for patients who might be suffering from delayed reactions to certain foods. Utilizing an antibody-based food sensitivity test can help prioritize the necessary foods to eliminate and create a customized diet plan around the patient�s specific needs.  

Gut Zoomer for Small Intestinal Bacterial Overgrowth (SIBO)

Gut Zoomer | El Paso, TX Chiropractor   Dr. Alex Jimenez utilizes a series of tests to help evaluate gut health associated with small intestinal bacterial overgrowth (SIBO). The Vibrant Gut ZoomerTM offers a report that includes dietary recommendations and other natural supplementation like prebiotics, probiotics, and polyphenols. The gut microbiome is mainly found in the large intestine and it has more than 1000 species of bacteria that play a fundamental role in the human body, from shaping the immune system and affecting the metabolism of nutrients to strengthening the intestinal mucosal barrier (gut-barrier). It is essential to understand how the number of bacteria that symbiotically live in the human gastrointestinal (GI) tract influences gut health because imbalances in the gut microbiome may ultimately lead to gastrointestinal (GI) tract symptoms, skin conditions, autoimmune disorders, immune system imbalances, and multiple inflammatory disorders.  
Dunwoody Labs: Comprehensive Stool with Parasitology | El Paso, TX Chiropractor
GI-MAP: GI Microbial Assay Plus | El Paso, TX Chiropractor
 

Formulas for Methylation Support

Xymogen Formulas - El Paso, TX

  XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call our office in order for us to assign a doctor consultation for immediate access.

 

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900. xymogen el paso, tx For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download   * All of the above XYMOGEN policies remain strictly in force.  
   
 

Modern Integrated Medicine

The National University of Health Sciences is an institution that offers a variety of rewarding professions to attendees. Students can practice their passion for helping other people achieve overall health and wellness through the institution’s mission. The National University of Health Sciences prepares students to become leaders in the forefront of modern integrated medicine, including chiropractic care. Students have an opportunity to gain unparalleled experience at the National University of Health Sciences to help restore the natural integrity of the patient and define the future of modern integrated medicine.    
Functional Neurology: Brain Health and Obesity

Functional Neurology: Brain Health and Obesity

Research studies demonstrated that brain health may ultimately be associated with obesity. Scientists also reported that obesity affects the overall size and function of the brain, as well as specifically altering certain neuronal circuits. By way of instance, a recent research study found a connection between smaller brain size and lower gray matter volume associated with obesity around the stomach region. Another research study also found that the prefrontal cortex, an essential area in the brain that plays a fundamental role in thinking, planning, and self-control, is less active in people with obesity. �

 

Scientists also demonstrated that a variety of specific brain cells or neuron can alter overeating habits in people with obesity. Several other research studies have also found further evidence showing the connection between brain health and obesity.�Dr. Ilona A. Dekkers, from the Leiden University Medical Center in the Netherlands, utilized MRI scans to understand how obesity can affect the size and function of the brain. Dr. Dekkers reported lower gray matter volume in people with obesity. Dr. Ilona A. Dekkers also found evidence between the structure of the brain and obesity, known as morphology. �

 

How Obesity Can Affect Brain Health

Dr. Dekkers and her group of colleagues demonstrated in a series of research studies how obesity can affect the size and function of the brain because previous research studies found an increased risk of cognitive problems and dementia in people with obesity. Scientists evaluated brain scans from more than 12,000 people who participated in the United Kingdom Biobank Imaging research study. The brain imaging methods and techniques that Dr. Dekkers and her group of colleagues utilized in the research study demonstrated additional insights into the participants’ gray and white matter volume. �

 

In another recent research study, Dr. Ilona A. Dekkers and her group of colleagues found that obesity is associated with smaller volumes of essential structures in the brain, including gray matter structures that are found in the center of the brain. Scientists also demonstrated that gender can affect the connection between fat percentage and specific brain structures. According to the research studies, men with obesity had lower gray matter volume in brain regions associated with movement while women with obesity had lower gray matter volume in the globus pallidus, a brain region associated with voluntary movement. According to the research studies, both men and women with obesity had white matter volume changes in a variety of brain regions. �

 

Obesity and Inflammation

Dr. Dekkers stated that information from MRI scans may ultimately help improve insights into which brain structures are affected by obesity. Scientists believe that lower gray matter volumes can reduce the number of brain cells or neurons and white matter volume changes could affect the signals between the remaining brain cells or neurons. Other research studies suggest that gray matter volume changes may also affect the “food-reward circuitry” in the brain, which could make it difficult for people with obesity to control their eating behaviors. However, further research studies are still required. �

 

Dr. Dekkers also demonstrated that, according to previous research studies, inflammation caused by obesity can affect brain health. Further evidence on how inflammation caused by obesity could affect brain health may explain the recent research study’s findings. “For future research studies, it would be of great interest to understand if differences in body fat distribution are associated with differences in brain morphological structure, as visceral fat is a known risk factor for metabolic disease and is connected to systemic low-grade inflammation,” stated Hildo Lamb, Ph.D., the research study’s senior author. �

 

Obesity and Neurodegeneration

The brain changes as a normal part of the aging process, often losing white matter and shrinking. However, the aging process is different for every person. A variety of factors may cause slower or faster brain changes as a normal part of the aging process. One research study concluded that people with obesity have lower white matter volume compared to people with “healthy” weights. The research study also evaluated the brain structure of 473 participants. The information ultimately showed that the brain of people with obesity appears to be up to ten years older compared to people with healthy weights. �

 

Another research study on 733 middle-aged participants demonstrated that obesity is also connected with the loss of brain mass. Scientists evaluated body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) of participants and utilized MRI scans to find symptoms of neurodegeneration or brain degeneration. The results demonstrated that neurodegeneration or brain degeneration occurs faster in people with higher BMI, WC, and WHR compared to people with healthy weights. Scientists believe that loss of brain mass may cause dementia but further research studies are still required. �

 

Obesity and Mental Health Issues

Obesity can also affect the way our brain functions. Dopamine is a neurotransmitter associated with the pleasure-and-reward center in the brain. One research study found that dopamine released in the brain is associated with BMI. People with higher BMI have lower dopamine levels that may cause a lack of pleasure after eating normal-sized portions as well as the urge to eat more to feel satisfied. Moreover, another research study ultimately demonstrated that people with obesity feel less satisfaction when eating compared to people with healthy weights due to lower dopamine levels in the brain. �

 

Dr. Alex Jimenez Insights Image

In conclusion, scientists found that obesity affects the overall size and function of the brain. Recent research studies demonstrated a connection between smaller brain size and lower gray matter volume associated with obesity. Dr. Ilona A. Dekkers, from the Leiden University Medical Center in the Netherlands, utilized MRI scans in a variety of recent research studies to understand how obesity can affect the size and function of the brain. According to these same recent research studies, obesity can ultimately affect brain health by causing inflammation, neurodegeneration, and various mental health issues. Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.�

 

Curated by Dr. Alex Jimenez �

 

References:

  • Sandoiu, Ana. �How Might Obesity Affect the Brain?� Medical News Today, MediLexicon International, 27 Apr. 2019, www.medicalnewstoday.com/articles/325054.php#1.
  • Wlassoff, Viatcheslav. �How Obesity Affects the Human Brain.� World of Psychology, World of Psychology Media, 8 July 2018, psychcentral.com/blog/how-obesity-affects-the-human-brain/.

 


 

Neurotransmitter Assessment Form

Neurotransmitter Assessment Form AE260 (1)

 

The following Neurotransmitter Assessment Form can be filled out and presented to Dr. Alex Jimenez. The following symptoms listed on this form are not intended to be utilized as a diagnosis of any type of disease, condition, or any other type of health issue. �

 


 

Additional Topic Discussion: Chronic Pain

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance. �

 

 


 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention. �

 

Food Sensitivity for the IgG & IgA Immune Response

Food Sensitivity Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate health issues associated with a variety of food sensitivities and intolerances. The Food Sensitivity ZoomerTM is an array of 180 commonly consumed food antigens that offers very specific antibody-to-antigen recognition. This panel measures an individual�s IgG and IgA sensitivity to food antigens. Being able to test IgA antibodies provides additional information to foods that may be causing mucosal damage. Additionally, this test is ideal for patients who might be suffering from delayed reactions to certain foods. Utilizing an antibody-based food sensitivity test can help prioritize the necessary foods to eliminate and create a customized diet plan around the patient�s specific needs. �

 

Gut Zoomer for Small Intestinal Bacterial Overgrowth (SIBO)

Gut Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate gut health associated with small intestinal bacterial overgrowth (SIBO). The Vibrant Gut ZoomerTM offers a report that includes dietary recommendations and other natural supplementation like prebiotics, probiotics, and polyphenols. The gut microbiome is mainly found in the large intestine and it has more than 1000 species of bacteria that play a fundamental role in the human body, from shaping the immune system and affecting the metabolism of nutrients to strengthening the intestinal mucosal barrier (gut-barrier). It is essential to understand how the number of bacteria that symbiotically live in the human gastrointestinal (GI) tract influences gut health because imbalances in the gut microbiome may ultimately lead to gastrointestinal (GI) tract symptoms, skin conditions, autoimmune disorders, immune system imbalances, and multiple inflammatory disorders. �

 


Dunwoody Labs: Comprehensive Stool with Parasitology | El Paso, TX Chiropractor


GI-MAP: GI Microbial Assay Plus | El Paso, TX Chiropractor


 

Formulas for Methylation Support

Xymogen Formulas - El Paso, TX

XYMOGEN�s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

Please call our office in order for us to assign a doctor consultation for immediate access.

If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download

 

* All of the above XYMOGEN policies remain strictly in force.

 


 

 


 

Modern Integrated Medicine

The National University of Health Sciences is an institution that offers a variety of rewarding professions to attendees. Students can practice their passion for helping other people achieve overall health and wellness through the institution’s mission. The National University of Health Sciences prepares students to become leaders in the forefront of modern integrated medicine, including chiropractic care. Students have an opportunity to gain unparalleled experience at the National University of Health Sciences to help restore the natural integrity of the patient and define the future of modern integrated medicine. �

 

 

Functional Endocrinology: Endocrine Disruptors

Functional Endocrinology: Endocrine Disruptors

Endocrine disruptors are chemicals that may interfere with the body’s endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in humans. It can be pesticides, plasticizers, antimicrobials, and flame retardants that can be EDCs. EDCs (endocrine-disrupting chemicals) can disrupt the hormonal balance and can result in developmental and reproductive abnormalities in the body.

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There are four points about endocrine disruption:

  • Low dose matters
  • Wide range of health benefits
  • Persistence of biological effects
  • Ubiquitous exposure

EDC can cause significant risks to humans by targeting different organs and systems in the body. The interactions and the mechanisms of toxicity created by EDC and environmental factors can be concerning a person’s general health problems. Including endocrine disturbances in the body since many factors can cause endocrine disruptors, one of the disruptors in the food contaminated with PBDEs (polybrominated diphenyl esters) in fish meat and dairy.

Researchers also pointed out that once the contaminated foods eliminated from a person’s diet, then the endocrine disruptors decline, and the body began to heal properly. When a person eliminates the food that is causing discomfort to their bodies, they are more aware of reading the food labels to prevent discomfort anymore to the body systems.

Obesogen

Obesogen is a subclass of endocrine-disrupting chemicals (EDC) that might predispose individuals to the development of obesity. Their structure is mainly lipophilic, and they can increase fat deposition. Since the fat cell’s primary role is to store and release energy, researchers have found that different obesogenic compounds may have different mechanisms of action.

Some of these actions can affect the number of fat cells that are producing, while others affect the size of the fat cells, and some obesogenic compounds can affect the hormones. These compounds will affect the appetite, satiety, food preferences, and energy metabolism when the endocrine system plays a fundamental role in the body to regulate the metabolism of fats, carbohydrates, and proteins. Any alternations in the body can result in an imbalance in the metabolism and causing endocrine disorders.

4-Figure1-1

Studies even stated that exposure to obesogens could be found either before birth on utero or in the neonatal period. Obesogens can even cause a decrease in male fertility. When this disruption happens to the male body, environmental compounds can cause a predispose to weight gain, and obesogens can appoint as one of the contributors because of their actions as endocrine disruptors. Obesogens can even change the functioning of the male reproductive axis and testicular physiology. The metabolism in the male human body can be pivotal for spermatogenesis due to these changes.

Endocrine Disruptors and Obesity

Some endocrine disruptors that can affect the body can be through pharmaceutical drugs that can cause weight gain. A variety of prescription drugs can have an adverse effect that can result in weight gain since the chemicals found in prescription drugs have similar structures, and modes of action might have a role in obesity. Prescription medicine can stimulate the gut to consume more food, thus involving the body to gain weight.

3-Figure1-1.png

Another endocrine disruptor is PAHs (polycyclic aromatic hydrocarbons). These are a family of environmental chemicals that occur in oil, coal, and tar deposits. They produce as by-products of fuel-burning like fossil fuel, biomass, cigarette smoke, and diesel exhaust. PAHs can either be manufactured to be used as medicines and pesticides or be released naturally from forest fires and volcanoes.

There are standard ways a person can be exposed to PAHs. One is through eating grilled, charred, or charcoal-broiled meats that a person eats. The other is through inhalation of smoke from cigarettes, vehicle exhaust, or emissions from fossil fuels that can irritate the eyes and breathing passageways in the body.

Coping with EDC Exposure

Even though obesity can adversely affect the body in a variety of health outcomes, there are ways to cope and minimize the exposure of EDC. Research shows that a person can minimize EDC exposure by consuming organic fruits, vegetables, and grain products insofar as possible. This includes an increasing number of fungicides routinely applied to fruits and vegetables that are being identified as obesogens and metabolic disruptors in the body.

Xenoestrogen vs. Phytoestrogen

When a person has an endocrine disorder, it might be due to the food they are consuming. Phytoestrogens are plant-derived compounds that are in a wide variety of food, mostly in soy. They are presented in numerous dietary supplements and widely marketed as a natural alternative to estrogen replacement therapy.

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There is a health impact on phytoestrogen, and the plant-derived compound can either mimic, modulate, or disrupt the actions of endogenous estrogen. Xenoestrogen�are synthetically derived chemical agents from certain drugs, pesticides, and industrial by-products that mimic endogenous hormones or can interfere with endocrine disruptors. These chemical compounds can cause an effect on several developmental anomalies to humans. It can also interfere with the production and metabolism of ovarian estrogen in females.

Conclusion

Endocrine disruptors can interfere with the body’s endocrine system causing a health risk to an individual. EDC (endocrine-disrupting chemicals) can target many different organs and systems of the body by various factors that the human body is being exposed to. One of the EDC factors is obesogen, and it can cause a person to gain weight and be obese. Another factor is the exposure of PAHs (polycyclic aromatic hydrocarbons) through environmental factors like smoke inhalation or consuming charcoal-broiled meats. There are ways to cope with EDC exposure, and one is eating organic foods, especially fresh fruits and vegetables. Another is products that target the endocrine system and helps support the liver, intestines, body metabolism, and estrogen metabolism to ensure not only a healthy endocrine system but also a healthy body to function correctly.

October is Chiropractic Health Month. To learn more about it, check out Governor Abbott’s proclamation on our website to get full details on this historic event.

The scope of our information is limited to chiropractic, musculoskeletal and nervous health issues as well as functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or chronic disorders of the musculoskeletal system. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900 .


References:

Cardoso, A M, et al. �Obesogens and Male Fertility.� Obesity Reviews : an Official Journal of the International Association for the Study of Obesity, U.S. National Library of Medicine, Jan. 2017, www.ncbi.nlm.nih.gov/pubmed/27776203.

Darbre, Philippa D. �Endocrine Disruptors and Obesity.� Current Obesity Reports, Springer US, Mar. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5359373/.

Holtcamp, Wendee. �Obesogens: an Environmental Link to Obesity.� Environmental Health Perspectives, National Institute of Environmental Health Sciences, Feb. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3279464/.

Janesick, Amanda S, and Bruce Blumberg. �Obesogens: an Emerging Threat to Public Health.� American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, May 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4851574/.

Janesick, Amanda S, and Bruce Blumberg. �Obesogens: an Emerging Threat to Public Health.� American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine, May 2016, www.ncbi.nlm.nih.gov/pubmed/26829510.

Kyle, Ted, and Bonnie Kuehl. �Prescription Medications & Weight Gain.� Obesity Action Coalition, 2013, www.obesityaction.org/community/article-library/prescription-medications-weight-gain/.

L�r�nd, T, et al. �Hormonal Action of Plant Derived and Anthropogenic Non-Steroidal Estrogenic Compounds: Phytoestrogens and Xenoestrogens.� Current Medicinal Chemistry, U.S. National Library of Medicine, 2010, www.ncbi.nlm.nih.gov/pubmed/20738246.

Patisaul, Heather B, and Wendy Jefferson. �The Pros and Cons of Phytoestrogens.� Frontiers in Neuroendocrinology, U.S. National Library of Medicine, Oct. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3074428/.

Singleton, David W, and Sohaib A Khan. �Xenoestrogen Exposure and Mechanisms of Endocrine Disruption.� Frontiers in Bioscience : a Journal and Virtual Library, U.S. National Library of Medicine, 1 Jan. 2003, www.ncbi.nlm.nih.gov/pubmed/12456297.

Unknown, Unknown. �Endocrine Disruptors.� National Institute of Environmental Health Sciences, U.S. Department of Health and Human Services, 2015, www.niehs.nih.gov/health/topics/agents/endocrine/index.cfm.

Unknown, Unknown. �Polycyclic Aromatic Hydrocarbons (PAHs): Your Environment, Your Health | National Library of Medicine.� U.S. National Library of Medicine, National Institutes of Health, 31 Apr. 2017, toxtown.nlm.nih.gov/chemicals-and-contaminants/polycyclic-aromatic-hydrocarbons-pahs.

Yang, Oneyeol, et al. �Endocrine-Disrupting Chemicals: Review of Toxicological Mechanisms Using Molecular Pathway Analysis.� Journal of Cancer Prevention, Korean Society of Cancer Prevention, 30 Mar. 2015, www.jcpjournal.org/journal/view.html?doi=10.15430%2FJCP.2015.20.1.12.

The Connection Between Back Pain and Obesity | El Paso, TX

The Connection Between Back Pain and Obesity | El Paso, TX

Chiropractic care is generally the first choice of treatment for back pain as well as for a variety of other injuries and/or aggravated conditions associated with the musculoskeletal and nervous system.�Chiropractic care has numerous health benefits that can focus on helping patients of all ages. But, what many people don’t realize is that chiropractic care was not designed for only a certain person or body type, instead, a chiropractor can adjusts their treatment techniques to match each person’s specific needs. Doctors of chiropractic, or chiropractors, feel strongly about improving the overall health and wellness of their patients. In the tradition of chiropractic care, a chiropractor will treat the body of a patient as a whole, rather than focusing on a single injury and/or condition.

 

A doctor of chiropractic can treat many of the health issues that may be causing a patient’s back pain, however, what if the patient’s back pain is caused by obesity? The topic between whether chiropractic care can be used to treat obesity is frequently discussed among healthcare professionals and the patient. Many people are not aware of the benefits chiropractic care can have on obesity. Read below to find out how chiropractic care can help improve back pain as well as help manage obesity.

 

Chiropractic Care and Obesity

 

Obesity can affect more than just the way a person feels cosmetically. It is a health issue that may ultimately affect the individual’s skin, organs, joints, muscles, and even the spine. Excess weight can place unnecessary amounts of stress on the spine, joints and muscles, which can commonly lead to back pain, among other health issues. Its an individual’s constant struggle between managing their weight as well as coping with the symptoms manifesting as a result of the weight gain that can make weight loss difficult for many people without the proper treatment. Fortunately, chiropractic care is a safe and effective, alternative treatment option which can help diagnose, treat and prevent a variety of health issues while helping to improve overall health and wellness.

 

Because chiropractic care focuses on both the body and mind, the purpose of the spinal adjustment and manual manipulation in the treatment of obesity is to help improve symptoms of back pain by carefully correcting the alignment of the spine in order to reduce pressure on the spine as well as to decrease stress which may be affecting the individual’s mood. Once the patient has been geared towards a healthier body and mind, a chiropractor can also recommend a series of lifestyle modifications, such as nutritional and fitness advice, which can help a patient manage their excess weight.�The largest connection in your body is the one between your brain and the rest of the body through the communication of the nervous system. When the connection between the brain and the body is interrupted as a result of a spinal misalignment, or subluxation, it can lead to a variety of mental and physical health issues that may result in painful symptoms as well as stress, anxiety and depression, all of which have been associated with weight gain and obesity.

 

Furthermore, chiropractic care can also help throughout the process of weight loss. Because your body will be continuously changing as you lose weight, your spine and joints will need to be accordingly maintained to keep up with the ongoing changes. By receiving regular chiropractic care, a patient participating in a weight loss program or simply following the chiropractor’s nutritional and fitness advice will be able to fully engage in their exercise and physical activity routines due to the reduced back pain and other symptoms. In order to understand how chiropractic care can work towards excess weight and obesity, its essential to first comprehend the relationship between back pain and obesity as well as what type of treatment methods can benefit weight management.

 

Back Pain and Obesity

 

Obesity is defined by doctors as a disease. Being overweight or obese is a serious disorder that can affect children and adults. Many healthcare professionals know that obesity contributes to the development of high blood pressure, diabetes, coronary heart disease, and even colon cancer. But were you aware that obesity is a common contributing factor for back pain? Being overweight or obese may significantly contribute to symptoms associated with osteoarthritis, osteoporosis, rheumatoid arthritis, degenerative disc disease, spinal stenosis, and spondylolisthesis.

 

Has your primary care physician suggested you lose weight to reduce the severity of your back pain? Perhaps you have back pain, but have not considered extra body weight to be a possible cause. Even an extra 10 pounds to your average weight can eventually lead to back pain. The outcomes of a big cross-sectional population-based research study confirmed the link between obesity and back pain. The analysis involved 6,796 adults where researchers found that the risk for back pain increases as body mass index, or BMI, does. The probability of low back pain among adults who are obese is four times larger than among adults with an average weight.

 

BMI and What It Means

 

BMI is a number based on your weight and height. In general, the higher the number, the more body fat a person has. There are four categories of BMI:

 

  • Normal weight�BMI less than 25
  • Overweight�BMI of 25 to 30
  • Obese�BMI of 31 to 35
  • Extremely obese�BMI of 36 or higher

 

For instance, someone who is 5�10� tall and weighs 174 pounds has a BMI of 25, while a person who is 5�10� and weighs 251 pounds has a BMI of 36.

 

Obesity and Risk for Low Back Pain by the Numbers

 

  • 2.9% for people of normal weight
  • 5.2% for overweight adults
  • 7.7% for obese adults
  • 11.6% for extremely obese adults

 

The study did not address why obesity increases the risk of low back pain. But, additional body weight can contribute to how the spine works and its mechanical well-being.

 

Small Changes

 

Modest changes in the degree of physical activity can substantially lower the risk for back pain. Individuals with extreme obesity (BMI 36+) who increase their time in moderate actions by at least 17 minutes every day can reduce their risk for low back pain by approximately 32 percent. Moderate activities may include briskly walking, performing water aerobics, riding a bike, ballroom dancing, and gardening.

 

How Obesity Can Impact the Spine

 

The spine is designed to carry your body’s weight and distribute the loads encountered during rest and action. When excess weight is carried, the spine is made to assimilate the burden, which may lead to structural undermining and harm, as in the case of injury, or sciatica. One area of the spine that is most vulnerable to the consequences of obesity is the lower back, or the lumbar spine.

 

Why Exercise is Essential

 

Lack of exercise may lead to poor mobility and flexibility as well as weak muscles, especially in the back, core, pelvis and thighs. This may raise the curve of the lower spine, causing the pelvis to tilt too far ahead. Further, this is detrimental to proper posture as well as posture, causing health issues along other regions of the spine, such as the neck, and resulting in debilitating symptoms. You might attempt to dismiss the reason behind some of these spinal health issues to the practice of normal aging. It’s true that to anatomy, structural and functional changes can be caused by the degeneration of the body with age. However, if you are obese or overweight, you likely have, or may have, back pain. You may also have or develop a few of the following conditions:

 

  • Posture: Unhealthy posture accounts for neck and back pain. A level of physical fitness is necessary to properly support the spine.
  • Low Back Pain: Obesity may aggravate an existing low back problem and contribute to recurrence of the condition.
  • Osteoporosis: A sedentary lifestyle coupled with an unbalanced diet can affect the density, or strength of the bones (spinal vertebrae). When the structural architecture of a vertebral body is compromised, it is at risk for fracture. Vertebral fractures can be painful and disabling. If you have been diagnosed with osteoporosis, you have probably lost between 25% to 30% of desirable bone density.
  • Osteoarthritis (OA) and Rheumatoid Arthritis (RA): The joints in the spine are called facet joints. Excessive body weight places unnatural pressure and stress on the joints during movement and at rest.

 

Development of Obesity

 

Industrialization and modernization has had a huge effect on the food we eat today. Food can be bought just about everywhere. No more is it necessary to expend effort to forage and hunt for food. There are vast numbers of processed food items available and devices which require little use of labor like microwave ovens to cook meals. The market for kitchen devices and several convenience foods came about when women entered the workforce. For the time period 2011-2012, the following statistics were published:

 

  • 34.9% of adults (age 20 and older) were obese
  • 16.9% of children and adolescents (ages 2-19) were obese

 

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Dr. Alex Jimenez’s Insight

A healthy weight is important towards many aspects of overall well-being, including for the wellness of the spine. Because the spine is the main source of support for the human body’s weight, obesity or excess weight can place great amounts of stress on the complex structures surrounding the spine, resulting in a variety of health issues. As a matter of fact, many cases of back pain have been previously attributed to obesity. Chiropractic care can benefit patients with back pain and obesity. Through the use of chiropractic treatment methods, a chiropractor can help reduce symptoms of back pain as well as recommend nutritional and fitness advice to help with weight management.

 

There are many tools available that could help people lose and maintain a healthy body weight. Speak with a chiropractor to find out how to begin a weight loss program alongside back pain treatment. This is important since in the event that you have spinal health issues, your exercise program will be different compared to a person without back pain. Bear in mind, no two individuals are the same, and believing that obesity is a disease, obtaining professional help might be the initial step for you. 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 .

 

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Additional Topics: Back Pain

 

According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.

 

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EXTRA IMPORTANT TOPIC: Back Pain Treatment

 

 

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The Role Of Epigenetics In Obesity And Metabolic Disease

The Role Of Epigenetics In Obesity And Metabolic Disease

Epigenetic Abstract:

The increased prevalence of obesity and related comorbidities is a major public health problem. While genetic factors undoubtedly play a role in determining individual susceptibility to weight gain and obesity, the identified genetic variants only explain part of the variation. This has led to growing interest in understanding the potential role of epigenetics as a mediator of gene-environment interactions underlying the development of obesity and its associated comorbidities. Initial evidence in support of a role of epigenetics in obesity and type 2 diabetes mellitus (T2DM) was mainly provided by animal studies, which reported epigenetic changes in key metabolically important tissues following high-fat feeding and epigenetic differences between lean and obese animals and by human studies which showed epigenetic changes in obesity and T2DM candidate genes in obese/diabetic individuals. More recently, advances in epigenetic methodologies and the reduced cost of epigenome-wide association studies (EWAS) have led to a rapid expansion of studies in human populations. These studies have also reported epigenetic differences between obese/T2DM adults and healthy controls and epigenetic changes in association with nutritional, weight loss, and exercise interventions. There is also increasing evidence from both human and animal studies that the relationship between perinatal nutritional exposures and later risk of obesity and T2DM may be mediated by epigenetic changes in the offspring. The aim of this review is to summarize the most recent developments in this rapidly moving field, with a particular focus on human EWAS and studies investigating the impact of nutritional and lifestyle factors (both pre- and postnatal) on the epigenome and their relationship to metabolic health outcomes. The difficulties in distinguishing consequence from causality in these studies and the critical role of animal models for testing causal relationships and providing insight into underlying mechanisms are also addressed. In summary, the area of epigenetics and metabolic health has seen rapid developments in a short space of time. While the outcomes to date are promising, studies are ongoing, and the next decade promises to be a time of productive research into the complex interactions between the genome, epigenome, and environment as they relate to metabolic disease.

Keywords: Epigenetics, DNA methylation, Obesity, Type 2 diabetes, Developmental programming

Introduction

Epigenetic mechanismsObesity is a complex, multifactorial disease, and better understanding of the mechanisms underlying the interactions between lifestyle, environment, and genetics is critical for developing effective strategies for prevention and treatment [1].

In a society where energy-dense food is plentiful and the need for physical activity is low, there is a wide variation in individuals� susceptibility to develop�obesity and metabolic health problems. Estimates of the role of heredity in this variation are in the range of 40�70 %, and while large genome-wide association studies (GWAS) have identified a number of genetic loci associated with obesity risk, the ~100 most common genetic variants only account for a few percent of variance in obesity [2, 3]. Genome-wide estimates are higher, accounting for ~20 % of the variation [3]; however, a large portion of the heritability remains unexplained.

Recently, attention has turned to investigating the role of epigenetic changes in the etiology of obesity. It has been argued that the epigenome may represent the mechanistic link between genetic variants and environmental�factors in determining obesity risk and could help explain the �missing heritability.� The first human epigenetic studies were small and only investigated a limited number of loci. While this generally resulted in poor reproducibility, some of these early findings, for instance the relationship between PGC1A methylation and type 2 diabetes mellitus (T2DM) [4] and others as discussed in van Dijk et al. [5], have been replicated in later studies. Recent advances and increased affordability of high- throughput technologies now allow for large-scale epigenome wide association studies (EWAS) and integration of different layers of genomic information to explore the complex interactions between the genotype, epigenome, transcriptome, and the environment [6�9]. These studies are still in their infancy, but the results thus far have shown promise in helping to explain the variation in obesity susceptibility.

There is increasing evidence that obesity has develop mental origins, as exposure to a suboptimal nutrient supply before birth or in early infancy is associated with an increased risk of obesity and metabolic disease in later life [10�13]. Initially, animal studies demonstrated that a range of early life nutritional exposures, especially those experienced early in gestation, could induce epigenetic changes in key metabolic tissues of the offspring that persisted after birth and result in permanent alterations in gene function [13�17]. Evidence is emerging to support the existence of the same mechanism in humans. This has led to a search for epigenetic marks present early in life that predict later risk of metabolic disease, and studies to determine whether epigenetic programming of metabolic disease could be prevented or reversed in later life.

This review provides an update of our previous systematic review of studies on epigenetics and obesity in humans [5]. Our previous review showcased the promising outcomes of initial studies, including the first potential epigenetic marks for obesity that could be detected at birth (e.g., RXRA) [18]. However, it also highlighted the limited reproducibility of the findings and the lack of larger scale longitudinal investigations. The current review focuses on recent developments in this rapidly moving field and, in particular, on human EWAS and studies investigating the impact of (pre- and postnatal) nutritional and lifestyle factors on the epigenome and the emerging role of epigenetics in the pathology of obesity. We also address the difficulties in identifying causality in these studies and the importance of animal models in providing insight into mechanisms.

Review

Epigenetic Changes In Animal Models Of Obesity

rabbit eatingAnimal models provide unique opportunities for highly controlled studies that provide mechanistic insight into�the role of specific epigenetic marks, both as indicators of current metabolic status and as predictors of the future risk of obesity and metabolic disease. A particularly important aspect of animal studies is that they allow for the assessment of epigenetic changes within target tissues, including the liver and hypothalamus, which is much more difficult in humans. Moreover, the ability to harvest large quantities of fresh tissue makes it possible to assess multiple chromatin marks as well as DNA methylation. Some of these epigenetic modifications either alone or in combination may be responsive to environmental programming. In animal models, it is also possible to study multiple generations of offspring and thus enable differentiation between trans-generational and intergenerational transmission of obesity risk mediated by epigenetic memory of parental nutritional status, which cannot be easily distinguished in human studies. We use the former term for meiotic transmission of risk in the absence of continued exposure while the latter primarily entails direct transmission of risk through metabolic reprogramming of the fetus or gametes.

Animal studies have played a critical role in our current understanding of the role of epigenetics in the developmental origins of obesity and T2DM. Both increased and decreased maternal nutrition during pregnancy have been associated with increased fat deposition in offspring of most mammalian species studied to date (reviewed in [11, 13�15, 19]). Maternal nutrition during pregnancy not only has potential for direct effects on the fetus, it also may directly impact the developing oocytes of female fetuses and primordial germ cells of male fetuses and therefore could impact both the off- spring and grand-offspring. Hence, multigenerational data are usually required to differentiate between maternal intergenerational and trans-generational transmission mechanisms.

Table 1 summarizes a variety of animal models that have been used to provide evidence of metabolic and epigenetic changes in offspring associated with the parental plane of nutrition. It also contains information pertaining to studies identifying altered epigenetic marks in adult individuals who undergo direct nutritional challenges. The table is structured by suggested risk transmission type.

table 1(i) Epigenetic Changes In Offspring Associated With Maternal Nutrition During Gestation

Maternal nutritional supplementation, undernutrition, and over nutrition during pregnancy can alter fat deposition and energy homeostasis in offspring [11, 13�15, 19]. Associated with these effects in the offspring are changes in DNA methylation, histone post-translational modifications, and gene expression for several target genes,�especially genes regulating fatty acid metabolism and insulin signaling [16, 17, 20�30]. The diversity of animal models used in these studies and the common metabolic pathways impacted suggest an evolutionarily conserved adaptive response mediated by epigenetic modification. However, few of the specific identified genes and epigenetic changes have been cross-validated in related studies, and large-scale genome-wide investigations have typically not been applied. A major hindrance to comparison of these studies is the different develop mental windows subjected to nutritional challenge, which may cause considerably different outcomes. Proof that the epigenetic changes are causal rather than being associated with offspring phenotypic changes is also required. This will necessitate the identification of a parental nutritionally induced epigenetic �memory� response that precedes development of the altered phenotype in offspring.

(ii)Effects Of Paternal Nutrition On Offspring Epigenetic Marks

baby sleeping holding handsEmerging studies have demonstrated that paternal plane of nutrition can impact offspring fat deposition and epigenetic marks [31�34]. One recent investigation using mice has demonstrated that paternal pre-diabetes leads to increased susceptibility to diabetes in F1 offspring with associated changes in pancreatic gene expression and DNA methylation linked to insulin signaling [35]. Importantly, there was an overlap of these epigenetic changes in pancreatic islets and sperm suggesting germ line inheritance. However, most of these studies, although intriguing in their implications, are limited in the genomic scale of investigation and frequently show weak and somewhat transient epigenetic alterations associated with mild metabolic phenotypes in offspring.

(iii)Potential Trans-generational Epigenetic Changes Promoting Fat Deposition In Offspring

excess nutritionStable transmission of epigenetic information across multiple generations is well described in plant systems and C. elegans, but its significance in mammals is still much debated [36, 37]. An epigenetic basis for grand- parental transmission of phenotypes in response to dietary exposures has been well established, including in livestock species [31]. The most influential studies demonstrating effects of epigenetic transmission impacting offspring phenotype have used the example of the viable yellow agouti (Avy) mouse [38]. In this mouse, an insertion of a retrotransposon upstream of the agouti gene causes its constitutive expression and consequent yellow coat color and adult onset obesity. Maternal transmission through the germ line results in DNA methylation�mediated silencing of agouti expression resulting in wild-type coat color and lean phenotype of the offspring [39, 40]. Importantly, subsequent studies in these mice demonstrated that maternal exposure to methyl donors causes a shift in coat color [41]. One study has reported transmission of a phenotype to the F3 generation and alterations in expression of large number of genes in response to protein restriction in F0 [42]; however, alterations in expression were highly variable and a direct link to epigenetic changes was not identified in this system.

(iv) Direct Exposure Of Individuals To Excess Nutrition In Postnatal Life

modern western lifestyleWhile many studies have identified diet-associated epigenetic changes in animal models using candidate site-specific regions, there have been few genome-wide analyses undertaken. A recent study focussed on determining the direct epigenetic impact of high-fat diets/ diet-induced obesity in adult mice using genome-wide gene expression and DNA methylation analyses [43]. This study identified 232 differentially methylated regions (DMRs) in adipocytes from control and high-fat fed mice. Importantly, the corresponding human regions for the murine DMRs were also differentially methylated in adipose tissue from a population of obese and lean humans, thereby highlighting the remarkable evolutionary conservation of these regions. This result emphasizes the likely importance of the identified DMRs in regulating energy homeostasis in mammals.

Human Studies

anatomy 3D model

Drawing on the evidence from animal studies and with the increasing availability of affordable tools for genome- wide analysis, there has been a rapid expansion of epigenome studies in humans. These studies have mostly focused on the identification of site-specific differences in DNA methylation that are associated with metabolic phenotypes.

A key question is the extent to which epigenetic modifications contribute to the development of the metabolic phenotype, rather than simply being a con- sequence of it (Fig. 1). Epigenetic programming could contribute to obesity development, as well as playing a role in consequent risk of cardiovascular and metabolic problems. In human studies, it is difficult to prove causality [44], but inferences can be made from a number of lines of evidence:

fig 1(i) Genetic association studies. Genetic polymorphisms that are associated with an increased risk of developing particular conditions are a priori linked to the causative genes. The presence of differential�methylation in such regions infers functional relevance of these epigenetic changes in controlling expression of the proximal gene(s). There are strong cis-acting genetic effects underpinning much epigenetic variation [7, 45], and in population-based studies, methods that use genetic surrogates to infer a causal or mediating role of epigenome differences have been applied [7, 46�48]. The use of familial genetic information can also lead to the identification of potentially causative candidate regions showing phenotype-related differential methylation [49].

(ii)Timing of epigenetic changes. The presence of an epigenetic mark prior to development of a phenotype is an essential feature associated with causality. Conversely, the presence of a mark in association with obesity, but not before its development, can be used to exclude causality but would not exclude a possible role in subsequent obesity-related pathology.

(iii)Plausible inference of mechanism. This refers to epigenetic changes that are associated with altered expression of genes with an established role in regulating the phenotype of interest. One such example is the association of methylation at two CpG sites at the CPT1A gene with circulating triglyceride levels [50]. CPT1A encodes carnitine palmitoyltransferase 1A, an enzyme with a central role in fatty acid metabolism, and this is strongly indicative that differential methylation of this gene may be causally related to the alterations in plasma triglyceride concentrations.

Epigenome-Wide Association Studies: Identifying Epigenetic Biomarkers Of Metabolic Health

A number of recent investigations have focused on exploring associations between obesity/metabolic diseases�and DNA methylation across the genome (Table 2). The largest published EWAS so far, including a total of 5465 individuals, identified 37 methylation sites in blood that were associated with body mass index (BMI), including sites in CPT1A, ABCG1, and SREBF1 [51]. Another large-scale study showed consistent associations between BMI and methylation in HIF3A in whole blood and adipose tissue [52], a finding which was also partially replicated in other studies [9, 51]. Other recently reported associations between obesity-related measures and DNA methylation include (i) DNA methylation differences between lean and obese individuals in LY86 in blood leukocytes [53]; (ii) associations between PGC1A promoter methylation in whole blood of children and adiposity 5 years later [54]; (iii) associations between waist-hip ratio and ADRB3 methylation in blood [55]; and (iv) associations between BMI, body fat distribution measures, and multiple DNA methylation sites in adipose tissue [9, 56]. EWAS have also shown associations between DNA methylation sites and blood lipids [55, 57�59], serum metabolites [60], insulin resistance [9, 61], and T2DM [48, 62, 63] (Table 2).

table 2 contdFrom these studies, altered methylation of PGC1A, HIF3A, ABCG1, and CPT1A and the previously described RXRA [18] have emerged as biomarkers associated with, or perhaps predictive of, metabolic health that are also plausible candidates for a role in development of metabolic disease.

Interaction Between Genotype And The Epigenome

Genotype EpigenomeEpigenetic variation is highly influenced by the underlying genetic variation, with genotype estimated to explain ~20�40 % of the variation [6, 8]. Recently, a number of studies have begun to integrate methylome and genotype data to identify methylation quantitative trait loci (meQTL) associated with disease phenotypes. For instance, in adipose tissue, an meQTL overlapping�with a BMI genetic risk locus has been identified in an enhancer element upstream of ADCY3 [8]. Other studies have also identified overlaps between known obesity and T2DM risk loci and DMRs associated with obesity and T2DM [43, 48, 62]. Methylation of a number of such DMRs was also modulated by high-fat feeding in mice [43] and weight loss in humans [64]. These results identify an intriguing link between genetic variations linked with disease susceptibility and their association with regions of the genome that undergo epigenetic modifications in response to nutritional challenges, implying a causal relationship. The close connection between genetic and epigenetic variation may signify their essential roles in generating individual variation [65, 66]. However, while these findings suggest that DNA methylation may be a mediator of genetic effects, it is also important to consider that both genetic and epigenetic processes could act independently on the same genes. Twin studies [8, 63, 67] can provide important insights and indicate that inter-individual differences in levels of DNA methylation arise predominantly from non-shared environment and stochastic influences, minimally from shared environmental effects, but also with a significant impact of genetic variation.

The Impact Of The Prenatal And Postnatal Environment On The Epigenome

fetus modelPrenatal environment: Two recently published studies made use of human populations that experienced �natural� variations in nutrient supply to study the impact of maternal nutrition before or during pregnancy on DNA methylation in the offspring [68, 69]. The first study used a Gambian mother-child cohort to show that both seasonal variations in maternal methyl donor intake during pregnancy and maternal pre-pregnancy BMI were associated with altered methylation in the infants [69]. The second study utilized adult offspring from the Dutch Hunger Winter cohort to investigate the effect of prenatal exposure to an acute period of severe maternal undernutrition on DNA methylation of genes involved in growth and metabolism in adulthood [68]. The results highlighted the importance of the timing of the exposure in its impact on the epigenome, since significant epigenetic effects were only identified in individuals exposed to famine during early gestation. Importantly, the epigenetic changes occurred in conjunction with increased BMI; however, it was not possible to establish in this study whether these changes were present earlier in life or a consequence of the higher BMI.

Other recent studies have provided evidence that prenatal over-nutrition and an obese or diabetic maternal environment are also associated with DNA methylation changes in genes related to embryonic development, growth, and metabolic disease in the offspring [70�73].

While human data are scarce, there are indications that paternal obesity can lead to altered methylation of imprinted genes in the newborn [74], an effect thought to be mediated via epigenetic changes acquired during spermatogenesis.

baby walking in the grass and mudPostnatal environment: The epigenome is established de novo during embryonic development, and therefore, the prenatal environment most likely has the most significant impact on the epigenome. However, it is now clear that changes do occur in the �mature� epigenome under the influence of a range of conditions, including aging, exposure to toxins, and dietary alterations. For example, changes in DNA methylation in numerous genes in skeletal muscle and PGC1A in adipose tissue have been demonstrated in response to a high-fat diet [75, 76]. Interventions to lose body fat mass have also been associated with changes in DNA methylation. Studies have reported that the DNA methylation profiles of adipose tissue [43, 64], peripheral blood mononuclear cells [77], and muscle tissue [78] in formerly obese patients become more similar to the profiles of lean subjects following weight loss. Weight loss surgery also partially reversed non-alcoholic fatty liver disease-associated methylation changes in liver [79] and in another study led to hypomethylation of multiple obesity candidate genes, with more pronounced effects in subcutaneous compared to omental (visceral) fat [64]. Accumulating evidence suggests that exercise interventions can also influence DNA methylation. Most of these studies have been conducted in lean individuals [80�82], but one exercise study in obese T2DM subjects also demonstrated changes in DNA methylation, including in genes involved in fatty acid and glucose transport [83]. Epigenetic changes also occur with aging, and recent data suggest a role of obesity in augmenting them [9, 84, 85]. Obesity accelerated the epigenetic age of liver tissue, but in contrast to the findings described above, this effect was not reversible after weight loss [84].

Collectively, the evidence in support of the capacity to modulate the epigenome in adults suggests that there may be the potential to intervene in postnatal life to modulate or reverse adverse epigenetic programming.

Effect Sizes And Differences Between Tissue Types

connective tissuesDNA methylation changes associated with obesity or induced by diet or lifestyle interventions and weight loss are generally modest (<15 %), although this varies depending on the phenotype and tissue studied. For instance, changes greater than 20 % have been reported in adipose tissue after weight loss [64] and associations between HIF3A methylation and BMI in adipose tissue were more pronounced than in blood [52].

The biological relevance of relatively small methylation changes has been questioned. However, in tissues consisting of a mixture of cell types, a small change in DNA methylation may actually reflect a significant change in a specific cell fraction. Integration of epigenome data with transcriptome and other epigenetic data, such as histone modifications, is important, since small DNA methylation changes might reflect larger changes in chromatin structure and could be associated with broader changes in gene expression. The genomic context should also be considered; small changes within a regulatory element such as a promotor, enhancer, or insulator may have functional significance. In this regard, DMRs for obesity, as well as regions affected by prenatal famine exposure and meQTL for metabolic trait loci have been observed to overlap enhancer elements [8, 43, 68]. There is evidence that DNA methylation in famine-associated regions could indeed affect enhancer activity [68], supporting a role of nutrition-induced methylation changes in gene regulation.

A major limitation in many human studies is that epigenetic marks are often assessed in peripheral blood, rather than in metabolically relevant tissues (Fig. 2). The heterogeneity of blood is an issue, since different cell populations have distinct epigenetic signatures, but algorithms have been developed to estimate the cellular composition to overcome this problem [86]. Perhaps more importantly, epigenetic marks in blood cells may not necessarily report the status of the tissues of primary interest. Despite this, recent studies have provided clear evidence of a relationship between epigenetic marks in blood cells and BMI. In the case of HIF3A for which the level of methylation (beta-value) in the study population ranged from 0.14�0.52, a 10 % increase in methylation was associated with a BMI increase of 7.8 %�[52]. Likewise, a 10 % difference in PGC1A methylation may predict up to 12 % difference in fat mass [54].

fig 2Conclusions

The study of the role of epigenetics in obesity and metabolic disease has expanded rapidly in recent years, and evidence is accumulating of a link between epigenetic modifications and metabolic health outcomes in humans. Potential epigenetic biomarkers associated with obesity and metabolic health have also emerged from recent studies. The validation of epigenetic marks in multiple cohorts, the fact that several marks are found in genes with a plausible function in obesity and T2DM development, as well as the overlap of epigenetic marks with known obesity and T2DM genetic loci strengthens the evidence that these associations are real. Causality has so far been difficult to establish; however, regardless of whether the associations are causal, the identified epigenetic marks may still be relevant as biomarkers for obesity and metabolic disease risk.

Effect sizes in easily accessible tissues such as blood are small but do seem reproducible despite variation in ethnicity, tissue type, and analysis methods [51]. Also, even small DNA methylation changes may have biological significance. An integrative �omics� approach will be crucial in further unraveling the complex interactions between the epigenome, transcriptome, genome, and metabolic health. Longitudinal studies, ideally spanning multiple generations, are essential to establishing causal relationships. We can expect more such studies in the future, but this will take time.

While animal studies continue to demonstrate an effect of early life nutritional exposure on the epigenome and metabolic health of the offspring, human data are still limited. However, recent studies have provided clear�evidence that exposure to suboptimal nutrition during specific periods of prenatal development is associated with methylation changes in the offspring and therefore have the potential to influence adult phenotype. Animal studies will be important to verify human findings in a more controlled setting, help determine whether the identified methylation changes have any impact on metabolic health, and unravel the mechanisms underlying this intergenerational/transgenerational epigenetic regulation. The identification of causal mechanisms underlying metabolic memory responses, the mode of transmission of the phenotypic effects into successive generations, the degree of impact and stability of the transmitted trait, and the identification of an overarching and unifying evolutionary context also remain important questions to be addressed. The latter is often encapsulated by the predictive adaptive response hypothesis, i.e., a response to a future anticipated environment that increases fitness of the population. However, this hypothesis has increasingly been questioned as there is limited evidence for increased fitness later in life [87].

In summary, outcomes are promising, as the epigenetic changes are linked with adult metabolic health and they act as a mediator between altered prenatal nutrition and subsequent increased risk of poor metabolic health outcomes. New epigenetic marks have been identified that are associated with measures of metabolic health. Integration of different layers of genomic information has added further support to causal relationships, and there have been further studies showing effects of pre- and postnatal environment on the epigenome and health. While many important questions remain, recent methodological advances have enabled the types of large-scale population-based studies that will be required to address the knowledge gaps. The next decade promises to be a period of major activity in this important research area.

Susan J. van Dijk1, Ross L. Tellam2, Janna L. Morrison3, Beverly S. Muhlhausler4,5� and Peter L. Molloy1*�

Competing interests

The authors declare that they have no competing interests.

Authors� contributions
All authors contributed to the drafting and critical revision of the manuscript, and all authors read and approved the final manuscript.

Authors� information
Beverly S. Muhlhausler and Peter L. Molloy are joint last authors.

Acknowledgements

This work has been supported by a grant from the Science and Industry Endowment Fund (Grant RP03-064). JLM and BSM are supported by the National Health and Medical Research Council Career Development Fellowships (JLM, APP1066916; BSM, APP1004211). We thank Lance Macaulay and Sue Mitchell for critical reading and comments on the manuscript.

Author details

1CSIRO Food and Nutrition Flagship, PO Box 52, North Ryde, NSW 1670, Australia. 2CSIRO Agriculture Flagship, 306 Carmody Road, St Lucia, QLD 4067, Australia. 3Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia�4FOODplus Research Centre, Waite Campus, The University of Adelaide, PMB 1, Glen Osmond, SA 5064, Australia. 5Women�s and Children�s Health Research Institute, 72 King William Road, North Adelaide, SA 5006, Australia.

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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

When There's No Cure For Your Aching Back E-book Cover

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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67 Mourtzakis M, Prado CM, Lieffers JR, Reiman
T, McCargar LJ, Baracos VE: A practical
and precise approach to quantification of
body composition in cancer patients using
computed tomography images acquired during
routine care. Appl Physiol Nutr Metab
2008;33:997�1006.
68 Bolton CE, Ionescu AA, Shiels KM, Pettit RJ,
Edwards PH, Stone MD, Nixon LS, Evans
WD, Griffiths TL, Shale DJ: Associated loss
of fat-free mass and bone mineral density in
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J Respir Crit Care Med 2004;170:1286�1293.
69 Kyle UG, Genton L, Karsegard L, Slosman
DO, Pichard C: Single prediction equation
for bioelectrical impedance analysis in
adults aged 20�94 years. Nutrition 2001;17:
248�253.
70 Kyle UG, Genton L, Slosman DO, Pichard C:
Fat-free and fat mass percentiles in 5,225
healthy subjects aged 15 to 98 years. Nutrition
2001;17(7�8):534�541.
71 Kotler DP, Burastero S, Wang J, Pierson RN
Jr: Prediction of body cell mass, fat-free
mass, and total body water with bioelectrical
impedance analysis: effects of race, sex, and
disease. Am J Clin Nutr 1996;64:489S�497S.
72 Kyle UG, Genton L, Mentha G, Nicod L, Slosman
DO, Pichard C: Reliable bioelectrical
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in liver, lung, and heart transplant patients.
JPEN J Parenter Enteral Nutr 2001;25:45�51.
73 Mattar L, Godart N, Melchior JC, Falissard
B, Kolta S, Ringuenet D, Vindreau C, Nordon
C, Blanchet C, Pichard C: Underweight
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five equations to dual X-ray absorptiometry.
Clin Nutr 2011, E-pub ahead of print.
74 Genton L, Karsegard VL, Kyle UG, Hans DB,
Michel JP, Pichard C: Comparison of four
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75 Robert S, Zarowitz BJ, Hyzy R, Eichenhorn
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in critically ill patients. Am J Clin Nutr 1993;
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77 Kreymann KG, Berger MM, Deutz NE, Hiesmayr
M, Jolliet P, Kazandjiev G, Nitenberg
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Ebner C, Hartl W, Heymann C, Spies C, ESPEN:
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78 Singer P, Berger MM, van den Berghe G, Biolo
G, Calder P, Forbes A, Griffiths R, Kreyman
G, Leverve X, Pichard C, ESPEN: ESPEN
guidelines on parenteral nutrition: intensive
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79 Magnuson B, Peppard A, Auer Flomenhoft
D: Hypocaloric considerations in patients
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80 Rigaud D, Boulier A, Tallonneau I, Brindisi
MC, Rozen R: Body fluid retention and body
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81 Kyle UG, Chalandon Y, Miralbell R, Karsegard
VL, Hans D, Trombetti A, Rizzoli R,
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82 Pison CM, Cano NJ, Cherion C, Caron F,
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JP, Costes F, Wuyam B, Similowski T, Melloni
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83 Pichard C, Kyle U, Chevrolet JC, Jolliet P,
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84 Pichard C, Kyle UG, Jolliet P, Slosman DO,
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cell lung cancer during multimodality
treatment. J Nutr 2010;140:1774�1780.
87 Ryan AM, Reynolds JV, Healy L, Byrne M,
Moore J, Brannelly N, McHugh A, McCormack
D, Flood P: Enteral nutrition enriched
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355�363.
88 Ndekha MJ, Oosterhout JJ, Zijlstra EE, Manary
M, Saloojee H, Manary MJ: Supplementary
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trial. BMJ 2009;338:b1867�b1875.
89 Ha L, Hauge T, Iversen PO: Body composition
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with individualized, nutritional supplementation
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MP, Darmon P, Pichard C: Body
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92 Antoun S, Birdsel Ll, Sawyer MB, Venner P,
Escudier B, Baracos VE: Association of skeletal
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measurements: interpretation finally
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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 (gmassetti@cdc.gov).

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

Degenerative Disc Disease Caused by Obesity

Degenerative Disc Disease Caused by Obesity

Degenerative disk disease (DDD), which could affect any one of us as we age, may be particularly problematic for people who are overweight. To understand why, take a step back and consider the construction and function of your spine.

The spine is made to help support the weight of your body. It’s designed to keep your weight balanced and evenly spread. For example, the vertebrae are positioned from smallest to largest: small in your neck (cervical spine) and greatest in your low back (lumbar spine). They grow in size because the lower parts of the back must support the most weight.

Your intervertebral discs�the cushions between your vertebrae�increase in size, also. Only because they need to absorb and adjust to the most weight, they are thickest in the lumbar spine.

The back must be functioning accordingly in order to ensure all of its structures are healthy. Nonetheless, in degenerative disc disease, their capability to properly operate are altered and often lost. Intervertebral discs gradually become less effective at absorbing and cushioning your motions. Joints, including the facet joints, may subsequently transform as they readjust to changes in the disc; and they may not move as easily, making it harder for your own body to take and distribute weight.

Extra weight puts additional stress on the back. In the event that you are overweight and have DDD, then you’re stressing and straining your vertebrae and discs much more. The excess weight might even accelerate the degenerative processes because the elements of your spine will need to work more to carry the additional weight�and the harder they work, the quicker they may wear out or degenerate.

A diagnosis of degenerative disc disorder might be the motivation you need to become more physically active to get rid of extra weight, stop smoking or make other lifestyle changes to benefit your back and overall health and wellness. Your doctor or alternative healthcare provider can offer helpful suggestions about lowering your body weight and enhancing your general well-being.

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: Weight Loss Eases Back Pain

Back pain and symptoms of sciatica can affect a majority of the population throughout their lifetime. Research studies have demonstrated that people who are overweight or obese experience more back complications than people with a healthy weight. A proper nutrition along with regular physical fitness can help with weight loss as well as help maintain a healthy weight to eliminate symptoms of back pain and sciatica. Chiropractic care is also another natural form of treatment which treats back pain and sciatica utilizing manual spinal adjustments and manipulations.

 

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Best Weight Loss Programs for People with Back Pain

Best Weight Loss Programs for People with Back Pain

Many people in the United States will experience back pain at some point in their lifetime, whether it’s a temporary or chronic issue. However, a great percentage of individuals with this debilitating complication are overweight or obese.

Fortunately, research has demonstrated that weight loss can have a considerable effect towards relieving symptoms of back pain. Weight loss programs can be very helpful for patients with weight problems and back pain. While there are a variety of programs available, not every program is the same and it may be difficult to find the best one for each individual. Some are commercialized and others are managed by a physician. Some weight loss programs recommend the use of supplements while others prescribe medications. Others may or may not be covered by insurance companies.

What to Look for in a Weight Loss Program

Considering all the differences in weight loss programs, it’s ultimately essential for Americans to first do some research in order to find the most appropriate program for them before signing up and spending any amount of money. Several weight loss programs may even provide practices that your healthcare professional may have advised you to avoid participating in if they would have been consulted first.

A recent study evaluated 191 different weight loss programs in the Maryland, Washington, DC and Virginia region of the country. From the wide array of programs, their websites provided little to no relevant information regarding they type of weight loss program. Important details, such as the type of diet, the amount of exercise and physical activity, types of behavioral therapies, and the use of medications, were all missing online, factors which were heavily considered for the study. Most websites had not been designed to offer details of each program, but rather offer contact information for clients.

Several of the weight loss programs also incorporated weight loss supplements and medications, an important piece of information which they also failed to mention on their websites. Individuals must be cautious of taking products which have not been approved by the FDA. There are U.S. Food and Drug Administration approved medications and supplements available to help treat excess weight and obesity, however, these must be prescribed by a licensed and qualified healthcare professional.

Three essential factors to an effective weight loss program, as recommended by the American Heart Association, American College of Cardiology and the Obesity Society, which should be featured include:

  • a moderately reduced caloric meal plan;
  • a regimen for increased physical activity;
  • and a behavioral therapy strategy.

Seeking Professional Advice

Because many weight loss programs are commercialized products or services, these can most commonly offer practices which may not meet professional standards. According to Dr. J Michael Gonzalez Campoy, MD, PhD, FACE, a specialist in obesity medicine, people seeking a weight loss program to participate in should primarily seek advice and guidance from a healthcare professional who specialized in treating weight issues and obesity.

�With the epidemic of overweight and obesity in this country, two-thirds of Americans will seek help managing their weight. The point is well taken that there is too much commercialism, or selling products with a promise of unrealistic achievements. It is best for each patient to address weight management with their personal healthcare professional first,” stated Dr. Gonzalez Campoy.

When it comes to finding the best weight loss program for your own needs, speaking to a licensed and qualified expert can be the most suitable alternative, as this option can often be safer and more effective than other weight loss programs. Patients can find obesity medicine doctors through the website of The American Board of Obesity Medicine, abbreviated as ABOM.

When Back Pain is an Issue for Weight Loss

Although many people with excess weight and obesity seek weight loss program alternatives to lose weight, it can often be difficult for them to engage in the practices due to back pain. Studies have shown that back pain is most prevalent on individuals with weight issues and that can play a huge role on their inability to engage in a proper weight loss program. However, inactivity can also ultimately lead to muscle weakness and stiffness, particularly affecting core strength, which is necessary for supporting the spine and its surrounding structures.

Aquatic therapy, or physical activity in a pool, is a low-impact form of exercise that can be a good choice for people with back pain, helping them reduce weight and strengthen the muscles. Additionally, people with obesity and excess are more likely to experience muscle weakness and stiffness along their lower back, making it difficult for them to walk on a treatmill or step mill. Although overweight or obesity complications can contribute to back pain, consulting a healthcare professional is a good approach to learning the best possible way for them to stay active and avoid further injury.

If symptoms of back pain worsen and/or they are accompanied by tingling sensations, numbness and/or weakness, it may be advised to obtain a proper diagnosis to determine the source of the symptoms and adjust or stop physical activity and exercise immediately. Furthermore, regular physical activity and exercise can help prevent aggravating back pain during intense or prolonged workouts. Over time, regular exercise and physical activity will help increase the individual’s strength, flexibility and endurance, improving their overall health and wellness.

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�blog picture of a green button with a phone receiver icon and 24h underneath

By Dr. Alex Jimenez

Additional Topics: Weight Loss Eases Back Pain

Back pain and symptoms of sciatica can affect a majority of the population throughout their lifetime. Research studies have demonstrated that people who are overweight or obese experience more back complications than people with a healthy weight. A proper nutrition along with regular physical fitness can help with weight loss as well as help maintain a healthy weight to eliminate symptoms of back pain and sciatica. Chiropractic care is also another natural form of treatment which treats back pain and sciatica utilizing manual spinal adjustments and manipulations.

 

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Weight Loss: Back Pain & Obesity

Weight Loss: Back Pain & Obesity

A good attitude about weight loss will go a long way in helping you to achieve success. Whether your weight problem has resulted from eating the wrong foods, lack of routine physical exercise, using food to resist anxiety, age, or genetics �you can help defeat that by setting reasonable goals and expectations that are realistic.

The initial step to take would be to discuss your set for weight loss and general health by means of your physician. Your physician can assist you to make informed choices about treatments that contain weight loss plans and exercise suitable to your needs.

blog picture of weight scale, tape measure and vegetables

  • Therapies include dietary, behavioral, drug, and for some patients, surgical alteration of the digestive system to reduce the quantity of food consumed. A safe and realistic weight reduction plan may result in success.
  • Evaluating your body weight is more involved than stepping on the scale. This info is assessed to find out your risks due to extra weight (eg, high blood pressure).

Nutrition Means To Feed Your Body

In the event you haven’t detected, the ‘D’ word (Diet) hasn’t been used in this post as it relates to weight reduction. Granted, caloric reduction will be required by a weight loss program. Yet, for many overweight or obese folks, a weight loss program means exercising, handling anxiety, and making lifestyle changes, which might comprise relearning how to eat.

It’s vitally crucial that you feed your body the nutrients it needs to be healthy and live. No one food contains all the essential nutrients �it takes combining a wide variety of foods to help meet your body’s needs. If you have been heavy or obese for a long time, your body may really be starving for necessary nutrients!

Nutrients Their Food Sources & Activities In The Human Body

*Fats are essential in taking the fat-soluble vitamins A, D, E, and K. There are just three types of fats:

  • Saturated Fat will raise blood cholesterol levels. These fats are found mostly in meat and diary products.
  • Polyunsaturated Fat tends to lower blood cholesterol levels. It’s mainly found in plant sources such as safflower, sunflower, soybean, corn, and cottonseed.
  • Monounsaturated Fat tends to lower the bad cholesterol or LDL (low density cholesterol). Examples include canola oil, olive oil, peanut oil, and avocados.

Although this amount is exceeded by most Americans, dietary ingestion of fat shouldn’t exceed 30% per day.

Remove the skin from poultry, trim visible fat from meat, an easy method to cut back fat consumption is to choose lean cuts of meat, choose water-packed tuna, and pick dairy products made from skim or low-fat milk.

 

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Managing Obesity Through Easier Healthy Habits

Managing Obesity Through Easier Healthy Habits

Getting overweight adults to adopt new heart-healthy eating habits is an uphill battle. But giving them a handout about nutrition may be better than nothing, new research suggests.

“There’s an urgent need for innovative approaches to support the implementation of current dietary advice,” said Dr. David Jenkins, lead author of the new study from the University of Toronto. To prevent chronic disease, U.S. nutrition guidelines recommend diets rich in fruits, vegetables and whole grains, plus foods that lower cholesterol such as oats, barley, nuts and soy.

Jenkins, who is chair of nutrition and metabolism at the university, and his team tried three ways of encouraging these healthy habits. The researchers randomly assigned more than 900 overweight adults to one of four groups.

Encouraging Healthy Eating Habits

One group received advice about diet through phone calls. Another got a weekly food basket but no advice about diet. The third group got both advice and food baskets. A fourth group, used as “controls,” did not receive advice or food baskets. Everybody in each group got a “food guide” handout about diet.

Six months later, participants overall had only slightly increased their consumption of healthier foods like fruits and vegetables, regardless of group. The researchers said the only consistent increases were seen in the group that received both food and advice. And by 18 months, that slight increase in healthy eating was dwindling, the investigators found. Still, weight and blood pressure dipped a bit in all the groups, including the control group, according to the study.

The results were published Feb. 27 in the Journal of the American College of Cardiology.

“These data demonstrate the difficulty in effectively promoting fruit, vegetable and whole grain cereals to the general population using recommendations that, when followed, decrease risk factors for chronic disease,” Jenkins said in a journal news release.

But the author of an accompanying journal editorial suggested looking at the results as a “glass half-full.”

“Each country and scientific society must prioritize the strategies best adapted to local customs and regulations,” wrote Dr. Ramon Estruch, an internist at the Hospital Clinic of Barcelona, in Spain.

“However, it appears that simply giving a copy of healthy dietary guidelines causes small changes in the right direction. Perhaps we should start with this extremely simple, no-cost procedure at schools, workplaces, clinics or sports centers, while the other strategies are slowly developed and implemented,” Estruch suggested. Jenkins disclosed grant funding from several food-related companies.

SOURCE: Journal of the American College of Cardiology, news release, Feb. 27, 2017 blog picture of a green button with a phone receiver icon and 24h underneath

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Additional Topics: Weight Loss Eases Back Pain

Back pain and symptoms of sciatica can affect a majority of the population throughout their lifetime. Research studies have demonstrated that people who are overweight or obese experience more back complications than people with a healthy weight. A proper nutrition along with regular physical fitness can help with weight loss as well as help maintain a healthy weight to eliminate symptoms of back pain and sciatica. Chiropractic care is also another natural form of treatment which treats back pain and sciatica utilizing manual spinal adjustments and manipulations.

 

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Obesity & Pre-Diabetes Can Still Cause Neuropathy

Obesity & Pre-Diabetes Can Still Cause Neuropathy

Peripheral neuropathy may be more common in patients with pre-diabetes than previously thought, and early interventions may be warranted in this patient population, according to researchers from the University of Utah.

Currently, 86 million adults � more than one in three U.S. adults � have prediabetes, according to CDC estimates. Without weight loss and moderate physical activity, 15% to 30% of these people will develop full-blown type 2 diabetes within 5 years.1

�We know now a lot more than we did 3 or 5 years ago about neuropathic pain in patients with prediabetes. Neuropathy affects patients with prediabetes in a continuum,� said J. Rob Singleton, MD, who is a professor of neurology at the University of Utah in Salt Lake City. �We think it is more obesity and dysfunction of lipids (fats) that is causing the problem.�

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Research Shows the Link between Obesity, Pre-diabetes and Neuropathy

In another study conducted by researchers from the University of Michigan, peripheral neuropathy was also common in obese patients, even if they had normal blood sugar levels, when compared with lean control participants. This same study also confirmed that rates of neuropathy were increased in participants with prediabetes and diabetes, leading the researchers to conclude that diabetes, prediabetes, and obesity are likely metabolic drivers of peripheral neuropathy. The findings were published in JAMA Neurology.1

Dr. Singleton and his team have been studying peripheral neuropathy associated with prediabetes and metabolic syndrome as well as what treatments may work best. Metabolic syndrome is the name for a group of risk factors that raise the risk for heart disease, diabetes and stroke. Risk factors include high blood pressure, elevated blood glucose, elevated cholesterol, and abdominal fat. Through their research, they have found that many patients with metabolic syndrome have pre-diabetes and peripheral neuropathy. Therefore, a multi-pronged approach to managing these patients is essential.

�We have shown that, in pre-diabetics with neuropathic pain, exercise reduces neuropathic pain and increases the intradermal nerve fibers in the thigh and ankle. We are in the process now of replicating that study,� Singleton said in an interview with Endocrinology Advisor. �You need to improve lipid (cholesterol) function and glucose levels. So, lifestyle issues have to be addressed.�

Relationship Between Nerve Damage and Pre-diabetes blog picture of young woman pointing to red button that says receive care today

New studies evaluating the link between prediabetes and peripheral neuropathy are filling in some of the gaps in knowledge.

In a study recently published in Diabetes Care, C. Christine Lee, PhD, of the University of Toronto, and colleagues reported that prediabetes was associated with similar risks for nerve dysfunction and damage leading to peripheral neuropathy as one develops with �new-onset� diabetes.2

While the exact mechanisms behind these associations are unclear, a growing body of evidence suggests that peripheral neuropathy begins in the early stages of diabetes pathogenesis, the researchers noted.

Lee and colleagues analyzed data on 467 individuals. The researchers found that the prevalence of peripheral neuropathy was 29% in adults with normal glucose levels, as compared with 49% in adults with prediabetes and 50% in adults with new-onset diabetes.

The researchers also found that progression of elevated glucose (pre-diabetes) over 3 years predicted a higher risk for peripheral neuropathy and nerve dysfunction.

Early intervention with lifestyle changes involving diet and exercise may be vital to preventing the severity of nerve damage, Dr. Lee stated.  This had previously been backed up by another study published in 2006 in Diabetes Care, by Dr. Singleton.  Singleton and his colleagues found that dietary changes and exercise can result in cutaneous reinnervation and improved pain in patients with prediabetes.3

Nerve Damage Occurs Long Before Diabetes

It is imperative to realize that the nerve damage seen in peripheral neuropathy can actually occur long before diabetes sets in.  In fact the most current research has shown that obesity, even with normal glucose (blood sugar) levels has been linked with causing peripheral neuropathy as well as pre-diabetes. Although it is important to strive for maintaining fasting glucose levels between 70 � 80 mg/dL, it is equally important to keep your weight down, lower LDL cholesterol and triglycerides.  All of this can be accomplished without the use of medication or bariatric procedures.blog picture of a green button with a phone receiver icon and 24h underneath

For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Additional Topics: Neck Pain and Auto Injury

Neck pain is characterized as the most prevalent symptom after being involved in an automobile accident. During an auto collision, the body is exposed to a sheer amount of force due to the high speed impact, causing the head and neck to jolt abruptly back-and-forth as the rest of the body remains in place. This often results in the damage or injury of the cervical spine and its surrounding tissues, leading to neck pain and other common symptoms associated with whiplash-related disorders.

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