My clients are often surprised that changing their eating habits alone can relieve the acid reflux symptoms. The key strategy is to do it right and to be consistent.
Many people around the globe and some of my clients struggle with the symptoms of acid reflux but not many know that acid reflux is not necessarily caused by having too much gastric acid but rather the acid is in the wrong place. It’s a common misconception about acid reflux to think that we have too much of gastric acid. On the contrary, the plentiful of people suffering from acid reflux have rather hypochlorhydria (too little stomach acid) than hyperchlorhydria (too much stomach acid).
Acid reflux is a common gastrointestinal complain with symptomology of heartburn, a burning pain in the lower chest. It’s driven by stomach acid flowing back up to the esophagus (the food pipe). It can happen for example when increased intra-abdominal pressure overpowers the lower esophageal sphincter (LES, a ring muscle), as seen in people with hiatal hernia or obesity. The esophageal sphincter acts as a valve preventing stomach acid, stomach content from backing up into esophagus. When this system fails, we may experience the symptoms of acid reflux. Noteworthy, reflux of gastric contents into the esophagus is normal physiology. However, when reflux (occurring frequently) leads to symptoms, esophageal mucosal injury or both, we talk about gastroesophageal reflux disease (GERD).
Acid reflux symptoms
Heartburn is a common symptom of acid reflux and some patients perceive it as an angina-like chest pain. Functional heartburn has the same symptoms without signs of reflux. Some people experience regurgitation which is a rise of gastric content into the mouth with sour/bitter tasting, without associated nausea or retching. Other symptoms of reflux may include hoarseness, cough, and asthma as well as pharyngitis, sinusitis, pulmonary fibrosis, recurrent otitis media, and sleep apnea. Some individuals will also experience bloating, burping, difficulty swallowing, hiccups, or nausea. Interpret these symptoms as your body sending you signals that there is something going on. “Treating” them with anti-acids and over-the-counter drugs (H2 blockers, aginate drugs, or proton pomp inhibitors), may help relieving the symptoms however will not address the underlying cause.
How to stop acid reflux?
The best to stop acid reflux is to find the underlying cause. Sometimes your own detective work will be enough and sometimes you may need some testing to find out what’s behind it.
Regardless of the cause, one of the most effective ways to reduce acid reflux is to invest in healthy eating habits.
Eat healthy foods. I am sure you have heard many times to eat healthy and you might be tired of it but if you want your digestive system to function at its best, a healthy diet is a must. Make your own meals by using fresh, real foods and by skipping processed foods. Go mentally back in time, before the convenient foods existed, what would you eat then? A home-made soup or an instant powder soup? A lollipop or a handful of berries? There is a difference not only in their taste, but also in their nutrient content. Keep it simple and avoid CRAP: processed foods, alcohol, sodas, artificial sweeteners, fried foods; and TRIGGER foods such as spicy foods, garlic, onion, tomatoes, chocolate and coffee.
Go for cooked over raw. When having digestive complaints, it’s often better to eat cooked (and warm if you like) foods over raw and cold foods, they are more soothing and easier to digest.
Chew well. Eat mindfully without rushing, CHEW your food properly (20 times before swallowing). Make eating moments mindful, look at your food, smell it, taste and savor it. It’s not only important what we eat but also how we eat. Proper chewing promotes better digestion. Be consistent with it.
Drink chamomile, peppermint, or ginger tea, or cabbage juice. Some people find a relief after having yoghurt or milk.
Avoid large meals. Don’t overeat, eat 4 to 6 small meals at fixed times. Don’t eat 2-4 hours before going to bed, especially heavy to digest meals.
Stay well hydrated BUT do not drink a lot with your meals as this increases the volume of the stomach and its contents. Drink mostly between meals.
Try slippery elm bark tea or chew on the bark, it has been used for generations to relief acid reflux.
Be physically active but keep it moderate, do something you enjoy.
Sleep with your head and upper body slightly elevated.
Consider stress managementactivities such as yoga, psychological therapy, relaxation, exercise, mindfulness – if you feel like stress is overtaking your life.
Consider chiropractic adjustment, osteopathic care or acupuncture.
What causes acid reflux?
Eating unhealthy and eating too much. A typical western diet rich in simple carbohydrates (sugars and starches), processed foods, and little vegetables promotes dysfunction of the digestive system and as a consequence acid reflux may occur. Often, when we eat convenient foods, we also have a tendency to overeat.
Obesity. Obesity is commonly associated with acid reflux and GERD. The access weight can put extra pressure on the valves and sphincter causing stomach acid release.
Hiatal hernia. Hiatal hernia is an abdominal abnormality observed when the upper part of the stomach and lower esophageal sphincter (LES) move above the diaphragm. In this scenario, acid can move up into the esophagus causing acid reflux symptoms. The diaphragm is a muscle helping to keep gastric acid in our stomach. Consider osteopathic or chiropractic care.
Overtraining. High impact exercises and overtraining can put extra pressure on your abdomen triggering acid reflux.
Smoking cigarettes. Smoking increases acid production and can contribute to GERD or acid reflux.
Certain medications and supplements such as antibiotics, muscle relaxers, blood pressure drugs, ibuprofen, potassium and iron supplements can affect the functioning of the digestive system and cause acid reflux.
Helicobacter pylori infection. Infection with H. pylori can manifest itself with heartburn. If you suspect it may play a role in your complaints, get yourself tested.
Low magnesium. Low magnesium can influence muscle tension and impair the function of the esophageal sphincter by not retaining the acid in the gastric cavity.
Chronic cough, stress, food sensitivities foods can also contribute to acid reflux.
Digestive issues. Think of reduced saliva causing decreased digestive buffering, poor digestive esophageal motor function causing reduced food clearance, or poor gastric emptying causing increased refluxate.
Underdeveloped GI tract as by babies, may also promote acid reflux because the digestive tract does not work optimally yet.
Pregnancy. During the pregnancy growing fetus can put extra pressure on the esophageal valve and this may promote the release of gastric acid and symptoms of heartburn.
If your symptoms do not subside after improving your eating habits and lifestyle, please seek medical help to properly evaluate the underlying cause. Long-term acid reflux (GERD) can lead to Barrett’s esophagus, manifested as esophageal scarring and constriction which leads to swallowing disorders.
Information provided here is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional.
Skin is the largest body organ and it acts as a barrier interacting with the outside environment. This barrier protects us, helps us to regulate body temperature, prevents the invasion of foreign particles and pathogens, prevents excess water loss, protects us from oxidative stressors, and allows the sensations of touch, heat, and cold.
Skin problems such as acne, eczema or psoriasis are often a manifestation of underlying health issues. The problem lies not in a lack of a particular soap, an anti-bacterial remedy or a corticosteroid immunosuppressant cream. You need to look deeper, “underneath” the skin. When I have clients with skin problems, we look at their wellbeing holistically, we don’t focus exclusively on skin itself, we look beyond that. To heal your skin, you may need to address possible underlying causes. Skin problems are often partly be determined by our genetics, our biochemistry and partly by our environment including the quality of food we consume, the air we breathe-in, the pollutants and toxins we are exposed to. So, if common skin disorders can be influenced by environment, factors such as nutrition and lifestyle might be sufficient in order to prevent and even reverse or reduce the flare-ups. Therefore, we want to focus on what we can influence, and we want to find our triggers and our soothers. Below you can find info on nutrients with a special role in skin health and on what to pay attention to when skin problems affect your life. Managing your skin health with nutrition, improving digestive function, reducing stress and optimizing lifestyle habits can provide benefits not only for your skin, but for your overall well-being.
First, take into account that your skin problems could be related to:
Allergies (IgE driven reactions to foods and airborne allergens), food intolerances (poor functions of certain digestive enzymes), food sensitivities (IgG driven reactions)
Hormonal imbalances (acne is often a result of hormonal imbalances)
Autoimmune disease
Gut health issues (dysbiosis, infection)
Poor nutritional status (low levels of vitamin A, vitamin D or zinc)
Exposure to toxins and environmental pollutants
Use of skin irritants (cosmetics, perfumes, chemicals)
Compromised skin barrier
Genetics
Chronic stress
Skin micronutrients
Certain nutrients are particularly important for healthy skin. Macronutrients such as amino-acids, lipids and carbohydrates are building blocks of the skin and are essential for its structure and function.
In addition to macronutrients, skin needs micronutrients such as vitamins and minerals to properly regulate its function. In this section, we will focus mostly on micronutrients.
These include vitamins A, C, E, and K2, zinc, biotin, sulfur, pantothenic acid (B5), niacin (B3), silica, selenium, and the omega-3 fatty acids. When we lack these nutrients, our skin can manifest it by dermatitis, rashes, acne, poor wound healing, raised bumps on the backs of the arms, and loss of skin firmness. Many nutrients act in concert with other nutrients so a deficit of one can make the other less effective. Thus, focusing on one nutrient only, might not entirely address the problem.
The best way to get these nutrients is by eating real, whole-food sources, eating colorful foods, and diversity of foods; and by avoiding processed foods, added sugars, food additives, foods from the packages.
Top nutrients required for healthy skin
Vitamin A for skin problems
Vitamin A: lack of it causes the skin to be rough and dry which often first appears as rough, raised bumps on the back of the arms. Vitamin A-rich foods include liver and cod liver oil, kidney, cream and butter (pastured cows), and egg yolks (pastured chickens). If you take cod liver oil, it will provide you with vitamin A and vitamin D.
Vitamin C for skin problems
Vitamin C plays an important role in the regulation of the structural protein collagen, which is necessary for the extracellular stability of the skin. Inadequate vitamin C levels can contribute to the development of hyperkeratosis pilaris, the common problem with the follicles being damaged when collagen formation is impaired. True deficiency of vitamin C is uncommon but we often consume low quantities of it, particularly in a diet with a low fruit and vegetable intake. The highest sources of vitamin C include bell peppers, guava, dark leafy greens, broccoli, Brussels sprouts, kiwi, citrus fruits, strawberries, cilantro, chives, thyme, basil, and parsley.
Vitamin E for skin problems
Vitamin E is a potent fat-soluble and anti-inflammatory agent, found in our skin. Our bodies store vitamin E in our fat cells, and we depend on adequate dietary intake to maintain optimal levels. Adequate levels of this vitamin in the skin may prevent inflammatory damage from sun exposure. Food sources of vitamin E include spinach, turnip greens, chard, sunflower seeds, almonds, bell peppers, asparagus, collards, kale, broccoli, Brussels sprouts, and olive oil.
Vitamin K2 for skin problems
Vitamin K2 is an important player in protecting us from heart disease, forming strong bones, promoting brain function, supporting growth and development, helping to prevent cancer, ensuring healthy skin, and this vitamin is likely beneficial for preventing wrinkles and premature aging. Vitamin K2 is also necessary for the proper functioning of vitamin A- and vitamin D-dependent proteins. Vitamin A is essential for proper skin cell proliferation and cannot work properly if vitamin K2 is not available. Vitamin K2 is important in the treatment of acne, keratosis pilaris, and other skin symptoms of vitamin A deficiency. Good sources of vitamin K2 include butter and other high-fat dairy products from grass-fed cows, egg yolks, liver, natto, sauerkraut and cheese.
Zinc for skin problems
Zinc supports immune function, protein synthesis, wound healing, DNA synthesis, cell division, regulation of gene expression. It also has anti-inflammatory properties and protects against UV radiation. People with serious acne are found to have lower levels of serum zinc than healthy individuals. You can find zinc in animal sources including seafood (oysters, scallops, and other shellfish), kidney, liver, and red meat. Plant foods such as pumpkin seeds and other nuts can also be high in zinc, but zinc from these sources might be less bioavailable.
Copper for skin problems
Copper serves as an antioxidant, stimulates the maturation of collagen, and modulates melanin synthesis. Food rich is copper include beef liver, sunflower seeds, nuts, dark chocolate, chickpea, asparagus, kale, and goat cheese.
Biotin (vitamin B7) for skin problems
Biotin (vitamin B7) acts as a cofactor for enzymes that regulate fatty acid metabolism with fatty acids being critical for the health of the skin. When biotin intake is insufficient, fat production is altered, and the skin cells are the first to develop symptoms. Low biotin intake/levels can contribute to hair loss, dandruff, erythematous (red and inflamed) dermatitis around the mouth and other areas of the face and scalp. In infants, inadequately low biotin amounts might contribute to “cradle cap” and seborrheic dermatitis in adults. Biotin rich foods include egg yolks, liver, Swiss chard, romaine lettuce, almonds, and walnuts.
Sulfur for skin problems
Sulfur is a critical mineral for skin health and overall wellness. Sulfur is necessary for collagen synthesis, which gives the skin its structure and strength. Having enough sulfur in your diet can help maintain collagen production and keep your skin looking firm. Foods containing sulfur include egg yolks, meat, poultry, and fish, garlic, onions, Brussels sprouts, asparagus, and kale. Fermented foods, like sauerkraut, with well bioavailable sulfur serve as an excellent source of sulfur and a healthy component of a diet for radiant skin.
Pantothenic acid (vitamin B5) for skin problems
Pantothenic acid (vitamin B5) is required for proper growth, metabolic function, energy production, for protein and fat synthesis, and is needed by many different types of skin cells for regeneration and growth. Vitamin B5 is also involved in the growth and differentiation of keratinocytes, which are essential for maintaining a healthy skin barrier. Keratosis pilaris (chicken skin) is a common skin condition caused by impaired keratinocyte growth, which may improve from increased pantothenic acid consumption. Pantothenic acid also significantly increases levels of glutathione in the cells, which acts as a potent antioxidant in the skin. Pantothenic acid can be found in various foods and some of the richest sources include liver and kidney, egg yolk, broccoli, fish, shellfish, chicken, dairy products, mushrooms, avocado, and sweet potatoes.
Niacin (vitamin B3) for skin problems
Niacin (vitamin B3) is a vital payer in cell metabolism acting as a coenzyme in energy producing reactions including the breakdown of carbohydrates, fats, and proteins, as well as anabolic reactions such as fatty acid and cholesterol synthesis. Niacin deficiency is uncommon, however in certain health conditions such as in celiac disease, IBS, Crohn’s disease impaired niacin absorption from the diet happens. Low niacin levels can lead to the skin-related symptoms such as dermatitis and scaling. Niacin rich foods include meat, poultry, red fishes such as tuna and salmon, and seeds. Milk, green leafy vegetables, coffee, and tea also provide some niacin. For most healthy people, a diverse diet with adequate meat consumption should be enough to meet niacin’s nutritional needs.
Silica for skin problems
Silica is required for normal collagen formation. It maintains the health of connective tissues by interacting with the formation of glycosaminoglycans (GAGs), such as hyaluronic acid, which are structural building blocks of collagen tissues. Inadequate silica content can result in reduced skin elasticity and impaired wound healing. To ensure adequate silica intake include in your diet leeks, green beans, garbanzo beans, strawberries, cucumber, mango, celery, asparagus, and rhubarb.
Selenium for skin problems
Selenium is a crucial trace mineral with numerous health benefits, for general health as well as the skin health. One of the most important jobs of selenium is being a component of glutathione peroxidase, an enzyme necessary for the antioxidant function of glutathione (master antioxidant in our body that protects against cellular damage from the free radicals that cause inflammation and aging and promote skin cancer). Individuals with acne have been shown to have low levels of blood serum selenium, as well as low levels of selenium-dependent glutathione activity. The richest food sources of selenium are Brazil nuts, organ meats and seafood, followed by muscle meats. Fish such as cod, tuna, halibut, sardines, and salmon are excellent sources, along with liver and meats like beef, turkey, lamb.
Omega-3 fatty acids (EPA and DHA) for skin problems
Omega-3 fatty acids (EPA and DHA) have anti-inflammatory properties and are essential in healthy skin. Adequate levels of omega-3 fatty acids have been shown to decrease inflammation and to reduce the risk of acne and other skin problems by decreasing insulin-like growth factor (IGF-1) and preventing hyperkeratinization of sebaceous follicles. These fatty acids are abundant in cold-water fatty fish such as sardines, salmon, mackerel, tuna, anchovies, and black cod. The added value of eating fish rather than taking fish oil is that apart from getting these omega-3s, you also get other nutrients such as vitamin D, zinc and selenium.
Skin problems - skin microbiota
You probably have heard about the importance of the gut microbiome to your health but did you also know that our skin is home to millions of bacteria, fungi and viruses that compose the skin microbiota. Skin microorganisms have essential roles in the protection against invading pathogens, the education of our immune system and the breakdown of natural products. When the skin barrier is broken, the skin is malnourished or when the balance between good and bad microbes is disturbed, skin conditions or even systemic disease can result.
Certain common skin diseases associated with changes in the microbiota (termed dysbiosis, meaning an altered microbial state) include acne, eczema and chronic wounds.
In order to preserve healthy skin microbiome, do not over-use skin products, unnecessary topical medications, detergents, skin irritants, or chemicals.
Skin problems - lifestyle
Manage your stress. Stress can be associated with numerous skin conditions as the skin is influenced by many of the hormones and neuropeptides involved in the stress response, such as corticotropin-releasing hormone, adrenocorticotropin hormone (ACTH), cortisol, epinephrine and norepinephrine. (Chronic) Stress compromises the effectiveness of the gut barrier as well as the skin barrier, impairing the integrity and protective function of these barriers. Stressful situations often trigger skin related flare-ups. If you are prone to feel stressed and you suffer from skin issues – managing stress will be essential for healthy skin. Find ways that work for you to deal with stress such as meditation, mindfulness, sports, a therapy and be consistent with practicing it. For example, have three “go-to” stress relievers that work for you such as taking a few deep breaths, stepping outside for few minutes, reminding yourself to just “let it go,” perking up your posture and carrying yourself confidently (stress can make you hunched over) or planning something you look forward to at the end of your stress-filled day. In addition, contact with nature, cultivating pleasure, connections, and making time for play and laugh are wonderful stress remedies.
Increase ultraviolet exposure especially if you spend most of the time indoors. Ultraviolet light (from sunlight or alternatively UVA/UVB tanning beds) can be helpful in the management of psoriasis, vitiligo, acne, eczema, dermatitis, and lichen planus. In addition, sunlight promotes vitamin D3 synthesis and offers additional cognitive benefits of spending time outdoors. Be mindful that (too much) sun exposure (particularly if it leads to sunburn) can make skin conditions worse, and not all skin conditions (such as rosacea) benefit from ultraviolet light. If your skin condition worsens after sun exposure, then reduce sun exposure until your skin condition is under control.
Get enough rest and quality sleep. Quality sleep helps you regenerate, calm the nervous system and get the inflammation under better control. Prioritize a healthy sleeping routine, minimize electronic media and distractions around bed time. Go to bed around 10pm-11pm.
Incorporate regular physical activity to your routine but avoid overtraining, choose an activity you enjoy doing
Apply the 8x8x8 rule: 8 hours of sleep, 8 hour of work, 8 hours of rest
Skin problems - supplements
Next to a healthy diet, which should serve as foundation of any therapy, there are certain supplements that may be helpful for people with skin complaints.
These include Vitamin C, quercetin, vitamin D, vitamin A, zinc, high quality multivitamin or group B vitamins, Cod liver oil or omega-3 fatty acids.
Nothing works?
If you do all the right things: eat healthy, exercise, sleep well, do not use skin damaging products, have stress under control and yet your skin does not improve – dig deeper to find the reason why. Asses your nutritional status, check your hormones, your gut health, digestion, rule out allergies, food intolerances or autoimmunity.
Information provided here is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional.
Hypothyroidism, in other words an underactive thyroid, is the most common thyroid disfunction. Thyroid hormones influence virtually every organ system in your body. Underactive thyroid (hypothyroidism) happens when your body does not have enough thyroid hormones.
Your thyroid is a gland located in your neck. Its shape resamples a butterfly and it weights between 10-30 grams.Thyroid produces vital for us hormones. Two main thyroid hormones include T4 (thyroxine; tetra-iodothyronine) and T3 (triiodothyronine); and relatively recently discovered T2 (do-iodothyronine) and T1 (mono-iodothyronine) hormones. Thyroid makes these hormones at different quantities, for example T4 comprises approximately 87% of the entire thyroid hormone pool, T3 approximately 8%, and T2 and T1 approximately 4%.
T4 circulates in your bloodstream and in various tissues and its job is to be available and ready for conversion to T3. Therefore, T4 is a “storage” type of thyroid hormone. On the other hand, T3 is an active thyroid hormone, meaning it powers-up your cells and facilitates energy generation, so that oxygen and glucose from foods can be converted to energy molecules (ATP) in your mitochondria.
How much thyroid hormones you make is largely regulated by your brain, by a part called hypothalamus. Hypothalamus senses the levels of circulating T3 and T4 hormones; when their circulating levels drop, the hypothalamus “tells” the pituitary gland (also in your brain) to send thyroid-stimulating hormone (TSH) to the thyroid to promote the release of thyroid hormones. It’s called a negative feedback loop. Therefore, when T4 and T3 levels drop –TSH raises. This is what we see when someone has hypothyroidism (underactive thyroid).
What is hypothyroidism?
Hypothyroidism, in other words an underactive thyroid, is the most common thyroid disfunction and is especially common in women 35 years old and older. Approximately 2 in 10 women 65 years of age and older have an underactive thyroid.
“Thyroid issues are more common among females than among males and the risk of thyroid problems increases with age”
Underactive thyroid (hypothyroidism) happens when your body does not have enough thyroid hormones. It can be a result of making too little T4, and/or not converting T4 to T3 efficiently, or by dysfunctional regulation by the brain. As mentioned above, when levels of T4 and T3 drop, the levels of TSH go up to correct the hormone balance and make more thyroid hormones. In hypothyroidism however, the thyroid doesn't respond optimally to TSH (might be because of tissue destruction or lack of nutrients), as a result not enough T3 and T4 is made and distributed throughout the body, then and body functions go into the slow mode; and the pituitary keeps “shouting” by releasing more and more TSH in an effort to stimulate thyroid hormone production, unsuccessfully. That's why TSH levels in the blood are elevated when thyroid function is low.
When body cells are deprived of thyroid hormones, they will make less energy and the energy coming from foods in a form of glucose will be stored in your body as fat. Actually, every cell in your body has receptors for thyroid hormones. These hormones are responsible for the most basic aspects of our physiology, impacting all major systems of the body. Thyroid hormones directly act on the brain, the G.I. tract, the cardiovascular system, bone metabolism, red blood cell metabolism, gall bladder and liver function, steroid hormone production, glucose metabolism, lipid and cholesterol metabolism, protein metabolism and body temperature regulation.
There are different types of hypothyroidism such as:
Hashimoto’s disease (most common and auto-immune),
Common symptoms associated with thyroid issues are related to energy, weight, mental health, sex and fertility, hair/skin/nail health, heart health and digestive health. Symptoms can range from very mild to very severe.
Someone suffering from hypothyroidism can struggle with:
weight gain,
tiredness/exhaustion,
brain fog,
memory problems,
constipation,
dry skin,
hair loss,
cold intolerance,
irregular menstruation,
infertility,
muscle stiffness and pain,
depression,
dementia,
hair loss,
brittle nails,
puffy skin,
enlarged neck,
infertility,
weak muscles.
If your thyroid slows down and you do not make adequate levels of thyroid hormones, your metabolism will slow down contributing to weight gain, a very common sign of an underactive thyroid.
Depending on the cause, hypothyroidism can be a temporal situation but can also be permanent.
If you experience 3 or more of the symptoms, it would good to asses your thyroid function by running a simple blood test.
Common causes of low thyroid hormones
Malnutrition - lack of nutrients to allow hormone synthesis, conversion, and functioning, such as selenium, iodine, zinc, vitamin C, tyrosine, vitamin D, vitamin B12). Tip: to get adequate selenium, eat 1-3 Brazilian nuts daily.
Suboptimal iodine levels - Lack and excess of iodine can contribute to thyroid problems. The daily recommended iodine dose ranges between 50-200 mcg (micrograms) for general population and from 200-350 mcg for pregnant and breastfeeding females. If your diet is rich in seafood, sea vegetables, seaweed, bread, dairy products, eggs, you use iodized salt and take a supplement containing iodine - you could be unconsciously getting more iodine than what your body needs. You also absorb iodine thorough skin by applying products that contain iodine, or bathing is salt solutions containing iodine.
Impaired gut health - poor diet, impaired digestion, low stomach acid, poor bile production, intestinal dysbiosis, increased intestinal permeability
Immune dysregulation - such as an auto-immune attack against own thyroid tissue causing thyroid destruction as seen in Hashimoto’s disease
Chronic stress - suboptimal cortisol levels, too high and too low, contribute to under-conversion of free T4 to free T3 and you can end up with the symptoms of hypothyroid symptoms even though the core problem does not lie in your thyroid
Toxins and chemicals - such as mercury, fluoride, or perchloride
Allergies and food reactions - individuals with allergies, food intolerances or food sensitivities might be at higher risk of compromised thyroid function because of the immune triggers and a possible effect on the digestive tract.
Viral infections - respiratory infections caused by influenza virus or infections caused by mumps virus can cause subacute thyroiditis (thyroid inflammation), often associated with gradual or sudden onset of pain in the region of the thyroid gland which may persist for weeks or months.
Radiation - treatment or exposure. Radioactive iodine is used to treat an overactive thyroid gland but it can damage the gland, causing permanent hypothyroidism. Also, radiation treatment for certain cancers (located in the head and neck) may damage the thyroid gland and/or the pituitary gland.
Medications - such as lithium (used in the management of depression or bipolar disorders), amiodarone (for management of arrythmias), interferons (in the treatment of cancer or hepatitis C).
Inflammation - inflammation suppresses the hypothalamus-pituitary-thyroid HPT axis, decreases both the number and sensitivity of thyroid hormone receptors, decreases the conversion of T4 to T3.
Thyroid TEST and DON’T GUESS
If you experience symptoms, I have listed above – get tested. Waiting and guessing may worsen the problem and create new problems. Untreated hypothyroidism can increase your risk for cardiovascular problems and other health issues. Keep an eye out for hypothyroidism symptoms and check your thyroid function on regular basis.
Consider following:
Blood serum test for TSH, free T4, free T3, anti-TPO, anti-TG
Thyroid ultrasound
Blood serum test for vitamin D, iron, ferritin, transferrin saturation, vitamin B12, CBC with differential and a lipid panel
One of the biggest challenges those with subclinical hypothyroidism face is that it is often underdiagnosed. Patients have “thyroid symptoms” but they have “normal” lab results (within a normal lab range), yet not optimal if you interpret them properly.
Typically, healthy thyroid function will be reflected by TSH levels within 0.45 and 2.5 mU/L (note that the normal lab range is slightly different 0.45 – 4.5 mU/L), the amount of available (free) T4 will be within 1.1–2.0 ng/dL, and the amount of available (free) T3 within 230-420 pg/dL. Various labs may have slightly different lab ranges. Young children and elderly typically have physiologically higher TSH levels without having any thyroid issues.
Thyroid self-examination
If you have risk factors for thyroid diseases (such as a family history or have some symptoms), it is a good idea to feel your thyroid gland from time to time. Your thyroid gland is located in the center of your neck, below your Adams apple and above the notch of your breastbone.
Below are easy steps for examining your thyroid:
Face a mirror or make a film while you are doing the examination so you can view it later.
Take a sip of water (don’t swallow).
Tilt your head back, while still being able to see the mirror (if you record it, you don’t have to make sure you look at the mirror or camera).
When you swallow the water, look for any lumps or areas that are not the same on both sides of the thyroid.
Thyroid nodules are usually round in shape and move with the gland when you swallow. You may feel the nodule rolling underneath your fingertips or see it move when you swallow. A goiter (swelling) can be found on one side of the thyroid or on both sides.
If you find any lumps or swelling, check it with your doctor. Noteworthy, lumps or nodules on the thyroid gland do not necessarily mean that you have a thyroid disorder. Thyroid nodules are very common and often do not cause any other issues.
Hypothyroid diagnosis – what to expect?
If you were diagnosed with a hypothyroid condition, the treatment strategy may differ depending on the cause and on the severity. The symptoms may or may not be due to borderline thyroid function, and not everyone who does have subclinical disease will progress to full-fledged hypothyroidism. Sometimes, it’s essential to take thyroid hormones (forever) to compensate for their lack and sometimes lifestyle and dietary interventions together with well selected supplements might be enough to support your thyroid health, so it can bounce back and do its job well again.
Information provided here is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional.
ANTIBIOTIC – antibiotics, or antibacterials, are a type of antimicrobial used to target bacteria, and are often used in medical treatment of bacterial infections. They can either kill or inhibit the growth of bacteria.
DYSBIOSIS – also called dysbacteriosis, this refers to microbial imbalance on or inside the body. Dysbiosis is most commonly reported as a condition in the digestive tract.
FERMENTATION – a chemical process that converts sugar and carbohydrates into acids, gases, and/or alcohol. It occurs in yeast and bacteria, but also in oxygen-starved muscle cells, as in the case of lactic acid fermentation. Humans use fermentation to produce food and beverages.
GUT MICROBIOTA – microorganisms residing in the gastrointestinal tract (GI tract).
GASTROINTESTINAL TRACT/DIGESTIVE SYSTEM – an organ system responsible for consuming and digesting foodstuffs, absorbing nutrients, and expelling waste.
INTESTINAL BARRIER (gut barrier) – is essential in human health and constitutes a tight barrier that controls what gets absorbed into the bloodstream. It is a semi-permeable barrier that allows the uptake of essential nutrients and immune sensing, while being restrictive against pathogenic molecules and bacteria, this filtering structure is essential function of the gastrointestinal tract. The central component of the barrier is formed by intestinal epithelial cells, which physically separate the intestinal lumen and the body. In addition, various molecules are secreted into the intestinal lumen to reinforce the barrier function and a variety of immune cells below the epithelial layer provides additional protection.
INTESTINAL PERMEABILITY - is defined as the system describing the control of material passing from inside the gastrointestinal tract through the epithelial cells lining the gut wall, into the rest of the body. The intestine normally exhibits some permeability, which allows nutrients to pass through the gut, while also maintaining a barrier function to keep potentially harmful substances (such as antigens) from leaving the intestine and migrating to the body more widely. A crucial function of the intestinal epithelium is the maintenance of a proper barrier function, allowing the permeability of nutrients, water and ions, but limits entry of pathogens and bacterial toxins.
INCREASED INTESTINAL PERMEABILITY aka LEAKY GUT – refers to a compromised intestinal barrier, meaning that the gut lining might have a sort of “cracks or holes”. Physiologically, our intestinal barrier is permeable but it’s problematic when the permeability is increased allowing translocation of partially digested food, toxins, and bugs to the tissues beneath the gut barrier. The expression “leaky gut” is getting a lot of attention in medical blogs and social media; however, many doctors will be unfamiliar with this term. This undesired translocation may trigger immune system, promote inflammation and lead to changes in the gut microbes that could lead to problems within the digestive tract and beyond. The current research shows that abnormalities in the intestinal barrier, intestinal bacteria and inflammation may play a role in the development of several common chronic diseases.
POSTBIOTIC - also known as metabiotics, biogenics, or metabolites - are products or byproducts made by live bacteria, or released after bacterial lysis. Studies demonstrate that postbiotics may play a role in general health and well-being, providing physiological benefits to the host. An example of a postbiotic is butyric acid. It’s a Short Chain Fatty Acid made by intestinal bacteria and by probiotic bacteria.
PROBIOTIC – live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. The term derives from the Latin preposition pro (“for”) and the Greek adjective βιωτικός (biotic), the latter deriving from the noun βίος (bios, “life”).
PREBIOTIC – generally refers to compounds (food ingredients) that induce the growth and/or activity of commensal microorganisms (eg bacteria and fungi) that contribute to the wellbeing of their host. A prebiotic is a selectively fermented ingredient that results in specific changes in the composition and/or activity of the gastrointestinal microbiota, thus conferring benefit(s) upon the host’s health.
SYMBIOSIS – interaction between two or more different biological species.
SYNBIOTYK - A mixture comprising live microorganisms and substrate(s) selectively utilized by host microorganisms that confers a health benefit on the host. Simply, Probiotic(s) + prebiotic(s) working to achieve one or more health benefits.
MICROBE – an organism that is microscopic.
MICROORGANISM – a microscopic living organism, single- or multiple-celled. Microorganisms include bacteria, archaea, protozoa and some fungi and algae. Viruses are also sometimes classified as microorganisms.
MICROBIOTA – sometimes called microflora; a community of symbiotic, commensal and pathogenic microorganisms inhabiting either the surface of the body or its different cavities: the skin, mouth, ears, vagina and gastrointestinal tract, among others.
MICROBIOME – the collective genomes of the microorganisms that reside in an environmental niche, such as a gut microbiome referring to microbial genomes found in the gut.
Blood sugar imbalance is a commonly undiagnosed problem. Stable blood sugar is essential to overall health. Blood sugar imbalance can relate to (chronically) low or high blood sugar. Some people experience both, fluctuating blood sugar levels between low and high. Drops in blood sugar are known as hypoglycemia and high blood sugar spikes can refer to insulin resistance.
The early recognition of these symptoms will help you prevent excessive and unnecessary inflammation, and will give you the opportunity to take effective measures to reclaim your health. Glucose serves as your brain’s fuel and fuel for the cells throughout the body. When you do not have stable blood sugar (glucose), you comprise your overall health and your brain health.
Many people are unaware that they have blood sugar imbalance and insulin resistance is a silent blood sugar problem. It is widely undiagnosed and if not managed it increases the risk for prediabetes, type 2 diabetes and a host of other serious health problems, including heart attacks, strokes, polycystic ovary syndrome (PCOS), hypertension, and hyperlipidemia known as metabolic syndrome, and cancer.
What is insulin resistance?
Insulin is a hormone made by the pancreas and its job is to help glucose in your blood (blood sugar) to enter the cells in your body, where it’s used for energy. Glucose comes from the food and drinks you consume. When blood glucose levels rise after you eat, your pancreas releases insulin into the blood. Insulin then helps to lower blood sugar (glucose enters the cells) to keep it in the normal range.
Insulin resistance is a condition when cells of the body don’t respond properly to insulin and they can’t easily take up glucose from the blood. As a result, it is more likely that glucose will build up in the blood leading to elevated blood sugar levels.
A growing body of evidence has consistently shown that insulin resistance is linked to low-grade systemic inflammation.
When the body becomes resistant to insulin, it tries to cope by producing more insulin (hyperinsulinemia), therefore people with insulin resistance are often producing more insulin than healthy people.
Insulin surges promote inflammation in the brain and in the body. Interestingly, blood sugar/insulin levels impact the brain’s ability to make neurotransmitters and are elucidated to play a role in neurodegenerative diseases such as Alzheimer's disease. Thus, unstable blood sugar affects brain’s biochemistry, causes inflammation and compromises your brain health.
Becoming insulin resistant does not happen over-night, it typically takes years to get there. Most common reason includes a diet high in sugars, sugary foods, sweets, cookies, sodas, bread, pasta, pastries, excess rice & potatoes, and grains. In addition, high stress, poor sleep and lack of physical activity. Being obese on itself increases insulin resistance as well. However, it is possible to be insulin resistant without being overweight or obese.
Insulin resistance symptoms
Insulin resistance develops in stages. During the initial - compensated phase of insulin resistance, insulin levels are higher, and normal blood glucose levels are still maintained. If compensatory insulin secretion fails, then either fasting or postprandial glucose concentrations increase. Eventually, type 2 diabetes develops when glucose levels become higher and the resistance increases and compensatory insulin secretion fails. The inability of the pancreatic β-cells to produce sufficient insulin in a condition of hyperglycemia is what characterizes the transition from insulin resistance to type 2 diabetes.
The symptoms become more pronounced once secondary effects such as higher blood sugar levels occur.
Insulin resistance symptoms may include:
thirst or hunger
feeling hungry even after a meal
increased or frequent urination
tingling sensations in hands or feet especially when insulin resistance progresses to type 2 diabetes
feeling more tired than usual
feeling sleepy after meals
frequent infections
difficulty concentrating (brain fog)
weight gain around the middle (belly fat)
high blood pressure
high cholesterol levels
Some people may have darkened skin in the armpit or on the back and sides of the neck, a condition called acanthosis nigricans
Polycystic Ovary Syndrome (PCOS) might be a red flag to consider insulin resistance
How can insulin resistance be diagnosed?
There is no single perfect test used in clinic for diagnosis. But the easiest screening way, next to the clinical presentation, is to do a blood test for (fasting) blood serum glucose and insulin (and often other markers like Ab1c, cholesterol, triglycerides).
There are also helpful tools for insulin resistance assessment such as the Quantitative Insulin Sensitivity Check Index or a Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).
Insulin resistance - eating to balance your blood sugar might fix the problem
If you suspect you may have insulin resistance or prediabetes, there are things you can do to reduce inflammation and to be healthier.
Golden tips include avoiding sugary foods and drinks, avoiding processed foods and drinks, and having balanced meals consisting of real foods. Plant foods (veggies, fruits) rich in phytonutrients such as polyphenols-flavonoids with their anti-inflammatory and anti-oxidative powers should be plenty full on your plate. Keeping a moderate carbohydrate intake is also recommended. Think of a Mediterranean like diet. Some people also benefit from a ketogenic diet.
Most people will do well keeping following proportions on their plate:
About 50-65% of non-starchy vegetables
About 15-25% of quality protein
About 15-30% of healthy fats
About 5-15% of healthy starches
Herbs, spices and salt
Healthy eating also includes eating fruits but preferably have them as a snack or a dessert.
Food groups: vegetables, fruit, protein rich foods, fat rich foods, herbs and spices, and heathy starches
Find your carbohydrate tolerance
First of all, having nutritious breakfasts with high quality protein and fat, (low-carbs) can be very powerful to stabilize your blood sugar.
For many people having little bit carbs for breakfast, a little more for lunch and even more for dinner will do the trick in keeping your blood sugar stable.
To find your carbohydrate tolerance monitor following: if you feel sleepy or crave sugar after you eat, you probably have eaten too many carbohydrates. But in case of severe insulin resistance you may feel sleepy even if you haven’t eaten any starchy or sweet foods. Let’s say you had beef and a salad for lunch and you still feel sleepy after eating. It might suggest that you are at the advanced stage of insulin resistance. In this case, it’s worth working with a professional who can help you correct the problem with nutrition and nutraceuticals.
Information provided below is meant for educational purposes only, and does not constitute medical or nutritional advice oract as a substitute for seeking such advice from a qualified health professional.
Reference list
Rhea EM, Banks WA. Role of the Blood-Brain Barrier in Central Nervous System Insulin Resistance. Front Neurosci. 2019;13:521. Published 2019 Jun 4.
Spinelli M, Fusco S, Grassi C. Brain Insulin Resistance and Hippocampal Plasticity: Mechanisms and Biomarkers of Cognitive Decline. Front Neurosci. 2019;13:788. Published 2019 Jul 31.
Tao L, Liu H, Gong Y. Role and mechanism of the Th17/Treg cell balance in the development and progression of insulin resistance. Mol Cell Biochem. 2019;459(1-2):183–188.
Ren N, Kim E, Li B, et al. Flavonoids Alleviating Insulin Resistance through Inhibition of Inflammatory Signaling. J Agric Food Chem. 2019;67(19):5361–5373.
Gołąbek KD, Regulska-Ilow B. Dietary support in insulin resistance: An overview of current scientific reports. Adv Clin Exp Med. 2019;28(11):1577–1585.
Yaribeygi H, Farrokhi FR, Butler AE, Sahebkar A. Insulin resistance: Review of the underlying molecular mechanisms. J Cell Physiol. 2019;234(6):8152–8161.
Ballak DB, Stienstra R, Tack CJ, Dinarello CA, van Diepen JA. IL-1 family members in the pathogenesis and treatment of metabolic disease: Focus on adipose tissue inflammation and insulin resistance. Cytokine. 2015;75(2):280–290.
Barazzoni R, Gortan Cappellari G, Ragni M, Nisoli E. Insulin resistance in obesity: an overview of fundamental alterations. Eat Weight Disord. 2018;23(2):149–157.
Zand H, Morshedzadeh N, Naghashian F. Signaling pathways linking inflammation to insulin resistance. Diabetes Metab Syndr. 2017;11 Suppl 1:S307–S309.
Maciejczyk M, Żebrowska E, Chabowski A. Insulin Resistance and Oxidative Stress in the Brain: What's New?. Int J Mol Sci. 2019;20(4):874. Published 2019 Feb 18.
Petersen MC, Shulman GI. Mechanisms of Insulin Action and Insulin Resistance. Physiol Rev. 2018;98(4):2133–2223.
During the day, depending on various factors, blood sugar (glucose) levels fluctuate slightly at physiological levels. This is normal.
Glucose is the main source of energy for our body and brain. Glucose comes from foods and drinks. One of the hormones involved in glucose utilization, is insulin. Insulin’s job is to help glucose enter our cells where it’s used for energy. The levels of circulating blood sugar should not be too low and not too high. The standard normal lab range is around 3.5 and 6.0 mmol/L (63 to 108 mg/dL).
A stable blood sugar level is essential to our overall health.
What is hypoglycemia?
If blood sugar falls below the healthy range, it’s called HYPOGLYCEMIA. Then, you might not feel well. There are several reasons why this can happen; the most common is a side effect of drugs used to treat diabetes. Diabetics are under a medical care and are educated about the risk of hypoglycemic symptoms so I am not going to talk about hypoglycemia in relation to diabetes management. Hypoglycemia can happen in people who do not have diabetes.
Here, I cover some aspects of non-diabetic hypoglycemia. It’s relatively common but many people are not aware of it.
Symptoms of hypoglycemia
Symptoms of hypoglycemia can differ from person to person. You may have one or more mild-to-moderate symptoms.
Typical symptoms of hypoglycemia include:
feeling hungry
feeling dizziness and light-headed if meals are missed
feeling shaky, jittery
feeling tired and eating to relieve fatigue
becoming easily irritated, upset, tearfull and nervous
craving for sweets between meals
increased energy after meals
weakness
tingling lips
a fast or pounding heartbeat (palpitations)
poor memory, forgetfulness
anxiety
blurred vision
paleness
Some people experience hypoglycemia also during sleep. If that happens, they may cry out or have nightmares, sweat excessively, feel tired, irritable, or confused after waking up.
Why some people feel anxious, they sweat, or have thumbing heart when their blood sugar levels drop?
Because low blood sugar triggers the release of stress hormones (to promote glucose release from its storage form like glycogen) and puts the body in the “fight-or-flight” mode. Moreover, at the point of glucose shortage (combined with a lack of ketones) the brain will not get enough glucose which can be manifested as drowsiness, difficulty concentrating, confusion, blurred vision, slurred speech, or numbness.
To know whether you are experiencing low blood sugar, you need to check your blood sugar. If you are experiencing symptoms and you are unable to check your blood sugar for any reason, you can try to treat hypoglycemia and best discuss it with your general practitioner.
What causes non-diabetic hypoglycemia?
There are two types of non-diabetic hypoglycemia:
Fasting hypoglycemia: may be related to a disease (liver disease, hypothyroidism, eating disorders), certain medications, herbal supplements such as fenugreek, ginseng, cinnamon, or to alcohol, malnutrition, or exercise.
Reactive hypoglycemia: which happens within a few hours of eating a meal, the causes may be unknown but possibly include: hyperinsulinemia (elevated insulin levels), meals high in refined carbohydrates such as white bread or foods high in sugar, prediabetes. And it’s more prevalent in women with polycystic ovary syndrome (PCOS).
In addition, low blood sugar can be caused by a low carbohydrate intake as well as by a high carbohydrate intake. Chronic high carbohydrate consumption (especially simple sugars) can cause over production of insulin and insulin helps our body to “insert” glucose into the cells where it can be utilized as energy. Some people make too much insulin (inappropriate levels for the level of blood glucose) and if insulin is able to effectively “insert” glucose into the cells, blood sugar can drop too much causing hypoglycemia. The possible risk of high insulin levels includes a high risk of brain issues because insulin inhibits lipolysis and ketogenesis, thus preventing the generation of alternative brain substrates (such as ketone bodies), the brain might be deprived of the fuel then.
NOTE. If you started a low-carb diet and you experience some of the symptoms mentioned above, you might be getting too little fuel (energy from carbs and/or fats). Meaning that your carbohydrate intake went down but your fat intake did not increase to balance the fuel intake which can lead to hypoglycemic episodes. It’s quite common to follow a low-carb diet without a proper consideration of providing the fuel for the body and the brain.
How to prevent low blood sugar?
Have small amount of protein every 2 - 3 hours. This does not mean eat a full meal every two to three hours – a few bites will do. The idea is to keep your blood sugar stable without activating your adrenals to release stress hormones and raise blood glucose. Suggested proteins include nuts, seeds, a boiled egg, or meat, or a low-carbohydrate protein drink. For some people, eating 5 to 6 small meals each day instead of 3 large meals and snacks works best.
Avoid refined carbohydrates such as white bread, cakes, cookies, regular sodas, syrups, and candy.
Avoid drinks or foods that contain caffeine and alcohol. Caffeine and alcohol may cause you to have the same symptoms as hypoglycemia, and may cause you to feel worse.
Avoid sweets before bed. If you have a tendency to hypoglycemia, your blood sugar will crash during the night, long before your next meal is due. Chances are your adrenals will kick into action, creating restless sleep or that 3am wake up with anxiety.
Eat diversity of healthy foods. In a nutshell, foods that should be on your menu include vegetables (various vegetables which will provide complex carbohydrates, polyphenols, anti-oxidants and other nutrients), protein source (mushrooms, poultry, fish, nuts, meat, seeds, legumes, eggs, alternatively a protein powder), healthy fats (extra virgin olive oil, flax seed oil, avocado, coconut fat, goose fat, duck fat, borage oil, evening primrose, and ghee/grass-fed butter), healthy (resistant) starches (sweet potato, rice, buckwheat, quinoa, tubers) in moderation, and various herbs and spices.
Check your carbohydrate intake. If you are on a very low-carb diet (and not on a ketogenic diet), you might be getting too little carbs to sustain a stable blood glucose.
Track your symptoms and situations in which they happen. Pay attention when your symptoms occur, is it before meals or when you skip a meal? Write down your symptoms, time the episodes and relation to food ingestion, comorbid conditions, medications and social.
In case of severe hypoglycemia, have a sugary drink or snack – try something like a small glass of fruit juice or a small handful of sweets.
Treatment of hypoglycemia
Treatment depends on the cause of the hypoglycemia. For example, if a medicine you take is causing hypoglycemia, you need to discuss it with your health care professional. If hypoglycemia is caused by low hormone levels, you may need to take hormones.
Information provided below is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional.
Reference list
Desimone ME, Weinstock RS. Non-Diabetic Hypoglycemia. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000.
Kittah NE, Vella A. MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia. Eur J Endocrinol. 2017;177(1):R37–R47.
Kandaswamy L, Raghavan R, Pappachan JM. Spontaneous hypoglycemia: diagnostic evaluation and management. Endocrine. 2016;53(1):47–57.
Scheen AJ. Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia. Diabetes Metab. 2010;36 Suppl 3:S31–S38.
Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Can J Diabetes. 2018;42 Suppl 1:S104–S108.
Mumm H, Altinok ML, Henriksen JE, Ravn P, Glintborg D, Andersen M. Prevalence and possible mechanisms of reactive hypoglycemia in polycystic ovary syndrome. Hum Reprod. 2016;31(5):1105–1112.
COVID-19 is a new disease caused by a novel coronavirus. There is still limited information on the risk factors for severe disease but as COVID-19 thrives around the globe, we see that obese and diabetic corona patients have worse outcomes and a more challenging time in dealing with the infection.
Realizing that the coronavirus will hang around, the best contingency plan is to do whatever we can to lower our risk of complications. Now is the time to make ourselves resilient to pull through, especially for individuals who are above their ideal weight and/or have diabetes (type 2).
Obesity is a critical risk factor for insulin resistance, and insulin resistance increases risk for type 2 diabetes, hyperlipidemia, cardiovascular disease, and some types of cancer. Obesity is a complex disease involving an excessive amount of body fat. Although there are genetic, behavioural, metabolic and hormonal influences on body weight, obesity occurs most commonly due to a combination of excessive food intake and lack of physical activity. When your body receives more calories than it needs and than it is able to burn, your body stores these excess calories as fat.
Below, I briefly touch upon inflammation and oxidative stress in relation to obesity and diabetes. Inflammation at physiological levels plays a protective role and is needed (for fighting infections and wound healing for example), however CHRONIC SYSTEMIC INFLAMMATION IS HARMFUL. Obesity and diabetes promote systemic inflammation and systemic inflammation in the light of COVID-19 complicates matters because the immune system, trying to fight the virus, goes into overwork. This can create a brutal cycle driven by cytokine molecules promoting a cytokine storm, an overwhelming inflammatory body state.
Why that happens? It’s a multifactorial and complex process but one aspect is known, a baseline inflammation and oxidative stress level is high.
OBESITY ADDS THE EXTRA INFLAMMATORY LOAD GENERATED BY ADIPOSE TISSUE
Excess fat cells results in excess pro-inflammatory cytokines, and it results in excess inflammation.
Fat tissue cells (adipocytes) secrete adipokines, aka cytokine molecules, to communicate with the body regarding long-term energy storage, reproductive function, blood pressure regulation, energy homeostasis, the immune response, and many other physiologic processes. The adipokines possess pro- and anti-inflammatory properties and play a critical role in integrating systemic metabolism with immune function. As adipose tissue expands during the development of obesity, this balance shifts to favor proinflammatory mediators. The pro-inflammatory adipokines are increased whereas the anti-inflammatory adipokines are decreased. Consequently, it creates and perpetuates a vicious cycle of low-grade inflammation in white adipose tissue (WAT), and metabolic disorders associated with obesity. The higher concentration of pro-inflammatory cytokines in the bloodstream, the higher chance of the body going into the cytokine/inflammatory storm in an event of an inflammatory insult, such as infection.
What’s more, obesity and production of inflammatory adipokines suppress insulin signaling resulting in insulin resistance. Simply put, obesity increases insulin resistance and it’s called obesity-mediated insulin resistance. The mechanism of it is not completely understood but it’s likely related to adipose tissue dysfunction/lipotoxicity, inflammation, mitochondrial dysfunction, and hyperinsulinemia. What’s worth knowing is that insulin resistance precedes diabetes.
INSULIN RESISTANCE IF NOT MANAGED CAN PROCEED TO DIABETES (type 2)
Taking the right measures on time can prevent diabetes, yet many people are unaware of having insulin resistance. WHY? The tests are not typically done and the symptoms are not always recognized, especially if you are not aware of what you should pay attention to. People are often diagnosed when already being (pre)diabetic, this is when their fasting blood sugar is abnormally elevated. If you want to learn more on the topic of insulin resistance, do check my other blog.
Type 2 Diabetes is a complex chronic inflammatory condition characterized by multiple metabolic and vascular abnormalities that can affect the response to pathogens. One of diabetic hallmarks is low-grade systemic INFLAMMATION. The body produces excessively pro-inflammatory cytokines (like TNF-α) and proinflammatory monocytes whereas there is decreased activity of anti-inflammatory cytokines such as interleukin- (IL-) 10. As a result, there is an imbalance between pro- and anti-inflammatory activities. Diabetes and uncontrolled glycemia are found to be significant predictors of severity and deaths in patients infected with different viruses.
Possible Scenario: existing systemic inflammation + infection
Now imagine: when virus infects you, the body responds by making pro-inflammatory cytokines (which is good) but if you already have high baseline inflammation, generating even more INFLAMMATION - on the top of existing low-grade inflammation - will be overwhelming for the body and more difficult to regulate, as a result can cause complications. The mechanism of the coronavirus pathogenicity hasn’t been completely deciphered yet but one of possible reasons why people with underlying health conditions (chronic inflammation) do not survive, is related to the cytokine storm (cytokine release syndrome), where excess inflammation and poor regulation of inflammation is devastating.
Cytokine storm refers to excessive and uncontrolled release of pro-inflammatory cytokines. Cytokine storm syndrome can be caused by a variety of diseases, including infectious diseases, rheumatic diseases and tumor immunotherapy. It is commonly manifested as systemic inflammation, multiple organ failure, and high inflammatory parameters.
OXIDATIVE STRESS
Next to excess inflammation it’s also common to have excess oxidative stress in a disease state.
Both, oxidative stress and chronic inflammation are known to play a role in metabolic diseases, including diabetes. Just as with chronic inflammation, oxidative stress is triggered by the imbalance between oxidative and antioxidative systems in the body. Imbalance results from overproduction of oxidative-free radicals and associated reactive oxygen species (ROS), and reduced anti-oxidant activities to clear ROS. In relation to coronavirus, it’s good to know that infections also increase oxidative stress.
To counteract the effect of free radicals, antioxidants can scavenge and neutralize ROS. For example, many foods like vegetables and fruits contain naturally occurring antioxidants including vitamins, minerals and phytonutrients. Another good reason to eat your veggies.
ROSare chemically reactive molecules containing oxygen, they are formed as metabolic byproducts. Examples includehydrogen peroxide, superoxide radicals, singlet oxygen, hydroxyl radicals and peroxynitrite anion. Excessive levels of ROS can be harmful because ROS can alter the structure and function of proteins and lipids. These altered proteins and lipids can impair the function of our cellsleading to dysfunctional metabolism, and overall poorer biological activity, immune activation and inflammation.
HERE IS WHAT YOU CAN DO
Reduce unnecessary inflammation and support antioxidative defenses.
Unnecessary inflammation is inflammation resulting from poor diet, poor lifestyle, lack of physical activity, stress, lack of sleep, various metabolic and hormonal imbalances, and disease. Necessary inflammation helps us to deal with certain stressors such as infections, wounds, allergies, or toxins by creating an inflammatory response to protect us.
Knowing that obesity is a risk factor for COVID-19 complications and that proper management of obesity will first of all help you prevent developing type 2 diabetes, and second of all will help you reduce unnecessary inflammation and oxidative stress: you should take this opportunity now and use effective lifestyle interventions to reclaim your health. Don’t wait. The earlier you act the better.
Dietary changes, increased physical activity and behaviour changes can help you lose weight. And weight loss can improve or prevent the health problems associated with obesity.
If you feel overwhelmed, take it step by step and work with a professional who can guide you in the process.
Don’t make excuses, just take the first step. For example, if your diet is low in vegetables – start increasing portions of vegetables with your lunch and dinner, and have more diversity of it. Adding veggies will provide anti-inflammatory and anti-oxidant molecules that your body can utilize to counteract inflammation and oxidative stress. If your diet is already healthy and balanced and you can’t lose weight or stabilize blood sugar, contact a professional for tailored made recommendations.
Want to learn more about healthy and nutritious meal composition? Check my blog about creating a healthy plate.
Information provided below is meant for educational purposes only, and does not constitute medical or nutritional advice oract as a substitute for seeking such advice from a qualified health professional.
Reference list
Bloomgarden ZT. Diabetes and COVID-19. J Diabetes. 2020;12(4):347–348.
Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?. Lancet Respir Med. 2020;8(4):e21.
Karczewski J, Śledzińska E, Baturo A, et al. Obesity and inflammation. Eur Cytokine Netw. 2018;29(3):83–94.
Muniyappa R, Gubbi S. COVID-19 Pandemic, Corona Viruses, and Diabetes Mellitus [published online ahead of print, 2020 Mar 31]. Am J Physiol Endocrinol Metab. 2020;10.1152/ajpendo.00124.2020.
Maddaloni E, Buzzetti R. Covid-19 and diabetes mellitus: unveiling the interaction of two pandemics [published online ahead of print, 2020 Mar 31]. Diabetes Metab Res Rev. 2020;e33213321.
Barazzoni R, Gortan Cappellari G, Ragni M, Nisoli E. Insulin resistance in obesity: an overview of fundamental alterations. Eat Weight Disord. 2018;23(2):149–157.
Mraz M, Haluzik M. The role of adipose tissue immune cells in obesity and low-grade inflammation. J Endocrinol. 2014;222(3):R113–R127.
Hussain A, Bhowmik B, Cristina do Vale Moreira N. COVID-19 and Diabetes: Knowledge in Progress [published online ahead of print, 2020 Apr 9]. Diabetes Res Clin Pract. 2020;108142.
Karam BS, Chavez-Moreno A, Koh W, Akar JG, Akar FG. Oxidative stress and inflammation as central mediators of atrial fibrillation in obesity and diabetes. Cardiovasc Diabetol. 2017;16(1):120. Published 2017 Sep 29.
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Many people suffers from abdominal bloating and if you are one of them you know that’s no fun. Majority of people that come to see me struggles with it, therefore I decided to give it a brief attention. If bloating interferes with your daily life, your work, your social of recreational activities, it’s something you need to look into.
Symptoms
Your abdomen feels bloated when your GI tract increases its volume due to presence of air or gas. It is a nasty feeling of fullness, swelling, tightness, or hardness. You may also experience pain, flatulence, abdominal distension, nausea, burping, belching, or gurgles. Some people feel like they “look pregnant” when bloating strikes.
What are the most common causes of abdominal bloating?
There can be various causes of being bloated, some of which are quite easy to tackle and some may need a professional help.
Consider following if you feel regularly bloated:
Eating and drinking too fast. Eating too much. When you eat and drink fast you may swallow too much air and promote gas formation, also rushing while eating impairs digestion. Chewing gum, smoking may also worsen the problem. Our digestive system has certain capacity to digest efficiently, if we eat too much food (too fast) it will obviously not be able to digest optimally. Eat slowly, not too much and chew your food thoroughly for better digestion.
Diet rich in starch and/or nuts. Overconsumption of starch (grains), nuts, processed foods, sugar, difficult to digest meal combinations such as high starch and high protein content in one meal. Overconsumption of starch intensifies the complaints related to candida and intestinal parasites.
Low gastric acid & indigestion. Low gastric acid and/or deficiency of digestive enzymes can result in abdominal bloating. I write about low gastric acid here.
Microbial GI dysbiosis. When your gut microbes get out of balance resulting in dysbiosis (beneficial and bad microbes are out of balance), the bloating may occur. Think of candida (Candida albicans) or other yeast overgrowth, parasitic infection (Dientamoeba fragilis or Blastocystis hominis), gastric Helicobacter pylori infection, or small intestinal bacterial overgrowth (SIBO).
Food Intolerance (lactose, histamine, fructose). People with inability or decreased ability to break down lactose (milk sugar), fructose or histamine may feel bloated.
Reactivity to gluten. You may feel bloated when your body does not tolerate gluten, sometimes it’s just too much gluten in your diet and sometimes it is a non-celiac gluten sensitivity or a celiac disease.
Crohn disease or ulcerative colitis. People with intestinal inflammation such as in Crohn disease or ulcerative colitis may experience abdominal bloating as well.
Impaired pancreatic function or bile production. Pancreatic -under or -overactivity, too little or too much bile can influence digestion of fats, starch and as a result aggravate the abdominal bloating.
Constipation. If you have a bowel movement only every few days, your abdomen will have a tendency to bloat because of an increased abdominal pressure.
Dehydration. The more dehydrated your body is, the higher chance you may feel bloated. Drinking too much alcohol, too little water and eating salty snacks can promote bloating.
Hormonal Changes such as during PMS and period. Due too hormonal changes and hormonal imbalances many women tend to feel bloated before and/or during their period.
Abdominal Water retention. Abdominal water retention called ascites takes place when fluid fills the space between the lining of the abdomen and the organs. It usually occurs as a result of liver problems.
What can you do?
Find the root cause.
First, you can experiment yourself by eating slowly, chewing properly, avoiding drinking with meals, eliminating processed and junk foods, eliminating sugar and starch rich foods, excluding diary, gluten, or histamine rich foods. If after your detective work you still experience abdominal bloating, get yourself tested. I would suggest starting with a fecal analysis that would include your microflora profile, parasites, digestion profile, inflammation markers, gluten reactivity markers, pancreatic elastase, bile salts, histamine) and a blood test.
For occasional bloating you can have a peppermint, ginger, fennel or chamomile tea, or other herbal remedies. Preferably avoid gassy fruits and vegetables, sodas, artificial sweeteners, sugar, starch, gluten and diary.
The easiest way to stay healthy: HYDRATE YOURSELF PROPERLY Let’s talk about the most basic nutrient: WATER, something so simple yet so powerful. I am constantly amazed how proper hydration helps me and my clients to feel better and to function better. Proper hydration is key to your overall health. Water is a major compound in the human body. About 70% of what we have within our bodies is water. Water is essential for our life. We can’t live without. When we provide too little water we will function but function poorly. Water facilitates many important processes to keep our body and mind in shape. I start my day with a large glass of (warm) water with a bit of sea salt or Himalayan salt dissolved in it (you can add a pinch of salt in your glass of water or if you want to be more precise about a quarter teaspoon of salt per 1 liter water. Do not overdo salt however; your total daily salt intake on average should not exceed 2-3 grams) or with a glass of warm water with a freshly squeezed lemon juice. It sets a good hydration start for the rest of the day. Sea salt enhances hydration, helps to balance electrolyte levels, and offers many other benefits. Through the day I will have a smoothie, drink more water (with and without salt), will have 2-3 herbal teas, and on some days a soup or bone broth. I recommend drinking ambient temperature water or warm water. Why do you need this basic nutrient?Water is your:
It serves as a solvent for ionic particles such as salts, glucose, amino acid. Thanks to water, various ions and molecules can move and reach various destinations within your body.
Building block. Water molecules occupy every space not taken by other molecules, within our cells and outside our cells. Water also facilitates the folding of amino acids to proteins to form proteins of proper structure and integrity.
Lubricant. Together with other molecules water lubricates surfaces and protects tissues functioning. Think of synovial fluid in joints, mucosal lining in GI tract, tears, or saliva.
Medium for biochemical reactions. Water as a medium facilitates the biochemical reactions constantly happening in your body. Water as a reactant also actively participates in the hydrolysis of proteins, carbohydrates and fats. Water is also a by-product of protein, carbohydrate and fat metabolism.
Transport medium. Water carries nutrients and waste products that need to move from one location to another location. Water helps nutrients reach cells and helps waste products on their way out of cells and out of the body. Water is the most basic nutrient of your blood and facilitates the functioning of the cardiovascular, respiratory, nervous and urinary systems.
Thermo-regulator. Water - thanks to its capacity to absorb heat, to hold it, to help to release it (perspiration) and to resist temperature changes - supports body homeostasis by maintaining body temperature.
Shock absorber. Water acts as a sort of gel assisting cells to maintain their shape and form and as a sort of cushion assisting tissues against the shock of movement. It provides the cushioning effect.
How do you know you drink too little water? If you experience the symptoms listed below there is a high chance your body is not properly hydrated.
Headache
Fatigue and weakness
Dry skin
Dry mucus membranes in the nose, mouth or throat
Nosebleeds (especially in dry air)
Dark and concentrated urine produced in small quantities
Constipation
Intestinal cramps
Nausea
Irrational behavior
Irritability
Low blood pressure
Shallow, rapid breathing
Weak, irregular pulse
How do you lose water? Via Skin, kidneys, respiratory and digestive tract. How much water do you need? Your optimal water intake may be affected by physical activity, exercise, metabolism, diet, health status, humidity and ambient temperature. If you sport and sweat you obviously need to drink more water. The average recommendation for adult females is about 2,5 liter daily, for adult males about 3-3,5 liter daily. When do you need even more water? If you lose more water, for example when you have a fever, you vomit, you have diarrhea, you have a respiratory discharge; you need to drink more water to compensate for the loss. Also get adequately more water if you follow a high protein diet, take diuretics, are on a plane, or live in a warm/hot climate. What about water versus other beverages? If you want to stay properly hydrated, pure water should be your first choice because of its highest osmotic power due to the least amount of solutes. It hydrates the body at the cellular level. Osmosis is reduced when you drink coffee, tea, sodas, or drinks containing sugar, protein, or artificial additives. Some common conditions can be improved by water Dehydrated body can’t function optimally. Point. As mentioned above, water facilitates a lot of important processes in your body so if you have too little of it, these processes will be impaired, impaired at the cellular level. If you are chronically dehydrated, at some point you will start experiencing signs and symptoms (listed above) of your body craving water. Just listen to your body. Take care of proper hydration in particular if you struggle with:
Hypertension
Low stomach acid and peptic ulcers
Arthritis
Low back pain
Coronary heart disease
Headaches (non-migraine, migraine, hangover)
Constipation
Colitis
Obesity
Edema of unknown origin
Chronic fatigue
Asthma and allergies
Sources:
“Water: the most basic nutrient and therapeutic agent” Herb Joiner-Bey. Natural Medicine text book, fourth edition. J. Pizzorno & M Murray. Elsevier 2013.
“Thirst and hydration status in everyday life” Mindy Millard-Stafford et al. Nutrition Reviews. Volume 70, Issue suppl_2, 1 November 2012, Pages S147–S151.
I want to share with you some stomach acid know-how essentials. It may surprise you that many health issues, not only digestive ones, are related to low stomach acid. Many people who come to see me have low stomach acid. I used to have it as well, without realizing it. Changing my eating habits and using some of the tips below helped me to restore my gastric acid production and as a result to feel better.
Why do you need stomach acid for?
Gastric acid (hydrochloric acid HCl) found in your stomach facilitates digestive enzyme secretion and protein digestion. Your stomach (muscular sac) acts as a sort of blender breaking your food physically (churning action of the stomach muscle) and enzymatically (the right gastric pH and activity of digestive enzymes). Low pH (1,5-2,5) of gastric acid is essential for digestive enzymes to become active and to digest. Apart from facilitating digestion, we need gastric acid as a first line of defense against food poisoning (Campylobacter, Salmonella), parasitic (Giardia, worms), bacterial (Helicobacter pylori, Small Intestinal Bacterial Overgrowth), and fungal (Candida) infections. Without adequate acid, we do not digest our food, we are at risk of mineral and vitamin deficiencies, and we are more vulnerable to various infections. Low stomach acid compromises our immunity. Therefore, you need stomach acid and it’s good for you.
Low stomach acid (hypochlorhydria) has been associated with many common health problems.
What symptoms to look for in association with low gastric acid?
Bloating, burning, burping, and flatulence right after meals
Abdominal fullness after meals
Poor appetite
Stomach upsets easily
Diarrhea or constipation
Undigested food in stool
Nausea after taking supplements
Reactivity to foods (food allergies, food sensitivities)
Iron deficiency
Chronic intestinal infections
Chronic candida infections
Acne
What can you do about low gastric acid?
Improve your digestion and restore your gastric acid production.
Imagine that if you are not able to properly digest your food and absorb the nutrients, cells within your body will not get the fuel, the nutrients they need for proper functioning. Because of impaired digestion and absorption you may experience some health issues. Digestion process starts even before you eat. When you see food, smell it, or think about it your senses are triggered, your brain is triggered, your digestive system is triggered. You may start producing saliva, gastric acid, hormones, and other molecules to prepare you for a meal. This is how digestion process begins.
Compare it with a scenario when you sit on a coach in front of TV, and while watching an interesting move you pop something in your mouth without realizing what and without realizing you eat. How well will your digestive system be prepared then to perform the task of digestion? Expectedly, not that well as if you eat mindfully.
It reminds me of something. One of my former colleagues years back, an Indonesian women, was always eating very mindfully. She was eating slowly and chewing her food very well. When she indulged few bites of her meal, my meal had already vanished. I was eating like it was a race and it always stroke me why she was eating so slowly, too slowly I thought then. But she simply knew that to digest well you need to eat well. In cultures where food sources are limited, people tend to eat more mindfully and slowly. They chew every single bite very well simply to extract as much nutrients as possible and to properly switch the digestive machinery on. Sound simple to do, right? Yet, in the current era of constant rush and stress it can be quite a task to do. Let me provide some guidelines that can change how you feel.
How can you digest better?
Chew your food thoroughly. Proper chewing is essential in order to promote gastric acid production and digestion. Try to chew your foods 20-30 times before swallowing. Eat smaller meals so the body can process your food properly and has possibility to heal. You may consider fasting or intermittent fasting as an additional boost for your general health and stomach. Part of your body healing is letting it recover. If you’re continually eating food from morning to sundown every day, your body doesn’t have the time to recover and heal.
Add bitterness to your menu. Include bitter herbs, bitter foods and bitter drinks. Bitterness increases secretion of saliva, gastric acid, pepsin, bile, and digestive enzymes so all we need to digest properly. Check your health-food stores for bitter/digestive herbal teas or bitter tinctures (Swedish bitters).
Drink adequate amount of (salty) water. Drink water with sea salt/Himalayan/Celtic salt every day to promote healthy gastric lining. You can mix 1-1,5 liter of (purified) water with about 1-1,5 gr of salt and drink it through the day (best after waking up, 30 min before lunch and before dinner, and before going to bed).
Avoid drinking (large quantities) during meals or shortly after your meals.
Have Apple cider vinegar (ACV). Some people find that ACV makes wonders for their digestion. Drink about 50-100 ml of water with 1-2 tablespoons of ACV 15-20 min before your (protein) meals. You can also add some ACV to your salads. You may need to gradually increase the amount of vinegar until you get the desired effect. Note: do not use ACV if you have histamine intolerance.
Take Digestive enzymes. Another help is to take digestive enzymes prior meals, also possible to take them with the apple cider vinegar. Digestive enzymes will help breaking down the nutrients (protein, fat, carbohydrates) you take in. Too high stomach pH does not allow for efficient food (protein) digestion. Take the enzymes until your stomach acid balances out.
Add betaine HCL (with Pepsin) with protein rich meals. If above tricks do not work, consider taking betaine HCL (with pepsin). Now, the trick with betaine HCL is you want to take the right amount, always start off with one capsule and see how you feel. Gradually increase the dosage from 300-750 mg to 1000-2000 mg per meal. When you get warmness/discomfort in your stomach, cut back by one capsule per every next meal. If you feel discomfort because of too high betaine HCl intake, you can neutralize the acid by drinking water or milk with 1 teaspoon of baking soda. Some people need one capsule; other people may need to take up to few capsules of betaine HCl. Once you have established a dose, continue this dose. It may however change over time as your digestion is improving, so stay vigilant and decrease the dosage when needed. With smaller meals, you may require less betaine HCl. Take betaine HCl only if you’re eating protein dense meals (with meat). Important: if you feel discomfort (heartburn) at the lowest dose of betaine HCl, it suggests you have a healthy response, no issue with low stomach acid and no need to take betaine HCl.
Try umeboshi plums. Umeboshi plums are salted and pickled plums helpful to relief indigestion. You can get them in Asian food stores, use them as umeboshi vinegar, as the base for tea or add as a salad dressing instead of salt and vinegar. ‘
Try acupuncture and/or chiropractic care.
Avoid processed foods and overeating.
Antacid?
Many people think they have too much stomach acid and therefore they take antacids. Antacids may relief some symptoms but most of the time the problem is not in too much acid in your stomach but in the fact that your stomach acid may just be in the wrong place, where it does not belong such as in esophagus. It may lead to acid reflux. I realize that the symptoms of too much and too little acid are similar, such as belching, burping, feeling of fulness after meals but be aware that too low acid is most of the time to blame for the symptoms described above.
Low stomach acid may be caused by pernicious anemia, chronic Helicobacter pylori, long-term term treatment with proton-pump inhibitors, autoimmune gastritis, or stress.
If your symptoms do not resolve after applying provided here tips, do consult it with you physician.
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