Electrolytes & other Nutrients for Keto

Electrolytes & other Nutrients for Keto

If you are experiencing symptoms on a ketogenic diet then it may be solved by increasing your electrolyte intake.  As the body begins to burn fat instead of glucose for energy there can be rapid water loss.  With this we can also lose a lot of salt and minerals.  Our nutrient intake will likely change as well.  With keto there is less of a need for some nutrients but others are essential.  For certain health conditions it can be helpful to track nutrients especially at the beginning or if symptoms arise. I’ll go over what to watch for with keto and some of the most common imbalances I see.

Mental Clarity: the Gut-Brain Axis

Healthy fats are excellent for brain health.  One of the benefits of keto is that people do feel a reduction in brain fog.  Before keto there can be a build up of endotoxins in our body.  If there is dysbiosis in the gut these toxins get released each time we eat.  Toxins like lipopolysaccharide (LPS) begin to circulate. The body responds by launching an inflammatory response.

The gut is meant to be a friendly place so when chronic inflammation occurs in there nothing really works.  Nutrient absorption, gut lining integrity and post-biotic production of short-chain fatty acids are inhibited. But keto takes out many of the foods that irritate the gut and intermittent fasting helps to stave off these toxins.  This reduces the inflammatory response and things calm down. And certain probiotic strains can actually be used to kill off some of these endotoxins.

Having variety in the types of fats you eat is important.  EPA and DHA are especially important for brain health.  If there is a lot of LPS then olive oil is better than coconut oil.  Variety in fats is helpful for maintaining a diverse gut microbiome.  Carb cycling using resistant starches, like cooked and cooled white rice or potatoes, also feeds the beneficial bacteria.  Prebiotics do this as well and I strongly suggest using these as part of your supplement plan during keto.

Fats also help with absorption of nutrients.  But by far the most benefit we see is the regulation of metabolism and a reduction in insulin resistance.  This calms cortisol and also reduces inflammation.  Stable blood sugar helps with energy, mental clarity and focus.  So let’s talk a little more about nutrients.

Eat More of These & Less of These

As a fat burner you may need less vitamin C because glucose competes with vitamin C.  Similarly the metabolic pathways for carbohydrates require more B vitamins.  That means in a lower carb state the need for certain b vitamins will be less.

However, many people who eat keto are consuming significantly less nutrients.  The way around this is to eat your way into keto with lots of low carb nutrient dense foods.  Examples of these include broccoli, green onion, asparagus, kale, spinach and carrots.  As long as you are tracking your protein intake and getting enough of grass-fed meats, wild fish and some shellfish or organ meats you should be fine. An app like cronometer is excellent for tracking micro nutrients as well as making sure your carb count is low. 

What About Nuts, Seeds & Dairy

Well these can be good for some people and bad for others.  Anyone with an autoimmune conditions needs to check if their symptoms become worse with these.  Lectins can be irritating to the gut and lactose or casein in dairy is a common, cross-reactive allergen.

On the up-side, these are nutrient dense foods full of good fats.  Some nuts can also be higher in carbohydrate so be cautious.  Dairy is highly palatable so it is easy to overeat and may raise LDL (low density lipoprotein).  It’s really meant to be a side-note or a condiment type of food.

Electrolytes & Salts 

If keto is working well for you in general but some symptoms have popped up then increase your electrolytes.  Keto flu is the term given to describe feeling yucky during the adaptive phase.  Symptoms that you haven’t had for awhile can also emerge.  People with thyroid or adrenal issues may see an exacerbation in symptoms.  While electrolytes won’t fix these issues, it may curb a flare.  Bone broth is a good source of electrolytes as long as you tolerate histamines & glutamate.

Ensure that your salt intake is also adequate.  Sodium follows a U-shaped curve and most people are scared to reach the high end but the slope is much steeper at the low end.  Any salt is ok to use as long as your electrolytes have a good profile of nutrients. I prefer pink salt in my kitchen and it could be because it’s pink!  

 

Why Understanding Cortisol is so Important

Why Understanding Cortisol is so Important

Many people have high total cortisol when experiencing what has commonly been called adrenal fatigue.

The term HPA axis (hypothalamus, pituitary, adrenal) dysfunction or maladaptation is a more accurate description due to the complex interdependence of glands, cells and the brain. Furthermore research and statistics show it is usually not a case of low output by the adrenals at all.

Why is this so important?

Cortisol has an impact on inflammatory response, thyroid function, glucose levels and the list goes on.  Studies show that early life events can set up a life long pattern that affects the HPA Axis and cortisol production.  This maladaptation also can occur when there is decreased output by the pituitary gland.  Receptor sensitivity is yet another way in which cortisol signalling can get disrupted. Lastly reduced bioavailability can happen at the tissue level by way of the binding globulin in the blood, conversion of cortisol to cortisone or cellular transcription.  The point is that the HPA axis is much more nuanced than the concept of adrenal fatigue lets on.

Research and Testing

Much of the research on cortisol has been done based on saliva tests which only show free cortisol.  Free cortisol levels can be very different, even opposite from total cortiso. Improper treatment can easily result.  Looking more closely can lead to early detection of thyroid disease, diabetes, leptin resistance and even certain cancers.

Pregnenolone and DHEA

Chronic stress leads to lowered DHEA, an important steroid hormone.  There is a common misconception that this is because cortisol is stealing from the precursor pregnenolone. Physiologically there is no evidence of this. Both pregnalone and DHEA are produced in mitochondria but in different tissues.  Cortisol is actually regulated outside of the adrenals. Also the amount of cortisol produced is significantly more than DHEA.  Location and function both debunk the myth that stress hormones ‘steal’ from sex hormones.   This is news to me as and not commonly understood in the medical community.   One way that this new theory can be proven is by looking at how supplementing pregnenolone will have no effect on DHEA.

Three ways of looking at Cortisol:

1. Is total cortisol low or high?  Looking into other factors that are present and that will be influenced by this.  Leptin and insulin resistance can be involved.

2. Is there a disrupted diurnal rhythm?  It is important testing is done properly because the morning cortisol curve happens in the first hour of waking.   Some tests are not specific enough by leaving a window of two hours. This creates misleading results.

3. Is there impaired cortisol metabolism?  When there is more cortisone present this could indicate thyroid involvement.

Evolutionary medicine reminds us that being human means that we are really good at adapting to our environment. This includes learning to ride the wave of positive stressors that move us forward in our lives. Noticing when we dip into too much stress and backing off is a skill that requires constant refinement. I teach a course on the HPA axis so please take advantage of this information. Stress is by far the number one factor influencing health today. The HPA axis is what allows us to regulate stress appropriately. We all have times when stress becomes too much. Knowing which tools to engage and how to recover is key to resiliency.

Five Key Habits for your Brain and Cognitive Function

Five Key Habits for your Brain and Cognitive Function

Brain health is influenced by many factors and we know there are a few habits that support long term function.

 

The inflammatory cytokine model of depression shows the influence diet has on cognitive function. Omega 6 oils are linked to depression and are pro-inflammatory. One in four adults experience mental illness in the US and the standard American diet is high in omega 6 oils. (1) Depression is increasing at an alarming rate of 20% each year.

1. Protein and Fat

Supplementing with omega 3’s is an option, however quality is an issue. Keep in mind that grass-fed dairy, meat and pastured eggs all are high in omega 3’s whereas conventional varieties are much higher in omega 6’s. Cold water, fatty fish that is wild is an excellent source of omega 3 oils as well as the important fatty acids EPA and DHA. DHA has been shown to support brain function particularly in depression, bipolar disorder and ADHD . Comparatively, vegetarians and vegans ingest 30-60% less EPA and DHA.

Monounsaturated fats like cold pressed, extra virgin olive oil increase the production of ACTH which is an important neurotransmitter. All neurotransmitters are built from amino acids in the gut. Glycine, a component of bone broth, reduces psychotic episodes and improves cognition by acting as an inhibitory neurotransmitter. It will antagonize norepinephrine which helps regulate the stress response. Cholesterol nourishes the myelin sheath of the brain.

A staggering 30-40% of people do not respond to anti-depressants. One of the ways these function is to inhibit the stress response by lowering high cortisol levels. Although, it can’t be known if an individual has high, normal, or low cortisol without testing. As a result this may explain why so many don’t respond. Cortisol is anti-inflammatory and by lowering it without proper testing it could actually increase inflammation.

2. Caffeine has many benefits in moderation

Caffeine is known to exacerbate anxiety especially in the afternoon and evening. The resulting lack of sleep and improper light exposure disrupt circadian rhythm. Over 20% of people with insomnia develop depression. In addition, those at high risk are mother’s whose iron and fat intake is not optimal. Interestingly half the population are poor metabolizers of caffeine. There may be a link between those with a gluten intolerance.

3. Gut Health and Gluten

The number of people who have undetected celiac disease and non-celiac gluten sensitivity is growing. The connection between celiac disease and cognitive dysfunction has determined at least 22% of people are likely to experience both. An astonishing 57% of those with neurological dysfunction test positive for anti-gliadin antibodies. Clinically I’ve seen people who tested negative for gliadin which is the standard test and when I test other gluten specific antibodies they are positive. The disorders associated with gluten include: seizures, neuropathy, ADD, ADHD, autism, ataxia, anxiety, depression and schizophrenia.

4. B-Vitamins

Vegetarians and vegans are 68-83% deficient in B12. B12 deficiency is associated with alzheimer’s, dementia, cognitive decline, memory loss, depression, bipolar and psychosis. B12 absorption can be impaired by dysbiosis, leaky gut, inflammation, pernicious anemia which is autoimmune, alcohol, pharmaceuticals, low stomach acid and IBD.

Folate and B6 are needed for serotonin synthesis. Additionally, a deficiency of these also increases inflammatory homocysteine.

5. The Minerals: Zinc and Magnesium

Copper and zinc act as neurotransmitters in the brain. The ideal serum ratio is .7 copper – 1 zinc. Oxidative stress and inflammation reduce zinc and increase copper. Low zinc indicates inflammation.

Magnesium acts at the blood brain barrier to prevent stress hormones from entering the brain. Prevents anxiety and depression after a traumatic brain injury. Caffeine and stress in excess deplete magnesium. Too much calcium inhibits absorption. Calcium from food is enough for most people.

Magnesium is stored in our bones. Acid reflux, Crohn’s, colitis, kidney disease and alcoholism contribute to a deficiency. Proton pump inhibitors are used to treat reflux by masking the symptoms and these will also deplete the body of magnesium overtime.

The recommended dose between 500-700 mg/day. Food sources include: dark leafy greens, cacao, bananas, soaked nuts, seeds and legumes. Protein will be better absorbed with a diet higher in protein. Some pharaceuticals block absorption and create deficiency of magnesium including PPI’s, Lasix, digoxin, nitrofurantoin, anti-malaria drugs and bisphosphonates.

Symtoms and conditions associated with low levels include: muscle cramps, heart arrhythmias, tremors, headaches, acid reflux, increased risk of heart disease, hypertension, metabolic syndrome, type 2 diabetes, migraines, premenstrual tension syndrome, asthma and hypothyroidism.

I recommend magnesium gylcinate and suggest that people take one capsule at night along with eating a nutrient dense diet free of the phytates that bind magnesium. Loose stool results from too much and can be to help with occasional constipation. Taking magnesium before bed will help relax your muscles and supports good sleep.

Your Gall Bladder & Gut Health

Your Gall Bladder & Gut Health

Cholecystectomy is the removal of the gallbladder.  In the later stages surgery is necessary but I’ll talk about how to avoid this and why.  A few years ago my dad had symptoms of a serious gall bladder attack.  I urged him to call the ambulance immediately.  I know how dangerous it can be if left untreated.  He was living out of town and was unable to drive because of the pain.

Surgery Doesn’t Treat the Underlying Cause

Surgery keeps people alive which I am so grateful for.  Now that his gallbladder is gone, bile flows from my dad’s liver to his small intestine via the common bile duct.  The liver continues to produce bile but an accumulation can still occur. Bile secretion directly into the small intestine has been shown to effect the microbiome and function of the gut negatively (1).  Also, those who have had a cholecystectomy can still have  gallstone issues if the underlying cause has not been addressed (2).

Gall Bladder Physiology

Bile is produced in the liver and travels via the common bile duct to the gallbladder. When dietary fats enter the small intestine, the gall bladder contracts to release bile. Bile is made up of mostly water, with only 3 percent consisting of a mixture of bile acids, cholesterol, phospholipids, bilirubin, inorganic salts, and trace minerals. Bile acids act like a detergent, helping to emulsify lipids in food. Without bile, these lipids go undigested, resulting in fatty stools. Bile is also crucial for proper absorption of cholesterol and the fat-soluble vitamins A, D, E, and K.

Gallbladder symptoms vary.  Initially pain in the upper abdomen that radiates into the back is common especially on the right side.  Nocturnal onset along with jaundice or yellowing of the skin, nausea and vomiting usually are involved (3).

Gallbladder diseases include:

  • Cholestasis: the backup of bile flow in the liver or in the biliary ducts.
  • Gallstones: stones form from the components of bile. 10-15% of adults are affected (4).
  • Cholesystitis: prolonged cholestasis characterized by inflammation of the gallbladder. 6 to 11% of patients with gallstones develop Cholecystitis (5).
  • Cholangitis: a complication where the flow of bile is blocked. The infection can also spread to the liver, so quick diagnosis and treatment are very important (6).

Leaky Gut

The connection between leaky gut and gall bladder problems is largely missed in conventional medicine. However, studies demonstrate a clear link between gluten intolerance (both celiac disease and in non-celiac wheat sensitivity) and inflammation of the gallbladder. Gluten damages the intestinal lining compromising the intestinal barrier function.  Largely this is due to zonulin.  Gluten increases this toxin resulting in a break down of the tight junctions.  Microbes and dietary proteins from the gut then ‘leak’ into the bloodstream (7).  The immune system sees these microbes and their microbial products as foreign invaders, and launches an immune response. The biliary system is affected by this inflammatory signaling. It has been shown to alter the gene expression and bile secretion in the liver (8).

Sure enough, research has linked gluten intolerance and celiac disease to increased prevalence of gallstones and biliary cirrhosis (9,10). Patients with autoimmune hepatitis are often also celiac (11). A study found that 42 percent of adults with celiac disease had abnormal levels of liver enzymes and I certainly see this in my practice. A gluten-free diet normalized liver enzyme levels in 95 percent of these patients (12).

Treating the gallbladder functionally

A low-fat diet may alleviate symptoms over the short term which is what conventional doctors often suggest.  But a long-term reduction of fat intake prevents gallbladder contractions which leads to more sluggishness and an increased risk of gallstones. Interestingly, a higher fat diet has been shown to protect against gallstone formation. Use it or lose it applies.

Gallbladder flushes are recommended by some natural health stores.  I learned long ago these have the potential to be dangerous as the bile duct can become obstructed. I typically stay away from extreme approaches that lack scientific evidence. I have yet to find a clinical trial on gall bladder flushes. I focus on treating the root cause.

Testing: markers like ALT, AST, bilirubin, LDH, GGT, ALP, and 5ʹ-nucleotidase can help discern what is going on.

Diet:  removing inflammatory foods like gluten, processed foods, and sugar are a great starting place.

Gut:  beak the cycle of gut inflammation leading to biliary stasis and lack of bile causing more gut inflammation.

Stimulate bile: with bitters like dandelion, milk thistle, and curcumin.

Reduce gallstones: with beet root, taurine, phosphatidylcholine, lemon, peppermint, and vitamin C.

Take bile: if you are having trouble with digestion of fats supplement with ox bile for a therapeutic period.

 

15 Sleep Solutions You Can Do

15 Sleep Solutions You Can Do

Sleep is a big deal  

Especially when two-thirds of adults don’t get the minimum required to meet basic physiological requirements.  In fact, less than 7 hours per night can shorten lifespan significantly.  Inflammation increases when we miss a night of good sleep.  Other sleep research shows up to 29% lower sperm count in men who sleep poorly vs those who regularly get enough rest.  Athletes performance drops 10-30%.

Why Parents are Crazy

As a parent of a young child I can vouch for how difficult it can be to get enough sleep.  When your infant finally starts sleeping through the night your cortisol and melatonin production is so confused insomnia becomes a thing. Catching up is not actually possible especially as a single parent.  Through trial and error I’ve discovered the ridiculous reality of living in a state of constant sleep deprivation.  Caffeine stops working.  You think everyone hates you and life is out to get you.  This is the real reason parents are crazy a lot of the time!  Anyone doing shift work or work late at night can be included in those who suffer the most.


Adults really do require 7-9 hours of sleep

  • Newborns (0-3 months): 14-17 hrs
  • Infants (4-11 months): 12-15 hrs
  • Toddlers (1-2 years): 11-14 hr
  • Preschoolers (3-5): 10-13 hours
  • Elementary school age (6-13): 9-11 hrs
  • Teens (14-17): 8-10 hrs
  • Adults (18-64): 7-9 hrs
  • Older adults (65+): 7-8 hrs

 

Sleep Hygiene: Focus on What to Do

1. Be consistent with your sleep schedule 

Set a realistic bedtime.  Train your brain to develop a regular circadian rhythm by going to bed at the same time most of the time.  

2.  Establish a bedtime routine

This can include a warm but not hot bath or shower.  Journaling in a book, meditating, stretching gently or reading are all appropriate activities.  Dim your lights and listen to relaxing music to unwind from your day.  

3.  Your bedroom needs to be quiet, cool and comfortable

Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress.  Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house. 

4. Turn off electronic devices in the evening

This allows for more connection, better digestion and a general parasympathetic or relaxed environment where you can reconnect and let go of the day.  Electronic devices emit blue light which stimulates the brain.  Cortisol and melatonin get confused and these hormones play a huge role in insomnia.

5. Exercise during the day

Exercise promotes continuous sleep.  Its also great stress relief.  Avoid intense exercise in the evening as this can interfere with deep sleep.  Stress management is crucial to sleeping well.

6.  Eat enough during the day

Blood sugar dysregulation causes spikes in cortisol and makes it more difficult to rest later on.  In fact, having enough carbohydrates during your evening meal has been shown to support better sleep.  Choose root veggies and unprocessed, gluten free options.  Often times food reactions cause an internal stress response that we aren’t aware of.

7. Use caffeine with caution

We know that 50% of people don’t metabolize caffeine.  This means it stays in the body for much longer and therefore amount matters.  Cut down on caffeine and avoid it after noon entirely.  This includes chocolate. Uncooked cacoa is easier on you.  Matcha has a longer burn than coffee and many health benefits.  Find alternatives like peppermint or dandelion tea. Golden tea is a delicious alternative as well.  I know its not easy to change this habit especially when you are sleep deprived but it can be done.  It may be the most important change you can make.

8. Get out of bed if you aren’t sleeping

Do a guided meditation or find another relaxing activity until you feel sleepy.  This is part of training your body that bed is for sleep.  Have a comfortable chair in your room and make a cup of sleepy tea.  Simple rituals like this work.

9. Avoid large meals later at night

A small protein rich snack before bed can help with night hunger but large meals late at night create a burden for the liver.  Finish meals a few hours before bedtime.  The liver kicks into gear at 11pm so being asleep by then is ideal.

10. Reduce fluids before bedtime

I’m training my son to drink more during the day so he won’t need pull-ups at night.  Just pretend you are 5 years old!  My mom has sage advice for parents.  Ask yourself if getting your kid up to pee in the night is more of a priority than your sleep.

11.  Nap or no nap?

I teach meditation to my patients.  I find if someone calms their nervous system for 5-20min during the afternoon it can support a deeper sleep later.  People may or may not nap as part of the practice. I don’t see any problem with this however long naps may inhibit sleep later on.

12. Avoid these because we know they interfere with sleep

Alcohol raises our body temperature and requires that the liver clear it.  Ever wake up between 1am and 3am after having a drink?  Cigarettes and some medications also make sleep more elusive.

13. Black out your room, hide the clock and wake naturally if possible

This is basic but an incredibly important game-changer.  Buy black-out curtains.  Don’t use night-lights except in the bathroom.  Turn your digital clock away from your bed while you sleep.  Don’t wake to an alarm as much as possible.

14. Creat an extended sleep schedule

For anyone who has suffered from sleep problems an extended sleep schedule can support getting more sleep.  Research shows that allowing a longer period of time in bed does increase the amount of sleep people get.

15. Only use your bedroom for sleep and sex

Train your body to expect only rest and pleasure in this space by creating this.  Bedrooms ought to be a place of sanctuary from the world.


 

An Important Ally: Your Morning Awakening Response

Its best to get up when you first wake up.  By exposing your eyes to bright full-spectrum light you are stimulating the cortisol awakening response (CAR).  This accounts for half or more of our daily cortisol secretion.  Remember the cortisol is anti-inflammatory and an important hormone that works synergistically with melatonin. Doing any kind of movement first thing supports morning cortisol.  This could be carrying a child, going upstairs, walking your dog or going for a run. Daylight stimulates cortisol release, and darkness stimulates melatonin.

Blue light boxes improve sleep and depression simply by stimulating this early morning response during the winter for those who have to get up before dawn or who can’t go outside first thing in the morning.  Beginning to notice this response and working with it can help repair your sleep-wake cycle if its been disrupted.

HPA-D is not Adrenal Fatigue

I’ve written extensively on this topic and the reason I bring it up is because you’ll see a bunch of recommended supplements for adrenal fatigue.  Insomnia is a symptom of a much more complex disorder called HPA-D.  (hypothalamus pituitary adrenal dysregulation).  By testing cortisol thoroughly we can see that pattern of dysfunction and supplement accordingly.  Giving adaptogens to everyone is not the answer.  Nervine herbs on the other hand are safe and interestingly ashwaghandha is both an adaptogen and a nervine.  Some of my other favourites include skullcap, passion flower and camomile.  Anything that makes you feel groggy upon awakening is inhibiting the cortisol awakening response so avoid this. Be careful using licorice as this potent herb increases cortisol.  L-theanine is an amino acid that is safe to use for anyone.

Certain patterns of HPA-D require increasing cortisol at certain times of day or decreasing it. Often there’s an issue with hormone clearance pointing to excess inflammation, inhibited liver function or thyroid issues.  The testing I do looks at both free circulating cortisol and total metabolized cortisol.  These are not always the same.  In many cases only free cortisol is tested resulting in treatment that is not neccessarily exact.

CBD is both anti-inflammatory and promotes sleep.  This is why standardized extracts need to made available.  For those experiencing recalitrant pain CBD can bring down the pain where other pain medications won’t.  A patient of mine with insomnia and endometreosis began using CBD.  Once her pain came down she was able to sleep and could start making decisions about her health.  She had been unable to work for many months.  I’ve seen this with backpain as well.

Thorough blood work including iron, blood sugar, thyroid and inflammatory markers is required to see a full picture and get a sense of what is going on.  A gut work-up is also important. Neurotransmitters play a role in HPA-D through the gut-brain axis.  Healing the gut so its producing neurotransmitters again and absorbing nutrients is the key in some patients. Supplementing with precursors like 5HTP are helpful in these patterns during treatment.  You may be noticing that it can take time to get to the root cause of insomnia.  Often we are also addressing trauma during treatment.  When we find out what works and are sleeping more, people report feeling that they got their life back.

 

 

 

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