Eat less and exercise more.  It’s generally a great prescription for improving health and improving body composition.  However, it doesn’t always work.

In a small number of people, even with an awesome exercise plan and a rock-solid diet, the results are less than stellar.  They suffer from mysterious symptoms and complaints that they just shouldn’t be experiencing based on how much effort they put into their fitness and health. 

Make no mistake; exercise and nutrition can make everyone better.  But, for some people, it doesn’t take them all the way.  Because there’s a physiological log-jam.  Something on the inside that’s preventing their progress.

Here at Precision Nutrition, when we meet clients who have issues that exercise and nutrition – not to mention their own doctors – can’t seem to solve, there’s one guy we call.  His name is Bryan Walsh. 

Dr. Walsh has a sharp mind, a fitness background, a degree in naturopathic medicine, and extensive additional training and certifications. His wife is a naturopath too. (We bet his kids are the healthiest on the planet.)

So, when clients have nowhere else to turn, Dr. Walsh turns from mild-mannered dad and husband into forensic physiologist. He pulls out his microscope, analyzes blood, saliva, urine, lifestyle – whatever he has to. And he frees up the physiological jam.

That’s why, when Dr. Walsh volunteered to work on a monthly case study feature with us, we jumped at the chance. By following along with these fascinating cases, you’ll see exactly how a talented practitioner thinks; and you’ll also learn how to improve your own health.

In today’s case, we’ll meet a client who came to Dr. Walsh with a single complaint: adult acne. However, upon further investigation, Dr. Walsh discovered that she was suffering from problems with her sex hormones, blood sugar, and stress hormones.

Learn how “Doctor Detective” Walsh unraveled the mystery and helped this client achieve surprising results.

The client

It’s not every day that a young woman with a great diet, exercise plan, and attitude walks into my office with health complaints. Lots of them, in fact. That got my attention right away.

Jill was 34 and healthy. But she had adult acne. Yeah, acne – y’know, the stuff you’re supposed to grow out of, right around the time you lose your crush on Justin Bieber and quit breaking into your parents’ liquor cabinet? Well, Jill’s acne never got the memo that it was time to move on.

Jill was a woman on a mission. She’d been to many conventional doctors who merely put her on a variety of topical and oral medications, which included antibiotics (minocycline, tetracycline, clindamycin), as well as Differin®, Retin A, and azelaic acid. When that didn’t work, she tried alternative treatments such as natural acne washes, zinc and chromium supplementation, and honey masks.

Nothing helped. Doctors told her nothing was wrong, and that she’d just have to live with the breakouts.

After two years of trying everything, not only was her acne unimproved, but she now experienced frequent urinary tract infections (likely from the antibiotics). She was frustrated. She knew something was wrong.

But what? She looked fit and healthy. She ate well on an organic diet. She exercised regularly. At 5’9” and 130 lb, her weight was normal. She was even upbeat and positive.

Yet acne was only one of her issues.

Jill believed she also had hormone imbalances. She’d been trying to get pregnant for 10 years with no luck. She and her husband had pretty much given up on her dream of having a baby.

The client’s signs and symptoms

I examined Jill when she came into my office. She had significant acne and mild facial hair growth. Other than low blood pressure (100/70), all other physical exam findings were normal.

I dug deeper, scribbling notes as I went. Jill described the following:

Aha, I thought. Based on her medical history, her signs and her symptoms thus far, Jill’s probably experiencing blood sugar issues (i.e. reactive hypoglycemia), sex hormone imbalances, digestive dysfunction, and possible adrenal hormone imbalances.

After being “Doctor Detective” for many years, I like to think my instincts are pretty good. Still, I’m a cautious guy. I don’t like to jump to conclusions. So I turned to the diagnostic tests for confirmation.

The tests and assessments

Taking a good medical history and critically evaluating symptoms often tells you everything you need to know about a case. However, there are some things you can’t learn just from asking questions.

I can’t see into clients’ blood vessels or cells, or guess the chemistry of their urine. Lab testing gives me insight that I can’t get from conversation. In fact, labwork is one of the most useful tools in my arsenal.

I like to start small with some basic tests. Sometimes these are all I need. I always start with a good blood chemistry panel plus a salivary hormone panel. Jill is also a candidate for a digestive function panel, but we opted against it for now.

The test results

Blood chemistry panel

When read correctly, a good blood chemistry panel speaks volumes about a patient’s internal physiological processes. Here are some of the significant findings from Jill’s blood chemistry panel:

You’ll notice that even though none of these values were outside the lab reference range, I still flagged some of them as problematic. Why?

Well, what most people don’t realize is that, except for lipids (cholesterol, HDL, LDL, etc), the range provided by the laboratory is derived from blood samples taken from people visiting their doctor. In other words, sick people. Healthy people go to the doctor far less often than sick ones do.

Therefore when your doctor says your blood work is “normal”, s/he’s really saying: “You are as healthy as 90 percent of people visiting the doctor today” and “Congratulations! You probably don’t have a weird unusual disease!”

That’s not enough for me. I don’t just want to know that people are surviving. I want to know how to make them thrive.

So we look at blood panels a different way: as a means to evaluate health and optimal function.

In addition to the findings above, we also saw evidence of possible dehydration (slightly elevated albumin, hemoglobin and hematocrit) on the blood chemistry, which could be masking an anemic tendency on her blood work. If someone is dehydrated, their anemia will be harder, if not impossible, to spot on a blood chemistry test.

Is it plausible there are a lot of dehydrated anemic patients walking around today being told there is nothing wrong with them today? You bet. More than most people realize.

Hormone panel

Hormonally, Jill had a number of things going on.

We ran a month-long female hormone panel to track her hormones over the course of an entire month. The results appear in the graph below. Note that normal estrogen for a female cycle is in blue, normal progesterone is in red. Jill’s results are in dashed green.

Hormone panel results - click to enlarge

Based on this graph, you can see that Jill has fairly normal progesterone levels and timing, but estrogen starts and ends elevated throughout the entire month. This tells us that estrogen is dominant. This consistently high level of estrogen, and its effects on her tissues, helps explain many of her symptoms during menses.

But perhaps the most significant finding with regard to her acne was what we found when testing her testosterone.

Although many people assume that testosterone is a “male” hormone and estrogen is a “female” hormone, both men and women produce both types of hormones. They just differ in the relative amounts.

Elevated testosterone in women is more common than people realize. High testosterone causes everything from infertility, low libido, mood issues, difficulty losing weight, to the more obvious signs like acne and facial hair growth.

As far as Jill’s acne was concerned, we felt this was the smoking gun we were looking for.

Cortisol panel

To add insult to injury, Jill also showed chronically low cortisol levels throughout the day (as you can see below — her results are mapped on the blue line), which is consistent with reactive hypoglycemia.

Cortisol, also known as a glucocorticoid, has powerful influences on maintaining healthy blood sugar levels. When people with low cortisol skip meals, their blood sugar drops too low, and epinephrine is released as a backup plan to increase glucose. It is epinephrine that causing the shakiness, lightheadedness, and irritability experienced between meals.

Cortisol panel results - click to enlarge

The prescription

We may be “health gunslingers for hire”, but we ain’t supplement junkies. Nor do we respect practitioners that send patients out with grocery bags of supplements. It’s simply not necessary. Some people need more than others, but there is no need to take a supplement without proof that you need it.

We also don’t believe in protocols for specific conditions. For example we don’t have an acne protocol, or even an acne supplement. Instead, we look at which physiological pathways are dysfunctional and seek to improve those pathways using targeted nutritional approaches.

That being said, let’s find out what we did for Jill.

Issue #1 – Blood sugar imbalances

Her symptoms and blood work (low LDH) suggested reactive hypoglycemia, otherwise known as excessive blood sugar fluctuations. This is critical to address, as reactive hypoglycemia in women often increases testosterone production.

It’s crucial for women with this condition to eat small, frequent meals, whether they feel hungry or not. Anytime Jill feels lightheaded or shaky between meals, she’s waited too long and created hormone havoc in her body. Addressing low cortisol will also help correct her blood sugar fluctuations.

Issue #2 – Vitamin deficiencies

Jill seemed to be deficient in a number of nutrients (vitamin B12, folic acid, vitamin C, zinc) solely based on her blood work, so we gave her a high-potency multivitamin-mineral called Complete Multi by Designs for Health (2 caps, three times a day).

We also gave her additional sublingual vitamin B12 (1mg three times a day), as digestive issues can inhibit vitamin B12 absorption. This was designed to help what appeared to be a sub-clinical macrocytic anemia.

Issue #3 – Digestive dysfunction

We had Jill start with a three-week elimination diet to help reduce gut inflammation caused by possible food sensitivities. We also supplemented digestive enzymes (Digestzyme by Designs for Health, 2-3 capsule per meal). Later in her protocol, we also put her on Designs for Health Probiotics Supreme (2 caps a day) to help combat the assumed dysbiosis she had from antibiotic use.

Issue #4 – Hormone imbalances

We needed to eliminate her excess hormones, specifically estrogen and testosterone. This is most easily accomplished by improving liver and gall bladder detoxification pathways, since this is the primary pathway steroid hormones are cleared out of the body. Specifically we used Designs for Health Amino-D-Tox (2 caps, three times a day), LV/GB (one cap three times a day) and Clearvite by Apex Energetics (one scoop three times a day, which also addresses gastrointestinal health).

Issue #5 – Adrenal imbalances

Normally we don’t address adrenal imbalances right away. Rather we support other systems for a period of time, re-evaluate, and see if anything improved. However, given that high testosterone was a key finding, we needed to address the low cortisol to stop the vicious hormonal cycle happening anytime her blood sugar got too low. We prescribed an adaptogenic formula called Adaptocrine by Apex Energetics (2 caps, three times a day) designed to help support the body’s stress response.

Obviously there were other things to address, and additional directions we could go, but this was enough for the next 12 weeks, at which time we’d redo lab testing and evaluate her symptoms.

While this may seem like a lot, it’s all for good reason. For example, if her testosterone is high, we need to stop its overproduction (i.e. due to blood sugar fluctuations) and get rid of the excess levels (i.e. liver support).

The outcome

A few weeks after finishing the protocol, Jill submitted follow-up blood chemistry panel and salivary hormone testing. However, while we were pleased with her symptom improvement, we were initially puzzled by the lab results.

Symptomatically, Jill reported a complete resolution of her acne. She also had an “abundance of energy”, no more gas and bloating, emotional balance for the first time in 10 years, and she felt “happier and more alive” than she had in a long time.

Mission accomplished, right? Not really.

Her testosterone had lowered considerably from 67 pg/ml down to 15 pg/ml, which is a good thing. However her estrogen and progesterone remained very elevated. And now she had high glucose, alkaline phosphatase, white blood cells, and lipids (cholesterol and triglycerides).

Not exactly the direction we wanted to go. Scratching our head we wondered where we went wrong, and where we were going to go next.

But then we got our answer.

One week later, we had our answer. Jill was finally pregnant! As she told us in an excited email:

“…Yet the best, most joyous and most unexpected result was … I found out that I was pregnant! Never in million years did my husband and I think we could fall pregnant with the current state of my hormones and so quickly, after addressing my health concerns.”

Her pregnancy explained the odd lab values that came back post testing. So yes, apparently mission accomplished.

Summary

So what can we take away from Jill’s story?

1. Symptoms of reactive hypoglycemia, including shakiness, lightheadedness and irritability between meals are often correlated with low cortisol.
2. Blood sugar fluctuations will almost always cause hormone imbalances in women, specifically elevated testosterone.
3. High testosterone in women can result in mood issues (i.e. depression), infertility, difficulty losing weight, low libido, as well as external manifestations such as acne and facial hair growth.
4. Getting rid of excess testosterone requires balancing blood sugar to slow down its production, and supporting liver detoxification pathways to clear out the excess that is already present.

In the next article . . .

Jill contacted us a year later, elated with a new baby boy, but with a whole new set of symptoms: extreme fatigue, depression, and difficult weight loss.

We ran a blood chemistry, and it showed a very high TSH (Thyroid Stimulating Hormone) coupled with low thyroxine and T3 (Thyroid hormones).  However, low thyroid hormone was not her primary issue.  Her problems were being caused by something very common today, which we’ll cover next month.

Stay tuned, detectives.

Click here to join the waiting list.

He interviewed me for the CrossFit Journal, and it’s one of my favorite interviews. We covered a wide variety of topics, some of which I haven’t talked about before, including:

• my latest post-workout nutrition strategies for athletes and recreational exercisers
• “Paleo” eating principles and what I think about them
• intermittent fasting and my latest fasting experiments
• self-experimentation and why it’s so important
• the Precision Nutrition Certification program
• and a lot more…

CrossFit Journal: Dr. Berardi, can you give us the two-minute commercial about who you are and what you do?

JB: Well, to begin with, training has been an important part of my life for nearly 20 years now.

Originally, I trained for football, rugby, and track and field; all sports I competed in at a fairly high level.

Then, once my competitive sport days wrapped up, I began training for bodybuilding and powerlifting. I had pretty good success there too, eventually winning the NABBA Jr USA bodybuilding contest. My best lifts at the time were a 430-pound bench press, a 600-pound deadlift, and a 650-pound squat.

Throughout those competitive sporting days, I always wanted to know how stuff worked. I had lots of questions. About physiology, biology, biomechanics, and more. So those questions pushed me into academics. And over the course of the next 10 years, I earned a Pre-Med undergraduate degree, a Masters in Exercise Science, and a PhD in Exercise and Nutritional Biochemistry.

Nowadays, my focus is sport and exercise nutrition.

I’m an adjunct faculty member at both the University of Texas and Eastern Michigan University. I teach graduate level courses in sport and exercise nutrition.

And I run one of the largest nutrition research and coaching companies around – www.precisionnutrition.com. Over 200,000 people subscribe to our newsletter. And we have over 500,000 people visiting our site each month.

CJ: Good stuff. And I recommend everyone check out precisionnutrition.com too. It’s been a great resource for me over the years.

I once heard you say that the best coaches have three things in common: 1) an education in what they’re coaching, 2) success doing what they’re coaching themselves and 3) experience coaching a lot of others to success. It’s clear you’re educated and have a lot of personal experience. What about your coaching experience?

JB: I’m glad you asked that. Because, for me, that’s what I’m most proud of. Through our web site, over 60,000 people have followed our nutrition principles and discussed their results in our Member Zone.

Further, myself and my team have directly coached over 7,000 clients in the last 3 years. Some are recreational exercisers looking to lose fat or build muscle. Others are high performance athletes looking to win gold medals or world championships.

So, if there’s one thing I’m most passionate about, it’s coaching.

In fact, for the last 3 years, I’ve acted as the director of the world’s largest body transformation research project. This one-of-a-kind fat loss coaching program has produced more total weight loss than all 11 seasons of The Biggest Loser combined!

CJ: But you’re not just about fat loss, right?

JB: Right. I’m interested in helping people use nutrition and training to achieve their most ambitious physique, health, and performance goals. And my team has worked with athletes at the highest levels of sport.

CJ: Yeah, I’ve heard you work with quite a list of top athletes. Care to share any names?

JB: Sure. At the professional level, in the last 10 years, I’ve had the good fortune of working with guys like UFC Welterweight Champion Georges St-Pierre, St Louis Rams running back Steven Jackson, Green Bay Packers wide receiver Greg Jennings, the Cleveland Browns organization, the Houston Rockets, and the Toronto Maple Leafs.

And, at the amateur level, I’ve worked extensively with US and Canadian summer and winter sport national teams like bobsleigh/skeleton, cross country skiing, alpine skiing, canoe/kayak, and rowing. In fact, in the last two Winter Olympics alone, athletes I’ve worked with collected over 25 medals, 12 of them gold.

CJ: Impressive list. I think it’s safe to say you’ve “been there, done that.”

JB: Although I’ve had an amazing career so far, I still feel like I’m a rookie!

One of my main goals, professionally, is to never stop researching. Never stop learning. And, to keep things fresh, I adopt the mental attitude that “I don’t know anything.” And sometimes I act like it. [Laughs]

By continually reminding myself that I can learn everywhere, from everyone, I keep making room to grow. And that keeps things fun. I have a helluva lot of fun doing what I do.

CJ: Kelly Starrett believes that you don’t need to be a physical therapist in order to work on your dysfunction. He is empowering the masses with www.mobilitywod.com. I feel that you have done the same thing with www.precisionnutrition.com. You don’t have to be a registered dietitian in order to eat well and help other do the same. You offer all the tools to get the average Joe eating food that will improve health, decrease body fat, and increase athletic performance. What are the basic principles?

JB: Well, first of all, I think Kelly is doing some really cool stuff and I applaud him for helping to make prehab, dynamic movement, and manual therapy part of everyone’s workout consciousness.

For me, the goal is similar. To demystify the eating process so that eating right for different goals is something everyone thinks about. And something anyone can do.

My general principles are pretty simple and straightforward.

If you want to improve your nutrition, you have to consider three things.

• food type (what you’re eating),
• food amount (how much you’re eating),
• food timing (when you’re eating).

And truly, improving muscle gain, fat loss, sports performance, or health is as simple as tweaking one or more of these variables.

CJ: How about some examples?

JB: Well, let’s start with fat loss. If you want to lose fat as your primary goal, you’ll adjust your food type to include mostly lean proteins, green vegetables, and healthy fats; you’ll adjust your food amount by eating less food than normal; and you’ll adjust your food timing by including your biggest, most protein and carbohydrate packed meal right after your workout.

On the other hand, if you want to gain muscle as your primary goal, you’ll adjust your food type to include lean proteins, a wider variety of fruits and vegetables, a wider variety of fats, and additional unprocessed carbohydrates; you’ll adjust your food amount by eating more food than normal; and you’ll adjust your food timing by eating your largest, most protein and carbohydrate packed meals during breakfast and the post-workout time.

Of course, individual differences apply here; no two athletes or clients are the same. However, these general rules serve as a great starting point. From there, either on your own, or with the help of your nutrition coach, you get to become your own science experiment. Tweaking and adjusting until you reach your goals.

It’s a lot of fun, actually. At any point in time, I’m running 5-10 mini-experiments with clients and athletes here at my own private training facility. Half the time, I’m a subject in these wacky experiments. And the results, for me, are pretty compelling. I’m nearly 40 years old and I maintain a body fat of about 5% while staying pretty strong and fit.

CJ: Speaking of fun with science, I honestly believe your “Essentials of Sport and Exercise Nutrition” is a must have for any coaches library. How and why did you come up with that book?

JB: Well, for starters, our “Essentials” textbook is part of the Precision Nutrition Certification program, a complete nutrition education and mentorship program created to teach elite fitness professionals the art and science of nutrition coaching.

It also happens to be the text for a masters level Sport and Exercise Nutrition course I teach.

The book is designed for, and meant to be used in, a personal training or strength coaching setting. In the program, we first teach the essential science of sport and exercise nutrition. Cellular biology, digestion, metabolism, macronutrients, micronutrients — if a coach needs to know it, we teach it.

Then, we teach coaches exactly how to add nutrition coaching to their work in the gym to guide an exercising client to their optimal physique. In other words, students learn a system for influencing the nutrition habits of any client, with any goal, beginners and advanced alike.

So the text comes in two parts. Unit 1 covers all the science you’d expect to learn in a nutrition certification and mentorship. And Unit 2 covers the practice of coaching, something you don’t really find in other places. Further, we have a complete online learning module with video lectures and more.

Again, all designed to help elite fitness pros begin to incorporate proper nutrition coaching into their practice.

There is no other educational program with that focus. I can tell you that, because if there was, I would have taken it myself. Because when I started out as a trainer, that’s exactly what I needed. But nothing like it was available.

CJ: So, I’m curious as to your thoughts on “Paleo” eating? A lot of people are promoting the benefits of the “Paleo” diet. What do you think of this way of eating?

JB: To a certain extent, I love this way of eating.

For most of the population – including recreational exercisers – eating fewer grains and less refined food should be a way of life. I mean, how can you go wrong eating a diet rich in lean meats, a wide diversity of dietary fat, a rich buffet of vegetables, and a host of nuts and seeds?

That’s exactly how most of us should be eating. Especially when we’re not blowing through lots of carbohydrates with high-level athletic training.

However, some exceptions do apply. When we’re not obsessively counting our calories – which most people shouldn’t do anyway – there are some folks who have a really hard time eating enough total food with only meats, veggies, nuts, and seeds.

I’ve seen it time and time again with elite athletes training 4+ hours per day. And with skinny ectomorphic guys who struggle to gain muscle. For their goals, the typical “Paleo” recommendations have to adapt a little bit.

This usually means we include more unrefined carbohydrates. Often at breakfast and during the post-workout period. We also include a protein/carb drink during training. And the rest of the day can be more protein, veggies, nuts, and seeds.

CJ: Speaking of protein/carb drinks, I know that you did your PhD research on peri-workout nutrition. The CrossFit “Open”, CrossFit regionals, and CrossFit Games are all at hand. These are intense competitions and recovery is of the utmost importance. Can pre, during, and post workout nutrition be accomplished effectively with whole food or should athletes be using liquid nutrition for these critical meals and supplementing for optimal performance?

JB: Basically, my graduate research focused on how we could use the right combination of protein and carbohydrate, in liquid form, to speed up recovery from endurance and strength exercise.

We started out studying the effects of post-workout protein/carbohydrate drinks on muscle damage, fuel utilization, glycogen resynthesis, and protein synthesis. And then we started looking at what happens when these drinks are consumed before and/or during training.

Although the research is complex, the conclusions are simple.

We found that if your training is hard enough to stimulate protein turnover and glycogen depletion, your recovery will speed up if you take a protein/carb drink during the peri-workout period.

Whether you drink it just prior to, during, or after training isn’t that important. All of them work. So whatever you’re most comfortable with. The most important thing is that you drink it.

Here are my recommendations based on one’s natural body type.

• If you’re skinny and usually have a hard time putting on muscle, take:
  45 g protein, 90 g carbs (520 cals) in 1000 ml of water

• If you put on fat very easily, take:
  15 g protein, 30 g carbs (180 cals) in 500 ml of water

• And if you’re somewhere in between, take:
  30 g protein, 60 g carbs (360 cals) in 750 ml of water

The key here is to be honest with yourself. If your training is moderate, you probably don’t need a recovery drink. And, for the sake of full disclosure, during most of my training phases, I don’t even use one. Because I’m interested in maintenance for most of the year.

However, when it’s go-time and my training ramps up, that’s when I’ll add in a recovery drink. Again, be honest. If you’re not training really hard, you probably don’t need the fast digesting sugars and proteins. If you are, they make a big difference.

CJ: Very cool stuff. I want to get back to the “Paleo” thing for a minute. I read one time that you didn’t like that it was called “Paleo” eating. Why not?

JB: While I like the style of eating, the name does bother me a little. Because it implies that we actually know how our Paleolithic ancestors ate. And it implies that they all ate one way.

Neither is true.

As new research comes to light, we’re realizing that the reason we used to think our Paleolithic ancestors only ate meats, fats, and fruits/nuts/seeds they could forage is because that’s all we could find in the fossil records.

However, I have a few good friends who are field archaeologists. Meaning it’s their job to actually go out and collect fossil records in Africa, Asia, and the Middle East.

Interestingly, new digs – and new scientific techniques – are finding that in some ancient cultures, unrefined, wild grains were actually part of their diet. As are a host of tubers and wild potatoes.

With this new research, some of the basic “Paleo” assumptions are falling into question. And this is just the beginning. As we develop new techniques, and find new civilizations, no one knows what we’ll discover about the way our ancestors ate.

Of course, none of this invalidates the style of eating. Indeed, it’s one that I generally embrace. Again, eating less processed food is very smart. As is eating more lean meat, veggies, and nuts/seeds.

With that said, I don’t want to tie my eating style to a moving target. And I don’t want to try to eat like a “Paleo” man. I want to eat like a modern man that’s interested in health, body composition and performance.

CJ: I’d also imagine you take issue with Paleo purists and the anti-grain, anti-legume, and anti-dairy campaign. What do you think about this?

JB: To some extent, I do take issue with it. Because, for certain individuals with specific goals, unprocessed grains and legumes are a huge help. You just have to keep the amount in check and consider timing.

And it all depends on your genes.

Indeed, new research is showing that while Paleo-type recommendations are a great baseline, further adjustments would need to be made based on someone’s genetic heritage.

For example, in the last 10 years we’ve learned so much about nutrigenomics. This area of science studies our genetic make-up and how our genes impact our experience in the world.

Obviously, our genes are linked to where our ancestors are from. And that’s where it gets interesting. There’s some fascinating new research showing that depending on where our family lineage is from, our nutritional tolerances could be completely different.

For example, there’s something called lactase persistence. It’s whether or not our genetic line has preserved the ability to make lactase, the enzyme that helps us digest milk.

In the UK, for example, almost 100% of the population has lactase persistence. This means that dairy is well-tolerated in nearly 100% of the UK. The same is true in Scandinavian countries and Northwestern Africa. However, in Eastern Europe, Asia, and Southern Africa, lactase persistence is less than 10%. Meaning, that in these areas, almost no one can handle dairy.

Knowing this, your thoughts on dairy consumption might need to change based on where your family comes from. But that’s another discussion for another day. With dairy, we also need to consider a host of other things, from hormones and antibiotics to homogenization and pasteurization.

There’s a similar relationship between our genetic heritage and our ability to digest and process carbohydrates.

People from Northern Europe, the UK, and Southern Asia make more salivary amylase and other carbohydrate-digesting enzymes because they’ve traditionally eaten a more carbohydrate-rich diet. While people from Africa and Northern Asia make fewer carbohydrate-digesting enzymes because of their traditional diet that’s lower in carbohydrates.

So it’s the same thing with as with milk. Your thoughts on grains would have to change based on where in the world your ancestors come from.

In the end, I’m not sharing any of this to confuse people. Rather, it’s to point out that nutrition plans should always be a starting point for further experimentation. Not rigid, immutable guidelines.

Of course, if you’re new to all this, you need some guidelines to work from. To put you on the right track. But after that, your best bet is to adopt the adventurous attitude of a physiological pioneer. To boldly experiment and tweak until you find what works for you.

That’s what my whole nutrition philosophy is about. And sometimes, a few unprocessed grains and chickpeas make for a great experiment.

CJ: Speaking of experimenting with yourself, I know that you have experimented personally with intermittent fasting. How does this fit into your thoughts on performance nutrition?

JB: Like most eating and exercise practices that have been around for thousands of years, I think intermittent fasting can certainly have its place. The key is to consider all the variables – your goals, your dieting experience, your training program, and more.

Personally, I’ve been playing around with a 24 hour fast once per week. Sunday is generally my fasting day. Here’s how I do things:

• 10 pm Saturday: stop eating
• 9 am on Sunday: 1 multi-, 5 BCAAs, ½ serving greens+ in 1L water, 1 c green tea
• 1 pm on Sunday: same as above
• 5 pm on Sunday: same as above
• 10 pm Sunday: eat a small protein, veggie, legume, and healthy fat meal

I’ve been doing this for 4 months, all as part of a fat loss experiment I’m working on. My goal is to lose as much fat as I can – and maintain this loss for a full year – while doing less than 90 minutes of super-intense exercise per week.

So, my eating plan and my exercise plan is designed with this goal in mind. And it’s all working very, very well. However, I wouldn’t necessarily recommend intermittent fasting to everyone, in all circumstances, always.

For example, if you’re trying to win an Olympic gold medal, I’d probably wouldn’t recommend intermittent fasting during your peak training phase. Why? Well, you need the calories and the recovery.

Also, if you’re an ectomorph (naturally skinny) looking to build muscle, I probably wouldn’t recommend intermittent fasting during a muscle-building phase. Again, you need the calories and recovery.

Also, if you have a history of disordered eating, fasting can be a trigger. So don’t risk it. Take a more moderate approach. Trust me, this is important.

Of course, there are different types of intermittent fasting and going through them all is beyond the scope of this interview. So I’ll leave you with this. Just like with the “Paleo” thing we talked about earlier, it’s easy to become a religious zealot for intermittent fasting. Or any diet, for that matter. And that’s a mistake.

When we take a single strategy and then try to convince others that this one thing is good for everyone, in all circumstances, always, we’re taking it to far. Heck, even veggies and green tea should be avoided in certain conditions.

So my best advice, when it comes to nutrition, is this. If you’re just starting out, stick with the best practices. Follow the rules. And then, once you know you can follow the best practices consistently, start tweaking things. Experiment. Become your own science project. Figure out what you like and don’t like. Figure out what works and doesn’t work.

In doing so you’ll learn a lot about yourself. And, if you do it right, you’ll really enjoy the process.

CJ: You mentioned that your coaching team works with thousands every year. I’m guessing they come to you, among other reasons, to look better naked. Although some won’t admit it, I know a lot of CrossFit members want to look better naked too.

Give me your single serving nutrition advice for the look better naked crowd.

JB: Looking good naked doesn’t need to be as complicated as everyone makes it out to be. In fact, there are probably only five important things you need to think about. And everything else? They’re just distractions.

First, to lose fat, you have to gradually decrease your calories. In other words, you have to start eating less.

Second, to support your muscle tissue, you have to gradually increase your protein. In other words, eat more lean meat, chicken, fish, or whatever lean vegetarian source you choose. These foods help speed up your metabolism, help you feel full, and provide important amino acids.

Third, to create the right environment for fat loss, you need to gradually decrease your carbs. In other words, eat less sugar and starches – like processed gains. Eating too much of these foods can wreak havoc on your bloodstream, increasing hormones that lead to fat gain.

Fourth, to make sure you’re healthy throughout the process, you need to gradually increase the amount of veggies you eat. You can think of it this way: start replacing your grains with greens. If you do this, you’ll be getting more fiber, vitamins, and minerals.

And fifth, to support your metabolism, you need to gradually replace your bad fats with healthy ones. By adding things like olive oil, avocados, nuts, seeds, and fish oils, you’ll speed your metabolism and lose more fat than ever.

That’s really it. If you do those things consistently, along with a solid training program, looking better naked is a pretty simple process.

CJ: Awesome advice, Dr. B. At this point I’d like to wrap up the interview. Thanks for taking the time to share your knowledge with us.

JB: No problem, it’s my pleasure.

CJ: Where can readers find out more about you and your nutrition ideas?

JB: I’d love it if folks popped over to our web site at www.precisionnutrition.com.

As we have hundreds of free articles on the site, I always encourage people to take one of our free, 5-day courses. They’re accessible right from the home page. And they’re a great way to learn all the essentials.

• Free course for men
• Free course for women
• Free course for fitness pros

PN Certification Program begins $cur_registration_open_datetime — waiting list now open.

If you’re reading this and you’re a fitness professional, we highly recommend checking out the Precision Nutrition Certification Program.

Based on over 10 years of research and statistical data from over 6,000 clients, the certification is a comprehensive nutrition coaching course designed specifically to teach professionals working in a personal training or strength coaching environment how to get clients in the best shape of their lives.

We’ve opened the waiting list for the $cur_registration_open_datetime program. I strongly recommend you get your name on the list now, because spots are limited and typically sell out within hours each time we run the program.

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In this video, naturopathic physician Bryan Walsh presents a basic overview of how some of the key controller hormones work. Here, he explains the fundamentals of the controller hormone system, and covers some of the most common causes of low hormone production.

Understanding hormonal pathways

Millions of men and women aren’t being properly treated nor managed for symptoms of hormonal imbalances. Knowing more about how hormone systems work can help you actively manage your health situation, and be a more informed consumer in discussions with your health care providers.

There is a common pathway for many of the “master controller” hormones, such as sex hormones (e.g. estrogen, testosterone, progesterone); thyroid hormone; and the adrenal stress hormone cortisol. Here’s how the pathway works.

1. The pathway starts in the brain with neurotransmitters such as serotonin, dopamine, or acetylcholine.
2. These chemicals stimulate a small gland in the brain known as the hypothalamus, which then stimulates another gland, the pituitary.
3. The pituitary then directs a particular gland, such as the thyroid or testes. That gland will then release its hormone(s) as directed, usually bound to a transport protein that helps to carry the hormone to where it’s supposed to go.
4. If the body doesn’t need all of this hormone, the excess can go to the liver, which along with the gallbladder’s bile, helps to excrete the excess through the large intestine for eventual disposal.
5. The body can also convert hormones into other things — either a slightly revised yet related molecule, or a new type of molecule with quite different properties (for instance, testosterone can eventually convert to estrogen).
6. Once converted, hormones then bind to a cellular receptor site. If it can do this effectively, it creates a cascade of events within the cell, known as a proteomic response. If this step doesn’t happen, there will be low hormone symptoms. In other words, even though there might be a lot of hormone circulating, and every other master controller gland is doing its job, if the proteomic response doesn’t happen properly, you’ll still end up with a low hormone response.

What happens when the process breaks down?

Defects can occur at any stage of this process.

1. Not enough neurotransmitters? You can’t stimulate the hypothalamus.
2. Hypothalamic or pituitary suppression can occur. The stress hormone cortisol, for instance, can suppress pituitary function. In fact, stress and inflammation are two of the most common causes for low hormone levels.
3. The gland itself (e.g. the thyroid or testes) may be unable to produce hormone(s) required. Often, though, we assume that the gland itself is the problem when in fact it may be higher up the chain.
4. Too much or too little binding protein can also cause problems. This is also very common.
5. The gastrointestinal detoxification system (liver, gall bladder, intestine) can be dysfunctional. This means hormones aren’t properly detoxified and excreted.
6. The conversion process can be faulty.
7. If the hormone doesn’t bind properly to the cellular receptor site (perhaps because the receptor is not working adequately) or can’t do its job once it gets into the cell, this can inhibit the hormone even though it may have reached its destination.

Thus, low hormone symptoms can have multiple causes. And many things can go wrong in this complex chain. If you’re experiencing symptoms of hormonal dysfunction, first things first.

Make sure you’re following a well-designed exercise program (incorporating at least 5 hours of physical activity per week), as well as a really good nutrition plan (The Precision Nutrition System anyone?).  Then, if the symptoms persist, look at the “big picture” and consider all the possibilities discussed above when seeking health care.

Click here to join the waiting list.

Hosted on the Men TV network, Body Fuel investigates the ways in which food and supplements can interact with our body chemistry to create powerful, athletic, and sculpted bodies.

And each week on Body Fuel, I host a short segment called Ask Dr John. In this segment I tackle a host of important, frequently asked questions about food, fitness, supplements, health, and performance.

In this week’s episode, I answer the following question:

“What can I do to get the muscle building benefits of a high protein diet without the risk of becoming too acidic?”

For more information about dietary acids and bases:

• Check out the Precision Nutrition System

Click here to join the waiting list.

Hosted on the Men TV network, Body Fuel investigates the ways in which food and supplements can interact with our body chemistry to create powerful, athletic, and sculpted bodies.

And each week on Body Fuel, I host a short segment called Ask Dr John. In this segment I tackle a host of important, frequently asked questions about food, fitness, supplements, health, and performance.

In this week’s episode, I answer the following question:

“What are phytochemicals and how can they help with my training?”

For more information about phytochemicals:

• Check out the Precision Nutrition System

Click here to join the waiting list.

Imagine seven people all lined up next to each other.

Each one of them reports that they have the exact same symptoms: fatigue, difficulty losing weight, constipation, the “blues”, cold hands and feet, and feeling puffy all the time.

These are all classic symptoms of hypothyroidism, or a low functioning thyroid gland, but what I’m about to show you is that each of these seven people can have a different defect in thyroid physiology.

Worse yet, there is a strong likelihood that none of them will be diagnosed correctly.

The Thyroid: Your Fat Burning Gland

The thyroid gland is the main metabolism gland in your body. As said previously, if your thyroid is not working correctly, you will have a difficult time losing weight.  However, the thyroid does so much more than that.

• Every cell in the body has receptors for thyroid hormone
• Low thyroid hormone leads to elevated cholesterol, triglycerides and gall stones
• There’s a higher chance of mental retardation in children whose mothers had low thyroid function during pregnancy
• Low thyroid hormone leads to poor digestive function, including low digestive enzymes and constipation
• There are intimate connections between the thyroid and other hormones
  • For example, thyroid hormone makes progesterone receptors more sensitive, meaning a woman with hormonal symptoms every month, may actually have a thyroid issue driving it
• Low thyroid hormone can impact neurotransmitters
  • For example, low thyroid hormone can cause low dopamine levels, leading to loss of motivation and will-power

In the end, as you can see, the thyroid is an important gland.  It is also a very sensitive gland. The thyroid gland is negatively impacted by a number of external chemical influences such as chlorine, fluoride, some heavy metals and other synthetic chemicals. This is one of the explanations why there are so many thyroid issues today.

But here is the reality. There are millions of people with a thyroid problem that do not know it because of flaws in understanding of basic thyroid physiology and in the way the thyroid is tested today.

Symptoms

Symptoms of low thyroid hormones are vast.  This indicates just how far reaching the effects of thyroid hormone are.
Some low thyroid symptoms include:

• fatigue
• weakness
• weight gain
• difficulty losing weight
• coarse, dry hair,
• dry skin
• hair loss
• cold intolerance (you can’t tolerate cold temperatures like those around you)
• muscle cramps and frequent muscle aches
• constipation
• depression
• irritability
• memory loss
• abnormal menstrual cycles
• decreased libido.

If you have several (or all of these symptoms), you should probably get some physiological testing done.

Problems with Testing

Before you get tested, understand there are three major problems with laboratory testing.

1. Broad reference ranges – Ranges are created using people who go to the doctor, not healthy ones. Therefore the reference ranges are far too broad to catch minor fluctuations in thyroid physiology.
2. Non-standardized reference range – Not only is the reference range too broad, but it varies from lab to lab, and state to state. Therefore you can have a thyroid issue in one state, but not another. That’s not health.
3. Insurance company influence – Doctors only run tests that are considered “medically necessary” by insurance companies. Therefore, doctors won’t often run a good thyroid panel because most insurance companies won’t pay for them.

Fortunately testing is available for some people in select areas. More on that in a bit.

Thyroid Physiology

Here’s a promise. If you understand this section, you will have a better working knowledge of thyroid physiology than most doctors.

Thyroid physiology is more complicated than this, but here is a basic working foundation of it that works very well in identifying the majority of thyroid issues.

There is a section in your brain called the hypothalamus that releases thyrotropin releasing hormone (TRH). It tells the pituitary gland to produce thyroid stimulating hormones (TSH), which then tells the thyroid how much hormone to produce.

The thyroid gland itself puts out a number of thyroid hormones, most of it being thyroxine, otherwise known as T4. Over ninety percent of thyroid hormone produced by the thyroid gland is T4, which is considered to be a prohormone because it has minimal metabolic effects on the body. Triiodothyronine (T3) is the active thyroid hormone, but only seven percent is produced by the thyroid gland. The rest has to be converted from T4.

The majority of thyroid hormones produced by the thyroid are bound to a protein (thyroid binding globulin) to transport them around the rest of the body. At some point in their travels, T4 is converted to T3 in many tissues of the body, primarily the kidney and liver, and free T3 then gets into the cells to exert its metabolic effect.

It should also be noted that twenty percent of thyroid hormone, T3 sulfate and T3 acetic acid, must be converted to active T3 by gut bacteria.

What Can Go Wrong

Getting back to the line of seven people, all experiencing the exact same symptoms, here is how they can all have a thyroid issue, but have a defect in a different area of thyroid physiology and therefore all requiring different treatment.

Defect #1 – Pituitary
If the pituitary is not functioning correctly, it cannot produce adequate amounts of TSH to stimulate their thyroid. This is most often due to suppression of the pituitary by cortisol.

Defect #2 – Thyroid
This defect is medically referred to as primary hypothyroidism, which is the one dysfunction doctors actually look for. However, the reference range for TSH is so wide, many people with this defect will be missed. Also, many people with this defect have an autoimmune thyroid condition (see Bonus Defect below).

Defect #3 – Thyroid Binding Globulin (TBG)
If there is too much thyroid binding globulin, thyroid hormone would be bound and unable to get into the cell. Thyroid function may be perfect, but if it’s all bound, it can’t get into the cells. This is most commonly caused by elevated estrogen in both men and women.

Defect #4 – Thyroid Binding Globulin (TBG)
If there is not enough thyroid binding globulin, there can be too much free thyroid hormone available for cells. While this doesn’t sound like a problem, elevated free thyroid hormone shuts down receptor sites and can therefore cause hypothyroid symptoms, despite high free thyroid hormone levels. The most common cause of this is elevated testosterone in both men and women.

Defect #5 – Conversion
If inactive T4 cannot be converted to T3, there will not be enough active thyroid hormone for cells. This can be due to a number of issues including certain mineral deficiencies (i.e. selenium), elevated cortisol or excessive oxidative stress.

Defect #6 – Dysbiosis
It is difficult to know the degree that dysbiosis can cause thyroid physiology issues. Because twenty percent of thyroid hormone is converted to active T3, if there is significant gut issues, or lack of healthy gut bacteria, there may be low thyroid symptoms.

Defect #7 – Thyroid Receptor
If thyroid hormone cannot get into the cell there will be low thyroid symptoms despite thyroid hormone levels in the body. Receptor site defects can be caused by elevations in cortisol, homocysteine or vitamin A deficiency.

Bonus Defect – Autoimmune Thyroid
In industrialized countries, the vast majority of primary hypothyroidism issues (Defect #2) are due to an autoimmune condition called Hashimoto’s syndrome. If this is the case, it is no longer a thyroid issue, but rather an immune system issue and must be managed as such.

Seven different people. Seven different issues. All resulting in the exact same symptoms. And most of the issues probably missed in the conventional medical system.

What To Do

To be honest, I’d love to tell you what to do for each of these. I really would. But it is not as easy as that. Without proper testing and a complete assessment, it’s hard to pin down the one or two things you’ll need to do to resolve a thyroid issue.

However, when traveling down the road to being healthy, you must start with the first few steps. Here they are:

1. Take a good look at the hypothyroid symptoms listed earlier in the article. If you have many of those symptoms, you may want to look deeper into your own physiology with testing.
2. Next, get a good blood work thyroid panel done. A good panel includes TSH, total T4, free T4, total T3, free T3, T3 uptake and thyroid antibodies (TPO and anti-thyroglobulin).
3. Get it interpreted by someone who uses a functional/optimal reference range and actually understands thyroid physiology.

In the end, the thyroid is a very different gland when it comes to health, as well as our ability to lose weight. When functioning well, you’re laughing.  However, when your thyroid system isn’t functioning well, there are a lot of links in the chain that need to be examined.

Editor’s note: Later this year, in conjunction with Dr Walsh, PN will be offering a suite of physiological testing services that’ll help you get a better grasp on all aspects of your physiology including: thyroid hormone status, oxygen processing, glucose utilization, reproductive/sex hormone status (for men and women), adrenal function, and more.  Stay tuned!

Click here to join the waiting list.

Take a moment and think about an elderly person you know.

• How well do they taste or smell their food?
• How good is their memory?
• How well can they balance or walk?
• How healthy is their digestion?

If they haven’t aged gracefully, chances are they can’t do any of those things very well.  And you can thank their brain function for these symptoms of degeneration.

Anti-Aging Gone Wrong

The degree to which the elderly can perform normal daily activities is directly related to the amount of brain degeneration they’re experiencing in their twilight years.  In fact, the anti-aging movement has it completely wrong.  It’s not about hormones.  It is about brain function.

When your brain stops functioning, your body stops functioning.  And conversely, the healthier your brain, the healthier your digestion, your response to stress, your hormones and your response to exercise.

In this article, we’ll provide a broad overview of a very complex system in the body, the brain.  Plus, we’ll share some ways of nutritionally improving your brain function today.

Your Brain – The Basics

Your brain is a vital organ that helps run every other system in our body.  For example, 90% of the brain stem’s output goes into something called the pontomedulary reticular formation, which stimulates the vagus nerve.

Uh, what?

Well, that’s just a fancy way of saying that 90% of your brain’s output directly impacts activities such as digestion, gastrointestinal motility, enzyme production and salivation, and other parasympathetic activities.

Of course, there are a vast array of anatomical structures in your brain.  And covering them all is well beyond the scope of this article.  Just know that there are at least 30 distinct parts to the brain with a dizzying number of connections between them all.  It’s this communication that’s critical for health, performance, and body composition.

The Brain’s Chemical Messaging System
One important communication method worth noting is chemical messaging.  Through this method, certain chemicals,  called neurotransmitters, travel around and relay messages between the neuronal receptors of different parts of the brain.  Their signals impact mood, behavior, memory, coordination, and more.  Some examples of powerful neurotransmitters include dopamine, serotonin, GABA, norepinepherine, and acetylcholine.

The Brain’s Immune System
In addition to an elaborate communication system, your brain also has its own independently operating immune system!  These cells, called microglia cells, are found throughout the brain and serve the purpose of searching the brain for unwanted invaders and then destroying them.

Unfortunately, the microglia cells can be hypervigilant at times.  And this means they can end up destroying healthy brain tissue in the process.  The other problem with microglia cells is, once they turn on, they don’t easily turn off.  Unlike other immune cells in the body that receive a signal when it is time to end the attack, microglia cells turn on and attack virtually everything in their path, including neurons.  This makes sense from an evolutionary perspective because, if something were to attack your brain, your quality of life would quickly disappear.  Therefore, microglia cells are there to protect one of your body’s most critical organs.  And they do so with a vengeance.

The Brain’s Hormonal System
In addition to having its own immune system, the brain also manufactures its own hormones.  Hormones have a critical impact on brain function.  For example, many people are familiar with the personality changes that occur during a woman’s monthly cycle.  This is largely due to hormonal impacts on the brain.  Hormones play a very important role to the brain, which is why it’s not surprising to learn that the brain can independently produces its own hormones, including testosterone, estrogen and progesterone.

The Brain’s Protective Barrier
Lastly, the brain is protected by a semi-permeable membrane called the blood brain barrier.  This barrier is designed to protect the brain from unwanted substances and invaders.  Again, knowing that the function of the brain directly impacts the health and function of the rest of the body, learning that it has a structure designed to protect it is not surprising.

Hundreds of thousands of pages have been dedicated to describing the intricate structures, mechanisms and functions of the brain.  So, obviously, this article doesn’t do it justice.  What must be known, however, is that the brain is an incredibly sensitive organ, governing multiple functions in the body.  It has the ability to synthesize, secrete and utilize a number of different substances including hormones and neurotransmitters, has an independent immune system, and it has a barrier to protect it.

Those are the basics.  Now let’s look at what can go wrong.

Causes of Neurodegeneration

One point that must be understood is this.  When a neuron dies, its dead.  Permanently.  There’s nothing you can do to get it back.  In fact, you will have probably lost quite a few neurons by the time you’re done reading this article.  It happens.  It’s normal.  But there are things you can do to speed up the process of neurodegeneration, and there are things you can do to slow it down.  It’s all up to you.

Again, ask yourself, do you want to age gracefully?  If so, don’t worry about anti-wrinkle cream or hormone balancing, you should worry about your brain.

The brain only needs three things for proper function:  Oxygen, Glucose, Stimulation.    Let’s look at how each of these can impact neurodegeneration.

Lack of Oxygen and Glucose
If the brain does not receive adequate amounts, or stable levels of, oxygen or glucose, brain function will diminish.  One way to know if you have poor circulation in your brain is to see if you have poor circulation to the other extremities.  If you have cold hands and feet you may have poor blood flow, which means you probably have poor circulation to the brain.  Also blood sugar issues, either chronically elevated or low, will impact neurotransmitter synthesis and ATP production, which impacts neuronal firing.

Lack of Antioxidants
Another issue is oxidation.  As much as we need oxygen in the brain, we also need anti-oxidants to combat free radical damage that occurs to neurons.  Unfortunately neuronal tissue is highly sensitive to oxidative damage and therefore must receive adequate amounts of antioxidants to reduce this damage.  The caveat is that these antioxidants must be able to cross the blood brain barrier to effectively protect the brain.  Inadequate levels of antioxidants, or excessive amounts of free radical damage greatly contributes to neuronal death, or neurodegeneration.

Overactive Microglia Cells
As previously discussed, activation of the brain’s immune system is important for reasons of protection.  But over-activation of microglia cells is a major promoter of neurodegeneration.  Activated microglia cells serve an important function, but can lead to neuronal death if left unchecked.  There are a number of natural compounds that have been shown to reduce microglia cell activity, which can be important in anyone with a history of head trauma, blood brain barrier permeability, or immune activation elsewhere in their body due to the impact these have on microglia cell activation.

Lack of Stimulation
Another issue is lack of stimulation.  Sure, failing to engage in varied activities such as exercise, stretching, music, art, math, learning and reading can cause this lack of stimulation.  But you also need neurotransmitter stimulation too.  As discussed, neurotransmitters are necessary for neuronal signaling and communication, which are required for healthy brain function.  Therefore if any given neurotransmitter is deficient or out of relative balance with other neurotransmitters, brain function will decline.

Lack of Brain Protection
As a somewhat separate issue to the brain itself, a damaged blood brain barrier can lead to neurodegeneration simply because it allows substances into the brain that otherwise should not be there, including compounds that can lead to microglia cell activation or that are damaging to brain tissue.  Things like alcohol, the stress hormone cortisol, homocysteine, oxidative stress and blood sugar dysregulation have all been shown to break down the blood brain barrier.

There are more, but these are some of the most common triggers for neurodegeneration.  Next, what to do about them.

How To Prevent Neurodegeneration

Optimal brain health and function is far more complex than can be described in this article.  But here are a few key things you can do to protect your most vital organ.

1. Improve oxygen flow to the brain – Firstly, rule out any subclinical anemic tendencies you may have using blood work.  Secondly, there are things you can take that can help increase blood flow to the brain.  Compounds like ginkgo biloba, capsicum, and feverfew have all been shown to increase oxygen to the brain.

2. Improve blood sugar management – Using blood work, identify any tendencies towards either hypoglycemia or insulin resistance.  Either will decrease glucose flow to your brain and negatively impact its function.

3. Decrease oxidative stress – Oxidative damage to mitochondira in our brain promotes massive neurodegeneration.  Therefore it is important to take nutrients shown by research to stop free radical damage in the brain.  Such nutrients include N-acetyl-cysteine, alpha lipoic acid, milk thistle, N-acetyl carnitine and creatine monohydrate.

4. Decrease inflammation – There are strong connections between the gut and the brain.  Therefore, following an anti-inflammatory diet and improving gut function can have profound impacts on brain function.  Also compounds such as curcumin, rutin, resveratrol, apigenin and luteolin have all been shown to have a positive impact on reducing neuroinflammation.

5. Improve fatty acid status – One of the most important fatty acids for the brain is Docosahexaenoic Acid, or DHA.  There is ample research showing DHA to be helpful in brain function, including with cell signaling and neurotransmitter function.

6. Balance neurotransmitters – There are no valid laboratory tests to evaluate neurotransmitters.  Some labs do exist, but the neurophysiology and scientific literature do not validate their use.    Therefore the only clinically valid way is to use subjective questionnaires, which can be found online, but are best evaluated by a medical professional.

7. Evaluate Blood Brain Barrier Function – Take 500mg – 1000mg of GABA on an empty stomach during a time when you’ll be able to evaluate symptoms.  If you have any response from taking the GABA, such as getting sleepy, lethargic or even anxious or giddy, that may be a strong indication you have a breach in your blood brain barrier.  While it is beyond the scope of this article to go into what to do about this, the first step is to know whether or not your BBB is intact.

The health of your brain directly impacts your entire life including your ability to taste and digest food, your ability to lift weights, your ability to recover from exercise, and your long term success in life.  The more you do to protect your brain today, the better off you will be throughout the rest of your life.

So if you do most of your time thinking about your muscle mass and body fat, it’s time to start thinking more about that organ between your ears.  And if you’ve been thinking about your brain, it’s probably time to do something about it.

A great first step is to contact a medical professional who can help you evaluate your brain function with questionnaires and physiological assessments.  Then, armed with data, an appropriate nutrition, supplement, and lifestyle plan can be put into place.

If you need more evidence that the brain can and does degenerate massively, check out this short video.  It’ll serve as a nice wake-up call.

Click here to join the waiting list.

Everywhere you look, there’s a ton of discussion about gluten and gluten sensitivity.  In fact, PN’s very own Ryan Andrews wrote a great article – All About Gluten – just a few weeks back.

But is gluten sensitivity really something you need to be concerned with?  Or is it merely a “Hollywood fad” that’ll disappear as quickly as it came?

Well, a host of new research studies suggest that this whole gluten thing can be a pretty big deal.  In fact, emerging research on gluten and its negative impacts on health, including brain function, is starting to look kinda scary.

Quick Gluten Review

Gluten is a sticky protein found in a number of grains that helps bind things together.  Basically, it’s the “glue” that helps bread hold its shape, stops sauces from curdling, and gives cheese spreads, canned meats and many condiments their smooth texture.

Gluten is ubiquitous in our food supply today and is found in everything from oats, bran and cereal – to the not so obvious – ketchup, soy sauce, chewing gum and salad dressing.  Truthfully, if you eat any type of processed food, you’re likely eating gluten.

For more on what gluten is and where it’s found, check out Ryan’s article here.

Interestingly, gluten-free foods are one of the fastest growing sectors in the nutritional world today – and with good reason.  If you’re sensitive to gluten, yet continue to consume products that contain it, there is a strong likelihood that some aspect of your health will suffer.

Celiac Disease vs. Gluten Sensitivity

Before discussing gluten sensitivity in depth, some distinction should be made between it and its cousin, Celiac disease. Celiac disease is an autoimmune condition affecting numerous systems in the body.  But its main target is the digestive tract.

Gluten sensitivity on the other hand simply implies that there is some type of immune reaction occurring to gluten in the diet.  For you clinical types, this immune reaction can be detected by anti-gliadin antibodies in the serum, stool or saliva.

In the end, the primary difference between the two is whether or not there is intestinal damage.

Gluten sensitivity + Intestinal damage = Celiac Disease

Gluten sensitivity + No intestinal damage = Gluten Sensitivity

Now, you might think that gluten sensitivity only occurs in a small percentage of the population, just like with Celiac Disease.  If so, you might be surprised to learn that in non-celiac disease patients, anti-gliadin antibodies can be found in as high as 35 percent of the population.

Gluten and Your Health

The seriousness of gluten sensitivity – with respect to everyday health concerns, as well as some atypical health issues issues – can’t be overstated.  Really, it’s a big deal.  But instead of taking my word for it, let’s take a look at some of the research.

Gluten and Women

Women with gluten sensitivity were found to have a higher incidence of stillbirths, spontaneous and repeated abortions, late onset of menarche, amenhorhea (no menses), anemia, and early menopause.

Because of the potentially negative impact of gluten on women’s hormone and reproductive system, one study recommended “celiac disease should be included in the screening of reproductive disorders.”

Gluten and Mood Disorders

Schizophrenia and depression have been linked to gluten sensitivity.  In fact, gluten sensitivity seems to be a causative factor for schizophrenia in patients genetically susceptible to the condition.

In one study, “A drastic reduction, if not full remission, of schizophrenic symptoms after initiation of gluten withdrawal has been noted in a variety of studies.”

Gluten and Your Brain

Gluten has particular reactivity to our nervous system and is no longer considered to be a gut issue.  Our brain and nervous system governs our perception, mood and quality of life.  When our nervous system deteriorates, our life deteriorates.

Research has correlated gluten sensitivity to seizures, neuropathies, ADHD, Alzheimer’s, MS, migraines and even EEG anomalies (brain wave abnormalities).

One study concluded, “Gluten sensitivity can be primarily, and at times exclusively, a neurological disease.”

Gluten and Metabolism

Gluten sensitivity has been correlated with decreased absorption of critical minerals, such as zinc.

Zinc absorption occurs in the small intestines (duodenum and jejunum), the two areas most affected by celiac disease lesions.  Researchers conclude, “These observations indicate that trace metal deficiency is another common nutrition complication of adult celiac disease.

Zinc has an important role in a variety of functions including our immune system, hormone production, brain function, taste, smell and our digestive function.

Gluten and Bone

There are numerous studies showing a link between gluten sensitivity and bone loss.  Numerous mechanism have been proposed, including decreased calcium absorption.  Researchers determined “Continuing long-term benefit of gluten withdrawal on bone metabolism in celiac patients.”

Gluten, Blood Sugar and Diabetes

Both Type 1 and Type 2 diabetes have been linked to gluten. “This population-based study showed the highest reported prevalence of celiac disease in Type 1 diabetes in Europe. Patients with celiac disease showed clinical improvements with a gluten-free diet (GFD). We recommend screening for celiac disease in all children with type 1 diabetes.”

Gluten and Behavior Disorders

Partial peptide digests of gluten, called “exomorphins” have been shown to have psychoactive properties that have morphine-like properties in the body and brain.  Studies have shown abnormal blood flow patterns in the brain in celiac patients at rates similar to ADHD children.  Also, celiac disease has been found more frequently in children with dyslexia.

There are literally hundreds more studies demonstrating the negative impacts of gluten in susceptible individuals to virtually every aspect of their physiology.

That’s right, this isn’t some fly-by-night, tree-hugging, tie-dye T-shirt wearing hippy craze.  Gluten sensitivity is very real and causing major health issues for a growing number of people, even if they don’t have symptoms – yet.

At Home Gluten Testing

As highlighted above – gluten isn’t something we should all be frightened of.  After all, only about 35-40% of the population may experience gluten sensitivity.  So please don’t get the idea here that I’m suggesting we all start on 100% gluten-free diets immediately.

However, and here’s the crux of the issue, many of us simply don’t know whether we fall into the 60-65% of the population that can tolerate gluten or into the 35-40% of the population that can’t.  So it’s important that we find out.

Fortunately, there are numerous ways of getting tested, the best of which (at least, at the present) seems to be a combination of stool and saliva testing through a company called EnteroLab (www.enterolab.com).

And here’s the cool part.  You can actually do the test yourself.  You simple order a test kit through the company’s website, perform the tests yourself at home, send the kit back to the lab, and receive the results a few weeks later.

Of course, it’s beyond the scope of this article to go into interpreting the test here, but should you look into this kind of testing, the tech support available at Enterolab will be able to help you with your results.

The Gluten-Free Lifestyle

So let’s say you do the test and determine that you’re sensitive.  What’s next?  Well, you’ll have to cut all gluten out of your diet.

But deciding to go gluten-free isn’t a simple lifestyle change.  It is more akin to a meat-eater deciding to become vegetarian.  Gluten is so pervasive in our society, it takes a conscious effort to avoid it.  And, because many of our comfort foods are full of gluten, it requires a change in perspective as well.

When many of my patients are reluctant to go off gluten – they just don’t want to give up some of the foods they love – I simply ask them, “Your bagel or your brain?”  It’s that simple.

If you have a proven gluten sensitivity, it IS destroying some part of your body every time you eat it. Your thyroid, your brain, your joints – it could be any or all of these.  And you must avoid gluten permanently.

This doesn’t mean being gluten-free most of the time, or “I’m gluten-free all week except for my one Ms. Fields chocolate chip cookie.”  There is evidence that gluten can stay in your system for up to 8 months making every exposure a long-term thing.  Does that sound too doom and gloom?  Totally, and it sucks, but it’s the reality.

In many ways, gluten sensitivity is akin to peanut allergy.  Any little bit of gluten can be cause for some real problems.  So again I ask – your brain or your bagel?

Additional Support

Once you’ve decided to avoid gluten, there are other things you can do to protect yourself.

Besides avoiding it everywhere you can, there have been a couple of novel enzymes found to help break down accidental exposure to gluten.  However, it is not a license to eat gluten. Rather, if you know you are sensitive to gluten, you can take these enzymes on a daily basis to help avoid any gluten that may have snuck into your diet.

Research has shown that the digestion of proteins found in gluten requires an enzyme known as DPP IV (dipeptyl dipeptidase IV).  This enzyme is normally found in intestinal cells and is known to be deficient in celiac patients.  In non-Celiac patients, if there is any damage to the intestinal wall, DPP IV will be decreased, causing an increases susceptibility to gluten and therefore damage.

In gluten sensitive individuals following a gluten-free diet, it is recommended to take a few capsules of a supplement containing DPP IV daily to prevent damage from accidental exposure.

Summary

Gluten sensitivity is a very real condition.  And if you test positive for gluten sensitivity, and you continue to eat gluten-containing foods, your health and performance are at risk.

Fortunately, we don’t have to employ any guesswork or speculate about gluten sensitivity.  With the genetic testing available today, we can be sure about gluten problems.

If you’re are interested in optimizing your performance and preventing future health issues, get tested and find out.

References

Sher, KS, Mayberry, JF.  Female fertility, obstetric and gynaecological history in coeliac disease. Digestion. 1994;55(4):243-6.

Kotze, LM. Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease. J Clin Gastroenterol.2004 Aug;38(7):567-74

Molteni N, Bardella MT, Bianchi, PA.  Obstetric and Gynecological Problems in Women with Untreated Celiac Sprue. J Clin Gastroenterol.1990 Feb;12(1):37-9.

Hadjvassioulu M, et al.  Headaches and CNS white matter abnormalities associated with gluten sensitivity.  Neurology 56:385-388; Feb, 2001.

Neuromuscular disorder as a presenting feature of Celiac disease.  J Neurol neurosurg psychiatry.  1997;63:770-775

Paul V, Henkerr J, Todt H, Eysold R. EEG Research Findings in Children with Celiac Disease According to Dietary Variations. Z.Klin.Med., 1985; 40: 707-709.

Hadjivassiliou M et al 2003. Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics. Brain 126: 685-91.

Tengah D et al 2002. neurological complications of coeliac disease. Postgrad Med J 78: 393-98.

Hadjivassiliou, et al. 2002. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry 72: 560-3

Volta U, et al. 2002. Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders. Scand J Gastroenterol 37: 1276-81.

Tursi A et al 2001. Low prevalence of antigliadin and anti-endomysium antibodies in subclinical/silent celiac disease. Am J Gastroenterol 96: 1507-1510.

Hadjivassiliou M, et al. 2003. Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry 74: 1221-24.

Will AJ. 2000. The neurology and neuropathy of coeliac disease. Neuropathy and Applied Neurobio 226: 493-96.

Cross A, and Golumbek, P. 2003. Neurologic manifestations of celiac disease. Neurology 60: 1566-1568.

Hadjivassiliou M, et al. 2002. The humoral response in the pathogenesis of gluten ataxia. Neurology 58: 1221-26.

Marsh M. Gluten, Major Histocompatbilty Complex and the small intestine. Gastroenterology 1992; 102:330-354.

Kalaydijian AE, et al.  The gluten connection:  the association between schizophrenia and celiac disease. Acta Psychiatr Scand. 2006 Feb;113(2):82-90.

Solomons NW, et al. Zinc nutrition in celiac sprue.  Am J Clin Nutr. 1976 Apr;29(4):371-5.

Pazianas M, et al. Calcium absorption and bone mineral density in celiac after long term treatment with gluten-free die and adequate calcium intake. Osteoporos Int. 2005 Jan;16(1):56-63.

Spiekerkoetter U, et al.  General screening for celiac disease is advisable in children with type 1 diabetes. Horm Metab Res. 2002 Apr;34(4):192-5.

Hansen D, et al.  Clinical benefit of a gluten-free diet in type 1 diabetic children with screening-detected celiac disease: a population-based screening study with 2 years’ follow-up. Diabetes Care. 2006 Nov;29(11):2452-6.

Zioudrou, C., Streaty, R., Klee, W. (1979). Opioid Peptides Derived from Food Proteins. The Journal of Biological Chemistry 254(7), 2446-2449.

Usai P, Serra A, Marini B, Mariotti S, Satta L, Boi MF, Spanu A, Loi G, Piga M. (2004). Frontal cortical perfusion abnormalities related to gluten intake and associated autoimmune disease in adult coeliac disease: 99mTc-ECD brain SPECT study.Dig Liver Dis. Aug;36(8):513-8.

Paul, K., Todt, J., Eysold, R. (1985). EEG Research Findings in Children with Celiac Disease According to Dietary Variations. Zeitschrift der Klinische Medizin. 40, 707-709.

Kozlowska, Z: (1991). Results of investigation on children with coeliakia treated many years with glutethen free diet Psychiatria Polska. 25(2), 130-134.

Zelnik et. al. Range of Neurologic Disorders in Patients with Celiac Disease. Pediatrics 2004; 113; 1672-1676

Knivsberg AM. (1997). Urine patterns, peptide levels and IgA/IgG antibodies to food proteins in children with dyslexia. Pediatr Rehabil. Jan-Mar;1(1):25-33.

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Many of you have decided to get vaccinated and you may have waited in long lines to get it. (Or you took up hockey.)

I’m not going to get into the great H1N1 vaccine debate, but I’m going to start a new vaccine debate.

If there was a vaccine against obesity, would you get vaccinated?

What if it meant you could eat whatever you want?

Is there an obesity vaccine?

Yes, it seems that researchers have made a vaccine to treat obesity. The vaccine doesn’t go after an obesity virus, but a small protein (aka peptide) that facilitates uptake of glucose and fat.

This peptide is called gastric inhibitory protein, or GIP, also known as glucose-dependent insulinotropic polypeptide.

It’s the Holy Grail of obesity. Okay, I might be exaggerating a bit, but it comes darn close. You see, GIP is a peptide hormone made by the large intestine (the duodenum, to be exact) that helps your body take in glucose and fat.

GIP tells the beta-cells of the pancreas to release insulin. That tells the tissues to take up glucose that is in the blood. GIP also gets triglycerides out of the blood and into tissue – such as fat cells (adipocytes).

So what happens when you have no GIP?

If you have no GIP then you can eat as much as you want and not get fat – at least if you’re a mouse (1).

In 2002, a group made genetically modified mice that had no GIP receptor. In that case, GIP became ineffective.

Instead of getting rid of the key (GIP), they broke the lock (GIP receptor). Without a working GIP receptor, (GIPR) then GIP couldn’t work to unlock the metaphorical door. No GIPR = no GIP activity.

When they got rid of GIPR (GIPR^-/-) it turned out these mice couldn’t get fat – even on a high fat diet that made normal mice fat. Using what is called receptor agonists, researchers could block GIP activity and make getting fat nearly impossible (2-4).

Note: Receptor agonists are decoys. Instead of the proper protein attaching to the receptor, this agonist attaches, which blocks the proper protein and thus causes the signal to be blocked. It’s like someone stealing your parking spot, leaving you (the proper protein) driving around the lot, quietly cursing.

In the case of GIP, a GIP agonist would attach to the GIPR (GIP receptor), which then blocks GIP from attaching to the receptor and triggering a chain of events.

Where does the vaccine fit in? I’ll tell you in the Methods section.

Fulurija A, Lutz TA, Sladko K, Osto M, Wielinga PY, Bachmann MF, Saudan P. Vaccination against GIP for the treatment of obesity. PLoS One. 2008 Sep 9;3(9):e3163.

Methods

What are non-genetically engineered organisms supposed to do if they want to block GIP? Researchers have to come up with another way to make this process work.

They decided to use the host’s own immune systems. Usually, your body doesn’t go after its own proteins or anything that it considers “self”. Your body knows its own cells and everything they make.

However, sometimes your body gets confused and starts attacking itself — a situation known as autoimmunity. With this experiment the scientists, in sense, create a very specific autoimmune disease – one that attacks GIP.

Tricking the immune system – a GIP vaccine

The first step in creating an autoimmune disease for a specific protein is to get the attention of the immune system. How do you do that? You attach a virus-like particle (VLP).

Your immune system doesn’t like viruses. It’s always on the lookout for them. Anything that looks even remotely like a virus gets red-flagged.

VLPs get the attention of the immune system. Once flagged, the immune system makes antibodies against VLPs and anything attached to VLP – like, say, GIP.

Thus, VLP-GIP protein is basically a vaccine against GIP. Once injected, the body attacks GIP the same way it would attack any other known virus.

The participants

So you probably figured out that this experiment wasn’t done on humans. Causing any sort of autoimmune disease, no matter how specific, is considered a no no. Like most studies of this nature, the “participants” were mice.

Researchers injected mice with the VLP-GIP protein like an immunization.

Then, some mice were put on a high fat diet (35% fat w/v) and some were put on standard mouse chow (4% fat w/v).

Measures

First, the researchers checked that the mice were making antibodies against GIP using a technique call ELISA (enzyme-linked immunosorbent assay or enzyme immune-assay). This is important to make sure the vaccine actually worked.

The researchers weighed and checked body fat by dual energy X-ray absorption (DEXA) scans to figure out body fat (yes there are mouse X-ray machines and MRIs).

And they figured out how much energy each mouse expended by putting them in special metabolic cages that measured all the oxygen used and all the carbon dioxide produced.

Results

There were four main findings in this experiment:

1. Good news! The vaccination worked! The mice made GIP antibodies.
2. The vaccinated mice were less fat (35% less) than the unvaccinated mice while on a high fat diet.
3. However, there was no difference between the groups when on a normal diet of mouse chow.
4. Now the cool part. Being vaccinated against GIP increased how much energy the mouse used. In other words, GIP vaccination increased the vaccinated mice’s metabolism.

The first three points are pretty straightforward. But the increase in metabolism needs a bit more explanation.

When fed the high fat diet, the GIP-vaccinated mice used more oxygen (VO₂) at any given time and they had a higher metabolic rate, but there was no difference in activity (figured out by how often the mice broke a light beam) and no difference in food intake. Thus, the GIP-vaccinated mice had a higher metabolism.

And even though activity levels weren’t considered statistically different, they appeared to be “real-world” different. The vaccinated mice tended to be more active. With more mice the researchers could figure out if there were, in fact, any real activity differences.

Conclusion

A few important things to point out:

1. Differences between unvaccinated and vaccinated mice didn’t occur until they were fed a high fat diet.
2. Vaccinated mice on a high fat diet gained less weight then their unvaccinated friends, but they still gained weight.
3. There was no change in lean tissue despite the increase in metabolism.

You might be asking yourself how could there be an increase in metabolism without an increase in lean (i.e. muscle) tissue? Chances are, the subtle differences in activity levels are what caused the change in metabolism.

Bottom line

Before you run off looking for the human version of the GIP vaccine, remember that the differences between vaccinated and unvaccinated mice only happened on a high fat diet. The vaccinated mice still gained weight. And you’re not a mouse.

As interesting as these experiments are, they are limited in how well they translate to humans… but they’re still pretty cool.

References

1. Inhibition of gastric inhibitory polypeptide signaling prevents obesity. Miyawaki K, Yamada Y, Ban N, Ihara Y, Tsukiyama K, Zhou H, Fujimoto S, Oku A, Tsuda K, Toyokuni S, Hiai H, Mizunoya W, Fushiki T, Holst JJ, Makino M, Tashita A, Kobara Y, Tsubamoto Y, Jinnouchi T, Jomori T, Seino Y. Nat Med. 2002 Jul;8(7):738-42. Epub 2002 Jun 17.
2. Chemical gastric inhibitory polypeptide receptor antagonism protects against obesity, insulin resistance, glucose intolerance and associated disturbances in mice fed high-fat and cafeteria diets. Gault VA, McClean PL, Cassidy RS, Irwin N, Flatt PR. Diabetologia. 2007 Aug;50(8):1752-62.
3. Early administration of the glucose-dependent insulinotropic polypeptide receptor antagonist (Pro3)GIP prevents the development of diabetes and related metabolic abnormalities associated with genetically inherited obesity in ob/ob mice. Irwin N, McClean PL, O’Harte FP, Gault VA, Harriott P, Flatt PR. Diabetologia. 2007 Jul;50(7):1532-40.
4. GIP receptor antagonism reverses obesity, insulin resistance, and associated metabolic disturbances induced in mice by prolonged consumption of high-fat diet. McClean PL, Irwin N, Cassidy RS, Holst JJ, Gault VA, Flatt PR. Am J Physiol Endocrinol Metab. 2007 Dec;293(6):E1746-55. Epub 2007 Sep 11.

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Two recent studies have shaken up the weight lifting and athletic worlds with respect to protein intake.  For those research geeks among you, here are the references:

Ingested protein dose response of muscle and albumin protein synthesis after resistance exercise in young men. Am J Clin Nutr. 2009.

A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. Journal of the American Dietetic Association, 2009.

So, what did these landmark studies show?

Well, the first study showed that when college-aged weight-trainers drink 0g, 5g, 10g, 20g, or 40g of protein after a weight training session, muscle protein synthesis is stimulated maximally at the 20g dose.  Interestingly, there were no further increases in muscle protein synthesis at the 40g dose.

Similarly, in the second study, when young and elderly volunteers were given 30 or 90g of dietary protein in a single meal, the 30g dose maximally stimulated muscle protein synthesis.  Again, there were no further increases in muscle protein synthesis at the 90g dose.

20-30 Grams and No More

Oddly, since the publication of these two studies, I’ve read no less than 2 dozen articles and blog posts suggesting that these two studies definitively close the case on protein intake.  Indeed, some authors have even suggested that we’re ignorant wastrels if we dare eat more than 20-30g of protein in a single sitting.

Milk? This is the best you can do? Maybe you should read PN's All About Milk article.

Here are a few quotes:

“So basically what you’re saying is that we don’t need to consume any more than 20g of high quality protein after exercise.  You could get that in a 500ml serving of milk…This info is really going to piss off a bunch of internet keyboard jockeys.”

“I’ve cut back on the amount of protein I eat during most meals…No more slogging down 50-60g in a sitting. “

“Looks like 3 eggs post workout is just as effective as drinking a protein shake.  Plus all that extra shake will be wasted.”

And so on…

Is Muscle The Only Reason We Eat Protein?

Now, while I can always appreciate a good muscle protein synthesis study, I sorta wonder if all the hoopla regarding these two studies is doing healthy eaters a service or not.

I mean, it’s definitely a good thing to discover that 30g of protein provides the upper limit of amino acids necessary for maximal protein synthesis at a particular point in time.  However, the important, big-picture question is this one…is building muscle the only reason we eat protein?

I think not.

Challenging the notion that eating more than 30g in a sitting is wasteful, here are a few thoughts I sent to a group of colleagues:

1)   What Else Will You Eat?
Let’s say you’re on a high calorie diet.  Maybe you’re into bodybuilding or you’re training for an athletic event.  And now you limit your protein intake to 20-30g per meal.  What else do you fill up with?  Carbs or fats?

Let’s take an example.  Say you’re eating 4000-4500kcal per day for competition, which many larger lifers and athletes will need to do.  And let’s say, because of these studies, you limit your protein intake to 5 meals of 20g each.  In the end you’ll be getting 100g and 400kcal from protein.

Well, that’s 8% of your diet.  What makes up the other 92%?  If you’re loading up with that many carbs or fats, body comp can suffer.  Remember, the protein is being replaced by macronutrients with lower thermic effects (more on this below).

2)   What About The Other Benefits?
Muscle protein synthesis isn’t the only reason to eat more protein.  There’s satiety, the thermogenic effects, the impact on the immune system, and more (see below).

Plus, there are probably a few benefits science can’t measure yet.  I say the last part because there’s so much experiential evidence suggesting that when you’re training hard and you up your protein, you do better.  So maybe we just haven’t looked in the right places to notice the real benefits.

Other Protein Benefits

In an article I wrote a few years back, I listed some of the benefits of eating more protein.  And although the article is a few years old, nothing’s really changed since then.  Here’s the list:

Increased Thermic Effect of Feeding — While all macronutrients require metabolic processing for digestion, absorption, and storage or oxidation, the thermic effect of protein is roughly double that of carbohydrates and fat. Therefore, eating protein is actually thermogenic and can lead to a higher metabolic rate. This means greater fat loss when dieting and less fat gain during overfeeding/muscle building.

Increased Glucagon — Protein consumption increases plasma concentrations of the hormone glucagon. Glucagon is responsible for antagonizing the effects of insulin in adipose tissue, leading to greater fat mobilization. In addition, glucagon also decreases the amounts and activities of the enzymes responsible for making and storing fat in adipose and liver cells. Again, this leads to greater fat loss during dieting and less fat gain during overfeeding.

Metabolic Pathway Adjustment – When a higher protein (20-50% of intake) is followed, a host of metabolic adjustments occur.  These include: a down regulation of glycolysis, a reduction in fatty acid synthesis enzymes, increase in gluconeogenesis, a carbohydrate “draining” effect where carbons necessary for ridding the body of amino nitrogen is drawn from glucose.

Increased IGF-1 — Protein and amino-acid supplementation has been shown to increase the IGF-1 response to both exercise and feeding. Since IGF-1 is an anabolic hormone that’s related to muscle growth, another advantage associated with consuming more protein is more muscle growth when overfeeding and/or muscle sparing when dieting.

Reduction in Cardiovascular Risk — Several studies have shown that increasing the percentage of protein in the diet (from 11% to 23%) while decreasing the percentage of carbohydrate (from 63% to 48%) lowers LDL cholesterol and triglyceride concentrations with concomitant increases in HDL cholesterol concentrations.

Improved Weight-Loss Profile —Research by Layman and colleagues has demonstrated that reducing the carbohydrate ratio from 3.5 – 1 to 1.4 – 1 increases body fat loss, spares muscle mass, reduces triglyceride concentrations, improves satiety, and improves blood glucose management (Layman et al 2003 — If you’re at all interested in protein intake, you’ve gotta go read the January and February issues of the Journal of Nutrition. Layman has three interesting articles in the two journals).

Increased Protein Turnover — All tissues of the body, including muscle, go through a regular program of turnover. Since the balance between protein breakdown and protein synthesis governs muscle protein turnover, you need to increase your protein turnover rates in order to best improve your muscle quality. A high protein diet does just this. By increasing both protein synthesis and protein breakdown, a high protein diet helps you get rid of the old muscle more quickly and build up new, more functional muscle to take its place.

Increased Nitrogen Status — Earlier I indicated that a positive nitrogen status means that more protein is entering the body than is leaving the body. High protein diets cause a strong positive protein status and when this increased protein availability is coupled with an exercise program that increases the body’s anabolic efficiency, the growth process may be accelerated.

Increased Provision of Auxiliary Nutrients — Although the benefits mentioned above have related specifically to protein and amino acids, it’s important to recognize that we don’t just eat protein and amino acids — we eat food. Therefore, high protein diets often provide auxiliary nutrients that could enhance performance and/or muscle growth. These nutrients include creatine, branched chain amino acids, conjugated linoleic acids, and/or additional nutrients that are important but remain to be discovered.  And don’t forget the vitamins and minerals we get from protein rich foods. (And lest anyone think I’m a shill for the protein powder industry, this last point clearly illustrates the need to get most of your protein from food, rather than supplements.)

Looking over this list of benefits, it’s hard to ignore the fact that we don’t just eat protein for its muscle synthetic effect.  We eat protein for a bunch of other reasons too.  And since a higher protein diet can lead to a better health profile, an increased metabolism, improved body composition, and an improved training response, why would anyone ever try to limit their protein intake to the bare minimum?

Take-Home Message

It seems to me that whether someone’s on a hypoenergetic diet (low calorie) or a hyperenergetic diet (high calorie), the one macronutrient they would want to be sure to “overeat” (relatively speaking) would be protein.

But that’s not what people do, is it?  Instead, their protein prejudice often leads them to look for what they consider the bare minimum of protein (whether it’s 20-30g/meal or 0.8g/kg/day), and then overeat carbohydrates and fats instead. That could prove to be a performance – and body composition – mistake.

To this end, my advice is the same as I’ve outlined in the Precision Nutrition System.

Women – 1 serving of lean, complete protein (20-30g) with each meal, every 3 hours or so

Men – 2 servings of lean, complete protein (40-60g) with each meal, every 3 hours or so

This pattern of intake will make sure you’re getting enough protein to reap all the benefits that this macronutrient has to offer.  Not just the protein synthetic benefits.

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