What they are and how to make sure you eat enough.
There are two fats that humans have to eat as the body cannot make them and they are required for specific functions. They are called omega-3 (ω-3) and omega-6 (ω-6) and known as essential fatty acids (EFA’s) for this reason. They are both polyunsaturated fatty acids (PUFA’s) which means that they have more than one double bond between their carbon back bone. They get their name from the carbon number where their first double bond appears (see pic).
In the diet omega-3 is found in flax, hemp, pumpkin and chia seeds as well as walnuts. The end products of omega-3 (ALA) that the body requires are called EPA and DHA. Fish already contains both which is why it is such a good source, as the body doesn’t need to convert it. The conversion from other sources is very small and many people struggle with it, hence the oily fish recommendation.
Omega-6 is found in vegetable oils from seeds of corn, sunflower, safflower, cotton and soybeans. It is also found in evening primrose oil, borage, starflower and blackcurrant oils. It is converted to a downstream product known as arachidonic acid (AA). This end product (AA) is freely available in meat, egg and dairy products.
Our intake of omega-6 tends to exceed omega-3 considerably due to the nature of most people’s diets and the relatively recent availability of vegetable and sunflower cooking oils. My parents are over 80 but my mum can still remember how she queued up in the grocers to buy a slab of butter, wrapped in greaseproof paper. Most processed foods and ready-made dressings, sauces and jars also contain omega-6.
Research scientist Simopoulos (2002) believes we historically consumed equal amounts of omega-3 and omega-6, a 1:1 ratio. We now consume 15-16.7 times as much omega-6.
Omega-3 and omega-6 fatty acids are however both important components of cell membranes. During the conversion process they produce downstream products (eicosanoids) which regulate our inflammatory responses. Omega-3 eicosanoids are known to have anti-inflammatory effects. The eicosanoids from omega-3 tend to be more anti-inflammatory and anti-coagulatory than omega-6, which produces both inflammatory and anti-inflammatory versions.
Omega-3 and omega-6 both utilise the same conversion enzyme (delta-6-desaturase) so theories have arisen that one process will deprive the other. A high omega-6 intake is thought to reduce the availability of this enzyme and so diminish our omega-3 conversion. This theory and the concept of an “ideal” ratio in the diet is contested but it is generally thought that a ratio of 4:1 (ω-6: ω-3) is optimum.
The European Food Safety Authority concluded that 250 mg a day of EPA and DHA was adequate. They also found that European intake was too low at between 20-40 mg per day for EPA and less than 100-130 mg per day for DHA.
It’s kind of difficult to think about ratio’s when you are out shopping or planning your menus, so this is the way I tend to advise clients. Providing your digestion is good then generally you can obtain enough EPA and DHA by consuming oily fish 2-3 times per week. Otherwise supplementation is likely the best option.
The role of cholesterol and fats in cardiovascular disease (CVD)
Cholesterol and fat receive a lot of attention in the health and wellness media especially in connection with cardiovascular disease (CVD). Most of it is negative and places the blame for heart disease on high fats diets in general and more specifically the cholesterol molecule. Of course there are numerous CVD risk factors such as age, genetics, sedentary lifestyles, obesity, diabetes and so on but this blog is focused on clarifying the role of cholesterol and fats.
Where does cholesterol come from and what does it do?
Only about 20% of our cholesterol comes from diet, the remaining 80% is made by the liver. So why does our body make it, if it’s harmful?
Cholesterol is an essential component of many processes in the body including the formation of every cell membrane. Our cell membranes consist of 1/3 saturated fat, 1/3 polyunsaturated fat and 1/3 cholesterol and it is here that all cellular activity (metabolism) takes place.
Cholesterol is the raw material of hormone production and we manufacture vitamin D from it, via the action of sunlight. We also need it for bile, which facilitates fat absorption and toxin excretion. It’s a key component of the myelin sheath surrounding our nerve fibres making it important for brain and nerve function. The list goes on, but you can see how important it is for many critical functions.
How does cholesterol go wrong?
The problem occurs when there is damage to the delicate lining of our blood vessels. The immune system steps in creating plaques to try and repair the situation and over time they can narrow our arteries. This process can result in an oxidised cholesterol molecule (LDL-c), which depending on the size, density and number of them can increase cardiac risk.
If our cholesterol metabolism is working correctly however LDL-c should be picked up by HDL-c and returned to the liver for excretion. For this process to work properly it requires a consistent supply of antioxidants.
So as is often the case it’s a question of balance.
What causes blood vessel damage?
The biggest culprits are high blood pressure from stress, sugar, trans fats and inflammation. This is because:
High blood pressure caused by the stress hormone adrenaline causes turbulent blood flow, which can easily damage the delicate blood vessel lining. Adrenaline can be triggered by any stressor such as: erratic blood sugar, lack of sleep, financial or emotional difficulties.
Refined carbohydrates and refined sugar are pro-inflammatory and can form ‘advance glycation end products’ (AGE) which stick to plaques further narrowing the arteries.
Trans fats which are contained in most biscuits, cakes and ultra processed food, raise LDL-c as well as making these particles more dangerous (atherogenic).
Inflammation arises from various sources such as infection and toxicity but vascular cell damage is also inflammatory so a vicious cycle emerges.
What if cholesterol is high? WHAT IF TOTAL CHOLEST
This may or may not be a problem but it’s always wise to investigate. Ideally our total cholesterol:HDL-c ratio should be less than 4.5 for men and less than 4 for women. The other important ratio is the HDL:LDL - c ratio and this is kept in balance by our level of antioxidants.
Preliminary check
An easy way to assess if there might be an issue is to calculate your waist to hip ratio (WHR). This is a good indicator of the presence of fat around the organs (visceral fat). Women should be 0.8 or more with a waist measurement below 90 cm (35 inches). The ratio for men is 1.0 or more with a 102 cm (40 inch) waist or less.
Can nutrition and lifestyle help?
The good news is there is so much you can do with nutrition, lifestyle and supplements to balance cholesterol metabolism and reduce risk. Medication may be necessary especially if there are genetics at play but this can often be minimised if every thing else is addressed.
Nutritional therapy is always very unique and personalised but it tends to focus on the following:
Nutrition
Lowering inflammation levels - through dietary change and supplements if required. Levels of omega 3 in the diet are important to evaluate.
Making sure sources of fat in the diet are good quality and that fats used in cooking are very stable. Trans-fats should be eliminated as much as possible. Digestion and absorption of fats is assessed and improved if needed.
Is the diet high in processed carbohydrates and refined sugar? Any excess will be converted to fat. Fat in the body doesn’t only come from the fat we eat.
Ensuring sufficient Vitamin D levels – these are highly protective against heart disease.
Balancing the antioxidant status in the body and levels of B3 – testing can be useful here
Adjusting levels of fibre in the diet to facilitate cholesterol excretion.
Checking sulphur intake in the diet. We are often low due to soil deficiency or we may not convert it to sulphate so cholesterol circulates as LDL-c. Some diets such as FODMAP can be low in this nutrient.
Testing and supplementation
A preliminary urine and blood spot test can be done to gage risk, before making the decision to invest in a more expensive, comprehensive CVD profile. The latter does help to establish blood lipid (fat) levels and direct priorities. The number and size of LDL-c particles and whether or not they are oxidised also helps to pinpoint risk.
Appropriate supplementation to fill any dietary gaps and tackle priorities.
Lifestyle
Stress management - 75% of people admitted with heart attacks have normal cholesterol with LDL levels below average (Dr. Aseem Malhotra FRCP).
Improve sleep for physical and mental recovery.
Improving breathing function to maximise nitric oxide production. This relaxes the blood vessels, improving blood flow to deliver nutrients and oxygen to the tissues, including the heart and the lungs.
Exercise – the right sort appropriate for age.
References:
Samsel, A and Seneff, S. (2013) Glyphosate, pathways to modern diseases II: celiac sprue and gluten intolerance. InterdisciplinaryToxicology 6(4): 159–184. doi: 10.2478/intox-2013-0026
Wannamethee, G. et al. (1995) Low serum total cholesterol concentrations and mortality in middle aged British men. British Medical Journal 12:311(7002): pp. 409-13. doi: 10.1136/bmj.311.7002.409.
Can't lose weight? 10 things to consider
This is a summary of some of the core reasons for why weight loss can be so difficult for some people. It’s a complex area involving biology, physiology, emotions and psychology to name just some. However if you feel like you have tried everything you could have a think about the list below which summarises some of the key areas to address.
Appetite regulation system, poor eating habits and compromised digestion.
This can include things like eating too fast. The satiety hormones take time to register and react to food intake. If we eat fast we can over eat before the feedback mechanism has time to respond and let us know we are full. Similarly, if we eat on the run or with our attention elsewhere such as the computer or TV, studies show that we eat more.
New research is showing that there are more stretch (mechano) receptors in the small intestine than the stomach. They tell the brain we are full via nerve feedback. If digestion is compromised in any way then food will take longer to reach the small intestine. It is now thought that this delays signals to the brain that we have eaten enough and extracted the nutrients we need. So improving digestive function can be part of the solution.
Eating slowly and chewing properly as well as other simple changes to the way we eat can make a big difference here. It takes an effort to change habits which are our default way of thinking about and consuming food. But once you correct them and the new habits are ingrained you can go back onto autopilot, it’s just one that serves you better.
Lack of movement and too few muscle cells.
The more muscle cells you have, the more mitochondria you will have. These organelles are responsible for turning food into energy. The more you have the higher your basic metabolic rate (BMR) will be. This is the amount of calories you burn to maintain your body’s function at rest. It is generally thought that our BMR accounts for 70%+ of our daily energy requirements. So another aspect of weight loss can be adjusting our training schedule to improve mitochondria numbers and function.
Lack of nutrition knowledge and understanding about how the body works.
This can result in a poor quality diet perhaps including a lot of ultra processed food (UPF) or a very low calorie diet and yo-yo dieting. Sometimes we need to keep an eye on portion size and plate content and a calorie assessment can be useful here. However I tend to focus initially on the nutrient and micronutrient content of the diet. Once we get this right and the body is nourished then we can take a look at tweaking plate content and construction. I think a lot of ‘diets’ fail because if the body isn’t nourished properly there maybe micronutrient deficiencies so the body craves food in an attempt to resolve this. This is interpreted as hunger.
There is no one method to lose weight. Different methods suit different people’s lifestyles, individual preference sand health status. To some extent they all work, at least initially. What’s important is to establish a baseline that keeps weight stable and the body healthy. This helps to make the body feel safe. Then we can mix and match different weight loss strategies to get the body to adapt. Remember we want it to do something it wouldn’t naturally want to do, based on evolution, which is to lose weight.
The problem with very low-calorie diets (VLCD) and yo yo dieting is the body does something called adaptive thermogenesis. It adapts to the altered calorie intake. It’s also very hard to maintain these over the long term and it can be stressful for the body. It is not a time to lose weight when we are stressed (see BLOG here https://helenmaxwellnutrition.co.uk/weight-gain-is-stress-to-blame/
Lack of hormetic challenge.
Exposure to hormetic stress builds resilience and occurs when we are challenged without overly exhausting ourselves. It includes such physical activities as high intensity interval training, cold exposure (showers or ice baths) and fasting. It’s the use it or lose it principle. It’s an adaptive response to a challenge generated by the environment. Even our response to drugs is a hormetic challenge of sorts. Modern life has evolved to reduce many of our physical hormetic challenges, think central heating, air conditioning and our indoor lifestyles. There are many simple ways to introduce this such as cold showers, breathwork and exercise.
This is probably the most useful starting point for most people. You need stable, well managed blood sugar (glucose) if you want to lose weight. If glucose levels in the blood are too high it has to be removed. Insulin takes glucose into the cells to use for energy but if there is no demand it will be taken to the liver where the majority will be stored as fat. Hence insulin is often referred to as the fat storage hormone. So we want to try and keep our levels of insulin low and there are numerous nutritional strategies and supplements that can help with this.
Equally if blood glucose is too low this is stressful for the body. Stress raises cortisol which triggers the release of glucose stores, known as glycogen, from the liver or muscle. Alternatively the body will make glucose by breaking down tissue. Initially this can trigger weight loss but if cortisol stimulation is ongoing, as in chronic stress, this can lead to sustained high blood sugar levels which will necessitate more and more insulin. If the cells become resistant to insulin from stress, poor diet, high sugar intake or poor liver function then insulin resistance can develop which is associated with fat storage (see https://helenmaxwellnutrition.co.uk/weight-gain-is-stress-to-blame/).
Poor thyroid and/or hormone function leading to a dysregulated metabolism.
Our thyroid regulates our metabolic rate which is how we make energy. If thyroid hormone production is low this effectively slows the metabolism causing symptoms such as ‘tired and wired’; anxiety; poor sleep; negativity and depression; shakiness between meals; irritability and a very short fuse. This often leads to abdominal weight gain. This kind of symptom pattern usually requires professional assistance from a qualified nutritional therapist and the medical profession to try to resolve the underlying hormone malfunction. Overproduction of cortisol can play a role in this so stress management is crucial, see below.
Stress and overload.
If the body is chronically stressed then it won’t be able to lose weight. To lose weight requires good digestion, good liver function and good blood sugar and insulin management. All of this requires energy for your internal organs to work properly. Chronic stress takes the energy away from internal function to the extremities, (arms and legs) and the heart so we can run, fight or hide. The body won’t undertake remodelling or restructuring when it’s focused on survival. It’s the same as life. When you are in a stressful life situation you focus on the essentials and the body is the same. You can read more on this here https://helenmaxwellnutrition.co.uk/weight-gain-is-stress-to-blame/
Gut and liver function.
The microbiome (bacteria) in our gut facilitates nutrient extraction from and absorption of food. The importance of nourishing the body in order to lose weight is covered in point 3 above. Most studies seem to point to the ratio of Firmicutes to Bacteroidetes being significantly higher in overweight and obese subjects (Ley, 2010; John and Mullin, 2016). In addition lean subjects appear to have a more diverse and complex microbiome (Kasai et al., 2015; Lv et al., 2019).
The gut microbiota plays a major role in energy generation (metabolism) from the fermentation of fibre and protein in the colon to produce short chain fatty acids (SCFA’s). SCFA’s affect body weight, glucose regulation and insulin sensitivity as well as playing roles in satiety and appetite. Hence the microbiome impacts weight in a number of complex ways through influencing food intake (type and quantity), gut microbiota, nutrient levels and metabolism.
Liver function is critical to maintain a healthy weight. It plays a major role in managing blood sugar (see 5). It controls the the conversion of excess glucose to fat and the breakdown of fat for energy. If liver function is impaired then this system can struggle, fat metabolism deteriorates, and as a result fat accumulates in the liver. This can lead to non-alcoholic fatty liver disease (NAFLD) and/or weight gain. The liver is of course the major detoxification organ of the body. If it malfunctions toxins can build up which can interfere with hormone function and affect metabolism, which often leads to weight gain.
Good gut and liver function are therefore key for successful weight loss. Focusing on improving both of these is often a significant part of any weight loss programme.
Sleep.
Modern lifestyles often mean insufficient sleep. Insufficient sleep causes stress which has already been discussed above. Stress and lack of sleep can lead to comfort eating which tends to be carbohydrate. This can easily become a vicious cycle as carbohydrates, if not wholegrain or good quality, elevate blood glucose quickly. This triggers a lot of insulin very quickly followed by a sudden drop which results in low blood glucose (hypoglycemia) and we end up with poor management of blood sugar (see 5).
The association between lack of sleep and being overweight is well known and shift workers are a prime example of this. Ideally we need 8-9 hours of sleep between 9:30pm and 6:30am. The emerging science of how circadian rhythm interacts with nutrition and health is called chrononutrition and adapting meal timing and structure to take account of our circadian rhythm can really help support weight loss and health.
Change and the brain.
Losing weight involves change on many levels and the organ of change is the brain. It contains the most neurons and the greatest potential to create change. There will often be a lot of negative thinking and slef around excess weight. We have 50-60 thousand thoughts a day and most are the same as the day before. To lose weight we want to start interrupting these thought patterns and changing our focus from what we don’t want, to what we do. Pictures of how you want to look, vision boards to remind you of your goals, even just taking a few minutes each day to tune into how you want to look and feel. Working with other therapists can help such as CBT, NLP, hypnotherapy, whatever it takes to keep on the right track. If meditation is your thing then Dr Joe Dispenza offers many options and this link talks about the brain and how to change https://www.youtube.com/watch?v=EpOMk1jOzgk&t=47s
References
Aoun, A. (2019) The Influence of the Gut Microbiome on Obesity in Adults and the Role of Probiotics, Prebiotics, and Synbiotics for Weight Loss. Cell: 179: pp.1129-1143. https://doi.org/10.1016/j.cell.2019.10.031
Kasai, C. et al. (2015) Comparison of the gut microbiota composition between obese and non-obese individuals in a Japanese population, as analyzed by terminal restriction fragment length polymorphism and next-generation sequencing. BMC Gastroenterology: 15(100). doi: 10.1186/s12876-015-0330-2
Muller, M.J. et al. (2016) Changes in Energy Expenditure with Weight Gain and Weight Loss in Humans, Current Obesity Reports: 5(4): pp. 413-423. doi: 10.1007/s13679-016-0237-4
Rattan, S.I.S and Demirovic, D. (2010) Hormesis can and Does Work in Humans. Dose-Response: 8(1) pp.58-63. doi:10.2203/dose-response.09-041.Rattan
Suffering with acne; infertility; tiredness and irregular menstrual cycles? Could it be polycystic ovary syndrome (PCOS)
This is such a distressing condition especially for young girls. As I am seeing it in clinic and the incidence is rising I thought I would summarise some of the current scientific information and clinical approaches here.
Diagnosis
For a diagnosis two out of the following three factors are required:
Irregular menstrual cycles: for years rather than months and this can mean they are very close together or more than 35 days apart and may include random bleeding.
Androgen excess – this can include total testosterone, free testosterone Dehydroepiandrosterone-sulfate (DHEA-S) and androstenodione.
Polycystic ovaries on ultra-sound – these are not cysts but follicles with an egg inside. In teenagers there is a risk of mis-diagnosis due to very sensitive ultra sound scans which are no longer recommended for this age range. This is because they may just have a lot of eggs because they have not fully gone through puberty yet or due to high stress levels. In addition birth control can cause cysts. A higher than average anti-mullerian hormone may help to clarify this.
Presentation and symptoms
Irregular or absent periods
Androgen excess symptoms such as: acne especially jawline acne, hair loss or coarse hair on the face, male pattern baldness.
Other symptoms can include cravings, poor appetite control, some abdominal weight or general weight gain.
PCOS is also the most common cause of infertility in the Western World.
So what’s going on?
1. Insulin resistance
This occurs when cells stop allowing insulin to escort sugar (glucose) into the cells. It is very often but not always present in PCOS although the severity is variable. If glucose can’t get into the cell it gets deposited in the liver resulting in abdominal fat, hence insulin is often called ‘the fat storage hormone’. With no glucose (energy) in the cells clients often feel exhausted and hungry and therefore eat more, so a vicious cycle emerges. Food should generate energy but instead it’s stored as fat (weight) which the body doesn’t utilise, for various reasons, and the resulting lack of energy promotes more food intake. Weight gain, especially abdominal, is therefore a common feature of PCOS. Both glucose and insulin in the blood are undesirable over certain levels and will damage blood vessels.
Insulin resistance can be tested by measuring and testing for: fasting insulin; fasting glucose; an oral glucose tolerance test; Haemoglobin A1c and High sensitivity CRP levels. Some clients will react to very low glucose levels as the sugar levels in their blood drop, others will have low levels of insulin or may struggle to detox it from the body.
2. Low oestrogen
Oestrogen is required for many actions in the body including regulating metabolism and it is made from testosterone. The pituitary gland in the brain triggers luteinising hormone (LH) to signal testosterone which is converted to oestrogen by the ovaries. The conversion is carried out by an enzyme called aromatase which is initiated by a hormone called follicle stimulating hormone (FSH) also controlled by our pituitary gland. In PCOS this conversion isn’t working properly so oestrogen levels remain low and the brain keeps stimulating testosterone production. This then results in high testosterone levels which cause inflammation and overload the liver. Poor detoxification of testosterone and oestrogen can result and these metabolites tend to become toxic.
3. High androgens
High androgens such as testosterone will be an issue for most PCOS clients because of the hormone cascade detailed above. High testosterone alters the gut microbiome which in turn results in greater testosterone production. A vicious cycle emerges of low oestrogen triggering LH, FSH and testosterone production resulting in high androgens which cause distressing acne and hair growth or loss symptoms
4. Problems with immunity
There are many Immune cells lining the gut which also contain oestrogen receptors. Dr Gersh considers oestrogen the master of the immune system for men as well as women. Oestrogen helps to turn inflammation on and off as required but also modulates the reaction to avoid a strong inflammatory chemical cascade. In PCOS, compared to controls, the threshold for inflammatory process activation is much lower. This inflammation can create all sorts of gut issues including toxicity and permeability resulting in dysbiosis and it’s many associated issues.
The underlying cause
Genetically a mild defect in oestrogen production was an evolutionary benefit as slightly higher testosterone made women a little less fertile (fewer children) as well as stronger and braver. Modern times, chemical toxicity and the modern Western diet have twisted this advantage into a modern disease.
Many of the issues above start with metabolic dysfunction, which is the process of converting food into energy, in the gut and the liver.
The research is showing that plastics, phthalates (plasticisers), BPA, BPF, herbicides, heavy meals and air pollution present in the environment, in utero and during puberty cause hormonal and metabolic disruption, especially in women who are predisposed. These EDC’s can block, mimic or interfere with the body’s hormone system causing many health problems.
2. Microbiome
The gut lining and the enteric nervous system have oestrogen receptors which play a key role in the metabolism of food into energy. Low oestrogen levels can result in gut dysbiosis, gut permeability and poor gut motility (constipation). These factors in turn can lead to an increase in toxicity and inflammation for the liver to deal with.
3. Liver function and jet lag
Oestrogen is the master clock hormone and it co-ordinates our metabolic function in tune with our circadian rhythm. Over a third of our genes are clock genes and many others interact with these (60%). Dr Felice Gersh describes the body and it’s organs as an orchestra all tuned to our inbuilt circadian rhythm. Each and every one of your gut microbes (bacteria) has it's own circadian rhythm. So without sufficient oestrogen and poor absorption of what is produced, the body’s metabolism malfunctions. It thinks it’s day when its night and vice versa. Remember how awful you feel when you have jet lag? It’s the same scenario just a different cause.
The absence of food at the correct time is highly stressful, so the body will trigger cortisol. In response to this the liver will manufacture its own sugar (gluconeogenesis), for energy to respond to the ‘stressor’. This means the liver pours out sugar overnight thinking it is daytime, which triggers insulin which then stores as fat. In time this can lead to fatty liver. It is this overloaded and confused liver which results in the downstream effects of insulin resistance, poor detoxification and immune dysfunction known collectively as metabolic dysfunction.
Why weight gain and infertility are such a problem
1. Weight gain
PCOS sufferers are susceptible to weight gain for a number of reasons. Oestrogen regulates energy control (metabolism) and also appetite so low levels can result in increased appetite and poor energy generation. When we are tired we often over eat. In addition there may be insulin resistance which leads to fat storage. The metabolism and regulation of energy becomes very dysregulated hence the weight can increase. There are different types of PCOS however and a lean PCOS syndrome has also been identified.
2. Infertility
In addition to low oestrogen production the receptors for oestrogen often malfunction in PCOS sufferers. Every organ in the body has oestrogen receptors and oestrogen connects metabolic and reproductive mechanisms. Pregnancy is inherently a metabolic stressor and in PCOS there are already many metabolic issues. Infertility is therefore a common downstream issue.
Recovery strategy
It can seem like a rather depressing picture and PCOS sufferers do have a lot of work to do. But the good news is by paying attention to diet and lifestyle there is a great deal that can be done.
PCOS can be helped dramatically with resetting circadian rhythm via obtaining light at the right time and eating at the correct times. In one study insulin and testosterone fell by over 50% in one month just by changing the structure of meals.
There are also various eating strategies which can ease pressure on the liver and help to regulate insulin function. Eating a very nutrient dense diet helps the microbiome to flourish so it’s important to work on the quality of food as well as the diversity and quantity. There are lots of therapeutic ways to nourish and rebuild the gut lining which in turn helps with reducing toxicity and supporting the immune system. We also work to support the liver which controls insulin production and whether we burn glucose or fat for energy.
In addition there are several supplements which I have found can really support clients with their energy generation and regulation and help with cortisol regulation. This does two things. It gives the client hope and also with less fatigue they have more energy to make the changes required.
Finally stress management is key as nervous system sympathetic tone is important. So breath work and meditation, yoga or alternative techniques can all help with this.
So the message is one of positivity and hope. By working in a personalised way we can support the body to make the changes required in a way that suits each individuals physiology and lifestyle.
References:
Parker et al, (2022) Polycystic Ovary Syndrome: An Evolutionary Adaptation to Lifestyle and the Environment Int. J. Environ. Res. Public Health 2022, 19(3), 1336; https://doi.org/10.3390/ijerph19031336
The results are in. This (2019) study involved 20 adults following either an ultra-processed (UPF) or unprocessed diet for 2 weeks at the NIH Clinical Centre. This was followed immediately by 2 weeks of the alternate diet. The diets were matched for nutritional composition: calories; energy density; macronutrients; sugar; sodium and fibre and participants were free to eat as much as they liked.
Despite composition matching, subjects on the UPF diet consumed an average of 508 extra calories per day, comprising more carbohydrate and fat, but not protein. Participants gained more weight during the UPF diet, an average of 1kg, and lost weight during the unprocessed diet. This implies that there is something about the processing itself which causes a metabolic issue.
Other interesting points to note were:
During the UPF diet
• The eating rate was faster
• Sodium consumption increased
• To compensate for the lower fibre level and match fibre intake for both diets, beverages with dissolved fibre were given
• Body fat mass increased
During the un-processed food diet:
• Appetite suppressing hormone increased
• Hunger hormone decreased
• Total cholesterol decreased
• Inflammation markers decreased
• Fasting glucose and insulin levels decreased
One thing is clear. Whilst there is much conflict about which diet is the ‘best’ the whole world seems to agree that avoiding processed foods is a good thing.
Refs: Hall, K. D. (2019) Ultra-processed diets cause excess calorie intake and weight gain: An inpatient randomised controlled trial of ad libitum food intake. Cell Metabolism; 30(1) pp. 67-77. e3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946062/
Intermittent fasting is in the limelight at the moment but many traditions have been incorporating fasting for millennia. Humans have historically fasted overnight, for religious reasons or during periods of food scarcity. Some monks have a precept called ‘no meals after noon’ and religions such as Taoism, Sikhism, Hinduism, Christianity, and Buddhism all fast.
Fasting principles
What we eat at mealtimes is our primary fuel source for 3-4 hours. After 4-12 hours we utilise sugar (glycogen) stored in the liver, muscle and brain. Somewhere between 10 or 12 hours we will start to burn fat out of the liver to produce glucose for energy (gluconeogenesis). It takes 2-3 days for fat to become the predominant fuel source.
The body will often store toxins in fat cells waiting for an opportune moment to detoxify. It’s a bit like us putting things in cupboards, pending a rainy weekend for a clear out. When we are constantly digesting this moment doesn’t materialise. The body never gets chance to undertake any longer term regeneration or deep cleaning projects and our cells and guts can become overwhelmed.
"fasting is the body's equivalent of spring cleaning your house or servicing your car"
The digestive system
The inside of our gastro intestinal (GI) tract is still considered external to the human body. The cells lining the GI tract act as the gatekeeper to our body’s internal environment. The lining is delicate about half the width of a human hair. Nevertheless it underpins all of our health by protecting our immune system and blood stream from toxins and pathogens. The lining is covered in a mucus layer which contains our gut flora (microbiome) and this forms a selective barrier between us and the outside world.
Host microbiome axis: Interaction between the GI tract, the mucus layer and our immune system
Source: Esser, D. et al. (2019) Functions of the microbiota for the physiology of animal metaorganisms; Journal of Innate Immunity; 11(5), pp. 393-404
The immune system
Just behind our gut lining sits our gut associated lymphoid tissue (GALT) which is host to the majority of our immune system. Most people eat at least 3 meals a day plus snacks. This means our immune system is on duty 14 hours a day assessing anything that filters through the gut lining for potential toxins and pathogenic material.
With constant stimulation and no rest, our immune system can’t build up reserves of antioxidants or take care of any long-term building projects. It then risks developing faults or errors of judgment which scientists believe can make us susceptible to:
Gut inflammation
Food sensitivity
Asthma/eczema
Allergy
Autoimmune issues
Diabetes
Cancer
Types of fasting
There are a number of different types of fasting (see below)*. There are also hybrid diets such as the fasting mimicking diet (FMD). This is low in calories and protein but high in fat and maintains micronutrient content. Time restricted feeding (TRF) when food is kept to an eating window of 12 hours (7am to 7pm) or 8 hours (8am to 6pm) will provide an overnight fast of 12 and 14 hours respectively. These variations may be more suitable for some people depending on their state of health and unique physiology.
Longer fasts of up to 5 days can promote autophagy which is a process of programmed cell dissolution. This takes place once all of our glycogen stores have been utilised c. 24-72 hours around the 4th or 5th day. With this process the body breaks down any damaged cells such as mis-folded proteins, ameloid plaques, damaged DNA etc. It’s a process of self-eating where the body recycles damaged materials for alternative use. Shorter fasts such as Intermittent fasting help the body to train into longer fasting periods. Fasting shouldn’t be undertaken without due consideration of your current health status and reference to your health practitioner or GP.
“You get rid of the junk during starvation — and once you have food, you can rebuild… The damaged cells are replaced with new cells, working cells — and now the system starts working properly.”
Dr Valter Longo
What fasting does
Your autonomic nervous system (ANS) carries out all the functions which basically run your body on a day to day basis. Fasting seems to press the reset button on your physiology and all the functions of your ANS including:
Gut / immune system reset - fasting appears to reset our metabolism and rejuvenate the immune system as it gets chance to rest and recover and restore our antioxidant reservoirs.
Gut hormone/stress reset – fasting resets our hormonal systems and avoids the constant adrenaline state to which so many of us have become accustomed.
Gut / brain reset – fasting can help to change our emotional relationship with food as we challenge the body to adapt to different levels of food supply.
Liver reset – fasting facilitates detoxification as we burn fat and sugar out of our liver compartments.
How fasting improves health
Studies in humans and mice of different types of fasting demonstrate improvement in multiple health indicators such as:
Weight loss
Reduced insulin resistance
Lower insulin levels
Decreased oxidative stress
Lower cardiovascular risk factors
Lowers blood pressure
Resets our microbiome
Decreases inflammation
Protective for cognitive function
Anti-ageing
My approach and cautions
I don’t introduce fasting until I believe the client is sufficiently healthy to follow the protocols safely. My approach is personal to each client. Before starting to restrict food intake we work to ensure that they are well nourished from a micronutrient perspective, have a well functioning liver and detoxification pathways and are hormonally stable. In addition they will preferably be trained in the breath-work I teach. This helps clients to work with their autonomic nervous system to manage their stress levels and emotional state in general, but also around food.
We typically start with 2-3 days of intermittent fasting. Usually it’s from the last evening meal at around 7 pm until about 1 pm or lunchtime the next day. This provides an 18 hour break for both the digestive and the immune systems.
Hydration is also important. I have a specific hydration protocol for clients to follow when they are preparing for or undertaking a fast or intermittent fast. There are some contraindications to fasting so I always recommend working with a health practitioner.
What the research shows
Most of the research is currently in mice but it seems to demonstrate:
There are metabolic benefits from fasting including time restricted feeding even if no weight loss is recorded.
As well as quality and quantity the timing of food intake appears to be a key parameter for nutritional and metabolic health. Circadian rhythm and metabolic processes are linked and their disruption can lead to weight gain. Gut bacteria appear to have their own circadian rhythm and fasting benefits this.
Get in touch on 07740 876233 for more information or if you would like or to discuss your health concerns and how I might be able to support you.
Please note: This article is intended for information purposes so readers can gain an understanding of the benefits of fasting for health. I highly recommend working with a health practitioner if you plan to try this as there are many aspects to take into consideration.
References
Chaix, A. (2022) Time-restricted feeding and caloric restriction: two feeding regimens at the crossroad of metabolic and circadian regulation; Methods Molecular Biology; 2482 pp 329-340 DOI: 10.1007/978-1-0716-2249-0_22
Longo, V.D. and Panda, S. (2016) Fasting, circadian rhythms, and time restricted feeding in healthy lifespan; Cell Metabolism;14; 23(6); 1048-1059.
Mattson, M. P., Longo, V.D. and Harvie, M. (2018). Impact of intermittent fasting on health and disease processes. Ageing Research Reviews: 29 pp. 46-58.
Rangan, P. et. al. (2019) Fasting-mimicking diet modulates microbiota and promotes intestinal regeneration to reduce inflammatory bowel disease pathology; Cell Reports; 5;26 (10); pp. 2704-2710.e6. doi:10.10.16/j.celrep.2019.02.019
Sutton, E.F. (2018) Early time-restricted feeding improves insulin sensitivity, blood pressure and oxidative stress even without weight loss in men with pre diabetes; Cell Metabolism; 5; 27(6); 1212-1221,e3.
Wei, M. et al. (2017) Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease; Science Translational Medicine; 15;9(377)
Vaughn, K.L and Mattison, J.A. (2018) Watch the clock not the scale; CellMetabolism, 27 pp.1159-1160.
Training
Zach Bush Biology Basecamp (2020)
Pending:- Intermittent fasting: personalization for better outcomes by Amanda Swaine, DipION, BANT, CNHC
* Fasting types:- intermittent fasting (60% energy restriction on two days or more), fasting mimicking diet, time restricted feeding (8 hour food window) and periodic fasting (5 day diet providing 750-1100 kcal).
Acid or Alkaline?
There are so many controversies in nutrition and one of these is the theory around the acid-alkaline balance of the diet. This blog explores the science and debate around this topic.
If you want to calculate the acid/alkaline of your meal ‘The PRAL’ (Potential Renal Acid Load) scale calculates how acid or alkaline a food is per 100g consumed. This scale is determined by measuring the pH of the ash remaining once the food has been burnt. It is however the subject of debate as the high temperatures used far exceed those of digestion and also burn off the sugar which is thought to cause acidity in the body itself.
The simple way to understand this topic is that alkaline forming foods include all vegetables especially spinach, all herbs and most fruit. Acid forming foods include all grains, cheese, meat, fish and peanuts as well as processed foods. Pure fats, sugars, and starches are neutral, because they don’t contain protein, sulphur, or minerals. A source of confusion is that some foods such as lemons and citrus taste acidic but have an alkalising effect on the body. Examples of highly alkaline vegetables are spinach, broccoli, kale, cucumber and parsley.
When we digest protein acids are produced however these are buffered by bicarbonate ions in the blood. This reaction produces carbon dioxide which is exhaled and also salts which are excreted by the kidneys. The kidneys produce ‘new’ bicarbonate ions which are returned to the blood. So as with most things in the body a cycle is created which enables the body to maintain blood pH within a range of 7.35 to 7.45. So whilst food is linked to acidosis through the potential to place a more acid or alkaline ‘load’ on your body, this is quickly resolved to maintain a stable blood pH.
It is important to keep in mind that sufficient protein intake is important for health generation as well as facilitating acid excretion. So a very low protein diet can in fact increase acidosis and have adverse health effects.
However if our body’s are in a constant acid-base disequilibrium this is a type of systemic stress. If compensatory mechanism’s diminish a persistent acidogenic diet may increase the likelihood of an H + surplus and lower levels of serum bicarbonate. The scientific term ‘acidosis’ refers to a process, a dynamic compensatory response not just a change in blood pH. Many health conditions such as osteoporosis, kidney disease and muscle wasting are associated with a chronic low-grade level of metabolic acidosis. Although the mechanisms are not fully understood it is thought that there is a trade-off for constantly countering the effect of acid foods. Over time this may deplete buffering reserves of alkaline minerals especially in bones and tax muscle, kidneys and endocrine systems.
Some researchers suggest our contemporary Western diet has a higher acid load relative to that of our ancestors. Minich and Bland (2007) suggest that the root of this may lie in the agricultural revolution, processed food and grain products and more recently popular diets such as Atkins and Paleo. The latter are high protein diets which increase our net dietary acid load. They are often accompanied by a decrease in the micronutrient and phytochemical intake from fresh fruits and vegetables.
However other researchers dispute these claims. For example the famous researcher and dentist Weston Price found the diet of primitive Eskimos to contain an acid/alkaline balance of 707:382. He was specifically interested in dental caries which in the modern Eskimo diet have increased from 0.9 to 130 per 1000 teeth, whilst the acid/alkaline diet balance reduced to 382:227.
What is clear is that our bodies strive to maintain homeostasis including normal blood pressure, normal blood sugar and normal blood pH.
If pH falls to below 7.35 then the body regulates acid-alkaline balance via the following:
Chemical reactions generating or consuming H+ at the cellular level
In the blood with bicarbonate and amino acids
Systemically through the release of carbon dioxide (acidic) from the lungs and hydrogen ions from the kidney.
Patrick McKeown author of ‘The Oxygen Advantage’, points out that acid forming foods stimulate breathing to off load carbon dioxide via the breath. Metabolic bicarbonate buffering processes occur over several days whereas adjustment via the breath can occur within minutes to hours. However this stimulus can cause people to resort to mouth breathing rather than nasal in order to restore homeostasis within the body. This aspect of pH adjustment is often ignored in nutrition articles but it’s one of the key reasons I trained in the Oxygen Advantage technique. Unfortunately mouth breathing or over breathing via hyperventilation can quickly become habitual which can then result in pH moving in the opposite direction causing respiratory alkalosis (Brinkman and Sharma, 2021). Symptoms are wide and varied and can include: shortness of breath (dyspnea); fever; chills; peripheral edema; weakness; confusion; light headedness; dizziness; anxiety; chest pain; asthma; abdominal pain; nausea; vomiting or weight loss.
Similar to most things in life it seems to be about balance. Indeed Sagen Ishizuka (1851-1910, founder of the macrobiotic diet, linked the equilibrium of acid and alkaline foods with the Chinese ideas of Yin and Yang. Natural balance not radical consumption of either or.
For help with nutrition or breathing advice and training please call me on 07740 876233.
I am receiving lots of enquiries about how to support their immune system and health through the winter season. I’ve put together some information on key nutrients to consider for support and why, together with some practical suggestions of what and how much to take. There is no substitute for eating a healthy nutritious diet but if you regularly suffer from colds, flu or infections over the winter season this extra support may be useful. As always please consult your GP or health practitioner if you are already taking medication or supplements to ensure there are no contraindications.
Vitamin D3
Recent studies show vitamin D3 supports the immune response to infection and protects against respiratory tract infection especially in vitamin D deficient people1,3. UK NHS guidelines recommend 400 IU per day 2 but many researchers recommend more especially if you aren’t getting at least 10 minutes sunshine per day. I usually recommend 1000 IU but it’s always a good idea to test first. Finger prick tests are available. I use a company called FORTH but you can also ask your GP to test. Use this link to benefit from my discount code:
Has been shown to stimulate antiviral immunity 4. Best taken with copper, 15mg per day should be sufficient for prevention 4. Lower serum concentration of both vitamin D3 and zinc have been detected in patients suffering with moderate Covid 19 symptoms as compared to mild or asymptomatic patients5.
Propolis
Propolis honey bee resin is formed from the resins which the bees collect from trees which form part of the plants natural immune system. It contains more than 300 naturally derived bio-active compounds. These flavonoids and phenolics are what make Propolis a powerful natural defence which may soothe sore throats and support upper respiratory tract infections.
Mushrooms
Mushrooms are fascinating powerhouses of nutrients and compounds that provide many positive health promoting actions including antiviral and antibacterial. We share 40% of their DNA making them more similar to us than plants. Many mushrooms have anti-viral properties and can inhibit viral replication. They can improve T-lymphocyte proliferation and increase Natural Killer cell activity to increase our natural defences against cancer and provide immunomodulatory benefits 6.
Quercetin
Quercetin is a flavonoid found in plants such as onions, brassicas, apples, grapes and berries. It is known to stimulate the immune system to generate aniviral activity and decrease pro-inflammatory cytokines and inflammatory mediators. It has also been shown to reduce the incidence of upper respiratory tract infections (URTI) due to exercise and can be utilised in URTI’s such as asthma and allergic reactions. 7
Ginger
Ginger has been shown to possess anti-inflammatory benefits and positive effects on acute respiratory distress syndrome.8
Ginger tea - take a large palm sized piece of ginger and cope into a few pieces. Bash each piece to release the flavour better or grate it and boil in 1 litre of water for 30 minutes. Optional - add 1/2 tsp of ground turmeric and a tiny pinch of cayenne pepper. Once it has cooled a little you can add the juice of 1/2 a lemon about 3 tbsp. Strain if desired and pour the liquid into a flask to drink when desired.
Get in touch for more information on nutrition to support your health and immunity. Call 07740 876233 or email me at helen@helenmaxwellnutrition.co.uk. https://helenmaxwellnutrition.co.uk/contact-2/
Please use this link to access product information and immune boosting juice and smoothie receipes
References1 Calder, P.C. et al. (2020) Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections Nutrients 12(4) p1181. 2 https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ 3 James, P.T. et al. (2021) The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. The Journal of Nutrition;151 pp.1554-1878. 4 National Academies Press (US) (2001) Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Institute of Medicine (US) Panel on Micronutrients. Washington (DC)5 Golabi, S. et al. (2021) The Association between Vitamin D and Zinc Status and the Progression of Clinical Symptoms among Outpatients Infected with SARS-CoV-2 and Potentially Non-Infected Participants: A Cross-Sectional Study Nutrients 13(10) pp. 3368.6 Chan, G.C-F. et al. (2009) The effects of beta-glucan on human immune and cancer cells; Journal of Hematology and Oncology 2(25) DOI: 10.1186/1756-8722-2-25 7 Micek, J. et al. (2016) 7 Nyguen, H.A. et al. (2020) Quercetin and its anti-allergic immune response; Molecules 623; doi:10.3390 8 Ginger on Human Health: A Comprehensive Systematic Review of 109 Randomized Controlled Trials 12(1) 157 https://doi.org/10.3390/nu12010157
Breathing for runners
Maximise your performance through
BREATHING
Learn how to
Reduce breathlessness whilst running
Improve running economy & running time
Achieve your personal best
Delay lactic acid & fatigue
Prevent gassing out too soon
Push your limits
Improve repeat sprint ability
Improve aerobic capacity
Improve respiratory muscle strength
Functional breath training and simulation of high altitude training with
Helen Maxwell certified Oxygen Advantage® Instructor
Contact Helen on 07740 876233
Breathing-pattern - could it be the missing link?
The way we breathe is intricately linked to the way our body functions on both a physical and psychological level. When we breathe correctly we oxygenate our organs to maximise their function.
Between 50-80% of the general population have some level of breathing-pattern disorder
The researcher and professor of physical therapy, Kiesel (2017), has found that between 50-80% of the general population have some level of breathing-pattern disorder. The Oxygen Advantage® programme is designed to reset and optimise your breathing-pattern to improve your overall health and well-being. It also works specifically on performance for sports and exercise.
Signs and symptoms that your breathing is disordered
Signs that your breathing may be disordered or that you need to improve your breathing include.
Feeling tense
Cold hands and feet
Hayfever and allergies
Frequent sighs and yawns
Poor sleep
Mouth breathing at night (dry mouth in morning)
Exercise induced breathlessness or asthma
Snoring
Frequent muscoskeletal injury
Low BOLT score
Why consider learning to breathe correctly?
Correcting how you breathe may be the missing link in your health journey. For example if you wake up tired or struggle to focus in the morning this may because of how you breathe during the night.
When we learn how to breathe properly we can impact all kinds of health issues such as:
Digestion
Immune function
Weight loss
Energy levels
Anxiety
Chronic fatigue
Asthma
Exercise induced breathlessness
Concentration
Focus
Sleep problems
Snoring
Sports performance
COPD
How is breathing connected to weight loss, energy levels, chronic fatigue and anxiety?
There is a close link between breathing and metabolism which is connected to energy and weight. There seems to be a relationship between the amount we eat and over breathing. Exercises designed to stimulate the para sympathetic nervous (PNS) system seem to bring the body back into balance. This PNS stimulation helps to lower anxiety levels, reduce emotional eating and appetite as well as improve the basal metabolic rate. This is through complex interactions between respiratory rate, heart rate, and the increased capacity of the blood to carry oxygen.
What about asthma and breathing difficulties?
This is one of the key reasons people undertake the programme. The mechanics and depth of how we breathe affects the amount of air and blood in our lungs. If we breathe well our lungs will protect us against pulmonary infections and we will generate an important molecule called nitric oxide. This molecule is generated in the nasal passages and is our first line of defence against foreign particles. Nitric oxide is anti-inflammatory, anti-bacterial and anti-viral and it dilates our airways and blood vessels to enhance delivery of oxygen and micronutrients to the tissues. Generating nitric oxide has been found to have significant health benefits especially with regard to chronic and age related disease.
By learning to breathe correctly, improving oxygen uptake and controlling the amount of air you breathe asthma symptoms may reduce or resolve and the need for medication can diminish.
Why does our breathing affect our digestion and our immune function?
Our gut membrane is the barrier between our internal and external world. It is the vital link between what we eat and the nutrients our body digests and absorbs. It’s surface area is as big as two tennis courts but it is delicate, only one cell thick and half the width of a human hair. Most of our immune system is situated just behind this membrane which starts in the sinuses and runs all the way down our throat to the stomach and intestines. It works to protect us from any unwanted substances we may ingest.
Many of us eat on the run, in a rush or whilst feeling stressed. When we learn to breathe correctly we oxygenate our gut so it can relax, digest and function optimally which in turn supports our immunity.
How can changing how we breathe improve our exercise performance?
Many of us gas-out too soon when we exercise. This breathlessness can actually put us off exercising. We instinctively think this is because we can’t get enough oxygen. It has much more to do with being unable to tolerate the build up of carbon dioxide and lactic acid in the body combined with weak respiratory muscles. This chemical oversensitivity can be retrained and reset so the body can do more with less. We can also retrain the mechanics of breathing to improve the strength of our diaphragm, and the inspiratory and expiratory muscles.
What is the Oxygen Advantage® programme?
The Oxygen Advantage® programmeteachesyou the science and the practice of breathing right. You learn the science of breathing and the ‘how to’ practical part which has two stages. The first stage is to assess your breathing and then learn how to retrain and repattern this for optimal function. The second stage of the programme uses exercises which simulate high altitude training. This teaches the body to do more with less, improving athletic performance for both recreational and professional sports people.
Once you have learnt the exercises and reset your breathing receptors you simply incorporate it into your daily activities.
Benefits
The physiological benefits will depend on how your body responds to the core benefits of:
improved breathing efficiency
better airway function and less breathlessness
improved oxygen delivery to muscles and organs
improved nitric oxide production
better circulation
improved functional movement
resetting the parasympathetic nervous system
less breathlessness during exercise
less sensitivity to lactic acid build up
We pay little attention to the way we breathe because it’s such an automatic process. The Eastern philosophies such as yoga and Tai Chi have always taught that it is a key component of health. We have never been taught to address it but with the Oxygen Advantage® programme you will learn the science and the practice from a fully qualified instructor.
You can read more about the Oxygen Advantage® programme here.
Kiesel, P.T. et al (2017) Development of a screening protocol to identify individuals with dysfunctional breathing. The International Journal of Sports Physical Therapy 12(51), DOI: 10.16603/ijspt20170774
Djupesland, P.G. et al. (1999) Nitric oxide in the nose and paranasal sinuses – respiratory tract physiology in a new perspective; Tidsskr Nor Laegeforen 119(27); pp.4070-4072.
Bryan NS, et al. (2017) Oral microbiome and nitric oxide: the missing link in the management of blood Pressure. Current Hypertension Reports:19(4):33.
Stephan BCM, et al. (2017) Cardiovascular disease, the nitric oxide pathway and risk of cognitive impairment and dementia; Current Cardiology Reports: 11;19(9):87.
