Disclaimer: this article may kill your buzz.

I am most certainly not here to knock alcohol. Those close to me can affirm that I enjoy a sloppy Santa or two (boxed wine mixed with whiskey) around the holidays (or year-round, really). I feel that acquiring knowledge allows you to make informed and educated decisions. We're all grown adults and we can choose to ingest whatever the fuck we want, whenever the fuck we want. Might as well learn what the hell you're putting in your body. 

 

Shocker: alcohol isn't good for us. Alcohol contributes "empty calories" to your diet and can likely lead to liver cancer, cirrhosis, and a plethora of other chronic diseases. But why is alcohol detrimental to our health, and why do some people become addicted to alcohol while others do not?

As with most addictive substances, there is a blatant disconnect between how our brain and our body perceive alcohol. Alcohol - chemically known as ethanol - is considered a toxin by the body and is preferentially metabolized in order to reduce tissue damage. Only minutes after ingestion, alcohol reaches the brain as a powerful stimulant. Alcohol is the only nutrient (substance that contributes calories) that acts as a stimulant and therefore causes the brain to "crave" alcohol. 

 

But wait...isn't alcohol a depressant?? Actually, the way in which alcohol affects neurotransmitters lend it to being considered both a stimulant and depressant. Here's why:

 

Alcohol as a depressant

• Suppresses the "excitatory" neurotransmitter- glutamate- which would normally increase brain levels and activity. 
• Increases the "inhibatory" neurotransmitter- gamma-Aminobutyric acid (GABA)-which reduces energy levels and increases feelings of calmness 

Alcohol as a stimulant

• Increases release of dopamine in your brain's "reward center". Other drugs that do this include cocaine and crystal meth. Over time, it takes more and more alcohol to release the same amount of dopamine until the dopamine effect diminishes completely. 

I don't think it's a surprise to anyone that the effects of alcohol on our brain lend to alcohol's addictive nature. It both stimulates our reward center while creating a feeling of calmness. As fun as drinking can be, alcohol ultimately fucks your body up. Here's why.

 

ALCOHOL METABOLISM 101

 

 

 

 Metabolism includes all reactions - both catabolic (breaking down) and anabolic (building up) - that occur after we ingest a nutrient.   While there are several pathways that alcohol can be metabolized in the body, the most common involves two enzymes: alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). Collectively, these enzymes break apart the alcohol molecule and allow it to be safely eliminated from the body.

Alcohol use and alcohol-related problems are strongly pre-determined based on individual variations in alcohol metabolism. These variations are both genetic and environmental - we all have slightly different variations of ADH and ALDH in our body. Moreover, our present nutritional status and overall health also plays a role in how effectively alcohol is cleared from our system.

In the first step of alcohol metabolism, alcohol (ethanol) is converted into a toxic compound and known carcinogen called acetylaldehyde by ADH.  Acetylaldehyde is then further broken down into a less active byproduct, acetate, by the enzyme ALDH. Finally, acetate is metabolized to water and carbon dioxide to be eliminated by the body.

It's not quite that simple, though. There are a host of other side reactions that take place as alcohol is metabolized. The enzymes cytochrome P450 2E1 (CYP2E1) and catalase also break alcohol into acetylaldehyde, but only after a person ingests a large amount of alcohol. Small amounts of alcohol are also removed by binding to fatty acids to create fatty acid ethyl esters (FAEEs). These fatty acid compounds play the largest role in deterioration of the liver and pancreas from alcohol.

The Genetic Component:  

I find it extremely interesting that the inherent genetic differences of the enzymes ADH and ALDH have a striking role in predicting alcoholism and the chronic health consequences of alcohol ingestion. Not only can we vary in the amount of these enzymes, but there are myriad variations of each enzyme itself. Some of the enzyme variations work more or less efficiently than others; this means that some people can break down alcohol to acetylaldehyde, or acetylaldehyde to acetate, more quickly than others.

The goal is to have acetylaldehyde in your system for the shortest duration possible. Therefore, a fast ADH variation will cause acetylaldehyde to accumulate quickly in the body. This can make drinking physically unpleasant - facial flushness, nausea, and rapid heart beat are common symptoms, regardless of alcohol intake. ADH1B*2 is a variation of ADH that is common in people of Chinese, Japanese, and Korean descent but rare in people of European or African descent. ADH1B*3 is another very efficient variation of ADH and occurs in 15-25% of African Americans. These populations are somewhat "protected" against alcoholism by the effects of alcohol intake, however, they are at a higher risk of alcohol complications due to the accumulation of acetylaldehyde if they do choose to drink.

The opposite can also occur: efficient variations of ALDH have been positively correlated with alcoholism, as the body is able to efficiently turn acetylaldehyde into acetate - therefore minimizing the negative physical effects of alcohol. ALDH1A1*2 and ALDH1A1*3 are examples of these variations and are typically seen in African American populations.

Health Consequences of Alcohol:  

• Alcohol metabolism and Cancer
• acetylaldehyde is a carcinogen that interferes with DNA replication and inhibiting the repair of damaged DNA
• Reactive-oxygen species are produced when alcohol is metabolized by CYP2E1. ROS damage proteins and DNA
• Fetal Alcohol Syndrome
• The presence of alcohol in the bloodstream interferes with the quality and quantity of nutrition that crosses the placenta. This results in slow fetal growth and permanent fetal damage
• Alcoholic Liver Disease and Pancreatitis
• The liver is the main place of alcohol metabolism. The accumulation of FAEEs contributes to fatty liver and increases risk for liver cirrhosis
• The pancreas is also involved, however, most research suggests that dietary habits and smoking are main contributors to the irreversible damage done to the pancreas
• Malnutrition and Obesity
• Alcohol contains 7 calories per gram and carries no nutritional benefit
• Increases the amount of fatty acids circulating in the bloodstream and does not regulate blood glucose control, causing our brain to increase hunger signals to increase amount of blood glucose. 

So, in conclusion: drink whatever the fuck you want. #themoreyouknow

INFLAMMATION: The root of disease as well as the reason we're all still alive.

We often hear the word "inflammation" thrown around as the cause of myriad diseases. Arthritis in your joints? Inflammation. Peptic ulcers? Inflammation. The redness surrounding a fresh cut? Inflammation. 

But what exactly is inflammation? Our bodies are designed to heal themselves. When the body senses an injury to your tissues, it initiates what is known as an inflammatory response in order to heal the damaged tissue. The inflammatory response involves the vascular system, immune system, and cells of the injured tissue. Basically, your body releases hormones which signal other hormones which signal cells that destroy the intruders and repair the tissue. Tissues can be "injured" in many ways. The most obvious instance of inflammation is when you cut the skin. You can see the signs of inflammation such as redness and swelling. You probably know enough about the immune system to understand that the body sends bacteria-fighting cells to ward off infection. 

Our internal tissues can become damaged too, and not just by a physical cut. Foreign cells such as bacteria and carcinogens can disrupt the tissue enough to trigger an inflammatory response. These intruder cells are able to penetrate our initial defenses when there is a disruption in the overall system, that is, when we are not taking care of ourselves properly via diet, rest, and exercise. 

When you hear that something is "pro-inflammatory", it means that the presence of it in the body triggers an inflammatory response. Stored adipose tissue, especially in the midsection, is pro-inflammatory, as is an abundance of LDL cholesterol and saturated fatty acids in the bloodstream. By nature, insulin is also pro-inflammatory: there are molecules called eicosanoids that sit on the outside of your cells and the presence of insulin changes their signaling to a pro-inflammatory response. So, what happens when we constantly ingest carbohydrates and fatty foods? We are constantly in a state of internal inflammation. This is what is called chronic, systemic inflammation and this is how chronic diseases usually develop. 

Diet and exercise impact the level of inflammation in the body. I'm sure you've heard that consuming refined sugars and processed foods isn't good for your health. As you  begin to understand the process of inflammation, you can see that this is because they are full of pro-inflammatory molecules. Pro-inflammatory molecules include omega-6 fatty acids, saturated fats, and simple carbohydrates. Most of the cooking oil that we use has a high percentage of omega-6 fatty acids. You may be thinking "wait...I thought unsaturated fats were healthy?" They are healthier than saturated fats. However, the "typical" Western diet has a much higher ratio of omega-6 to omega-3 fatty acids than what we need. Omega-3 fatty acids, such as those found in freshwater fish, flaxseed, and walnuts are anti-inflammatory. An interesting side note: grass-fed beef, that is, cows that are raised ENTIRELY on grass and not on grain, are also good sources of omega-3 fatty acids. The typical beef you buy for cheap in the grocery store is grain-fed, which is popular because it is cheaper and quicker for bulk sale. 

As for carbohydrates, the inflammatory response is based on the glycemic index. The glycemic index is a scale that indicates how easily the body can break down and utilize simple sugars from the foodstuff itself. The higher the number, the faster the body can metabolize the food. For example, Corn Flakes have a higher glycemic index than All Bran, because the fiber in All Bran slows the digestion and metabolism of the carbohydrate. 

You guessed it: Exercise reduces inflammation. How? Go back to the concept of chronic, systemic inflammation. The inflammatory response includes the release of cytokines, which are small proteins that serve as messengers between cells. Cytokines down regulate the production of growth signaling factors in the brain, further exacerbating systemic inflammation (and reduce cognitive function, interestingly...). When you produce movement to a point where there is positive stress on the body, i.e, exercise, your body increases the production of growth signaling factors in your brain. Thus, regular exercise counteracts the degeneration and decreases the negative change in growth signaling factors. To boot, cardiovascular training improves cardiac function and strengthens the vascular system, and an increase in muscle mass has been shown to reduce cytokine levels and improve insulin sensitivity. 

BOTTOM LINE: I like to look at things as logically as possible. Acute inflammation, such as a cut on your leg, a burn, or a bacterial/fungal/viral infection that happens to get past your initial defenses is a beautiful thing. The inflammatory response is necessary so things like that don't kill us. However, your body becomes confused when you don't take care of it over and over and over and over. Your hormones are out of whack, and instead of treating the cause - i.e, eating healthy, exercising, and not getting worked up over every little thing - we depend on medication that just causes more side effects. In order to truly be well, it's important to eat nutritious food in the correct quantities and to treat your body to exercise and rest. 

Gluten intolerance for dummies

If you still think you have gluten intolerance...shocker...YOU DON'T.

Gluten intolerance is as real as unicorns. There is a greater chance that you will wake up with Sasquatch in your bed tomorrow morning than that you actually have gluten intolerance (although I've dated some guys who could pass for Sasquatch).

So what's the deal with gluten intolerance versus actual celiac disease??? I wrote an article for my gym's newsletter this month. Check it out:
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The gluten-free market has grown exponentially in the past ten years. Although we have gained more knowledge into the pathophysiology of celiac disease (gluten-sensitive enteropathy), most of the awareness comes from the expansion of the gluten-free consumer market. Not only are gluten-free products marketed to those with diagnosed celiac disease, the diagnoses of "gluten sensitivity" has become prevalent. In counseling, I find that a lot of clients aren't fully aware of what celiac disease actually entails. 

Celiac disease is an autoimmune disorder caused by genetic predisposition. Wheat and related grains contain gluten, which is a protein. Gluten is responsible for the structure and elasticity in baked goods, and is the main source of protein in carbohydrates.

Our immune system can normally recognize and tolerate proteins such as gluten, and activate the appropriate response. This results in the successful digestion of gluten.

However, those with celiac disease express the antigen-presenting molecules HLA-DQ2 and HLA-DQ3. When these molecules bind to gluten peptides, they produce cytokines which cause inflammation and produce antibodies against gluten peptides.

This response leads to  atrophy of the villi in the intestine, malabsorption, malnutrition, and malignancy.

Basically, those with celiac disease don't just get stomach upset when they ingest gluten - it decreases the efficiency of the intestine for ALL nutrients, causing a huge nutrient deficiency and eventual death if not diagnosed.

So, what's the deal with gluten intolerance?  In 2011, Peter Gibson headed a study in which he found and announced to the world that gluten intolerance did exist. Like any scientist, he wanted to conduct another study to ensure that he reported accurate results. Gibson recently finished the second study and revoked his findings, stating that there had been errors in the first study and that the gastrointestinal upsets were due to FODMAPs, not gluten.

FODMAPs is an acronym for "Fermentable, Oligo-, Di-, Mono-saccharides and Polyols". Basically, FODMAPs include carbohydrates and alcohols that are poorly absorbed in the small intestine and cause GI upset.

The foods that are highest in FODMAPs in our diet include most grain products, beans, apples, apricots, and cauliflower.

In conclusion, celiac disease isn't a trend, it's a life threatening condition. Gluten intolerance is not a condition, it is the poor absorption of certain carbohydrate chains - not peptides in the carbohydrate - that cause GI distress. You can stop paying too much for gluten free, and instead research a low FODMAP diet if you feel as though grains are causing you pain.

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Would a picture help??? Pardon my crafty side, but I couldn't help doing an illustration as well. ENJOY

Intermittent Fasting: Fancy terms for "Don't stuff your face all day long"

Yes, I'm cynical. I hate on a lot of diet fads, but not without reason. The intermittent fasting diet is the newest thing to hit the scene, and, surprise-surprise, I think it's overrated. 

The basis for most of these diets are actually rooted in common sense. For example, the Paleo diet emphasizes whole foods instead of processed foods. The Atkins diet downplays the role of carbohydrates in a sedentary world. Intermittent fasting - known as a dieting pattern to followers, not a diet- is based on the concept of only eating during a set amount of hours to achieve caloric restriction. 

My thing is this: did anyone think that eating consistently for 24 hours was a good idea prior to this diet?

I get it, it gives people a routine or a schedule, and that can be nice at first. Most people choose to eat in an 4, 6, or 8 hour window. 

The "studies" (I have yet to find a solid, long term, peer reviewed study on the topic) state that the followers of intermittent fasting took in less calories overall in a 24 hour period. I wonder, however, if these claims are based on what the previous intake was of the same person or the intake across a statistical population norm...hmm. 

I did some research on the topic for the latest newsletter coming out for Edgewater Athletic Club. This is the resulting article. If you have any thoughts or feelings on the topic, I would love to hear what you have to say. 

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DIET(ITIAN) REVIEW: 

INTERMITTENT FASTING

     
I'm a firm believer that there are positive lessons in even the most extreme fad diets. The dieting pattern that has recently blown up on the scene is intermittent fasting. 

WHAT IS IT? 
The basis of intermittent fasting (IF) is working periods of fasting (no food) into your lifestyle. While there are tons of different dieting patterns advocated by proponents of IF, these are the two most common options: 

• Longer IF 1-2x a week: This is taking a longer fasting period (up to 24 hours) and repeating 1-2x a week. Note that 24 hours is not skipping a whole day, as stopping to eat on 6pm Tues and then having your next meal at 6pm Wed is 24 hours. 

• Shorter "Daily" IF: This means that it is done more than a couple times a week (can be daily) with a condensed eating window and less fasting than seen above. There seems to be a wide range in the time of day and duration of fast. Some articles propose an 8 hour window of eating time, others say 6 or 4 hours. While most advocate having this period during the day, others recommend it in late evening (I would not recommend this, unless you work nights). 

ALLEGED BENEFITS OF IF

• Weight loss
• Increased insulin and leptin sensitivity
•  Normalizing ghrelin levels 
• Lowering triglyceride levels 
• Reducing inflammation, lessening free radical damage
• Preserving memory function and learning

POTENTIAL CONSEQUENCES OF IF 

• Chance of overeating (binge) after a fast, making weight loss benefits not happen (calorie excess overall).
• Less of a focus on making healthy food choices
• Longer fasts are a bigger stress on the body, and may not be suitable for people who have already a high stress load or metabolic/blood sugar/health* concerns
• May not work well with high active lifestyle if calories are still too restricted overall.

DISCUSSION FROM THE DIETITIAN

 

The concept of intermittent fasting is not a new one. We've known for a while that caloric restriction results in a significant reduction in chronic disease and a longer lifespan. Caloric restriction in this sense is not malnutrition or undernutrition, but simply eating enough to maintain a healthy weight without the use of excess exercise. 

 

The benefits that are claimed to be associated with intermittent fasting are really the benefits of eating less: 

 

-Insulin, ghrelin, and leptin are dose-response hormones. They are released in response to how much you eat. The more you eat, the more these hormones are released. The more they are released, the less sensitive your body is to them, and the less your body will respond to them. 

 

-Consuming less carbohydrates in your diet will lower your plasma triglyceride levels. New research has also linked excessive carbohydrate consumption to deteriorating mental states such as Alzheimer's and dementia. 

 

-Free radicals (see the article about micronutrients to the right) are created from the normal process of metabolism in our body. The less we eat, the less we metabolize, and the less free radicals (inflammation) we form. 

 

The take away here is that intermittent fasting is a way to get you to eat less overall. It doesn't focus on the quality of your meals. Most of us can benefit from eating less, but it doesn't have to be in a fixed amount of time. 

 

If you're the type of person who likes to follow a regimented schedule, has a moderately sedentary lifestyle (you're not running around all day long for your job or kids), and doesn't take medications that would require the presence or timing of food, then this diet may work for you. Make sure that you fill your fed state with lots of vegetables, fruit, lean protein, and some complex carbohydrates. 

 

Detox Your Life, Not Your Diet

There are short term rewards and long term effects of every decision we make, no matter how small. 

From the time I was a teenager, I always wanted to work in wellness.  I struggled with obesity, then eating disorders, and then exercise compulsion. It wasn't until I finished college and started my dietetic internship working for a hospital that I really saw the meaning of "being well".

The fast food that you eat today really can make a huge difference in how your heart works in 40 years. The cigarette that you smoke today could really kill you. The overuse of supplements or alcohol and other drugs really can destroy your liver and kidneys. Although these are chronic diseases, it is so easy to form toxic habits that end up destroying our bodies.

So many of the patients that I saw - of ALL ages - urged myself and the other interns to take care of our bodies today. They told us stories of how they wished they would have avoided their vices in the past to avoid being in the situation they were now, which was a painful and expensive one for both themselves and their families. 

I'm not here to lecture you, by any means. I hate when people tell me what to do - it makes me want to automatically discredit any attempt at help. This is real. I met with a young man who took steroids for the first time, was diagnosed with acute kidney failure, and died 2 days later. I met with patients who were on their 4th stent placement and had their family bring them in McDonald's Big Mac's because they didn't like the hospital food. According to them, why make a change when insurance covers the cost of their care? 

We aren't as lucky at this point in healthcare and quite frankly, I'm relieved. You are now responsible for your health. Insurance is outrageous, deductibles are high, and the burden on your fellow human to cover your cost of healthcare is something we all can relate to. Why not insure your health by making responsible choices, or at least accepting that you're irresponsible choices can kill you much sooner than you may want.





My take on wellness is simple: live the longest, healthiest life that you can. A lot of what we do today is based on the environment that we place ourselves in and how we react to stimuli, both positive and negative.

We can't eliminate all stressors from our life, but we can certainly take the time to analyze why you are experiencing stress and whether or not it is coming from a positive place or not.

Most of the time, it is these negative emotions that cause us to indulge in self destructive behaviors. This doesn't mean that you won't experience negative emotions. All emotions are a part of life and should be embraced equally.  I want you to stop and think about why you are experiencing them and be able to move on in a manner that promotes wellness and self growth.

 

You see in the media today a lot of hype for cleanses of all sorts - juice cleanses, detoxes, etc. I challenge you to cleanse your life of the longstanding impact of negative emotions and I guarantee that your cravings for food or other vices will decrease in a much more sustainable and healthy way than simply juicing or detoxing with external sources. Detox yourself and be well :)