Antihistamine Precautions: Alternatives for Navigating Spring Allergy Season

It is indeed allergy season! Read on for the most common questions followed by actions you can start taking today towards relief.

Q:  Many people are really struggling this spring with allergies.  Things like headache, constant congestion, and runny nose, and we know the issues are seasonal because the symptoms only appear during spring (mostly) and fall.  We already know over-the-counter antihistamine drugs have a lot of side effects such as drowsiness and listlessness (lethargy.)  Do you know of some natural solutions that really work?  There’s a lot of stuff on the internet, but we aren’t sure if any of them are effective.  Or is there a way to take the drugs without all the side effects?  

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A:   You are right about the side effects of typical anti-histamine medications.  These drugs often leave a person feeling drugged, sleepy, or foggy-brained.  They also can have other potent (but not often publicized) side effects such as dizziness, blurred vision, nausea, or making an enlarged prostate or a yeast infection worse. We encourage patients to avoid them whenever possible.  And yes, there are several natural choices that we have seen make major improvement.  Not only with seasonal allergy symptoms but also asthma and ongoing, chronic allergy.

The Physiology of Allergy

Our immune system can react with alarm to the protein in a particular type of pollen and develop antibodies to these “foreign invaders”. Think of antibodies as your body’s “Most Wanted” criminal list. Exposure to them then causes our mast cells to release histamine, triggering swelling of mucus membranes and the flow of mucus.  Despite the discomfort, our immune system really does have our best interests at heart ! Mucus can flush unwanted substances out of the body and protects delicate tissue. The problem is that our immune systems can get overwhelmed, especially if clients are (1) chronically stressed, (2) consume lots of sugar/sweeteners/chemicals,  and/or (3) are not well-rested (three factors which influence our immune system greatly).

The following conditions can put you at risk for Pollen Allergies
  • asthma
  • constipation
  • unmanaged stress
  • food allergies
  • poor nutrition
  • lack of exercise
  • sleep deficit
  • deviated septum
  • nasal polyps
  • recent trauma or illness
  • pregnancy

All these conditions are a signs of inflammation. Let’s use the glass of juice analogy.

The body is the glass. The juice is inflammation. A body battling asthma, eczema, constipation, food allergies is like an overflowing glass of juice. Aka, a body full of inflammation. Allergies to pollen cause more inflammation. Thus when the trees bloom, the glass spills over and horrid allergy symptoms commence.

However, when the above conditions are addressed and inflammation is lowered, the body will resemble a glass half full of juice. Therefore, this body will be able to handle pollen allergies much better with a lot less symptoms.

Natural Solutions for Allergies
Eat Lots of These Foods
  • fresh fruits: mango, pear, watermelon, apple, kiwi, cantaloupe, grapes, berries
  • fresh vegetables, organic when possible, here is the list of the dirty dozen
  • dairy substitutes: coconut milk, hemp milk, almond milk, rice milk
  • cooking oils: olive oil, coconut oil
  • leafy herbs
  • organic, free range eggs
  • gluten free grains: quinoa, rice, oats
  • freshly wild caught fish
  • freshly cooked organic poultry
  • herbal teas such as Green Tea

The above foods are low histamine foods which means they are least likely to irritate the immune system.  They are also power houses of Vitamins such as Vitamin C, Vitamin D, Magnesium, and Antioxidants such as Quercitin.

Dairy foods are mucus-producing in many people, hence a short term removal of these foods may provide some relief 

Reduce or Avoid These Foods

These foods prevent the immune system from working properly.  In order to avoid allergy symptoms, we need a strong immune system.  One that doesn’t over-react or under-react.

  • sugar
  • caffeine
  • bottled / store bought fruit juices (yes even organic)
  • food preservatives
  • decrease/avoid dairy and gluten (even non gmo, organic, grass fed, etc)Keep in mind too that dairy foods are mucus-producing in many people.  You might want to embark on a trial, full elimination of all dairy foods (e.g. milk, cream, cheese) to see how it affects you, at least until the worst of the allergy season has passed.
  • processed foods with ingredients that you can’t pronounce or have no idea what they mean
  • cured meats
  • wine, chocolate (wahhhh, we know!) and strawberries are all very high in histamine
Reduce your exposure to Pollen
  • Wear a protective mask when gardening or doing yard work.
  • Modify the indoor environment to keep out allergens. Use HEPA (high-efficiency particulate air) filters in air conditioners to better trap pollen spores. Change air condition filters often.
  • Check pollen counts before you travel. To find pollen counts, go to the National Allergy Bureau (www.aaaai.org/nab)
  • Protect your eyes. Wear sunglasses when outdoors to reduce the amount of pollen coming into the eyes,
  • Wash your hair and shower at the end of the day to wash out pollens. This will help avoid pollen transfer to the pillowcase and bedding.
  • Exercise in the morning or late in the day. Pollen counts typically are higher on a hot, windy, sunny day compared with a cool day without much wind.
  • Check the pets, they are known pollen carriers.
  • Leave your shoes at the door. Tracking in mud and pollen through the house will make symptoms worse. (This is my biggest challenge in my house, uhm uhm husband uhm)
Supplements

To access some of the items listed below click HERE.

Please speak with your functional medicine practitioner about what is appropriate for you. Some supplements can interfere with certain medications and/or other supplements.

  • Nasal Saline rinse twice daily, will wash pollen out of nose, reduce symptoms, and decrease medication use by 62% (article). An effective way is to rinse your nose after coming in from outside to immediately get the pollen out.
  • Vitamin D (preferably D3 with K2) Vitamin D, a critical vitamin for immune system function is found in Eggs, Salmon, Cod Liver Oil, Tuna, Sardines.  Emerging evidence shows Vitamin D to increase the effectiveness of nasal corticosteroids in those suffering from Allergic Rhinitis (allergic runny nose) (article)
  • Quercetin (pronounced kwehr’-suh-tin). It is best used as a long term remedy starting about 4-6 weeks before allergy season.  (article) A natural extract from plant foods like onions, apples, berries, buckwheat, and citrus fruit, quercetin is technically a flavonol.  These polyphenols help to determine a plant’s color – in this case, a bright yellow. Quercetin is a natural anti-histamine without the side effects of many medications!  Quercetin actually calms the immune system to reduce or prevent histamine release. Several patients over the years with chronic seasonal allergies or asthma have found great relief.  As an aside, quercetin is also being researched for circulation and cardiovascular health too, as it’s been shown to increase blood flow via artery dilation, promoting the release of nitric oxide. This action creates greater tissue oxygenation, nutrient flow, and waste removal.  For this reason, it may also improve symptoms of fatigue and malaise due to poor circulation or in those with anemia or mild hypertension.  Be cautious using quercetin, however, for those already taking blood thinners (e.g. Coumadin, Plavix, or daily aspirin). In a supplement, quercetin is often combined with bromelain, an extract from pineapples that is a potent anti-inflammatory that also calms the immune system and increases the effectiveness of quercetin.  For seasonal allergies, we recommend clients start using quercetin right away to build up levels in their body and continue throughout the full allergy season.  Consider starting with 1000 mg, taken twice daily on an empty stomach. Allergic reactions to quercetin are virtually unheard of;  we believe this is a safe supplement to explore.

Quercetin actually calms the immune system to reduce or prevent histamine release

But quercetin has also been heavily studied in recent years because of its ability to heal intestinal permeability.  This is especially helpful for those who may be prone to allergies/sensitivities in part because of the ongoing immune insults that having a leaky gut allows.  This makes Quercetin a perfect two-solutions-in-one remedy!

  • Stinging nettle leaf (very important:  leaf, not root) has been shown to have effective ‘antihistamine’  action because it makes histamine receptors less sensitive.  Because of this mode of action, we tend to use stinging nettle as a synergistic, additive pairing with an antihistamine like quercetin (vs. an agent on its own).  This can be a powerful combination for more entrenched cases which don’t find sufficient relief via quercetin alone.
  • Another excellent choice is the herb Butterbur.   This one has actually been formally studied and found to be just as effective as Zyrtec at treating seasonal allergy symptoms.  Unlike quercetin, butterbur is helpful because it is an anti-spasmodic remedy.  Phytochemicals in butterbur relax swollen nasal membranes and alleviate muscle spasms in the respiratory system.  When our immune system reacts to a perceived “foreign invader” (like an allergen), our cells produce  inflammatory signaling molecules called leukotrienes (which usually happens in concert with the production of histamine, as mentioned above).  Leukotrienes trigger spasms in the trachea which can help us to cough – to expel undesirable substances.  Overproduction of leukotrienes, however, causes major inflammation in the respiratory system in the case of asthma and allergy.  Butterbur simply interferes with the production of leukotrienes.   Short-term use (3-4 mos) is generally regarded as quite safe; long-term use has not been studied.   Note that butterbur is not suitable for pregnant or breast-feeding women (or for very young children less than six years of age).   A typical therapeutic dose of butterbur extract is about 200mg/day (divided into an AM and PM dose for greater absorption).  Mild headache or stomach ache may be side effects of butterbur and can be best avoided by taking it on a full stomach.  Before you ask:  yes, in very tough cases, it would be quite syergistic to pair these three agents together.
  • Vitamin C, an antihistamine, is one of the most important antioxidants and immune enhancing nutrients to an allergy sufferer.  Found in Red Peppers, Oranges, Kiwi, Melons.  The effect of Vitamin C is enhanced when taken with Quercetin (article)
  • Local Raw Honey, in those older then 12months old, has shown promise in the prevention of Seasonal Allergies (article).  Honey ingestion is thought to help via Oral Sensitization.  In other words, eating the allergen regularly can help the body recognize the specific allergen as a non threat.  It is important to buy the honey locally, because pollen from Brazil won’t help much in New Jersey.  The only exception is Manuka Honey from New Zealand due to it’s antibacterial, antimicrobial, and immune system boosting properties.  Furthermore, make sure it’s raw. Processing destroys most of the nutrients.
  • Last but not least, Omega-3’s found in Salmon, Free Range Eggs, Free Range Grass Fed Meats, Avocado, Olive Oil, Nuts.  It has been shown to boost the immune system (article)


Adapted From the School of Applied Functional Medicine’s Clinical database and our colleague Dr. Ana Maria Temple

Eat Seasonally for Health & Wealth!

Six reasons why eating the whole foods of the season can optimize your health and keep more money in your wallet

New seasons bring on changes. And those changes should include what’s on your plate.
You may have heard that eating locally and seasonally is a good thing, but with all these convenient options, is shlepping to the farmers market actually worth it? Short answer: Yes.

Eating seasonal fruits and vegetables throughout the year benefits your health and saves you money, and is kinder to the environment. Eating in harmony with the seasons may seem like a trendy health fad, but it’s actually been a way of life for humans for thousands of years—and for good reason.
Here are the many reasons to make seasonal foods an integral part of your diet this fall:

🧄Seasonal produce is fresher and healthier.
Time is the enemy of fresh produce: As soon as they leave the vine or tree, fruits and vegetables start to lose their nutritional value. Some produce—such as spinach and broccoli—begin to lose nutrients within hours of picking, while others—such as apples, carrots, and potatoes—stay fresher longer. Produce that’s not in season is picked, stored, and often transported, which affects the quality.

Seasonal produce is more flavorful.
Vine-ripened tomatoes are often prized for their flavor, as they have a richness from fully maturing in the sun. That’s because the freshest, best-tasting produce comes right from the vine or tree. Foods grown out of season are typically picked before they are ripe, so they can be transported and stored without spoiling. Out-of-season produce may look good, but the flavor can be bland compared to a crop picked at high season.

Seasonal produce can help broaden your horizons.
Let the season’s fresh produce inspire you to try some new foods. Some fruits and vegetables may only be available certain times of the year. What a great opportunity to test out a new recipe?!!

Seasonal produce suits the season
Don’t you crave pumpkin-flavored, well, everything in the fall? The traditions that surround food that are in season are not by accident. These foods follow their natural growing and ripening rhythms. When certain fruits and vegetables are not in season, post-harvest treatments, known as ripening agents, are used to make them available year-round. These include chemicals, gases, and heat processes. So avoid the extra chemicals and take advantage of what Mother Earth is producing. 

Seasonal produce is plentiful and therefore cheaper!

When a fruit or veggie is in season, it’s abundant and available at a lower price. Eat well and save money- it’s a WIN WIN!

🍎Seasonal produce is environmentally friendly

Environmentally, seasonal foods typically require less transportation and less intensive farming methods. Less travel and imports mean fewer fuel emissions. 

For a full list of what’s in season check out this article by The Spruce Eats: https://www.thespruceeats.com/

Clinical References
Seasonality and dietary requirements: will eating seasonal food contribute to health and environmental sustainability? Aberdeen, UK: Public Health Nutrition Research Group,Rowett Institute of Nutrition and Health, University of Aberdeen, 2014. 
https://www.ncbi.nlm.nih.gov/pubmed/25027288
Top 10 Reasons to Shop at a Farmers Market. Nutrition.gov. 
https://www.nutrition.gov/subject/shopping-cooking-meal-planning/farmers-markets)
Maximizing the Nutritional Value of Fruits and Vegetables. University of California, Davis. 
http://www.fruitandvegetable.ucdavis.edu/files/197179.pdf

Food Spoilage, Storage, and Transport: Implications for a Sustainable Future 

BioScience, Volume 65, Issue 8, 01 August 2015, Pages 758–768 https://academic.oup.com/bioscience/article/65/8/758/240222

Tip #2-Your Skin is One Giant Mouth

A concept we work diligently with clients on is the understanding that our skin is one BIG MOUTH and most of what we slather on it goes into systemic circulation. Epsom salt baths(magnesium) can be particularly helpful for muscle aches, but most of what we’re absorbing through our skin is not solely magnesium.  In Functional Medicine we teach patients that we really shouldn’t put anything on our skin that we wouldn’t be willing to eat. We work closely with patients to help them to start fresh with their home, beauty & personal hygiene products, with this truth in mind.

A great app for quick reference on everything from baby food, sunscreen, shampoos, and household cleaners is EWG’s Health Living app, which will rate products from low to high hazard. you can scan barcodes while you’re navigating the aisles at Target for quick reference!

Read on for guidance on everything from hair color to toothpaste to root canals, lawn fertilizer and everything in between!

  • Purchase the most natural cleaning and other household products you can find.
  • Avoid spraying pesticides or herbicides in your home or property. Seek out more eco-friendly lawn treatments such as Mark, from Ecology Lawn, here in NJ.
  • For hair and other personal hygiene products (including shampoo and colors) look for products without alcohol, sodium lauryl sulfate, triclosan, paraben, phthalates, or other petrochemicals. Check to see if there is an environmentally-oriented hair or nail salon in your area. 👉🏼Two organic hair salons we love in NJ are Clarity Hair Salon and Hair Potions and most nail salons carry Dazzle Dry.
  • Avoid using hair sprays.
  • It’s hard to avoid polycarbonate plastic because it’s ubiquitous. Unfortunately it also contains BPA. Examples are CDs, the faces of laptops, many toy parts, kitchen utensils, water cooler carboys, eyeglass lenses; it’s often identified as #7 in the recycling symbol on the product. Try to minimize exposure and in particular, using these against your skin, especially when warm and/or wet.
  • Avoid perfumes or other skin or hair care products that use synthetic fragrances (the word “fragrance” or “parfum” often indicates the presence of phthalates).
  • Use low-toxin make-up and skin creams (avoid products with: phthalates, parabens, propylene glycol, alcohols, artificial colors, and fragrances). In general, skin care products from health food stores without the above ingredients are a safer bet.
  • Consider using antioxidant creams on your skin: low solvent products with CoQ10, Vitamin C, and possibly DMAE and botanical squalene.
  • Avoid aluminum-containing antiperspirants and antacids. Since virtually all antiperspirants contain aluminum, it may be advisable to minimize or discontinue use. Choose a natural deodorant instead.
  • Try to avoid bottled water in soft plastic containers as the plastics often leach into the water. Don’t drink water from plastic water bottles that have been in a hot car or stored in a hot warehouse.
  • Get second opinions on root canals. Avoid if possible having 2 different metals in your mouth – but in particular in adjacent teeth.
  • Pick a dentist who is aware of healthy choices for the mouth—perhaps a more holistic or biologically oriented dentist who does not place new silver amalgam (i.e. mercury-loaded) fillings.
  • Avoid all toothpastes and dental treatments involving fluoride.

Controlling What You Can – RIGHT NOW. Tip #1 – Recycled Air & Toxins  

We focus so much on disease in the world of “healthcare”.  The truth is that sustainable health naturally repels disease.  It’s time we start focusing more and more on CREATING HEALTH.  Proactively.  Sustainably. In the next few newsletters our Integrative Nutrition Coach, Jessica, will be sharing our top 10 action items you can start implementing to CREATE HEALTH for yourself RIGHT NOW. 

These are in no particular order and when I meet with clients we customize the order depending on each person’s needs and what they are inspired to focus on. 

First Up! Get Fresh Air
Everyday.  Yes, even if it’s cold.  Or rainy.  Indoor air can become quite toxic due to outgassing from textiles, mattresses, chemicals, flooring and building materials.  This is especially true during the cold months.  And in our own homes! 


Quick Tips:

1- Short or Long- You choose! Even if it’s just a short 4 minute walk around the block or out to the edge of the parking lot and back- it’s SO much better than no fresh air at all.

2- Leave your phone (EMF’S) home. While you’re outdoors, leave your phone indoors.  Use the opportunity to shift your visual focus to the horizon to see and appreciate nature, the birds, the sky, all the sounds.  Take some deep breaths cleansing belly breaths.  Allow the exhales to be long and slow.  Stand or sit up straight, no phone (no EMF’S) glued to your hand.  All of this has you connect with your parasympathetic nervous system mode that allows digestion, relaxation, healing, fertility, and ease. More specifics on why engaging the parasympathetic nervous system is so important is reviewed in Dr. Millers video on Resiliency and Recovery during the Pandemic!

3- No energy to walk? Plan B. Some of our patients are dealing with being chronically ill for years, even decades, and some days cannot walk to the mailbox. In this circumstance something is better than nothing. Lower the heat, bundle up and open the windows in each room of the house for 10-20 minutes. Take this time to do gentle stretching, connecting with your body as you inhale and exhale (a key to detoxification is our breath!)

Resiliency and Recovery During the Pandemic

An informative video where Dr. Miller covers both food, lifestyle and supplement options for supporting ones immune system.

Here is a breakdown of when certain topics are covered:

2min    How fear is detrimental to our health leading to decreased immune function, decreased ability to detoxify and more to promote repair

5min    Resiliency –Risk factors that worsen our outcome with corona virus: diabetes, heart disease, low Vitamin D, low Secretory IgA, vaping/smoking

7min    Why does diabetes & high blood pressure increase your risk?

8min    What is inflammation?

9min    What is a cytokine and cytokine storm? It is not the corona virus that results in death

10:30   Post covid syndrome/Long haul: Healing the damage that was done to feel better 

11:45   The course of the virus, when you’re most infectious, 98-99% of people have a mild clinical case

13min  Testing options and possible limitations. Antigen vs. PCR vs. Antibody testing

15:45   Understanding branches of the immune system and how they react to foreign invaders. Once you make an antibody do you have it forever? 

17:45   Active immunity vs. passive immunity

19min  Mucosal Immunity: What probiotics, vitamins and minerals help improve the immunity in the gut. 

21min  Imbalanced gut leading to increased inflammation and impaired immune function. 

22min  Importance of medical mushrooms, astragulus, elderberry. When you want to avoid taking elderberry.

23min  Additional supplements to consider such as quercetin, EGCG found in green tea, NAC and resveratrol  esp with recovery and function in the lungs. 

24min  How obesity can play a role in worsening corona virus. Leptin resistance and oxidative stress

27min  Diabetes and COVID

29min  Genetic variations that make you more/less at risk for the corona virus

30min  Vaccine overview: Does it stop transmission?

35min  Could you have immunity to corona virus without showing antibodies?

37min  Dietary changes to prevent severity of disease

38min  Sleep: Why sleep is critical, tryptophan steal and neurotransmitter overview

40min  How to improve sleep and the downside to using sleep aids

42min  Exercise and how it applies to post covid recovery

43min  Ways to activate your parasympathetic nervous system 

45min  Post covid/Long haul syndrome

47min  Oxidative stress, liposomal glutathione and detoxification

47:30min  Supplement summary – when to stop calcium, methylation and helping lung tissue recover

51:45   Why is Vitamin D so important-preventing viral replication

53:45   Zinc & Copper ratios

56min  Optimizing Melatonin to quiet inflammation

57min  Additional supplements to consider

Tips for a Strong Immune System

We know the news over the last few months has been quite frightening and the stats can be scary and overwhelming. Although there have been reports that those dying from Covid have no co-morbidities, further investigation is finding our lifestyle and nutrition choices are contributing factors. Most commonly, lower vitamin D levels, eating a SAD diet (standard American diet) of processed or packaged foods and/or a sedentary lifestyle contribute to weakening our immune defenses.

We want to remind all of our patients that you have more control over your health than we are led to believe.  Our choices influence our genetic activation (genes are NOT our fate) and inform our immune system on the status of our world. Nutrition can seem confusing and contradictory but the fact remains that our health comes down to the choices we make, especially in the areas of food, toxins, sleep and stress.  

Are we under physical or emotional stress? Is our diet nutrient dense or nutrient poor?  Do we skip meals or are we “running on Dunkin'”? What is our toxic load (heavy metals, pesticides, plastic water bottles, personal hygiene products?) Do we take time to get out in nature and breathe deeply or are we “going and doing and going and doing?”

The best prevention from cold and flu season is a strong and robust immune system.  Below are our top tips for a strong immune system this season.

FOOD

Avoid packaged and processed foods and focus on a eating a rainbow at each meal. Smoothies are your friend here! Aim for 3 colors minimum per meal

Load up on liver loving, detoxifying veggies like broccoli, cauliflower, brussel sprouts and cabbage. Aim to have 1/2 your plate to contain 50-70% plant based veggies of all colors

Limit alcohol consumption. Boo hoo! Yes it’s true, alcohol is a toxin no matter which way you slice it! 

Probiotic rich foods like kefir (Califia farms makes a great dairy free yogurt), kimchi, pickled veggies, in addition to a good quality probiotic of mixed strains and at least 20 billion CFU’s

STRESS MANAGEMENT & SLEEP

High stress = high cortisol release (sympathetic dominant state) = high inflammation = down-regulated immune system.  The body heals, rests and digests ONLY when in a parasympathetic state and it is estimated that digestive secretions are decreased up to 50% when we are under stress. 

Take time to breathe. click here for one of our favorite breathing techniques that can be done anywhere, even in the bathroom at work! 😆

Walking in nature – notice what is beautiful around you. Even this winter aim to bundle up and get outside it does wonders for your mood!

SLEEP – shift your bedtime slightly earlier and aim for a minimum of 8 hours of rich deep sleep/night and try to stick to the same time each evening. Limiting screen time and blue light exposure around bedtime is essential for a strong immune system.

SUPPLEMENTATION

There are many supplement companies that make high quality products, and many who do not. This is especially true for certain products, such as glutathione, curcumin, and probiotics. For more information please visit https://us.fullscript.com/welcome/drjessicamiller

**At minimum, we recommend that you take:

Vitamin D: 2000-5000iu daily (unless you have kidney issues)

Vitamin C: 1-3g daily

If you get sick:

Curcumin 500-1000mg daily

Vitamin D- increase to 50,000iu twice daily for 3 days (not for those w/ compromised kidney function)

Zinc Picolinate or zinc lozenges 25-50mg

Quercetin 500mg 3x/day

If there are lung issues or shortness of breath:

N-Acetylcysteine (NAC): 600 – 900 mg twice/day

Vitamin A: up to 10,000 – 25,000 IU/day (not safe for pregnancy)

**Please note that these recommendations are NOT medical advice.  Most are not safe for pregnant women, and if you are taking medication or have any serious health condition, please make an appointment with your doctor to customized a regimen for your unique circumstances 


Carb Cycling

Our bodies primarily run on two sources of fuel, carbohydrates and fats.

Carbohydrates provide us with readily available energy and are used as our default fuel.  Carbohydrates fuel our workouts and allow for muscle growth.  In addition, carbohydrates cause a spike in insulin levels which in turn promotes fat storage.   Carbohydrates are stored as glycogen by the liver and in the muscles.  When your carbohydrate intake is high, these stores fill up.  In this case, carbohydrates are converted to fat and stored by the body as potential energy.

The ability for the body to store excess energy is endless.  Your body will simply continue to store fats in the fat cells if there is an excess of energy intake.   Fat cells release leptin.  As was stated in a previous article, leptin is a hormone that regulates energy expenditure and appetite.  When circulating levels of leptin are high, your appetite will decrease and your energy expenditure will go up.   Conversely, when leptin levels are low (as with a high carb, low fat diet), your body increase your appetite and decrease your resting metabolic rate to store energy.

The caveat to the above statement is that in people with significant obesity, their leptin sensitivity decreases.  Because circulating leptin levels are directly proportional to the amount of fat or adipose tissue present, obese individuals have consistently high circulating leptin levels.  The constant elevation of leptin results in decreased sensitivity to leptin, or leptin resistance.  The result is that despite high levels of fat, these individuals are still hungry and continue to store fat.

Fat metabolism is turned on by the body when glycogen stores get low or circulating levels of leptin decrease.  Compared to carbohydrates, fat provides the body with a more sustainable form of energy.  About 100 grams of glycogen is stored in the liver and the rest is stored in the muscles.  These glycogen stores in the liver can be depleted in just one day of fasting.  When glycogen levels drop, it takes different individuals varying amounts of time before their body can efficiently metabolize fat to makes ketone bodies.  Ketone bodies can then be used as a form of energy.

The theory behind carb cycling is to provide the body with the beneficial effects of carbohydrate intake (i.e. muscle growth, fuel workouts, gut health) without the drawback of increased fat storage due to elevated levels of circulating insulin.

By eating a low carb diet, insulin sensitivity is increased and glucagon (a hormone which increases the synthesis of glucose from glycogen) production is increased as well. The ultimate result is more efficient fat burning for energy.  In theory, a prolonged low carb diet can lead to decrease in thyroid hormone production, elevated cortisol levels (a stress hormone), loss of periods (amenorrhea), bowel dysfunction and immune dysfunction.   According to Paul Jaminet, PhD, low carb diets can also cause the body to decreases production of certain proteins and molecules resulting in symptoms of dry eyes, dry mouth, and decreased healing times in superficial wounds.  Persistent low carb diets also can stress the liver.  When needed, the liver synthesizes glycogen from proteins (or fats) in a process called gluconeogenesis.

Carb cycling is used to allow the beneficial effects of low carb dieting, but to offset or prevent the above mentioned potential side effects.  In individuals consuming a consistently low carb diet, the body becomes very efficient at burning ketone bodies(fat).   Often these individuals reach a plateau or stall with their weight loss attempts.  By adding in a higher carb meal or “cheat meal” this essentially jump starts your metabolism and up-regulates the fat burning process through the effect of leptins.

It is important to note that using complex carbs such as sweet potatoes, brown rice, slow cooked oatmeal, yams, etc. is more beneficial than using simple carbs such as breads, sugary foods, candies etc during your high carbohydrate days.  This is because complex carbohydrates are digested more slowly and do not cause as much of an insulin spike.  Complex carbohydrates that are not processed also contain vital vitamins, minerals and nutrients your body requires. In addition, it is felt that the undigestible (resistant) starches found in certain plant-based complex carbohydrates may have a beneficial effect on gut flora and increase mucin (one of the main parts of mucous, which helps to lubricate/ moisten body surfaces) production to offset symptoms of dry eyes or dry mouth.

The timing of carb cycling is very important.  For example, eating a meal high in carbohydrates before bedtime will promote fat storage due in increased insulin levels and decreased energy demand.   At this time, research indicates that the best time to increase carbohydrate intake is after a heavy training, lifting or sprinting day when the glycogen stores are depleted.   The carbohydrate influx will be used by the body to refuel the glycogen stores instead of stored as fat.   This increase of carbohydrate intake will also raise the leptin levels transiently.  The rise in leptin levels will result in a decrease in hunger cravings and prevent down-regulation of hormones which would otherwise decrease the overall metabolism.

The reason for fat cycling or decreasing fat intake on the high carb days is to allow an individual to maintain a fairly consistent calorie intake.  On the lower carb days, high quality fats can be eaten to increase calorie intake and stimulate satiety.  On higher carb days, fats should be limited so that overall calorie intake for the day remains constant.  In addition, the combination of high carb and high fat intake can result in an unfavorable changes in the type of fats found in the blood stream.

In summary, carb cycling is a way to allow an individual the benefits of eating a low carb diet, without the potential drawbacks of a persistently low carb diet.  Intermittent carbohydrate “refeeding” helps to prevent “stalls” in weight loss, refuel glycogen stores in the liver and muscles, regulate leptin levels and prevent possible thyroid or immune consequences of continuous low carb diets.   If one suffers from symptoms of worsening hypothyroidism or adrenal fatigue, it may indicate that more complex carbs should be added into the diet.  In those individuals with significant obesity, carb cycling is often not as effective in “jump starting” the metabolism due to persistently high levels of leptin, or leptin/insulin resistance.   To help decrease insulin resistance and increase leptin sensitivity, a low carb diet coupled with adequate sleep, routine exercising and stress relief is recommended.

Eating Time With Regard To Exercising

To answer this question, I have been reviewing the literature on this topic and it appears that there is not a general consensus on this subject.  The answers, which are still up for debate seem to depend on the goals you are trying to achieve.   It appears that not only the timing of meals, but the type of meals, and the timing of exercise plays a role on the metabolic effects.

In an animal study by Sasaki published in Nov 2014, his findings suggest that eating in the morning and exercising later in the afternoon or evening has a more beneficial effect with regard to body fat and weight gain.  In the group that ate early and exercised later, the was less body and fat weight gained.  In addition, there was an increase in skeletal muscle weight gain.    So according to his findings, eat earlier in the day and exercise later for increased fat loss and increased skeletal muscle weight gain.

Bo published a study in Dec 2015 in the International Journal of Obesity that found that the same meal consumed in the evening resulted in a decreased resting metabolic rate and increased insulin response. In English, this means that you will essentially burn more Calories by eating a meal in the morning then you would by eating the same meal in the afternoon or later evening. Furthermore, multiple studies have observed that skipping breakfast is correlated with obesity, elevated BMI (body mass index) and increased waist circumference.

According to KJ Hackney in a study published in the journal of Medicine and Science in Sports and Exercise, consuming protein before heavy resistance training (weight training) results in an increase in resting energy expenditure (increased metabolism) as compared to consuming carbohydrates prior to heavy resistance training.   Other research suggest that whey protein is beneficial because it is fast absorbing and contains branched chain amino acids, specifically leucine, which has anti-catabolic (muscle breakdown) and increased anabolic (muscle building) signaling.

For trained athletes who are competing in endurance (long time or long distance) exercises, the recommendation at this time is to consume low glycemic carbohydrates or complex carbohydrates such as oatmeal, heavy mixed grain breads, or most vegetables.  Exercising in a fasted state compromises fuel stores and results in less than optimal performance.    There is also some research to suggest that high fat or even protein intake before exercise can be beneficial as well.  Therefore, again there is no definitive consensus on the type of food to consume prior to exercise.

In another study, published by Sasaki in 2014 in the Journal of Nutritional Science and Vitaminology, eating between 1 and 4 hours before exercise resulted in no difference in the metabolism of trained subjects.    The metabolism of both carbohydrates and fat oxidation remained the same despite the timing of intake.  Thus, as long as you eat between 1 and 4 hours before exercise there is no difference in the body’s ability to metabolism fat and carbohydrates afterwards.

Obviously, eating a very heavy meal immediately before exercise is not recommended because your body will shunt blood to your stomach and GI tract to help with digestion and this blood flow will be at the expense of your muscles.    Small meals with moderate complex carbohydrates and protein, such as an almond milk smoothie, with protein powder and a little fruit, eaten at least 30 before exercise may be ideal.  This allows for some digestion to occur prior to exercise and allows for fuel stores to replenish.

With regard to eating after exercising, the British Journal of Nutrition published a study in 2013 by NM Farah, that contradicts the above studies, and demonstrated that there may be an advantage for body fat regulation exercising before breakfast instead of after breakfast.

Further research suggests that eating a meal right after resistance exercise (weigh training) may increase muscle mass and decrease adipose (fat) tissues as opposed to eating a meal several hours after weight training.  After your workout, your body needs to repair itself and restore the energy you just burned.    For the first 2 hours after your workout, your body uses your food intake to refill your muscle energy stores.  Two-hours post exercise, this ability to store energy decreases by about 50%, and then those Calories are more likely to be stored as fat.

As was discussed in prior articles, insulin sensitivity is very important.  The more resistant you are to insulin, the more likely you will have issues such as abdominal obesity, heart disease, high blood pressure, diabetes, etc.   By eating within 2 hours after exercise, there is a beneficial effect on your body’s insulin sensitivity for the next 24 hours.

A small meal at least 30 minutes to 1 hour prior to exercise appears to refuel your energy stores and enable more optimal performances during exercise.   Eating within 2 hours of completing exercise helps to refuel your muscle glycogen stores and appears to enhance metabolism and increase insulin sensitivity for the following 24 hours.    Our bodies are remarkably complex and depending on genetics, environment, and baseline level of fitness, our needs are different.   As always, it is important to listen to your body and eat accordingly.

Why No Gluten?

Gluten is one of the proteins found in wheat (durum, emmer, spelt, farina, faro, KAMUT ®, Khorasan wheat, and einkorn) as well as rye, barley and triticale.   Gluten is commonly found in breads, baked good, sauces, salad dressings, cereal, pasta, soups and sauces.  Barley is commonly used in malt, food coloring and beer as well.

Gluten has been around for only about 10,000 years.  Its use in food dates back to the Industrial Revolution where it was used as a type of food glue to help foods maintain their shape.  Because gluten was not part of our evolutionary diet, our bodies are not equipped with the proper enzymes to fully digest this protein.  There are no nutritional benefits derived from eating gluten.  In addition, though the quality of the gluten in our foods has not changed significantly over the past few centuries, the quantity found in foods has increased significantly.

Approximately 70-80% of the population are able to tolerate gluten with no problem.  Because we all lack the enzymes to fully digest gluten, gluten is only partially broken down by the GI tract.  According to studies done by Dr. Alessio Fasano, the head of the Department of Pediatric Gastroenterology and Nutrition at Mass General Hospital for Children, the undigested fragments of gluten and gliadin cause transient intestinal inflammation and can release a molecule called zonulin.

Zonulin causes an opening in the barrier of the GI tract.    Essentially the spaces between the cells lining the gut wall open up and allow foods and other toxins to cross into the blood stream, which would not normally get through.  In 70-80% of the population this is not a problem because the immune system works properly and can remove any offending bacteria, toxins, etc.

The immune system is remarkably complex, however essentially it is composed of two branches.  The innate and adaptive immune system.  The innate immune system is the first line of defense in the GI tract.  The innate immune system is immediate and is not very specific. It will release molecules that destroy or eliminate anything it thinks is foreign.  For example, when the innate immune system is exposed to gluten and gliadin fragments, cytokines (small proteins released by cells that are important in cell signaling and can affect the behavior of other cells) are released in an attempt to breakdown these gluten and gliadin fragments.  Cytokines can induce an attack on the gluten, but can also cause a local inflammation in any tissues nearby.  This can cause very microscopic damage to the gut wall which is not always seen on biopsy because repair occurs fairly quickly.

If the innate immune system is unable to handle the “foreign invader”, then the adaptive immune system takes over.  This branch of the immune system is much more specific, sophisticated and takes more time.  The adaptive immune response can lead to either an antibody-mediated attack or to a cell-mediated attack.

In the case of the antibody-mediated the body customizes antibodies to attack the gluten and gliadin protein fragments.    Occasionally, the immune system malfunctions and the antibodies customized to attack the gluten and gliadin can cross-react or get activated by cells in our body.  When this happens, in addition to destroying the gluten fragments, these antibodies also destroy important tissues in our bodies. Depending on which tissue is being attacked will determine a person’s symptoms.  For example, if the antibodies cross-react with joint tissue, a person can develop arthritis.

According to Dr. Fasano, there are three scenarios which could occur when you eat gluten.

  • The gluten is eaten and partially digested. The undigested gluten causes the release of zonulin which opens up the spaces between the gut lining and these protein fragment breach the intestinal barrier.  The innate immune cells respond appropriately and eliminate the fragments and the tiny amount of local inflammation is repaired quickly and the person has no consequences from eating gluten.
  • A person eats gluten and the partially digested fragments activate the immune system as above. However, the innate immune system is unable to eliminate the protein fragments and the adaptive immune system gets activated.  There is a miscommunication between the two branches of the immune system.   The adaptive immune system builds antibodies (or cells) to attack the gluten and gliadin fragments which cross-react with the cells found in the intestinal tract.  The immune cells stay locally in the gut and inflammation persists.  In this scenario the person will develop celiac disease.
  • The third possibility is that the scenario 2 occurs, except that instead of the antibodies (or cells) staying the in the gut and cross-reacting with tissues in the GI tract, the antibodies and/or activated cells travel throughout the body and cross react with different body tissues. In this case, there will be minimal damage in the GI tract, but the personal will have chronic inflammation elsewhere in the body.  Depending on the tissues which cross-react with the antibodies or activated cells, will determine the person’s symptoms.   This scenario is termed non-celiac gluten sensitivity.

Non-celiac gluten sensitivity can cause multiple symptoms.    Symptoms can often be vague, such as abdominal pain, headaches, foggy mind, chronic fatigue, and depression.

People can live for years without any issues with gluten intolerance.  However, it appears that a change in gut flora (as was addressed last week) can be one of the inciting event which can activate gluten intolerance.   There are no nutritional benefits from ingesting gluten, in addition, it causes inflammation in the gut and the release of zonulin leading to increased intestinal permeability.  Interestingly, it appears that zonulin also causes an increase in permeability of the blood brain barrier and may be associated with inflammatory disorders of the brain.