A case study of someone I'm helping out... with surprising findings

Almost 8 weeks ago, a lady was referred to me through a friend. I've been working with her for the last few weeks, trying to help her overcome what I'm realizing is a common problem.

(she agreed to share her story in an attempt to help others).

Here's her story:

Kate (not her real name!) is from the UK but has lived in the GCC for a number of years. She's in her early 40s, married and has 3 young children.

For the past 5-6 years, she's suffered from frequent weight gain, fatigue, insomnia, etc.

She's tried absolutely everything:

- She's seen multiple doctors and ran over 30 tests, including some back home in the UK

- She counted calories religiously for a long time, and even followed Weightwatchers for several months

- She's worked with 7 different personal trainers at 3 different gyms, as well as a yoga teacher

- She's reasonably knowledgeable about what to eat, and generally eats a clean diet devoid of processed foods (most of the time anyway)

Yet she was still struggling:

- She lost weight with Weightwatchers only to gain it back and then some

- The same thing happened with her personal training: she would get better, and then get worse again

- Her blood tests came back all ok: no low iron/anemia, now thyroid problem (at first glance), blood sugar and cholesterol "within the range"

But something was clearly "off".

After 2 long calls with her, I asked her to get another blood test: I had a suspicion of what might be going on, but the doctors usually don't run these tests (doctors are trained to treat diseases, and they couldn't find one with her...).

I asked to test for:

- Full Thyroid panel (not just TSH)

- Full adrenal hormones panel

- Inflammatory markers

Initially, the doctor was refusing to conduct these tests, saying there is no reason for her to do them: TSH was normal on her previous tests, white blood cell counts were normal, so inflammation unlikely... but she insisted and got it done (on her own dime). Here's what we found out:

- While her TSH was normal, her T3 was well below the "range"

- Her DHEA (produced by her adrenal glands) was also very low

- She "flagged red" on inflammation markers, including hsCRP

The Thyroid Problem

- the Thyroid produces primarily T4 (and a little bit of T3)

- T4 is "inactive". It gets converted to its "active" form (T3) mainly in the gut and liver

- T3 is the one that controls your metabolism

- Depending on the concentration of T4 in the blood, the Pituitary Gland in your brain secretes Thyroid Stimulating Hormone (TSH), which tells the Thyroid to produce more T4 because the level is too low. The Pituitary is basically the thermostat

In Kate's case: TSH was normal, so from the doctor's perspective, T4 was normal, so no "hypothyroidism" and thyroid hormones could not be the reason for her weight gain and other problems. So he never wanted to run a full thyroid panel.

When she did do the test which showed that T3 was low, the first thing that the doctor did was prescribe "thyroid replacement hormones". For him (and most doctors) it's simple: T3 too low? ok here's some artificial T3. 

I'm not a medical doctor, so I obviously cannot give medical advice. But my recommendation to her was to hold off, and give us time to jointly find out what's causing T3 to be low in the first place... back to that in a minute.

Low DHEA

DHEA is produced by your adrenals. This hormone is absolutely crucial for health: Low levels of DHEA have negative implications on strength, memory, female reproduction, cardiovascular health risks, etc.

One reason for low levels of DHEA that I've historically seen is "adrenal fatigue", which is typically the result of consistently high levels of stress (physical or mental). For example, Crossfit or ultra-endurance athletes are typically prone to adrenal fatigue. 

Kate is "active" but not an endurance or Crossfit athlete, so I didn't think stress was the reason behind low DHEA. 

I had another suspicion which I'll tell you about in a minute. 

My Suspicions... 

First, low T3 for me was a clear indication that hypothyroidism was at least partially responsible for her weight gain problems (and other symptoms).

Second, the inflammation evidenced by her inflammatory markers told me that inflammation could be the primary reason for low T3. 

My theory: she wasn't showing any symptoms of inflammation, but the test said it was there. T4 gets converted to T3 in the gut, and that wasn't happening (low T3). ==> so my theory was that there was some form of gut inflammation happening.

In addition, a gut inflammation would lead to inability to absorb nutrients from food, so even if you're eating "clean", your body cannot get access to those nutrients. When this happens, the body goes into "survival" mode, bringing metabolism down even further, increasing fat storage.

Mission #1: find out if gut inflammation is to blame and work on fixing it.

Regarding low DHEA: of course inflammation could be a contributor, but given her total cholesterol level of 160mg/dL, I suspected that she didn't have enough cholesterol to even manufacture DHEA.

You see cholesterol is the "mother" of most steroid hormones in the body. You need cholesterol to make sex hormones, DHEA, cortisol, Vitamin D, etc. Low cholesterol means you don't have enough "raw materials" to produce any of these...

Mission #2: increase total cholesterol to provide enough building blocks for the body to make hormones.

...and What We Did About it

So here is what we did:

1. I looked at her diet and removed any inflammatory foods. She already ate clean diet, with minimal sugar or processed foods, and had even been gluten free for a year. I took out 1 item that was prominent in her diet: 3 boiled egg-whites daily. It was the only inflammatory food she ate regularly (other than occasional grains).

2. We increased healthy fat intake: grass-fed butter, coconut oil, organ meats, grass-fed lamb, etc...

And here's what happened

Week 1:

- Her sleep quality (as measured by Sleep Cycle on iphone) went from an average of <50% to 70-80%

- She only had 1 day of sugar-cravings, compared to daily cravings 

- She did 3 personal training sessions and for the first time in years, felt "good"

Week 2:

- She had told 1.5Kg by the 10-day mark

- She was sleeping through the night, and felt stronger

- Sugar cravings had all but disappeared 

I was confident we had "cracked" it: it was the EGGS! She was severely sensitive to eggs, and they were causing inflammation in her gut. Even though she wasn't having any major digestive symptoms, the gut inflammation meant she couldn't absorb nutrients, and even worse: couldn't convert T4 into T3.

Week 6:

We retested:

- DHEA was in normal range

- T3 was in normal range

- She had dropped 7Kgs without counting calories or dieting

If you know someone who's suffering from similar issues and you think would benefit from a similar approach, please feel free to share my contact details with them.

Antioxidants: hoax or some truth somewhere in there...

We are constantly bombarded with ads for antioxidants... so what's the deal there? How much of it is all hype? Are you wasting your money or is there a true life-extending and life-improving benefit in taking them?

I'll try to simply things without getting too much into the science. I'll also provide some practical recommendations and approaches.

Reactivate Oxygen Species (ROS)

What are they and why should we care about them?

Simply put, there are chemical molecules present in your body, and which are highly reactive: this means that they have a tendency to react with almost anything they touch, causing all sorts of damage to cellular membranes, proteins, lipids and even a cell's DNA (the code which tells the cell how to behave).

For example, it can change a cell's DNA to instruct it to trigger Apoptosis (suicide), which is linked to aging. On the opposite side of the spectrum, in can change a cell's DNA to have it reproduce uncontrollably, turning it into a cancerous cell.

So why do we have them then?

Believe it or not, ROS actually do have a reason to exit: they are produced naturally by our body and play important functions in things like cell signaling and homeostasis (maintain an optimal balance in your body): sometimes you need cells to "commit suicide" in order to replace them with new ones, that's normal behavior. 

But if too many ROS are floating around, they go on a rampage, causing damage everywhere they go. In fact, ROS have been identified as main triggers for aging, cancer, atherosclerosis (increase in thickness of artery wall, increasing risk of stroke), and Alzheimer's (among others).

So a few ROS are helpful, and therefore naturally produced by our bodies, and too many are destructive...

So what causes ROS to rise dramatically?

A number of reasons, including:

• Exercise: believe or not, ROS are a natural by-product of ATP production - when the mitochondria (power plants) in your cells produce energy, they release ROS as a by-product. The more energy is being produced, the more ROS being churned out (so the harder/longer you exercise, the more ROS you're producing)

• High levels of blood glucose: in fact, that's a primary cause of the formation of plaque on arterial cell wall, eventually leading to cardiovascular disease (see http://ow.ly/wzYTE for further details)

• In fact, the typical Western Diet (packed with oxidized fat and sugar) is notorious for causing ROS (see http://ow.ly/wA22H for more details on that and how antioxidants partially countered it)

• Inflammation: this is not limited to inflammation caused by injuries or infections - inflammation can easily (and often is) caused by various types of foods ingested, such as gluten, corn, grains, soy, legumes and others...

• Stress: anything that stresses your body, whether physical (exercise) or psychological/emotional, will lead to an increase in ROS

• Exogenous factors: tobacco (first and second hand smoking), air quality (pollution), radiation, pesticides (buy organic!)

But doesn't our body have a defense mechanism to deal with ROS?

Sure it does, and they're called "antioxidants". Our bodies naturally produce antioxidants, and their main "raison d'etre" is to hunt for ROS and deactivate them.

But just like anything in life, our body can sometimes become overwhelmed: the number of ROS being produced outpaces the number of antioxidants being produced. It actually gets a little worse: you see when some ROS react with anything (proteins, enzymes, etc), they turn THEM into ROS! In a way, ROS are like zombies, one bite and YOU become an ROS.

So unless we can quickly recruit more "zombie fighters", the ROS will gradually overwhelm our entire body: but don't be alarmed! that's the natural aging process... Circle of life, so to speak...

So why worry about it then? 

You don't have to... but if ROS causes aging (normal), then too much ROS cause accelerated aging and more diseases. So... if you can do something that prolongs your life and slows down aging, why wouldn't you do it?

Some will say: "human beings lived for thousands of years without worrying about such things". That may be true, but those human beings weren't expose to:

• Cross-bred wheat
• Refined grains and sugars
• Potentially: Genetically modified foods (virtually all wheat, corn, soy you eat today)
• Highly processed foods and drinks with a wide range of chemical additives
• Pollution
• Increase solar radiation (ozone hole)
• Greenhouse gases
• Recycled air (air-conditioned homes, offices, malls)
• EMF radiation (just imagine how much radiation there is in a modern office, where you're surrounded by WIFI and cellular signals, computers and screens, bluetooth, etc)
• Blue light: part of artificial light
• Stress from traffic, financial pressure, etc

ALL of these have been shown to dramatically increase ROS. So yes our body is designed to produce antioxidants to counter ROS, but not this many!

When ROS exceed antioxidants, our bodies are in a state called "Oxidative Stress". There are broadly 2 types of Oxidative Stress (OS) situations: short-term and long-term.

Short-term OS occurs (for example) after a heavy bout of exercise: it's a moderate imbalance which can eventually be rectified as the body produces more antioxidants.

Long-term OS occurs when several factors contribute to a tsunami of ROS, and where our bodies cannot produce antioxidants fast enough.

But before we get into what you can do about that, a word about exercise.

How exercise impacts ROS production and why it matters to us

As I mentioned earlier, ROS is a natural by-product of energy production in our cells: the more energy being produced, the more ROS being churned out.

Our bodies can deal with "moderate exercise", as the ROS being produced can be dealt with before it goes out of control (moderate Oxidative Stress).

But there are 2 scenarios to consider here which can tip us into long-term Oxidative Stress:

• Combine "moderate exercise" with any of the ROS-causing factors I mentioned above (say, processed foods for e.g.), and now you have multiple factors causing ROS to rise dramatically, potentially out of control

• "a lot of exercise" will churn out a lot more ROS as well. So those of us active in endurance sports (triathlon, ultra-running) or Crossfit-type exercise are certainly generating a lot more ROS than most people.

Does this mean we shouldn't exercise? or even that we shouldn't compete in triathlons or Crossfit competitions? Absolutely not, but we should be aware of what's happening to our bodies and take steps to minimize the damage and accelerated aging that comes along with it.

Oh and by the way, going back to that analogy of what human beings did for thousands of years: yes hunter/gatherers did have to occasionally sprint (run away from a lion), run long distances (chase a prey), or lift heavy things (build houses), but they certainly did not do this "5-6 days a week all year-round and earning a finisher's medal in the process!".

Ok, so now let's talk antioxidants. What exactly are they?

Let me make it clear from the beginning: this does NOT mean that you have to take supplements: good clean eating will provide more than sufficient antioxidants. 

Of course, you can supplement from time to time when you know that ROS production is off the charts (see below for examples of such situations).

There are 2 groups of antioxidants our bodies naturally utilize to combat ROS:

• Group 1: Antioxidants which our bodies can synthesize internally (i.e. you do not need to obtain them from food or supplements)

• Group 2: Antioxidants which our bodies are not capable of synthesizing, and which can only be obtained from food or supplements.

Group 1 consists primarily of: Glutathione, Ubiquinol, Uric Acid, and Melatonin

Group 2 consists primarily of: Vitamin E, Vitamin C and Beta-carotene

(Note: you will note that I mentioned Melatonin as part of Group 1. Melatonin is your "sleep hormone". It's produced to get your body ready to sleep, and of course, as an antioxidant, it helps "repair" your body while you sleep. But guess what? Blue Light blocks your body's ability to secrete Melatonin. Blue light is emitted by many sources of artificial light but especially handheld devices, smartphones, tablets, computers, etc)

As molecules, antioxidants are tremendously powerful: they are continuously on a "search and destroy" mission on free radicals (ROS). In fact, they operate like a well-organized army, with several lines of defense:

1. First line of defense: as preventative antioxidants - stopping the formation of an ROS chain reaction (killing the first zombie)

2. Second line of defense: as scavengers / hunters of ROS

3. Third line of defense: as "repair" battalions, fixing damage caused by ROS

4. Fourth line of defense: adaptation - they learn from previous attacks, a "let those zombies try again this time" attitude

Ok fine, but you didn't answer my question: do I need to take antioxidants?

Let me try to simply it by going back to the 2 scenarios I talked about earlier:

Scenario 1: you're in Short-Term Oxidative Stress - moderate exercise, plenty of recovery, and limited exposure to all the external ROS-causing factors I talked about earlier.

Scenario 2: you're in Long-Term Oxidative Stress - any combination of: heavy exercise, not enough recovery, not enough sleep, any of the external factors mentioned above.

Who's in Scenario 1? To be perfectly honest? I don't think I know anyone who's in Scenario 1, because:

• Most of us are exposed to urban pollution
• Most of us are breathing recycled air
• Most of us are eating food that's either processed, covered in pesticides, or transported on planes and trucks
• Most of us are exposed to blue light for 16-18 hours a day
• Most of us are pretty stressed out most of the time
• Some of us are smokers
• Some of us are hard-charging athletes (triathletes, crossfitters)

So in my mind, most of us are in Scenario 2: Long-Term Oxidative Stress.

But hold on! Before you pack your bags and move to Nepal, there are some things you can do to counter the damage.

Recommendation 1: be aware of ROS-causing factors and try to limit them

Recommendation 2: obtain as many antioxidants from whole foods as possible

Recommendation 3: when required, obtain some Group 2 antioxidants from supplements

Recommendation 4: in extreme situations, obtain some Group 1 antioxidants 

Recommendation 1: manage your exposure

• Limit your exposure to blue light: avoid fluorescent lights, minimize TV watching before bed, avoid smartphones and tablets in the evening, install filters on your computer screens (I use flu.x at work and at home), and if you want to take it to the limit, use blue-light blocking glasses  

• Breath fresh air as often as possible: get out from the office frequently, use air filters and check them for mold

• Exercise moderately or give yourself the opportunity to recover if active in more demanding physical activities (endurance sports, Crossfit, etc)

• Use deep breathing exercises to manage stress levels throughout the day. Research other stress management tools and tips

• Of course, avoid processed foods and wash your vegetables well with water/vinegar to get rid of pesticides and pollutants

• If you can, get away from the city as often as possible to breath fresh clean air

Recommendation 2: eat real nutrient-dense food

I won't get into the massive topic of what nutrient-dense foods are and what you should be eating. Rather I'll focus on a list of foods with the highest content of Group 2 antioxidants (Vitamins C and E and beta-carotene): 

• All types of berries (blueberries, blackberries, strawberries, raspberries, cranberries)
• Citrus fruits (lemons, limes, oranges, etc)
• Bell peppers (especially red)
• Certain fruits (Prunes, Apples
• Tea (especially green and black tea)
• Onion and garlic
• Spices (cinnamon, turmeric, black cumin)
• Dark chocolate (at least 75% and no processed sugar)
• Beta-carotene rich foods: sweet potato, carrots, spinach)

Needless to say, try to obtain these from high quality sources, don't let nutrients leach into water (boiling) and keep things fresh.

Natural sources of Group 1 antioxidants:

• Ubiquinol is available in sufficient concentrations in beef, pork, tuna, chicken

Recommendation 3: Group 2 supplements

My preference is always to obtain all of your Group 2 antioxidants from food. However sometimes this may not be possible (travel, bad quality of produce, seasons, etc.). 

Also sometimes, your Oxidative Stress may be higher than normal (back to back Crossfit workouts, an office full of coughing and sneezing co-workers, etc.). In such cases, it's fine to supplement with Group 2 antioxidant supplements:

• Vitamin C: make sure it's from natural sources. Note that "most" of the VitC supplements out there are synthetic and made from corn through a chemical process involving more than 20 steps!
• Vitamin E: remember, this is a fat soluble vitamin: you have to take it with fat-containing food in order for it to be absorbed. Also, keep it in the fridge
• Beta-carotene: again, shoot for natural sources

Recommendation 4: Group 1 supplements

I  would rarely recommend taking Group 1 antioxidant supplements (Glutathione or Ubiquinol). 

While they are tremendously beneficial, I would prefer to allow my body to naturally produce these powerful antioxidants on its own, and continue to adapt and produce more over time.

However, there are "unnatural" circumstances which the human body simply wasn't designed to deal with on a regular basis, and where a "helping hand" in the form of Glutathione and / or Ubiquinol may help.

Examples include:

• Extensive travel: exposure to solar radiation and EMF on planes, a wide range of bacteria and viruses, sleep disruption, etc.
• High volumes of exercise: heavy training for ultra-endurance events (ironman, ultra-marathons, etc), or insufficient recovery between high-stress exercise sessions (back to back Crossfit workouts), or the whole combination of traveling to a race (14-hour flight, sleeping in hotels, racing, ingesting processed sport nutrition, flying again, etc.)

In terms of supplements:

• Glutathione is available in capsule format as a supplement
• Ubiquinol is available in 2 forms: Coenzyme Q10 (precursor to Ubiquinol) or straight Ubiquinol. Studies have shown that as you age, you start losing your ability to convert CoQ10 into Ubiquinol. As a general rule of thumb, if you're above the age of 25, use Ubiquinol. For more info on that, read this.  

So what how do I personally manage all that?

Perhaps using myself as an example can shed some light on a "practical" approach to adopting the recommendations (1-4) I included above. So here are some of the main things I do to minimize the damage from ROS, counteract accelerated aging, and protect my body from the world we live in today:

Lifestyle

• I get out of the office every 30min for a walk outside (within reason)
• I spend 2min doing deep breathing exercises several times a day to keep stress (and related hormonal impact) under control (these are also very helpful when stuck in traffic or airport passport queues)
• I've installed f.lux on both my office and home computer
• I keep the brightness on my iphone a the lowest possible setting and avoid looking at it (and the ipad) before bed
• I keep my iphone in airplane mode when on the bed stand at night: avoid radiation so close to my head during the night

Nutrition

• I avoid all processed foods, period
• I avoid all genetically modified foods
• I avoid all refined grains and sugars (including sports nutrition)
• I avoid inflammation-causing foods (wheat/gluten, corn, soy)
• I keep my gut healthy with probiotic-rich foods (main defense against all sorts of infections)
• I make sure to frequently eat nutrient-dense foods, focusing primarily on vegetables, healthy fats, a bit of protein and less carbs

Exercise

• As a triathlete, I train hard, but I'm also in tune with my body: I know exactly when it's recovered and ready for the next workout. 
• I make sure I challenge all energy systems in my body: not to become a one-trick pony
• I make sure to include strength training

Supplements

• On easy or non-training days: nothing, I get nutrients from real food
• During moderate training blocks: multivitamin, Cod liver oil, Vitamin C
• Occasionally Vitamin D (when I feel I'm not getting touch sun exposure)
• During very heavy training blocks/racing or heavy travel: Glutathione, Magnesium

My 2 cents in Ice Baths

http://ow.ly/wtTL2

NOTICE

Note that I often post interesting studies I come across on sports performance, training, nutrition and general health on my Google+ account