Getting the Metabolic Edge

By Dr. Michael Ruscio

The following are some notes from my public lecture on metabolism, please forgive grammatical errors.

Summary:

• The primary driver of metabolism are hormones
• Diet, exercise and internal health all effect hormones profoundly.
• Dietary science has shifted from calorie counting (quantitative) to calorie type (qualitative)
• Exercise science has shifted from calories burnt to hormones secreted
• Inflammation, digestive health, infections and toxicity are the 4 most common internal factors that derange metabolism.  

• Inflammation, digestive health, infections and toxicity are the 4 most common internal factors that derange metabolism.  Aim for a 2:1 resistance training to cardio ratio
• Use body weight/resistance type movements
• Choose movement that require total body or at least more than one joint
• Use higher reps, 12-15
• Do a few exercises back to back with no rest in between.  Push ups, squats, pull ups…rest… repeat.  

Below we see (working from top left in a clockwise direction)

Cushing's Disease, a disease of high cortisol levels

A body builder using mega-doses of steroids (hormones)

Someone with dwarfism due to low pituitry function

An anti-aging physician who injects hormones to have levels of a  25 year old

The worlds tallest man, who also had a pituitary tumor causing high levels of growth hormone

The take away is the hormones dictated how the body would look, tall, fat, muscular, short....  So calories are a slave to hormones.

Why doe this matter?  Because we can impact hormones with diet and exercise very strongly.  

Below is a chart depicting that as we age we decrease growth hormone, which keeps us lean, and increase cortisol, which destroys our muscle mass and causes increased belly fat.

We are able to fight this decline with high VO2 max exercise (sprinting, burst training), essentially working really hard for a short burst.  Note, this is the opposite of 'cardio'.

In fact, the Textbook of Medical Physiology by Guyton suggest we can get more growth hormone from exercise, than from sleep.  

Here is another great study showing that men who weight train end up having better testosterone secretions and less cortisol secretions.  Other studies have show better growth hormone secretions with this type of exercise.  J Sports Med Phys Fitness. 1989 Mar;29(1):9-26. PMID: 2671501

So we know we can achieve better growth hormone and testosterone levels with the appropriate exercise.  It will please you to know that if you eat the right way, you can pour gas on this metabolic fire we are creating.  Lets now look at how blood sugar regulation ties in.

A high starch, high carb, high whole grain, etc meals effect on blood sugar.

A lower carb., paleo like meals effect on blood sugar

Now from Lippincott's Textbook of Biochemistry we see the science version of this... When blood sugar goes high, you release insulin are more likely to gain fat and have high blood sugar which can eventually lead to diabetes and other problems.  When you keep blood sugar controlled or in the sweet spot, you have better release of growth hormones and other energizing hormones.  This provides you more energy and a better body comp. 

Here what this change looks like on a cellular level.  A high carb. diet elicits an insulin response, which shunts blood calories (yellow circles) into the fat cells and does not feed the power generating mitochondria.  Result; you gain fat and are tired.  A controlled carb. diet elicits a growth hormone (GH) response which shunts blood calories into the mitochondria to be burnt for fuel and thus generates energy.  Results; you have energy and do not gain fat.  

In summary, it appears better for one to eat less carbs. and to replace them with more fat, some protein and vegetables.  If you are saying, "well if I eat fat won't that cause heart disease and make me fat?" this is being disproven by currently studies.  Here are just a few examples of many.

Essentially these studies showed that low a carb. diet provided better weight loss.  Additionally low carb. dieting was also as good as and ever better than high carb. dieting for your heart in some cases. 

So the diet summary is as follows.  I would make one tweak and that would be to keep you carbs between 25-50 total grams/day if you need to lose weight or if you tend to crave carbs. 

When diet and exercise do not work here is what you should look into.

We just covered a lot.  Sorry if the info is a bit fragmented, but without writing a book I wanted to get across some major concepts.  I hope you find this helpful and feel free to contact me with questions.  www.DrRuscio.com

Dr. Michael Ruscio

Low cholesterol caution: Why you need cholesterol

We frequently hear about the dangers of high cholesterol, but keeping cholesterol as low as many doctors recommend may be doing your body more harm than good.

Although conventional medicine has demonized cholesterol and many healthy foods as a consequence, too little cholesterol can be harmful in a variety of ways. Your body uses cholesterol to make cell membranes, hormones, vitamin D, bile acids (to help you digest fats), and it’s vital to good brain function.

Cholesterol prevents depression and memory loss

Cholesterol is abundant in brain and nervous tissue. It provides insulation around nerve cells that transmit electrical impulses, thus maintaining healthy communication in the brain. It also supports the activity of neurotransmitters, chemicals used for communication that greatly affect our mood, personality, and cognitive function. In fact, sufficient cholesterol is necessary to prevent depression and cholesterol-lowering medications have been linked with loss of memory and cognition.

The majority of your brain is made up of fat and the fats you eat help determine the chemical structure of your brain. Many of the foods people are told to avoid in order to lower cholesterol—eggs, fatty meats and fish, butter—also contain choline, a precursor to a brain chemical called acetylcholine. Acetylcholine is necessary for learning, memory, concentration, and focus. It’s important to eat healthy, natural fats and avoid processed vegetable oils. You also want to strictly avoid trans fats, or hydrogenated oils, which have been shown to damage the brain and raise your risk for heart disease.

Cholesterol needed for healthy hormones

Cholesterol is a primary building block for the reproductive hormones, such as estrogen, progesterone, testosterone, and adrenal hormones. When cholesterol is too low, hormone deficiencies may result. Sufficient cholesterol is also necessary to digest vitamins A, D, E, and K, which are found in fats and are important antioxidants.

Although cholesterol scares are over inflated, it is nevertheless important to pay attention to other lipid panel markers, such as the ratio of HDL to LDL, triglyceride levels, and small, dense LDL. It is important to note too that some people have a genetic tendency toward extremely high cholesterol. In those situations medical attention beyond diet may be necessary.

Inflammation is the real culprit in heart disease

Researchers are increasingly finding chronic inflammation, not healthy dietary fats, damages the walls of the arteries and raises the risk of heart disease. Cholesterol's job is to repair this damage by creating patches, or plaques—it is more the Band-Aid for arterial damage than the cause.

High blood sugar and insulin increase inflammation and heart disease risk

High blood sugar and insulin levels are a primary cause of chronic inflammation. Sweet and starchy foods such as desserts, pastries, cereal, white rice, sodas and sweet drinks, and any other foods that spike the blood sugar and subsequently insulin are the real threat to the arterial walls.

When it comes to looking at your risk of heart disease on a blood test, inflammatory markers such as C-reactive protein (CRP), a protein in the blood that rises in response to inflammation, are important to check. High triglycerides and abnormal blood sugar levels are other markers that can reflect whether your diet may be promoting inflammation.

To learn more about healthy cholesterol and a genuine heart-healthy diet, contact my office.

How to motivate yourself to exercise

Exercise is the golden bullet when it comes to lowering your risk of heart disease, bone loss, dementia, high blood pressure, diabetes, obesity, and a long list of other modern health maladies. Yet many Americans just can’t seem to make the time or find the motivation.

The problem, say researchers in a New York Times article who have studied the issue, is that exercise is a “should” instead of a “want.” For many people, exercising to prevent a possible health problem later in life is not a good enough reason to get out of the office chair or off the sofa. Being scared into exercising because of a current health condition, like obesity, heart disease or bone loss, may be more effective, but still fails many.

Give exercise an emotional hook

With most of the population struggling with overstuffed schedules, people will only fit in what they feel is absolutely necessary for that moment. Therefore, say research psychologists, we need an emotional hook to compel us to stay physically active. The solution is not to exercise for theoretical medical reasons or some long-off health goal, but because it makes your life better now. Instead of using media scare tactics or self-admonishment to make yourself exercise, find what’s enjoyable about it and use that.

For instance, one researcher suggests a busy working mom use a walk with her kids as a way to spend time with her children and teach them the importance of physical activity.

Another woman, struggling with obesity and diabetes, decided to use long walks to spend time away from her kids and fulfill a life-long dream of taking photos during her walks to use for paintings later.

Another woman in her 60s meets her daily goal of walking for an hour thanks to the company of a friend, so that her morning walks are also a time to socialize.

Reasons that will motivate you to exercise

A number of emotional benefits can help motivate you to exercise if health goals aren’t good enough carrots on a stick. Below are some reasons that may give you cause to get moving.

• Sleep better at night
• Relieve depression
• Relieve anxiety
• Relieve stress
• Boost energy and productivity
• Better able to cope with daily frustrations
• Endorphin rush, that natural high from physical exertion that lasts for hours
• Boost self-esteem; exercise makes you feel better about yourself and how you look
• Time to socialize if you exercise with one or more friends (adding the health bonus of socialization)
• Time with the family
• Time away from the family
• Time with a favorite pet
• Time doing something fun and playful (dance, skating, Frisbee, golf, hiking, etc.)

Making exercise fun improves motivation

When trying to meet your exercise “dementia-prevention” quota or weight loss goal, it’s easy to get trapped in a boring, noisy gym, staring at the television while on the treadmill, or going through a tired old weights routine. Although certainly better than not exercising at all, some people may find such routines too boring and eventually lose motivation to continue.

Find ways to turn your exercise into play time; scientists have found other species of intelligent animals, such as dolphins, chimps, and otters, play throughout their adult lives as a way to stay active and socially connected. Think back to when you were a child and what you found enjoyable. Perhaps you will have more fun taking your walks to an outdoor hiking area, swimming, doing Zumba, or even roller skating.

Although regular exercise is a powerful tool for health, its ability to simply enhance your current quality of life is undersold by the media. By dropping the health obligations and making exercise into something fun and enjoyable, you will look forward to doing it every day.

Diet for diabetes may be different than you thought—20 percent are “type 1.5”

Although insulin resistance and type 2 diabetes get pinned on diet and lifestyle choices, in some cases these disorders could be associated with an autoimmune reaction, which is the mechanism behind type 1 diabetes. If so, this changes the diet for diabetes to manage the autoimmune condition. It is estimated that 20 percent of people with type 2 diabetes also have an autoimmune reaction against the cells of their pancreas, prompting researchers to dub this “type 1.5 diabetes.” Type 1.5 diabetes may be even more prevalent than type 1 diabetes.
Insulin resistance (pre-diabetes) and diabetes are typically linked with a long-standing diet heavy in sweet, starchy foods and processed fats, as well as overeating and a lack of exercise. This is often referred to as “adult-onset diabetes,” although it’s becoming more common in younger people as their obesity rates rise. In these cases a diet for diabetes would involve managing blood sugar. Type 1 diabetes, referred to as “juvenile diabetes,” is an autoimmune disease in which the immune system attacks and destroys pancreatic beta cells, which produce insulin.
A person with type 1.5 diabetes may have aspects of both: diet and lifestyle affect pancreatic function, as does an autoimmune reaction which may or may not have been identified. In this case a diet for diabetes would address blood sugar and autoimmune management.

Are you a slender, healthy diabetic or pre-diabetic? Consider type 1.5

Some individuals are at a healthy body weight, exercise regularly, and eat a healthy diet yet can’t seem to control their consistently high blood sugar levels. With type 1.5 diabetes an autoimmune reaction destroys cells of the pancreas, but the pancreas still secretes insulin—autoimmune damage is not advanced enough to shut down insulin function. In type 1 diabetes, on the other hand, more than 90 percent of the insulin-producing cells have been destroyed. Because a person with type 1.5 diabetes has not sustained pancreatic damage to such a great degree he or she is often misdiagnosed.

Identifying type 1.5 diabetes

If a diet for diabetes that is lower in carbohydrates begins moving blood sugar toward a normal range, it may be that your insulin resistance or type 2 diabetes does not have an autoimmune component. However, if insulin resistance or type 2 diabetes are stubborn despite a diet for diabetes, or if you are slender and active, it’s worth screening for antibodies against pancreatic beta and islet cells. Additionally, some people have antibodies against the glutamic acid decarboxylase (GAD) enzyme, which is involved in the release of insulin from the pancreas. GAD is also found in areas of the brain, and an autoimmune reaction to GAD may be associated not only with a blood sugar disorder but also with such neurological symptoms as obsessive-compulsive disorder, dizziness, or problems with balance.

A diet for type 1.5 diabetes

Because type 1.5 diabetes is autoimmune, these individuals will want to go beyond a diet for diabetes that manages blood sugar to include managing the immune system. This means strictly avoiding immune-reactive foods, which for most people includes gluten and dairy. The GAD enzyme may cross-react with gluten so that eating gluten can stimulate an immune attack against GAD. Additional foods that trigger autoimmune reactions can be ferreted out by adhering to an autoimmune diet for a period of time. With type 1.5 diabetes, a diet for diabetes should be an autoimmune diet that also manages blood sugar.
Beyond a diet for diabetes, a number of nutritional compounds have been shown to regulate the immune system and dampen autoimmunity. Ask my office for advice on managing autoimmunity.

When your blood is drawn could affect TSH level and hypothyroidism diagnosis

If you check your thyroid levels in the afternoon with a blood draw, results may come back normal even though you’re hypothyroid, according to a new study. Checking your TSH in the morning can give you more accurate results.

Like other hormones in the body, thyroid-stimulating hormone (TSH) follows a daily rhythm and is not consistent throughout the day. Researchers in the study evaluated untreated patients with subclinical hypothyroidism along with patients taking a T4 hormone. They tested the participants’ TSH before 8 a.m. and again between 2 and 4 p.m.

In both groups TSH dropped substantially during the afternoon test, which would have led to hypothyroidism not being diagnosed in about 50 percent of the untreated participants.

Their TSH was 5.83 mU/L in the morning and 3.79 mIU/L in the afternoon. In the group being treated with thyroid medication TSH was 3.27 mIU/L in the morning and 2.18 mIU/L in the afternoon.

A 2004 study also showed that late morning, non-fasting TSH dropped 26 percent compared to early morning, fasting TSH.

Timing of TSH test adds new ammunition to thyroid range controversy

The researchers concluded that the timing of your blood draw plays an important role in how to decipher the results of your thyroid panel.

Unfortunately, even with an early morning blood draw, many hypothyroid patients still slip through the cracks because most doctors use ranges that are too wide.

It’s still very common for doctors to diagnose hypothyroidism using a TSH range of 0.5 to 5.0 mIU/L even though the American Association of Clinical Endocrinologists recommended years ago the range should be 0.3 to 3.0 mIU/L.

Functional medicine uses narrower ranges and more markers to identify hypothyroidism

In functional medicine we use an even narrower range of 1.8 to 3 mIU/L. We also know in functional medicine that looking at TSH alone can miss hypothyroidism.

For some, TSH may be normal but other thyroid markers are off. That’s why it’s important to order a thyroid panel that looks at a more complete thyroid picture, which can include total and free T4 and T3, reverse T3, free thyroxine index (FTI), T3 uptake, and thyroid binding globulins. Many conditions can cause poor thyroid function, including inflammation, hormonal imbalances, and chronic stress. Evaluating other thyroid markers gives insight into these imbalances.

Always screen for autoimmune Hashimoto’s hypothyroidism

In addition to these markers, anyone with hypothyroid symptoms should be screened for Hashimoto’s, an autoimmune disease that attacks and destroys the thyroid gland. Hashimoto’s accounts for about 90 percent of hypothyroid cases in the United States. You screen for Hashimoto’s by checking TPO and TGB antibodies.

Although thyroid medications may be necessary to maintain thyroid function, they do not address the immune system’s relentless attack against the thyroid gland. Not managing Hashimoto’s increases the risk of developing other autoimmune diseases. These can include pernicious anemia, rheumatoid arthritis, vitiligo, and Type I diabetes.

Ask my office how to properly evaluate your thyroid symptoms and lab markers for appropriate thyroid management.