EXERCISE AS MEDICINE AND ENHANCED PERFORMANCE

Dr. Chuck Wile is a supervising physician at Cheng Integrative Health Center/Doctor’s Weight Loss Center, Columbia, SC.  Dr. Wile served in the US Air Force Medical corp and is a retired Air Force Colonel.

“Eating alone will not keep a man well, he must also take exercise.” {Hippocrates, 400 B.C.)   

“Exercise is loathsome.” {Mark Twain}   

“The best exercise is the one you like because then you are likely to stick with it over time.” {Martin Bibals}        

“GET MOVING; KEEP MOVING; AND, DON’T STOP.” {Jordan D. Metzl, MD}

          Regular exercise is a key to health, wellness and longevity. In the early 1900s, Medicine shifted its focus from the prevention of disease to its treatment. Simultaneously and coincidentally, Americans fell in love with spectator sports. Physical activity was no longer the medicine for the masses, but it became the privilege of elite athletes. We forgot/ignored the benefits of exercising: Regular exercise will help you to sleep better. Exercising increases blood flow to the brain helping to create new brain cells and blood vessels because of the increased Brain-Derived Neurotropic Factor (BDNF). This repairs and protects the brain cells from degeneration, both by repairing and restoring cellular mechanisms. Exercising releases endorphins and other chemicals that dull pain and improve your mood, especially decreasing your anxiety and lightening your depression. This helps with building and maintaining your resiliency.

          Regular exercise enhances memory and quicker learning. Your work will be more productive. Also, you’re medical costs will be less. You’ll have decreased risks for developing chronic diseases: for example, type 2  Diabetes is both preventable and treatable, as well as CAD and CVD. Exercising helps to burn fat better for energy, causing fat cells to shrink. {Since muscle mass is heavier than fat, don’t be over-focused on your scales, because your weight may actually increase while your body fat decreases. The real question is do your clothes fit better?} You can help to prevent and treat dementias. The increased blood flow reduces toxins (beta-amyloid and alpha-synuclein) that cause aging and cell death, and reduces inflammation. You can protect your chromosomal telomeres and slow your cellular aging: exercise increases Nuclear Respiratory Factor 1 (NRF1) which protects telomeres from shortening. You can increase blood flow to your skin and help wounds to heal faster. By producing weight bearing muscle contractions, you can make your muscles grow, and, also, increase your bone density. You can decrease your risk for at least 13 different types of cancer, including breast, ovarian and colon cancers. Regular exercising can help with rehabilitation from strokes, and help to  improve other chronic physical diseases and emotional problems.

          You will experience few or no adverse side-effects. Your costs will be low or absent. Exercise is safer and more effective than any drug on the market for health. Although it is much easier to take a pill for what ails you, the risks and side-effects are much more problematic. Exercise benefits both young and old, women who are pregnant, and people who are well or ill. You don’t need a fancy health club, clothes or equipment. JUST MOVE. ***Some exercise is better than none, and even a little exercise can do you a lot of good.

          Humans are notoriously bad at assessing the long-term benefits and risks of their lifestyle choices. The promise that: “exercise is good for you” is not a strong enough motivator to make regular exercising a part of one’s daily lifestyle and choices. Here is a glimpse at the problem: only 20% of Americans get the recommended 150 min of strength and aerobic training per week. More than 50% of “Baby Boomers” take zero exercise per week. Over 80 million Americans (over 6 years old) are inactive. Many schools have eliminated Gym classes from their curriculums. Half of High Schools don’t have weekly PE classes. Only 15% of Elementary Schools require PE 3 days per week. The result is Exercise Deficit Disorder”. Long term consequences include: obesity;  increased osteoarthritis; increased low back pain; increased anxiety; increased depression; poor skin complexion; increased risks for heart disease, cancers, dementia, diabetes, and early death.

          Humans are motivated by immediate rewards. Although people are motivated for health and personal growth, knowledge alone is usually not sufficient to motivate change. And, the best motivation is not externally imposed, but, rather, elicited from within the person. The hardest part of any work-out regimen is getting started. Don’t be stopped by the most common excuses: “I’m too…busy, tired, lazy”. Know that exercise releases “feel good” endorphins, and there are ways to manage Delayed Onset Muscle Soreness (DOMs).

1. ***Rather than focus on how good exercise is for your health, {which it really, really is, but it is a nebulous standard}, focus instead upon how exercise will give you an energy boost, improve your mood, enhance your productivity, and improve your sleep.
2. PICK AN EXERCISE PROGRAM THAT YOU ENJOY. Forget the idea that exercise is supposed to hurt or feel like punishment, or else its not helping you– {“no pain, no gain”}, and, therefore, not worth doing. THIS ISN’T TRUE. If you enjoy something, then you will look forward to participating again, and, thus, you will most likely take the time to make the activity a part of your daily routine.
3. Make exercising a social opportunity. A friend will offer you encouragement and will help to keep you accountable to yourself (possibly because you want to avoid their judgmental disappointment and disapproval). Exercise can be a time for high quality personal connections with your friend(s).
4. Don’t back down from a little competition. A competitive atmosphere focuses on different qualities than a chummy  one does. With competition, the most active participants become the benchmarks to beat, and, thus, everyone’s activity level is increased. In a social group, people who drag their feet seem to draw the most attention, draw down the group energy, and give others an excuse for less participation.
5. Make exercising non-negotiable. Be sure to make yourself prominent reminders, and, become aware of your self-sabotaging triggers. Your goal is to make regular exercising an automatic choice.
6. Put money on the line. Studies show that people are motivated more by losses than by gains, and that they prefer getting rewards now rather than later. For example, if you are trying to lose weight, consider sending a donation, each day that you don’t meet your exercise goal, to an organization that you hate. AND, give yourself a non-food reward for accomplishing your goal.
7. Use a Fitness Tracker. {In order to avoid unrealistic expectations, be aware of  the caveat: a tracker can’t force you to change your behavior, it is merely a source of information.} First, establish your exercise baseline for a week. Then start your exercise program and evaluate your data over time, looking for any improvements. Then, understand what you changed so that you can do it again and continue improving. Once you have a realistic assessment of your abilities, it will be easier for you to commit yourself to an individualized program and a long term behavioral change. Remember, “it’s the learning, not the digits.” {Ref. Martin Gibala: “The One Minute Workout.”}        

                                                 AEROBIC EXERCISING:

1. Doing an aerobic exercise program for at least 30 minutes 3 times per week will maintain your body’s basal metabolic rate (BMR). Your weight will remain stable if there is a balance between caloric input and energy output. If you don’t have an aerobic program, and you restrict calories, your BMR will decrease to conserve energy during relative starvation. In order to lose weight and remain healthy, it is necessary to maintain a normal BMR, and then restrict caloric intake.  The WHO and US CDC recommend making your exercising goal be 150 minutes per week (divided however you choose) in order to effectively lose weight, achieve cardiovascular fitness, and enhance your overall health and sense of well-being. {This includes time for twice weekly muscle strengthening.} {NOTE:  For time-conscious people: ***High Intensity Interval Training can produce the same results in half the time.***} Think of your exercise as THE BEST MEDICINE you can give yourself. REMEMBER:  in order to prevent injuring yourself by over-doing it initially, because of your enthusiasm to see results quickly, when starting out: GO SLOWLY, and then steadily build up to your desired goal. And, more is NOT necessarily better. There is a “sweet zone”. Too much exercising can stress your joints and your heart-lung capacity.
2. Look OUTWARD (rather than the usual advice to look inward) to support your motivations for exercise. Motivation is often thought of as a quantity of inward reserve, and people often lament its absence as a personality flaw. Instead, manipulate your environment to support your motivation. For example, purchase an audiobook that you’ll really enjoy and look forward to listening to, and make it available ONLY when working out. Your desire to engage with the plot will support your motivation to exercise.
3. When choosing an aerobic exercise activity, have FUN! Pick something that you will enjoy doing so that you will incorporate it into your lifestyle changes. If you go power walking, walk with a partner that enjoys a good conversation. Or, vary your activities from working out at a gym, to swimming, to dancing in order to keep it fun. Or, create your own energetic music CDs so that you can crank up the volume for an exuberant work out. Try exercising mindfully: bring attention to your breath, your steps, your surroundings, and you will find that your pains will be alleviated.
4. If you choose RUNNING more is NOT better, especially as we get older. A 2 to 3 mile run is all that is needed. Runners with the greatest longevity ran at a slow to moderate speed for 1 to 2 hours/week. Time is required for recuperation after a work-out. After age 45, people generally have their joints feel better after a brisk walk compared to a run. Women runners have a greater risk to injuring their bodies than men. Women have higher arches, and, when running, point their toes outward, and land with a heel strike which increases their skeletal impact. Also, they generally have less hip and core body strength, have an anatomical shift in their hips and their knee alignments, and have increased body fat. {In contrast, women have more joint flexibility than men, and they are better at pacing themselves in a race.}  Remember that stretching and warming-up your muscles is important to preventing injuries. Also, remember to stretch again after running. If you suffer from arthritis, it is much better to participate in non-impact aerobic activities such as swimming, working out on a glider or an elliptical trainer, or rowing.
5.           However, a theory proposed by Dennis Bramble and Daniel Lieberman in a paper published in Nature in 2004 proposes that humans are born to run and to run far. The theory proposes that early humans evolved endurance adaptations for running to be able to chase prey animals “until the animals collapsed from exhaustion and heat stroke. Winning the footrace meant dinner. In addition to being furless, we have far more sweat glands than most other mammals, giving us an advantage over furrier animals that have to stop and pant to cool down. A larger gluteus maximus muscle—a big butt—is a distinctively human feature.We rely on it minimally for walking, but it’s crucial to stabilizing us when we run. Our legs have long tendons—that act like springs, helping generate force and reducing the energy cost of running. And they don’t seem to provide much benefit to walking, another piece of evidence that our bodies are made for running.” {Reported in Discover Magazine, July/August 2018, pp. 50-51.}
6.           “There are 2 types of muscle fibers: Type 1 (slower contracting or slow-twitch fibers) and Type 2 (faster contracting or fast-twitch fibers). Everyone has a mix of both fibers in their muscles. Fast-twitch fibers are for short, powerful bursts; they contract quickly but also fatigue quickly. Slow-twitch fibers have more mitochondria (the cell’s powerhouses that use oxygen to make energy) so they don’t fatigue as easily and are ideal for longer activities. Sprinters have more fast-twitch fibers, while endurance athletes have more slow-twitch. Although partly genetic, there’s some evidence we can train in order to change the proportion of fibers our muscle have.” {Reported in Discover Magazine, July/August 2018, p. 50.}
7. WALKING lowers your risks for diseases and probably will extend your life. Walking helps to keep you limber longer and helps to make you feel happier. In a study of 80,000 women, their risk of breast cancer was decreased by 42% by walking for a few hours per week. Other studies similarly demonstrate a decreased risk of kidney and prostate cancer mortality by walking. Walking has the lowest “quit rate” of any exercise. In a study of 400,000 Taiwanese who walked for 15 minutes daily, they lived 3 years longer than their sedentary peers. A 5-minute walk outdoors can elevate your mood and enhance your creativity, decrease your anxiety and depression, and increase your sense of well-being. SUGGESTIONS for success: pick-up your pace so that it becomes a power-walk rather than a stroll. {Maintain a pace that makes you a little breathless when walking and talking.} Count your steps: your goal is 7,000 to 10,000 steps/day, with 3,000 purposeful steps. Break-up your day into 50-step mini-walks every 45 minutes. Walk with a group for mutual support.
8. ***High-Intensity Interval Training (HIIT) alternates periods of intense exercise with periods of less-intense exercise or recovery time. “If you want the benefits of very time-efficient exercise, then you need to push hard. There is no way around that.” {Martin Gibals} For example, consider riding a stationary bike for 10-minutes 3 days per week for a total of 30 minutes per week: after a 3-minute warm-up, pedal very hard and fast for a 20-second spurt of intense energy, then pedal less hard for a minute, then repeating this sequence two additional times, followed by 3 more minutes of slower pedaling.
9.                                                       TOTAL FITNESS
10.           1)   In addition to regular aerobic exercising, Total Fitness is achieved by enhancing your muscle strength, doing regular stretching, and, improving your balance and coordination.
11.           2)  What counts as moderate-intensity exercise? Brisk walking, playing with your kids, dog walking, carrying heavy groceries, mowing the grass with a push mower, raking leaves, car washing, gardening, snow shoveling, etc. when done for at least 10-minutes at a time. ALL movement counts. Plus, to protect against injuries and to build muscle and bone, you need interval strength training. In addition to using free weights and resistance training, Tai Chi, Yoga and Pilates are excellent forms of strength training.
12.             3)  In studies, dynamic resistance training is superior to static (isometric) resistance training for building muscles through the full range of motion of your joints. Pilates and working out with Nautilus equipment are two example of effective dynamic resistance training.
13.             4)  RESISTANCE TRAINING increases your muscle mass, thus, generating more strength, and faster muscle force (power). Unless you over do it, you won’t become muscle bound. Resistance training also helps to make your bones more dense. Ten million Americans (80% are women) have osteoporosis (thin and breakable bones). {A decrease in sex hormones with aging helps to create this common problem.}  Resistance training also helps to improve your metabolism, increase your glucose tolerance (or, said another way, decrease your insulin resistance) and decrease your risks from type 2 diabetes. It also helps to decrease both coronary artery disease and cerebrovascular disease risks. Other than doing free weight lifting or using a dynamic weight resistance machine, such as a Nautilus device, there are various simple ways to do resistance training such as: Yoga, Tai Chi, Pilates, using flexible bands, sitting up and down using a chair and your own body weight, swimming, doing Zumba dancing, doing heavy gardening such as raking and digging, doing vigorous house cleaning, taking the stairs rather than using an elevator, jumping rope, etc. The stronger you are,  the more self-esteem, confidence, and positive thinking you will usually have.  However, because resistance training requires work and effort, only about 20% of people actually follow strength training recommendations. PLEASE DON’T BE LAZY.
14.               Resistance exercises have a greater impact on cognitive function than aerobic exercises. It increases blood flow to the brain, thus, increasing oxygenation and the provision of nutrients. It helps to promote angiogenesis from existing blood vessels and neurogenesis from stem cells in the hippocampus {an area responsible for organizing memories}. It increases the production of neurotransmitters: serotonin {which helps to regulate mood and sleep}, acetylcholine {which helps with cognition, learning and memory}, and GABA {the main inhibitory modulator}. It also increases neurotropins {proteins that regulate neuron survival}.  [Mavros, et. al. “Mediation of cognitive function improvements by strength gains after resistance training in older adults with mild cognitive impairment: outcomes of the study of mental and resistance training,” J. of the American Geriatric Society, October 2016.]

1.             5)  In my opinion, Hatha Yoga and Pilates are the best ways to completely stretch your muscles and joints, tone and strengthen your muscles, especially your “core” abdominal muscles, and achieve overall physical fitness, and mental, emotional and spiritual balance, inner harmony, and peacefulness.
2.             6)  I applaud the American Academy of Sports Medicine’s program: “Exercise Is Medicine”. They recommend that physicians should inquire about exercise with each health visit. They recommend following the 5 A’s approach: Ask, Advise, Agree, Assist, and Arrange. People should be asked about what barriers they face in order to exercise and what helps to facilitate their choice to exercise. After assessing a person’s physical activity level, the practitioner is advised to prescribe physical activities that the person will agree to pursue. Physical activity counseling can be offered along with referral resources to help facilitate the process. Within a person’s social and economic context, it is important to support and empower the person, just like a good coach, by emphasizing that they have both choices and competence. Motivational interviewing is useful to explore and resolve ambivalences and insecurities and to understand and encourage/support internal motivators for behavioral changes. By understanding a person’s values and goals, a health care provider can help people to envision a better future. Depending upon a person’s personality, they may choose to “leap-into the deep end of the pool” and make massive changes in their lifestyle, which can be disruptive and stressful.  Or,  they may choose to ease into the “shallow end of the pool” and take baby-steps, focusing upon small and measurable goals and achievements. Either way, the exercise prescription must be “patient-centered” and individualized in order to be effective for the long term. Setting goals work best when they are realistic, specific and present oriented. Challenges to maintaining changes is the rule and not the exception. Thus, it is very helpful to maintain a continued coaching partnership in order to  encourage and support a person’s health goals.

1.     SUPPLEMENTS TO CONSIDER FOR ENHANCED ATHLETIC PERFORMANCE

1. Consuming an over-abundance of calories for a long time will suppress the AMPK (adenosine monophosphate-activated protein kinase) system—the metabolic master switch. AMPK activation: reduces insulin resistance and supports glucose transport, inhibits the metabolic syndrome’s associated inflammation, increases utilization of stored fat for energy, improves mitochondrial fat burning, reduces weight gain by enhancing the effect of the anti-obesity hormone: adiponectin, and improves immune function and other bodily functions that support longevity. A suppressed AMPK system leaves the body in a state of continued energy storage and reduced energy utilization. Cutting calories forces the body to activate AMPK. Exercise is another powerful AMPK activating strategy. (Note: Only when you are adding exercising will calorie reduction be truly effective for weight loss.) ***For people who have problems exercising because of physical problems, there are supplements to promote AMPK activation.*** Two documented ingredients include:  a) Gynostemma pentaphyllum and b) Trans-tiliroside. A proprietary product is available, called “AMPK Activator” from www.LifeExtension.com. Also,  Hesperidin, found in citrus peel extracts and in orange juice, activates AMPK, as does the medication Metformin. AMPK activation helps to remove excess stored fat, particularly metabolic abdominal fat, and to decrease metabolic syndrome risk factors. Increased AMPK activity also normalizes hyper-activated mTOR activity. {Excessive mTOR accelerates cell aging and malignant transformation, and depletes stem cells.}
2. RE-FUEL YOUR MITOCHONDRIA:  “Mitochondrial Dysfunction” results in obesity, insulin resistance, diabetes, anxiety, depression, neuro-degenerative diseases, aging, chronic fatigue syndrome and fibromyalgia syndrome. {Consider: if the blood test Reverse T3 is high, then mitochondrial dysfunction is present.} The following NUTRIENTS can help to re-fuel the mitochondria energy generating centers in each cell:  a) D-Ribose 5 gm/tsp: 1-2 tsp three times per day. b) ALA (Alpha-Lipoic  or R-Lipoic Acid) 300 mg to 400 mg/day. c) CoQ 10 (or its activated form Ubiquinol) at least 200 mg/day. d) NADH (Nicotinamide Adenine Dinucleotide –reduced form) 10 mg twice per day. e) L-Carnitine 2,000 to 3,000 mg/day.
3. Short term supplementation with powdered cherries boosts athletic performance. Using 480 mg of powdered cherries caused half-marathon runners to average 13% faster finish times compared to taking placebos. Inflammatory markers were 47% lower, and there were attenuated markers of muscle catabolism, a better maintained redox balance, increased performance, and post-run muscle pain faded faster. {J Int Soc Sports Nutr. 2016 May 26.}
4.         Tart cherry juice is also helpful for osteoarthritis pain and other inflammatory conditions, particularly gout. It is easier to take when mixed in a fruit smoothie. For example, 100 patients with a history of gout received 1 Tbs of Brownswood Acres tart cherry juice concentrate [which can be obtained at Whole Foods] twice per day. 92% of the patients had >50% reduction in the number of gout attacks. Their uric acid levels did not change. Tart cherry constituents can switch critical genes off and on; modulate cell-signaling molecules like tumor necrosis factor; and, target multiple cardiovascular factors producing a 65% reduction in early mortality. Tart cherries surpass red wine and dark chocolate in antioxidant content. Tart cherries are rich in the flavonoid anthocyanin and contain novel anthocyanins absent from blueberries or bilberries. They also contain higher amounts of phenolics and anthocyanins than sweet cherries. It is useful for treating osteoarthritis, inflammation related to obesity and the metabolic syndrome, and lowering triglycerides associated with cardiovascular disease.
5.           Rich sources of polyphenolic compounds, such as tart cherries, play a neuro-protective role and exert a variety of anti-carcinogenic effects. 20 women were given 2, 10.5 ounce bottles of tart cherry juice or a placebo for 3 weeks. Those taking the cherry juice had reduced levels of the inflammatory marker C-reactive protein. Obese adults given 8 ounces daily of tart cherry juice for 4 weeks had markedly decreased inflammatory markers: sedimentation rates, tumor necrosis factor levels, and monocyte chemotactic protein. Runners were given tart cherry juice or a control drink for 5 days before, on the day of, and for 2 days after a marathon race. Runners drinking the tart cherry juice had significantly lower inflammation biomarkers (Interleukin-6 and C-reactive protein) than the placebo group. They also recovered isometric strength quicker and demonstrated an accelerated recovery following strenuous exercise. Runners in a double-blind trial participating in a 24-hour relay race drank two 355 ml beverages containing either tart cherry juice or a placebo daily for 1 week prior to the race and during the race. Both groups reported muscle pain after the race but the runners who drank tart cherry juice experienced a substantially smaller pain increase after the race.
6. Cordyceps sinensis extract is a parasitic fungus that grows on caterpillar larvae native to high altitude regions of China, Nepal and Tibet. It has pharmacologically active anti-oxidant, anti-inflammatory and lipid lowering properties. It enhances the immune system and increases stamina for endurance athletes through greater aerobic capacity and oxygen use. It stabilizes blood sugar metabolism and increases libido and sexual functionality.
7. Velvet Deer Antler (VDA) is a pillar of Traditional Chinese Medicine used to strengthen and replenish blood, reduce and reverse signs of aging, relieve pain and inflammation, overcome exhaustion, accelerate wound healing, reduce blood pressure, treat insomnia, relieve headaches, improve mood and memory, help infertility, restore vitality, heighten libido and increase muscle strength and endurance. One key component is a growth hormone called insulin-like growth factor “IGF-1”. This keeps muscles strong and helps to heal cartilage and tendon injuries. Also, glycosaminoglycans are plentiful which help to restore healthy cartilage. It contains Type II collagen along with a rich supply of minerals including potassium, sodium, calcium, copper, zinc, iron, selenium, magnesium and phosphorus. A proprietary product called “VDA Pure” can be obtained from www.VDAPure.com . The recommended dose is 2 caps daily before eating.
8. Asian ginseng (Panax ginseng) and Siberian ginseng (Eleutherococcus senticosus) “can be used as a tonic to combat feelings of lassitude and debility, lack of energy and ability to concentrate, and during convalescence,” according to the German Commission E advisory about herbs.  The suggested dose is 1 tsp steeped in a cup of boiling water to make a tea.  Ginseng can improve athletic performance when taken regularly for up to a month, and it can also beneficially stimulate the immune system.  It is an adaptogen for managing adrenal stress, and improves alertness, coordination and memory.
9. Dimethylglycine (DMG): is an amino acid adaptogen made in the liver which diminishes in quantity as we age. It was formerly promoted by athletes as “vitamin B-15”. DMG aids in critical processes associated with cellular respiration and energy production, immune response, and oxygen utilization in the body. It helps to prevent fatigue, improve physical endurance and performance, and supports mental clarity. DMG stimulates both antibody response and cellular immunity. It has also been used to support cardiac function in heart disease. Additionally, it makes all other nutrients taken with it work better. High quality DMG can be obtained from www.TargetedNutrients.com . Typically usage is 1 cap once or twice daily.
10. Beetroot juice can raise serum nitrate levels which can improve athletic performance, lower blood pressure and protect against glaucoma. Nitrate is metabolized to nitric oxide which helps to dilate smooth muscles, and improve blood vessel flexibility and tone. It enables athletes to use less oxygen while exercising at the same intensity, which makes exercising easier, and one can continue it for longer. Blood nitrate levels peak two to three hours after consuming beetroot, and remain elevated for six to nine hours. The key is to drink beetroot juice three hours before exercising, and take it daily to maintain higher blood levels of nitrate. One of the leading 2.4 ounce beetroot “sport shots”, called “Beet It”, provides 400 mg. Most blood pressure lowering studies have used 180 mg of beetroot juice daily. So, you could take half of “Beet It” one day and half the next. Serious athletes can use one or two shots daily. Two shots will saturate the blood stream and provide maximum benefits, so larger amounts will have no additional effects. Be aware, your urine may turn pink, but this is a harmless side effect.
11. Resistance training is supported by key nutrients. And, when used together, they  provide synergistic benefits: a) Whey Protein: helps to preserve lean body mass. Although the Institute of Medicine recommends 0.8 grams/kg body weight (which equals about 58 gm in an aging adult weighing 160 lbs), the optimal dose is 1.0 to 1.3 gm/kg body weight (which equals 73 to 94 gm in an aging adult weighing 160 lbs). b) Creatine:  improves the Type 2 (fast contracting) muscle fibers that commonly atrophy in older adults. It helps to increase muscle force, power and mass and to decrease fatigue. c) Branched Chain Amino Acids (BCAAs):  especially leucine, isoleucine and valine (which are also found in whey protein), helps to promote muscle tissue synthesis. Also, they help to decrease the perception of exertion and mental fatigue during exercising. d) Glutamine:  helps to replenish muscle stores of glycogen (a ready source of stored energy). Also, in healthy adults, taking 2 gm of the amino acid glutamine will increase the output of human growth hormone by four times. e) Vitamin D3:  helps to preserve Type 2 muscle fibers and to protect cognitive function. f) Carnitine:  is an amino acid which helps to transport fatty acids into the intracellular mitochondria for fuel for the production of ATP energy. It supports exercise recovery, enhances performance, and decreases general fatigue. Propionyl-L-carnitine helps to regulate levels of ATP. g) D-Ribose:  helps to facilitate ATP production and to facilitate the speed of muscle function recovery after high-intensity exercising.  h) Omega-3 Fatty Acids:  eicosapentaenoic acid (EPA) helps to preserve muscle mass. And, both decosahexaenoic acid (DHA) and EPA are anti-inflammatory, and help to manage sarcopenia. 6 gm of deep sea fish oil can help to eliminate muscle soreness after resistance training.

                   DELAYED ONSET MUSCLE SORENESS (DOMS)

          Immediate muscle soreness is due to the partial metabolism of glucose (for energy) into lactic acid, which accumulates waiting for increased oxygenation after an exertion has finished, in order to be fully metabolize into carbon dioxide and water: the “oxygen debt”. The results of the incomplete oxidation of glucose  into lactate resolves within a few hours after exercise. DOMS occurs a day or two later as a consequence of repairing the micro-tears in the muscles caused by the exercise. The soreness, stiffness, mild swelling, tenderness, decreased strength and decreased range-of-motion will resolve in a few days. And, with your next exercise, you will be stronger and DOMS will be milder. Since it takes time for healing, it is important to space-out your resistance training during the week.

          You CAN have gain without (a lot of) pain. Drinking 2 cups of tart cherry juice can reduce both exercise-induced  inflammation and DOMS. {Be aware of  consuming the extra calories.} NOTE: A pre-emptive use of NSAIDs the day before and the day of a long distance race did NOT reduce DOMS (compared to non-users), and the users had mild endotoxemia due to the consequent drug-induced leaky-gut. Using NSAIDs intermittently for pain management after exercising may be helpful, if needed. BOTH localized Cold Therapy and Heat Therapy can reduce joint and muscle soreness, but cold is superior. However, tub hopping from hot water to cold water and repeating, probably isn’t worth the effort. Therapeutic Massage can help with DOMS. {Most studies look at massage within 3 hours after exercising for at least 20 minutes.} A foam roller is a low-cost alternative for self-massaging.

                  PRECISION EXERCISE RECOMMENDATIONS

1. For Weight Management:  Initially, focus on adjusting your diet to decrease your total calorie intake.  Adjusting one significant lifestyle change at a time is a successful strategy to increase your own compliance and persistence. {For example, a decreased input of 500 cal/day equals 3,500 cal/week, which equals 1 pound of body fat reduced per week. Compare this to vigorous walking for 2 hours which equals using 500 cal.} In a 12-week comparison study, people who attended Weight Watchers lost about 9 lbs, versus people who simply worked-out at a Gym, who lost about 3 lbs. So, initially establish a structured eating-plan that you will adhere to, that includes reducing your portion size and the amount of food that you actually consume. And, for exercise, at first, simply determine to move more.
2.           Once you have experienced successful weight loss, then combine your dieting with exercise. {It becomes easier once you have lost some weight and feel better rather than when you feel heavy and lack energy.} Pair cardio training with resistance training. Cardio activities burns calories and resistance training keeps you toned so that you lose fat rather than muscle. People who regularly work-out are twice as likely to keep the weight off than those who don’t. Exercise stimulates hormones which signal burning more fat as fuel. Emphasize to yourself how much better you feel when you are active. This may help to cancel-out any feelings of deprivation which could result in self-sabotaging behaviors. Remember that exercising is NOT a free-license to binge eating.
3. To improve your Stress level, Self-Esteem and Mood:  In a 1999 study at Duke University, people who did aerobic exercise for 45-minutes 3x/week improved their moods equivalent to matched sedentary people using the SSRI Zoloft. Exercise increased their serotonin levels and their endorphin levels, and decreased their cortisol levels. The effect on mood only lasted for about 24 hours, so, regular exercise is the key to success. Mix-up your activities for fun and fitness: vary the kinds of exercise, frequency, timing and intensity. Remember that you need both cardio and strength training.
4. To increase your Energy and decrease your Fatigue:  try a low to moderate intensity exertion for 20 minutes, 3 to 4 times per week. You will feel better within 4 weeks for all conditions. The intracellular size and number of your mitochondria {energy centers} will increase. You will increase burning your fat for energy, decrease your insulin resistance with a consequent good decrease in your glycation process, and balance both your intracellular and extracellular salts and fluids. You will sleep better: fall asleep quicker, remain asleep longer, and awaken more refreshed. Exercise energizes you. Don’t give-in to feeling drained of energy. Fake yourself-out: instead of saying that you feel “too tired”, say that you will walk for just 10-minutes—you’ll likely go longer because you will start to feel better.
5. To ease chronic health problems and limit medical visits:  monitor yourself with a fitness tracking device such as FitBit or a Garmin watch. All movement counts. An encouraging 2013 study compared people doing short activity bursts, such as raking leaves or pacing when talking on the phone, with 150 min/week of aerobic bike riding. The groups had similar BP, lipid levels, waist circumference, and C-reactive protein inflammatory markers. When starting out: be sure to see a Pro and Go Slow. Increased endorphins will ease your pains. Try to minimize IMPACT aerobic activities: your joints will feel happier because they will be better lubricated and respond to inflammation more effectively, thus, easing your arthritis. Your heart rate and blood pressure will decrease, and your glucose intolerance will improve. Anticipate a slow and steady improvement.

                             EXERCISE AND CARDIOVASCULAR DISEASE

          An observational study published in Circulation, 5/15/2018, of 11,000 adults in the Atherosclerosis Risk in Communities (ARIC) study, demonstrated people doing 150 minutes of vigorous exercise weekly were 31% less likely to develop congestive heart failure (CHF). Couch potatoes who started exercising decreased their risk of CHF by 23%. This study supports the JAMA July 22/29, 2009 study of 20,000 male physicians who had a healthy lifestyle for more than 20 years who developed significantly less CHF. A similar study of 36,000 Swedish women published in the Archives of Internal Medicine, 5/11/2009 who were eating a DASH diet (to manage hypertension) along with doing regular exercise for 7 years had a 37% decrease in CHF.

                     THE PROBLEM OF SARCOPENIC OBESITY IN AGING

          After age 50 there is an exponential drop in muscle function. (This starts to occur after age 40 and accelerates after age 75.) Sarcopenia means a loss of muscle mass, strength and function. There is a faster decline in Type 2 (fast contracting) muscle fibers compared to Type 1 (slower contracting) muscle fibers. Therefore, there is a decreased speed of muscle contractions with aging. Evaluating muscle function and strength is more important than evaluating muscle mass. Muscle “power” is a function of force-strength and velocity. {Imagine the difference between just placing a fist against the side of a head (force) and then adding velocity to the fist placement (power)}. Power drops quicker than muscle mass. With decreased muscle power, especially in the core and lower extremities, there is decreased capacity to accomplish the functional tasks of daily living and an increased risk of falls and injuries, with an increased risk of consequent death. Because women start out with less power then men, older women have increased problems with a loss of balance and decreased muscle power which increases their risk of falls and hip and vertebral fractures (especially with their additional increased risk for osteoporosis.) This is primarily caused by suboptimal sex hormonal support, inadequate dietary protein intake and nutritional deficiencies, oxidative stress and inflammation. This is most often found in people who are physically sedentary and inactive.

          Obesity has become a significant increasing problem in America. In a study of nursing homes, in 1992 about 15% of patients (mostly women) had a BMI (Body Mass Index: weight divided by stature) of >30 (defining obesity). By 2002 the average BMI had increased to >25%. A fall risk for over-weight people was 15% compared to a fall risk for obese people of 25%. The combination of obesity plus sarcopenia (decreased muscle power) makes the loss of independence 2 to 3 times more likely because of diminished capacity for activities of daily living (ADL).

          Our aging population needs a combination of power training (eg. high velocity dynamic muscle resistance training using lower weights at higher speeds) twice per week along with aerobic interval training three times per week in order to improve their functional outcomes. While aerobic training helps the cardiovascular and cerebrovascular systems, resistance training provides superior protection against injuries. It stimulates human growth hormone which supports cell growth and regeneration. It also supports local mechano-growth factors. And, it enhances bio-identical hormone replacement therapy (BHRT) interventions.

           A report in the magazine The Week, 6/15/2018, (from reviewing an article on  MedicalNewsToday.com,) states that moving the large muscles of the legs (walking, climbing stairs, running) triggers brain stem cells to renew brain neurons. Researchers immobilized the hind legs of mice for 28 days then they examined the subventricular zone in their brains. They found a 70% decrease in neural stem cell activity. This helps to explain why people who are bedridden often deteriorate rapidly in their cognitive functions.

                                        JUST DO IT!   {Nike Shoes Slogan}

A good reference is “The Science Of Exercise” edited by Siobhan O’Connor and Mandy Oaklander, TIME Inc. Books, 2018.

One of the easy and probably the most effective exercise regimen is High Intensity High Interval Training (HIIT). HIIT can be done at almost all ages, almost anywhere, with or without any special equipment. Best of all, you can do it at home!

This is how to do it:

Warm up for 15 minutes, adding a few 20-second bursts at the end to prepare for the workout. Run, bike, or row for 30 seconds at a nearly all-out effort. Take three minutes active recovery and repeat the 30 on/3 off pattern five or six more times. Finish with a 10-minute cool down.  You can do this on a stationary bike, or in a swim pool, or outside on the grassland, or even up and down the stairs.  Of course, make sure you do this in a safe environment.  You don’t want to hurt yourself nor others who may be around.  Repeat this 3-5 times a week.

Healthy Eating Habits:

1. Eat your last meal at least 3 hours before your bed time (before 7 pm for most people).
2. Wait between 13 and 18 hours before you eat another meal.  In other words, if you eat your supper of the previous day at around 7 pm, then don’t eat breakfast until at least 8 am, or better, until 12 noon!  This is intermittent fasting (13-18 hours fasting without food, you can drink water though) allows your mitochondria (an important cellular organ in metabolism) to recover.
3. The first meal of the day should be the biggest,  should be heavily fat with 80-90% of the calories from healthy fat. One won’t feel much hungry throughout the day after such a fatty meal.
4. Try to fast for at least 24 hours a week (e.g., on a Saturday), drinking water only.

The above measures are proven to improve your health, improving your mitochondria and helps you to lose weight.

In our regular Monday Lecture Series, Dr. Cheng will present on Ketogenic Diet (KetoDiet for short) for Weight Loss and Health. Topics to be discussed include:

1. What is Ketogenic Diet?  Why (healthy) fats are good for you.  Why carbs are bad. KetoDiet, it‘s health benefits.
2. Why is KetoDiet a foundation for all chronic disease?
   1. Case studies of KetoDiet and nutritional therapy for autoimmune diseases like psoriasis, skin rash.
3. Nutritonal KetoDiet (for health or for chronic disease management) vs. Restricted KetoDiet (for cancer management).
4. How to eat on ketogenic diet, introduce some keto recipes.
5. Other factors in a healthy diet.
   1. Brief introduction to oxidative stress, mitochondrial health, and nutritional approach to health.
6. How to combine KetoDiet with our current weight management protocols to better manage your weight and other chronic diseases (autoimmune disorders, diabetes, heart disease and even cancer).

Date and Time: Apr. 2nd, 2018, Monday, at 1 pm.

Address: Cheng Integrative Health Center/Doctor‘s Weight Loss Center, 6149 St. Andrews Rd., Columbia, SC 29212 (across stree from Cici’s Pizza, in fornt of the K-Mart).

Dr. Richard Cheng, MD

Ketogenic means ketone producing.  ketone is produced when fats are digested.  So ketogenic diet means ketone producing diet, or in other words, ketogenic diet contains predominantly (healthy) fat, very little carbs and appropriate amounts of proteins. Ketogenic diet is different from Atkins diet, and is NOT a high fat diet.  The total calories one needs to consume is limited (to one’s needs).

Benefits of ketogenic diet:

1. weight loss
2. anti-inflammatory (anti-oxidant)
3. lower cancer risk
4. muscle strengthening
5. inhibiting appetite
6. reducing insulin levels (insulin inhibits fat release.  So this reduction in insulin release can help in more fat release and weight loss).

Ketogenic Diet:

1. Healthy fats calories, about 80-85% of the total calories.
2. Protein calories: about 10% of the total calories
3. Carb calories: 5-8%.

Healthy Eating Habits:

1. Intermittent Fasting: Every day there should a period of 13-18 hour without food intake, water is ok. One may choose either to skip breakfast or skip dinner.  Research shows this type of intermittent fasting boosts your mitochondrial (Mito) function.  Mito is the rechargeable battery in your cells.  Dysfunction of Mito is found to be a major contributor to most, if not all, chronic diseases esp. cancer, and aging, including obesity.
   1. Skipping breakfast. For example, if one finishes dinner at 7 pm, then do not eat anything until at least 8 am (13 hours fasting) or, even better, 11 am (16 hours).
   2. Skipping dinner: Don’t eat anything after 4pm.  Then eat breakfast at around 8-10 am (that’s 16-18 hours fasting).
2. Ketogenic Diet (see above). One other reason why I advocate ketoDiet is the drastic reduction of carbohydrates.  Carbs cause lots of problems, esp. today’s carbs are heavily contaminated by all sorts of pesticides, herbicides, more so than other foods.  Carbs like wheat are a major to cause to many GI problems such as leaky gut which contribute to our autoimmune diseases and symptoms.  Allergy is just one of them. (I have been on the KetoDiet for a while now.  I really feel the difference: improved stamina, reduced seasonal allergy symptoms (I used to take Zyrtec daily.  But now, even in this pollen season, I have gone a whole week without needing Zyrtec.  This is amazing since for the last 25 years, I have never, NEVER, skipped several days, let alone a whole week, without an allergy pill).

We will close at 12/25/2017, Monday, for Christmas holiday.

and close at 1/1/2018, Monday, for New Year holiday.

MICROBIOME AND  PROBIOTICS

          We have co-evolved with the microbiota. Probiotics are beneficial live microorganisms which when taken in adequate amounts confer a beneficial health effect on the host. Most are bacteria. Almost every society has consumed some type of fermented food. Using probiotics is SAFE. Approximately 5000 species of microbes reside in a healthy human body. 100 trillion microbes reside in a human body. This is 10 times the number of human cells and 100 times the number of human genes. Some people propose that we are not autonomous agents. Rather, we are biomolecular networks called “holobionts” with the host and microbial genomes referred to as “hologenomes”.

          The GI tract contains 90% of these microbes in a symbiotic relationship. The large intestine is one of the densest microbial ecosystems on the planet. The vagina is like a sparsely populated prairie compared to the lower gut which is like a rain forest teeming with life. People are very different from one another, but they are consistent with themselves. Two healthy Americans’ microbial communities can differ by as much as 90%, but an individual’s distinctive ensemble of bugs tends to stay stable over many years.

          Microbes predigest our food, chemically modify the pills we take, shape our immune system responses, and repel infectious invaders. Nearly ¾ of the body’s immune cells are in the Gut Associated Lymphoid Tissue (GALT). The microbial inhabitants of the GI tract stimulate the immune system for optimal functioning.  GALT immune responses differentiate between beneficial and harmful dietary proteins (antigens) and beneficial and harmful microorganisms (bacteria, viruses, parasites).  Probiotics activate B-lymphocytes , T-lymphocytes and macrophages, stimulate the complement system, and reduce responses to “like-antigens”.  They digest nutrients and compete for nutrients with pathogens; modify the local pH to create conditions unfavorable to pathogens; produce bacteriocins that inhibit pathogens; scavenge superoxide radicals; stimulate epithelial mucin production; enhance intestinal barrier functions; compete for adhesions with pathogens; and modify and metabolize pathogen derived toxins.

          Probiotics have several mechanisms for their clinical effects:  1) direct interaction with intestinal cells with effects on intestinal barrier functions.  Skin and mucosal surfaces have adherent normal bacterial flora which provides protective barriers where neutrophils attack and macrophages engulf and ingest foreign bodies. The complement system stimulates and mobilizes the phagocytes (clean-up cells).  2) Interaction with immune intestinal B-lymphocytes stimulates plasma cells to produce antibody immunoglobulins such as increasing IgA.  Also, T-lymphocytes (which include killer, helper, suppressor and memory cells)  produce stimulating chemicals (lymphokines) and destructive chemicals (lymphotoxins).  3) They modulate gut microbes and compete for gut nutrients and metabolic pathways.  4) They directly antagonize intestinal pathogens.  And, 5) they create metabolic effects.

***I strongly recommend using probiotics to help manage constipation;  diarrhea;  irritable bowel syndrome;  infant colic; and, especially while taking antibiotics and after using antibiotics***  Probiotics are found in fermented foods such as  yogurt, beet kvass, kefir, sauerkraut, and, kombucha. The easiest way to consume adequate amounts are in powder or capsule form. I recommend for children 5 to 15 billion count capsules (which can be opened  onto food or mixed in a drink) daily, and for adults 15 to 30 billion count capsules daily. There is no upper limit and no adverse side effects.  NOTE: As we age, we tend to selectively lose one of the main players in our colon, namely Bifidobacterium species. The best way to restore them is to consume them (look for Bifido-rich yogurt or probiotic capsules) and to provide them with the food they need to live on in our colons: lots of vegetables, a little fruit, and limiting (toxic) doses of sugar that might feed competing species.

          ALSO NOTE: ***soil-based spore-forming bacteria are essential for our health. They are “pseudo-commensuls” because they pass through the gut rather than establishing a home there. Our ancestors regularly consumed them when eating wild foods and drinking from ponds and streams. The spores not only survive traversing through the hydrochloric acid and bile salts of the stomach,  they are activated to viably reach the intestines. An excellent product {that is unfortunately only available through a health care provider}  is called “Mega-Sporebiotic” from Microbiome Labs which contains Bacillus indicus, HU36; B. subtilis, HU58; B. coagulans; B. licheniformis; and B. clausii.

          I also strongly recommend reading the book by Dr. Josh Axe, MD called “Eat Dirt”.

          Six host factors disrupt our natural gut bacteria balance:  1)  Antibiotics: disrupt the number and relative proportions of gut bacteria. 2)  Infant Formula: breast feeding transfers bacterial diversity from mother to baby. Caesarian section delivery also disrupts this normal transfer of flora.  3)  Excessive hygiene.  4)  Our Western Diet high in animal proteins, fats , sugars and refined carbohydrates. 5)  Modern medical treatments such as artificial ventilation, skin-penetrating devices, tubes and catheters and their attendant antibiotic use.  6)  Age. 

          Our immune system co-evolved with parasites. Their absence can profoundly affect immune regulation leading to physical and psychological consequences. IgE immunoglobulin evolved to help manage parasites. Because of our overly cleanly environment with minimal parasites, IgE now responds to allergens with manifestations of Allergic Rhinitis and Asthma. People who are infected with hookworms have a lower incidence of auto-immune diseases than parasite-free modern humans. People who have been immunized with Bacille-Calmette-Guerin (BCG) are not only protected against developing tuberculosis, but they are less likely to develop melanomas.

                                THE IMPORTANCE OF MULTIPLE SPECIES

          Although good bacteria can be found in small amounts in food, changing the entire ratio of gut bacteria requires substantial and consistent dosing with supplements providing potent levels of beneficial bacteria to enable their survival. {Therap Adv Gastroenterol. 2010 Sept;3(5):307-319.}  Two types of probiotic bacteria commonly used include Lactobacillus and Bifidobacterium. There are many specific types of the bacteria within each of these two broad groups, and health benefits associated with one type may be unique to that specific species and not hold true for others. This means that using multiple different species delivers better odds of reversing the negative effects of “dysbacteriosis”, a condition where there is an imbalance between good and bad bacteria. {Eur J Nutr. 2011 Feb;50(1):1-17 and Anaerobe. 2012 Aug;18(4):405-413.}

Probiotics and Allergy:  Lactobacillus and Bifidus reduce the risk of eczema for children when used by pregnant and breast-feeding women. Lactobacillus reduces symptoms of eczema/atopic dermatitis for children and adults. Probiotics prevent and treat food allergies. The neonatal gut starts out nearly sterile. Breast-feeding, the environment, use of antibiotics all influence the infant’s microflora. Probiotics play an important role in establishing and maintaining a child’s general health. There is also benefit in preventing upper respiratory tract infections.  Probiotics improve the endogenous intestinal barrier and enteral antigen balance; improve regulation of secretory inflammatory mediators; decrease the Th1/Th2 ratio and reduce serum IgE levels.

Probiotics for Infant Regurgitation:  In a randomized controlled trial, formula-fed infants (mean age: 6 weeks) received lactobacillus reuteri or placebo for 4 weeks. The median number of regurgitation episodes during the final 7 days was lower with active treatment than with a placebo: 1 vs. 4 episodes. {Eur J Clin Invest. 2011;41:417-422.}

Probiotics and Vaginosis:  The vagina and its microbiota form a finely balanced ecosystem dominated by  lactobacilli. Lactobacilli play an important role in maintaining a favorable vaginal acidic pH and hydrogen peroxide production. Probiotics can improve vaginal health, microbiota balance, and reduce and treat some vaginoses. For example, some women can prevent recurrent vaginal yeast infections by routinely douching with plain yogurt once per month. This replenishes normal vaginal flora with healthy probiotics that suppress yeast.

Probiotics for aspirin-induced GI damage: In a randomized trial, elderly patients taking 100 mg/day of aspirin who had unexplained iron deficiency anemia received L. casei (5.5 billion to 63 billion) for 3 months. Compared with a control group that did not receive probiotics, the L. casei group had significantly fewer small intestinal mucosal breaks and significant improvement in intestinal mucosal appearance. {J Gastroenterol. 2011;46:894-905.}

Probiotics before colonoscopy:  In a double blind study, constipated patients scheduled for colonoscopy received probiotics (Bacillus subtilis and Streptococcus faecium) or placebo 3 times daily for 2 weeks prior to the colonoscopy. Compared with placebo, the probiotics increased the proportion of patients who had a satisfactory bowel preparation (54.9% vs. 20.8%). {Dig Dis Sci. 1010;55:2344-2351.}

Probiotics may boost your mood. A gut full of beneficial bacteria seems to promote the production of brain neurochemicals that ease feelings of anxiety and depression, while an abundance of harmful  bacteria may actually trigger these symptoms.

                                                    TAKING “PREBIOTICS”

          Prebiotics are carbohydrates that feed the beneficial bacteria in your body. Prebiotics include: slightly green or under-ripe bananas; durum pasta or egg noodles; sourdough bread; boiled rice (especially arborio, S. Andrea, and originario); the pectin in green apples; onions, leeks, and garlic (raw or cooked); Jerusalem artichokes; asparagus; raw chicory root; cooked oats; blueberries; and cooked dried beans (pinto, black).

          Eating prebiotics feeds Akkermansia microphilia, a bacteria which helps to regulate the immune system; increases vitamin D receptors and helps to regulate their function; helps fat absorption; helps bile-salts to function as nutrient signaling molecules; and, causes decreased C. difficile in the gut. NOTE: CBD oil also helps to feed A. microphilia and helps improve gut health.

                                          SPECIFIC DISEASE BENEFITS

          Although research tying specific probiotic strains and species to particular diseases is still in its infancy, scientists have identified a few disease treatment benefits for six of the most studied probiotic species:

1. Lactobacillus acidophilus:  reduced diarrhea and improved bowel function in cases of radiation-induced enteritis. Increased HDL  (good) cholesterol.  Improved markers for metabolic syndrome, inflammation, and heart disease.  Improved allergy-driven immune response.  Improved markers  for ulcerative colitis and irritable bowel disease.   Increased control of blood sugar. Decreased   the DNA damage that can trigger malignant cell development.
2. Lactobacillus rhamnosus:   reduced diarrhea and improved bowel comfort in cases of radiation-induced enteritis. Improved markers for metabolic syndrome, inflammation, and heart disease. Reduced  allergic response to milk in milk sensitive patients. Improved markers for ulcerative colitis, Crohn’s  disease  and improved irritable bowel syndrome. Also, there is an important association with helping with weight loss.
3. Lactobacillus paracasei:  enhanced therapeutic management of minimal hepatic encephalopathy. Improved markers for metabolic syndrome, inflammation and heart disease in elderly patients. Improved markers  for ulcerative colitis.
4. Bifidobacterium lactis:  improved immune function in healthy elderly individuals. Greater weight  gain and less gut inflammation in preterm infants.  Improved  immune response and respiratory symptoms from birch pollen allergies in children. Increased control of blood sugar.
5. Bifidobacterium bifidum:  improved markers for liver inflammation and damage in alcohol-related liver disease. Improved inflammation profiles in ulcerative colitis.
6. Bifidobacterium longum:  reduced diarrhea and improved bowel function in cases of radiation-induced enteritis.  Increased  HDL cholesterol.  Improved  markers for ulcerative colitis and Crohn’s  disease. Decreased  the  DNA damage that can trigger malignant cell development.  They improve cognition and decrease stress physiology and behavior. {This was not noted when people were given Lactobacilli because different bacterial strains will cause different effects.
7. The probiotic Lactobacillus Reuteri lowers cardiovascular risk:  L. reuteri 30242 produces an enzyme called bile salt hydrolase which makes cholesterol less absorbable so that it becomes trapped in the gut and later excreted in fecal matter. Further cholesterol reduction comes from the organism’s ability to increase cholesterol metabolism, thereby promoting its breakdown and excretion. It additionally reduces inflammatory markers.  A proprietary product called “FlorAssist Heart Health Probiotic” is available from www.LifeExtension.com.  
8. Saccharomyces cerevisiae, is a yeast found in sourdough bread, which helps to normalize intestinal microbial flora and specifically relieve symptoms associated with irritable bowel syndrome. Also, Saccharomyces Cerevisiae-Derived Peptides (SCDP): 500 mg twice per day help to induce weight loss by limiting calorie intake by modulating appetite regulating hormones, reducing new fat production, reducing body weight and fat mass, and, most importantly, reducing the size and weight of dangerous abdominal fat. Having a waist circumference out of proportion to BMI is an important cardiovascular risk factor. A proprietary product is available from www.LifeExtension.com called “Eatless peptide complex”. {Additionally, Perilla frutescens is an herb in the mint family that has beneficial flavonoids, especially vicenin-2 and rosmarinic acid which inhibit excitatory nerve and muscle activity in the intestines, which relaxes gut motility and reduces pain perception. It reduces inflammatory signaling molecules. And, it also supports the intestinal barrier reducing permeability–leaky gut. A proprietary product containing 150 mg of Perilla leaf extract plus the probiotic Saccharomyces cerevisiae called “Tranquil Tract” is available from www.LifeExtension.com.
9. Another product combines a 15 billion colony forming unit blend of 6 different probiotics PLUS 4 types of BACTERIOPHAGES called “Florassist GI with Phage Technology”.  The addition of bacteriophages is designed to remove unwanted bacteria in the intestines to make room for the beneficial probiotics. Phage cocktails have been used successfully in numerous human clinical and therapeutic settings to treat common bacterial invaders, including staph, strep and E. coli. They have demonstrated an extremely strong safety profile. Phage therapy encourages the growth of healthy bacteria in the gut microbiome which can competitively reduce harmful bacteria. Developed more than 100 years ago, phage therapy is experiencing a revival with the rise of antibiotic-resistant bacteria.
10. S. salivarius strain BLIS M18 and Bacillus coagulans GBI-30, 6086 supplementation results in significant improvement in oral and gum health. S. salavarius produces enzymes that help break down dental plaque and neutralizes acid to maintain a healthy oral pH.  A low pH demineralizes teeth and creates an environment in which bad bacteria thrive. It produces “lantibiotics” that kill competing organisms associated with periodontitis and reduces levels of cytokines associated with gingivitis. Bacillus coagulans competitively inhibits the growth of Streptococcus mutans which contributes to tooth decay and also reduces the production of inflammatory cytokines that promote the inflammatory response. A proprietary product is available from www.LifeExtension.com called “Florassist Oral Hygiene”.
11. S. salvarius K12 promotes throat health by helping to regulate inflammation and reduce damage caused by organisms that reside in the throat. It produces locally acting lantibiotics that target and inhibit beta hemolytic streptococcal infections. Clinical studies demonstrate a significant reduction in strep throat infections in people supplementing with S. salivarius K12 lozenges. It also contributes to a reduction in viral sore throats attributed to a reduction in cytokine signaling molecules including interferon gamma. A proprietary product is available from www.LifeExtension.com called “Florassist Throat Health.”
12. The combination of Lactobacillus helveticus R0052 plus Bifidobacterium longum R0175 helps to restore normal neurochemical and hormonal balances that obviate the symptoms of anxiety and depression. This combination also helps to decrease anger and hostility scores and chronic stress levels, and improved mood scores, and reduced stress induced abdominal pain, nausea and vomiting. A proprietary product is available from www.LifeExtension.com called “Florassist Mood”.
13. Pu-erh Tea is a unique probiotic. It is made from Camellia senensis leaves in the Yunnan district of southwest China. Fully fermented black tea is aged under high humidity and molds and bacteria grow on the leaves. It has less caffeine than black tea and the bacteria produce a small amount of lovastatin which can help to lower lipids. It is an acquired taste because the tea may smell musty and taste stale.
14. Lactobacillus helveticus can improve sustained attention, especially in older adults.

          A probiotic that is 100 times more potent than the average probiotic is called “VSL#3” containing 3 species of Bifidobacterium, 4 species of Lactobacillus, and 1 species of Streptococcus. There are 450 billion bacteria in each flavored and unflavored packet that can be mixed into cold or room temperature beverage or soft foods, or a vegetarian capsule that contains 112.5 billion bacteria in each capsule. It can be obtained from www.vsl3.com. Prescription strength “VSL#3-DS” (double strength) contains 900 billion live cultures of bacteria. It is particularly helpful for gastrointestinal problems including IBS and Ulcerative colitis. There are no adverse effects nor risk of overdosing.

                                                   LEAKY GUT SYNDROME

          Leaky gut syndrome may be the underlying cause for developing and exacerbating auto-immune diseases.  Zonulin is a protein at the tight junction between the epithelial cells lining the small intestine which selectively opens up the space between enterocytes and allows certain substances to enter the body while keeping others in the gut.  It is thought that large protein molecules, foreign substances and even microorganisms can enter the blood stream when the space at the tight junction between cells in the small  intestine is wider than it should be. Antibodies then target these antigens that don’t belong in the body, and an immune response develops. Where an auto-immune disease develops is a function of the antibodies attacking similar proteins in the body. Thus, the same basic problem has many manifestations. The tight junctions between enterocytes are perpetually opening and closing in response to a plethora of stimuli such as food, hormones, inflammatory markers, and the dietary state. Certain microorganisms can hijack the cellular pathways at these tight junctions or increase the zonulin levels, leading to increased gut permeability. One of the most powerful triggers is gliadin, a protein found in wheat. Like gluten, it has been linked to celiac disease. The idea that a porous intestine directly leads to disease is controversial. However, physicians don’t know enough about the gut, which is our biggest immune system organ, so we need to acknowledge our ignorance and keep an open mind because this theory may indeed be an accurate explanation. Food sensitivities are real. I believe that probiotics are essential for management. Also, anecdotally, thousands of people have benefitted from a gluten/gliadin-free (wheat free) diet even if they test negative for celiac disease. Additionally, nutritional supplements such as glutamine can be beneficial. 

                                                                    DYSBIOSIS

          When the ratio 85% “good microorganisms” to 15% “problematic microorganisms” of a healthy gut is disturbed, a condition called “dysbiosis” occurs. Also, an overgrowth of certain organisms can cause this problem, such as an overgrowth of Candida albicans. For example, 2 phyla of anaerobic bacteria, Firmicutes and Bacteroidetes, are so-called “fat-bugs” because they are associated with obesity. Food emulsifiers and artificial sweeteners enhance the growth of these bacteria which also results in insulin resistance. These fat-bugs can cause food cravings and manipulate our behavior: they change the number of dopamine receptors AND also change the reward centers in the brain. We need the balanced 15% problematic bacteria to keep our GALT stimulated so that our immune system can help us to prevent and fight off an infection. The GI tract is really the external world inside us, so we need this protection.

                                                 THE GUT-BRAIN CONNECTION

          The “Enteric Nervous System (ENS)” is separate from the Central Nervous System (CNS). It is composed of 2 thin layers of over 100 million nerve cells—more than in the spinal cord. The ENS lines the GI tract and controls blood flow, secretions and contractions. It also helps us to unconsciously “feel” (like a second brain) what is occurring in the GI tract. It has glial cells to support the gut neurons. It uses over 40 different neurotransmitters. It produces 50% of the body’s dopamine and 95% of the body’s serotonin. L. brevis can produce GABA. It has a barrier, similar to the blood-brain barrier, for protection. It may have its own memory (although it is not capable of thought). The gut and the brain are connected by the vagus nerve with about 90% of the signals going from the gut to the brain. {The vagus nerve also connects cardiac functions.} The bi-directional communication occurs by various physiological channels including autonomic pathways, neuro-endocrine pathways and neuro-immune pathways. People with Parkinson’s disease have the same protein clumps in the ENS as in the CNS. And, people with Alzheimer’s disease have the same neurofibrillary tangles and amyloid plaques in the ENS as in the CNS. {Thus, a gut biopsy may make earlier diagnosis possible.} 

          Both external and internal STRESS can create a challenge or a threat that disrupts an organism’s homeostatic balance. It can alter the composition and the function of the gut microbiota. For example, maternal stress can affect the fetal gut microbiome directly and through epigenetic factors. This can affect systemic dysregulation in early life and persist into adulthood. Potentiation of heightened anxiety may be transmitted because of this complex mixture of both biological factors as well as psychological factors that act in feedback loops. Chronic stress is associated with dysregulation of the hippocampal-pituitary-adrenal (HPA) axis. Irritable bowel syndrome results from a heightened gut sensitivity and limited ability to modulate an acute stress response.

          Vaginally delivered infants have a different and increased variety of  microbiotia than babies born by C-section. (Variability in flora becomes similar by about 8-weeks.) Hospital use of antibiotics and different feeding patterns (bottle vs. breast-feeding) also affect neurobiological development. Aging adults in long-term facilities compared to living in their communities have less diversity in their gut microbiome. 

          Changes in the microbiota may help to ameliorate psychological disorders. A probiotic cocktail has been associated with improving depression on the Beck Depression Inventory. L. helveticus can improve sustained attention in older adults. Polyunsaturated omega-3 fatty acids modify the gut microbiota resulting in improved cognition, dampened HPA activity with less anxiety and depression, and improved psychological well-being.

                                                THE GUT-HEART CONNECTION

          Probiotics can reduce both systolic and diastolic blood pressures. The greatest effect is found when the baseline BP is elevated and when the daily consumption is >100 billion colony forming units for over 8 weeks duration. Lactobacilli help to reduce blood cholesterol levels. Some bacteria express the enzyme bile salt hydrolase which affects intestinal cholesterol reabsorption. Yogurts help to decrease total cholesterol andLDL-cholesterol and improve the LDL/HDL ratio. There is an inverse relationship between fiber consumption and CVD: the more fiber ingested, the less the risk for CVD. Prebiotics stimulate bacteria to produce butyrate which helps to lower cholesterol, triglycerides and atheroma plaques.

          Modifiable risk factors include: 1) Obesity: Germ-Free mice (GF-mice) are a useful model. They are leaner than wild mice. When there is a fecal transplant from obese mice to GF-mice, they become fatter than from lean mice donors. 2) Cholesterol levels: certain gut microbes, such as Eggerthella, Pasteurellaceae and Butyricimonas alter the bile acid pool which modulates hepatic and systemic lipid and glucose metabolism. 3) Toxic burden: microbes can directly alter chemical activity and structure; produce metabolites that compete for detoxification pathways; and, affect expression of detoxification enzymes. 4) Leptin and Insulin resistance: microbial fermentation of dietary fiber produces a short-chain fatty acid called butyrate which increases leptin expression in adipocytes and improves insulin sensitivity. 5) Inflammation: gut microbes mediate inflammatory signals. Age-associated dysbiosis causes increased inflammation and increased CVD. 6) Nutrient deficiency: gut microbes synthesize B-vitamins, vitamin K and vitamin C and some are absorbed by the host. However, “greedy microbes” may preclude absorption. 7) TMAO and Heart disease: Trimethylamine-N-Oxide (TMAO) is produced via microbial metabolism of choline to trimethylamine (TMA) with subsequent oxidation in the liver. An increased amount of TMAO is an independent risk factor of increased CVD. It is microbial dysbiosis, and not dietary choline, which is the problem.

          The liver is a key player between the gut and the heart during nutrient deprivation (that is, fasting). In fasted GF-mice, the heart relies upon glucose metabolism for energy. Evolutionarily,because the heart needs a constant supply of energy to function, it has the capacity to use different substrates, depending upon availability. In mammals, fasting conditions cause an increased production of ketone bodies in the liver which results in increased ketone utilization by the heart, brain and other tissues. Gut microbes can cause increased acetate production which increases the pool of hepatic Acetyl CoA which is the starting molecule for ketone production.

          Gut pathologies and CVD: 1) Dysbiosis: animals with hypertension have an increased Firmicutes to Bacteroides ratio, and they have decreased bacterial diversity and richness. Also, they have decreased butyrate and acetate microbial metabolites with resultant increased inflammation. People with chronic CHF also have decreased microbial diversity and diminished important bacterial genra. 2) Small Intestinal Bacterial Overgrowth (SIBO): is associated with increased arterial stiffness and decreased Matrix Gla Protein (MGP), which when activated prevents the calcification of blood vessels. Decreased MGP is related to decreased vitamin K absorption by the small intestines and/or to decreased vitamin K production by colonic bacteria. Also, SIBO causes systemic inflammation which is associated with increased CVD. 3) Infections: Chlamydia pneumoniae and Helicobacter pylori infections are associated with increased CVD. Patients with chronic CHF had increased quantities of pathogenic bacteria, including Campylobacter spp, Shigella spp, Salmonella spp, Yersinia enterocolitica, and Candida spp in their colons. Bacterial DNA can be identified in >50% of coronary plaques. 4) Intestinal Permeability: A “leaky gut” allows bacteria and their metabolites to enter the blood stream, triggering an immune response, and allowing them to become associated with the heart. TLR4, a receptor of the adaptive immune system, binds to lipopolysaccharides which are a component of gram-negative bacterial cell walls. This binding initiates inflammatory signaling. In mice, if the TLR4 receptor is ablated, there is decreased atherosclerotic plaque formation. Increased intestinal permeability both induces inflammation and weakens coronary plaque stability. {Plaque rupture is the trigger for an acute MI.} Patients with chronic CHF have increased intestinal permeability compared with healthy controls.

                                         SUGGESTIONS TO HEAL A LEAKY GUT

1. Eat probiotic rich foods—fermented foods like kefir, yogurt and sauerkraut.
2. Eat raw honey and bee pollen.
3. Get a dog or a cat for a pet.
4. Swim in the ocean.
5. Get grounded: “Earthing”.
6. Regularly take soil-based, spore-forming probiotics, such as “Megasporebiotics”.
7. Eat locally from Farmer’s Markets.
8. Substitute for cow’s milk: such as coconut milk, almond milk, hemp milk, rice milk, goat milk or sheep milk.
9. Substitute for wheat flour: coconut flour, almond flour, manioc (tapioca) flour, sprouted ancient grain flours such as buckwheat, sorghum, amaranth, quinoa and millet.
10. Choose healthy oils: coconut oil (or manna), olive oil, flaxseed oil.
11. Substitute for sucrose (table sugar): honey (especially manuka honey), green leaf stevia, maple syrup.
12. ***Use BONE BROTH: it contains gut sealing collagen, key amino acids (proline, glycine, and glutamine), and easily absorbed minerals.

NOTES:

• Coconut products are high in lauric acid which kills pathogenic bacteria and fungi.Fermented vegetables enhance nutrient absorption and provide both prebiotics and probiotics.
• Fermented daily products (kefir and yogurt) provide probiotics and decreased lactose.
• Cooked vegetables, especially boiled or steamed) are easier to digest than raw and are packed with vitamins, minerals and antioxidants.
• Grass-fed meats and wild-caught deep sea fish have increased omega-3 fatty acids.
• Soil-based organisms help heal the gut. a) Bacillus subtilis elicits an immune response that supports healing the gut lining and suppresses pathogenic bacteria. b) Bacillus coagulans improves nutrient absorption. Spores are activated by stomach acid and bile salts and produce lactic acid in the intestines which helps to reduce inflammation.
• Medicinal mushrooms, such as Cordyceps, Reishi, Shiitake, Lion’s Mane, and Turkey Tail, help to balance microbes in the microbiome. They supply prebiotics to keep them fed. They boost the immune system, detoxify chemicals and heavy metals, and help to reduce histamine release. They inhibit pathologic immune responses in auto-immune disorders, destroy tumors and cancer cells, and help to fight viruses and Candida. They act as adaptogens to balance cortisol and stress responses.
• Blue-green Algae, such as Spirulina and Chlorella, are nutrient rich.
• Beneficial yeast, such as Saccharomyces boulardii destroy pathogenic bacteria and improve diarrhea; relieve intestinal gas and bloating; repair intestinal wall mucus membranes; strengthen GALT; help inflammatory bowel disease; help acne; and, help destroy Candida albicans.
• Bentonite clay (1 teaspoon 3x/day) can help with constipation and cleansing the intestines. However, too much along with not enough water can be constipating.
• Bone Broth is nutrient dense, easy to digest, full of collagen and the beneficial amino acids proline, glycine and glutamine. It helps to decrease inflammation and heal a leaky gut by restoring the mucosal lining. It provides easily absorbed minerals such as calcium, phosphorus, magnesium, silicon and sulfur. It contains glucosamine which helps to stimulate and heal the immune system. Beef bone broth is high in types 1 and 3 collagen which helps the skin and nails. Chicken bone broth is hight in type 2 collagen which helps the gut and joint cartilage. Fish bone broth is high in type 1 collagen which helps to produce human type 1 collagen which is found in 90% of the body. Drink 1 to 2 cups of bone broth daily “to heal and seal”.

                                       CONSIDERATIONS FOR THE FUTURE

1. Treating colitis with fecal transplants to re-establish healthy gut flora in patients who have received antibiotics with consequent resistant C. Difficile infections.
2. Banking a patient’s own microbiome before chemotherapy in order to be re-inoculated them afterwards to speed their recovery.
3. Treating babies with microbes that shape the immune system to stave off autoimmune diseases like asthma and psoriasis. For example, c-section babies, who miss out on their mother’s vaginal flora through a passage through her vagina, can be washed with their mother’s vaginal fluid after birth to give them a similar protective advantage.

An Interesting story:  Soldiers stationed in Morocco during World War II were getting gravely ill with dysentery, and no one could figure out why or how to stop it. They noticed that locals weren’t getting as sick. When Moroccans began to get ill, they would follow their camels and eat the droppings. Although  this seems disgusting, we now know that the droppings were full of B. subtilis bacteria which cured the disease.

Dr. Chuck Wile, Seminar Series at the Cheng Integrative Health Center, on 12/4/17

Fibromyalgia syndrome is a collection of symptoms without a known cause. Commonly people may experience pain trigger points and generalized pain, fatigue, sleep disruption, anxiety and depression, “brain fog” with difficulty concentrating, chronic headaches, touch sensitivity, environmental sensitivity, muscle spasms, muscle and joint stiffness, and bowel problems. Based on large amount of research, Dr. Dan Purser, MD proposes that the underlying cause for FS is copper toxicity. Because of a genetic defect, there is an excessive amount of the metabolite of hemaglobin, known as Pyrrole, which is bound to the body’s key antioxidant, glutathione, for urinary excretion, decreasing the quantity of glutathione. Also, excretion of pyrrole pulls zinc, vitamin B6 and other nutrients from the body. This creates an imbalance of the copper and zinc ratio in the body resulting in an excess of  “free copper”, unbound to ceruloplasmin. This “free copper” deposits in muscles causing pain and systemic toxicity. Molybdenum is a co-factor for enzymes that help to detoxify copper and other heavy metals. With FS, there is also a molybdenum deficiency. The detoxifying enzymes are consequently dysfunctional. Thus, the primary treatment for FS involves first supplementing with zinc and vitamin B6, then, slowly adding molybdenum. Additionally, supplementing with topical glutathione and other nutrients helps people to experience significant symptom relief. An additional hypothesis regards FS as a mitochondrial defect. Thus, supplementing with phospholipids, the adrenal hormone DHEA, various nutrients, and oxytocin has also been helpful.

Contributed by Dr. Chuck Wile, MD

-This again shows the importance of balance (or the lack thereof) of various nutrients, vitamins, as well as the importance of mitochondria in our health. Those diagnosed with FS should schedule an appointment to see us for a proper workup and treatment.  – Dr. Richard Cheng