Paleo Doc

Gain Muscle Mass - 4 Hour Body - Paleo Style

One of the main difficulties with eating a strict paleo style diet is in gaining muscle mass, modest gains are the norm for most.  Clients are always happy with the fat loss and their lean bodies but unfortunately many have inadequate lean mass to begin with and need to build muscle as well.  Resistance training and simple carbs have always been the mantra of muscle gains so how is this optimized while eating paleo?

Two years ago, after the release of the Tim Ferriss book 4-Hour Body, I was excited to try his Time-Under-Tension (TUT) technique after he described his 35# muscle mass increase in 28 days.  The problem was the amount of grains that he consumed was not in line with my dietary desires and besides I had no desire to gain 35# of muscle.  So in the Tim Ferriss spirit I decided to be my own experiment.  Over the previous 5 years my weight had stayed fairly consistent and my body fat stayed between 7-10% and I had tried various different work outs but rarely any dramatic results, I was even skeptical of the 4-Hour Body claims.  I assessed my baseline: 5'10" 165#, 7.1% body fat with 61 kg of lean mass - this was by DEXA scan so no uncertainty in these numbers.  My baseline calorie intake was right around 2000 calories a day so I decided to increase it to as close to 3500 as I could get.  In order to do this I added a 550 calorie protein shake in the morning and one right after the workout.  Now this shake has specific requirements: needs to have 50-60 grams of whey protein isolate and 60-75 grams of sugar.  Yes, I said sugar, not necessarily paleo but it is functional nutrition to achieve this goal.  If you have a specific low card protein drink that you like then get the NOW brand dextrose powder = 25 grams of dextrose per tablespoon and add 2 spoonfuls.  Dextrose is perfect, fast absorbing and can be utilized by the muscle, sugars that contain fructose (table sugar, fruits, etc) are not good options as fructose cannot be used in muscle.  NOW brand dextrose is made from corn but they do make every effort to use non-GMO sources.  I also added a serving of sweet potato or white rice each evening in order to keep the simple carbs rollong.  Protein intake for the day was between 250-300 grams.

Below is the workout that I performed every 3 days:

1 set bench press

1 set straight bar curl

1 set pull-ups - these sucked with the slow count!

1 set barbell military press

1 set back squats (if you do not feel sick after these then it was not done the right way)

1 set ring dips

1 set bent over barbell row

These sets were performed with continuous movement with a 5 second positive movement and a 5 second negative movement, no pausing at the top or bottom, and the reps were to failure (7-12 reps each set).  The weight should be 60% of 1RM for each exercise.  The key components of TUT workouts is to maintain tension for AT LEAST 40 seconds but preferably between 1-2 minutes and to get to true muscle failure.

My results in the 28 day period were: 7.7# increase in lean mass, 1# increase in fat mass and body fat went up to 8%.  I probably would have avoided the fat gain if I had cut back slightly on the calories.

Bottom line is this plan does work for muscle gain and requires only slight deviation from strict paleo eating.  I have been using this routine with my clients over the past two years and have seen dramatic results.  Had one that gained 28# of lean in 2 months with a 20 pound fat loss.

 

Weight Loss: Not Always a Simple Answer, 6 factors to consider

There has been a recent tidal wave of online debate regarding obesity since the AMA announced it was recognizing it as a disease.  Most are not very sympathetic toward the gravity challenged population.  I admit that I certainly would never consider obesity a disease we have now classified it, not unlike many other "symptoms" in our society, as a disease.  Many physicians and non-physicians alike are pretty blunt in declaring that obesity is nothing more than the result of poor willpower.  We even learn this in medical school - during our two weeks of nutrition education - that calories in minus calories out is the simple equation.

I do consider myself a bit of an expert in this area because I have focused a good part of my career on the clinical side of this topic.  I spent 10 years as a bariatric surgeon and medical  bariatric doctor, I performed around 3000 gastric bypass surgeries and evaluated around 10,000 overweight individuals.  During this career, I came to the glaring conclusion that weight loss surgery was never a good option so I now focus on lifestyle changes and wellness education.  There are many researchers and epidemiologists out there that come up with their theories but I have lived in the trenches of the clinical world and would like to share with you six areas where I have found that weight loss could be impaired despite the client making honest efforts.

1. Serving size misconception - this one is pretty obvious.

2. High density food choices - This one is pretty simple as well but rests on our reliance on grain based diets.  Foods that generally contain large numbers of calories in very small volume - crackers, chips, pretzels, pasta, breads, rice, etc.  We can consume large quantities of these foods and not feel full.  Not only is this a volume issue but it also disrupts our hormones that signal the brain about our calorie stores and calorie needs - ghrelin, leptin, and adiponectin.

3. Food allergies - This one sort of caught me by surprise.  The first time I found this issue was a client that had been with us for about two years and had only been making modest progress at best.  She had told me that she was extremely allergic to fish and had avoided it since her teenage years.  She had noted some reactions to grain recently and so we decided to do a comprehensive food allergy and sensitivity panel.  Results came back as no reaction to fish but significant allergies to turkey and chicken, which was her primary food intake.  She began eating fish again and avoiding the chicken and turkey and within 3 months made more progress than in the past two years.  She had increased energy and overall increased vitality as well.  Since that time we have tested many people for food allergy/sensitivity and when they remove the offending foods, not only begin losing weight but also begin to feel overall much better.  In addition to the common findings of grain allergies, eggs and casein protein seem to be very common.  These sensitivities are causing inflammation in the body, creating these issues.

4. Excess cortisol/Adrenal fatigue - This is really a spectrum and almost seems contradictory to include the two together.  Cortisol excess is from stress and chronically high levels of cortisol lead to increased glucose through increased insulin resistance, muscle breakdown, and decreased glucose utilization.  The body basically goes into a hibernation state.  With prolonged elevations of cortisol, we get a dysregulation of the HPA-axis and eventually cortisol production will begin to diminish.  This may appear to be a good thing on the surface but what is important is that the cortisol and DHEA both plummet thus aggravating an already dysfunctional homeostasis.  This leads to decreased metabolic use of calories, muscle wasting and fat gain.

5. Gut dysbiosis - This one has only been recognized in recent years and in fact has been getting much attention recently.  Our gut bacterial cells significantly outnumber our own human cells and this little civilization living within each of us has a significant impact on our health.  When these >200 different species are unbalanced, so are we.  Inflammation in our bodies can be caused by leaky gut, bacterial toxins, and bacterial translocation.  Our gut has a huge nervous system of its own, the enteric nervous system, and communicates directly to the brain through the vagus nerve.  Interestingly, 90% of that communication is from the gut with only 10% to the gut - makes you wonder about who is in control.  Some studies are now suggesting that the metabolic activity of  our gut bacteria can explain why two people can eat the same number of calories while one person gains weight and the other loses.

6. Set point theory - I used to deny that there was any set point that the body tries to achieve but again my clinical experience taught me a lesson.  I have had several clients over the past few years that even when I put them on a 1200-1500 calorie diet failed to lose weight, some even gained.  What seems to work in these individuals is to do a 30-60 day 600-800 Kcal diet where they eat only a lean protein and servings of vegetables for three meals a day.  Suddenly, they are losing weight but the interesting thing is that even after completion of the severe calorie restriction and they resume a 1200-1500 Kcal diet, they continue to lose weight on the diet that did not work before.  I attribute this to changing the set point although I am considering the possibility that the severe calorie restriction changed the mix of gut bacteria.

So you can see, there are many circumstances where the train can be derailed.  I hear many clinicians that are too quick to give up on patients that are not making progress and attribute it too poor compliance.  I think it is important to consider all possibilities before going down that dark road.

Book Review - "Eating on the Wild Side"

At Synchronicity Wellness, we are constantly working to improve our nutrition knowledge so that we can pass this information on to each of our clients.  We are in an ongoing state of flux as we improve on this knowledge.  Real unprocessed foods have been a constant for us but as we have learned over the years, this guideline has its variables as well.  Years ago, we figured if it were meat or grown from the ground, it was a safe choice.  Many of our clients would ask us about such things as; what is the best type of meat?  What are the better fruits and vegetables? But then we started getting more complex questions such as; pastured vs. industrial meats, organic vs. non-organic, and GMO vs. non-GMO.   It really is great to see that consumers are becoming more conscious about their choices.  Giving them guidance on where to find the information can be difficult because opinions shift like the wind, scientifically “proving” one thing and then debunking that guidance in a few short years.  We are left to wonder “how can we really know what is best to optimize our physiology?” 

 

We are always searching for new resources to assist our clients in optimizing their nutrition and love it when we find one that clearly and concisely educates the consumer on every aspect of a topic.  This is the case with Jo Robinson’s new book “Eating On the Wild Side: The Missing Link to Optimum Health,” released June 4, 2013.  Jo Robinson is a nationally recognized expert in the movement to recapture the nutritional value of our food supply.  She has compiled a remarkable book that covers, in great depth, not only the indigenous history behind our fruits and vegetables but also the way these once highly nutritious foods have been modified down through the course of history to produce the low nutritional foods that the average consumer purchases.  Jo Robinson gives us practical tips on buying, preparing and growing fruits and veggies as well a sources for buying seeds. She neutrally conveys the facts without judgment and leaves us with the good news that all is not lost……that we still have marvelous choices and can easily move back to eating foods with amazing nutritional value.  This is 400 pages of history, nutritional info, and tips on all of the common fruits and vegetables.

 

The health implications of genetically modified foods are becoming clear. We as consumers can change that picture for ourselves and for future generations..  Jo Robinson’s book “Eating on the Wild Side: The Missing Link to Optimum Health” is a must read, we recommend that you move it to the top of your summer reading list and set an intention to be part of the change in our food culture. Thank you Jo Robinson for this amazing new resource.

Buy it at Amazon:

http://www.amazon.com/Eating-Wild-Side-Missing-Optimum/dp/0316227943

Carb Loaded Beef in our Food Chain

I first read the article on Reuters News about 6 weeks ago and thought that it was some sort of joke or conspiracy statement until I saw different versions crop up on different news networks.  I was really astonished by the fact that this did not create major social network buzz or even news headlines.  The story is that the national drought has brought about a shortage of corn and thus price increases.  The beef producers were looking for ways to fatten up the cows on the cheap and guess what they found.....gummy worms, ice cream sprinkles, Froot Loops, and even marshmellows!  Apparently, all of these seem to fatten their cows as well as the corn and at a much cheaper cost.  

Most of us, especially the readers here, would not even consider putting the above items in our body so why do some not see the problem with consuming meat that has been fed these items?   We all know the benefits of consuming healthy fats - it changes the composition of our body fats, changes the way our lipoproteins function, and decreases inflammation.  So, what happens when cows are fed corn, gummy worms or even ice cream sprinkles......It changes the fat.  Lets look at what happens when we feed beef grain:

Some farms will grass feed and then finish the 1-3 months prior to butcher with grain.  In the graph above, you can see that in just 30 days alone the fat undergos dramatic reductions in Omega-3, this is one of the reasons we want our beef grass-fed start to finish.

Buy organic, buy grass-fed, and buy local.

I'm Sad for Paula Deen

I was not sure how exactly to approach this post so I have written and modified it multiple times over the past 24 hours.  My initial reaction was frustration and anger over the perceptions of society, the medical community, and excuses which were put forward regarding the diagnosis of Type II diabetes for TV southern cook Paula Deen.  I have since questioned why I am angry and frustrated and realized that neither emotion serves any purpose.  I now am at a point where I am very sad for this woman because not only does she not get it but neither does most of society.

First, Type II diabetes is not a disease in the strict sense, sure it is a symptom of insulin resistance which is the result of poor lifestyle choices.  Unfortunately, people latch onto the term disease in order to give it an excuse, a pass, a way to avoid responsibility.  Mrs. Deen, when asked if it was related to her lifestyle, she emphasized that there are many factors and really made a point of emphasizing genetics.  Now granted I will say that there is some weak evidence that some people are more genetically PRONE to getting diabetes, but that is no different than lung cancer in a smoker - sure some people are more PRONE from genetics to develop lung cancer if they smoke but its hard to ignore the elephant in the room - you still have to smoke!  Paula Deen has Type II diabetes because she is overweight, she eats poorly, and she doesn't exercise.  Her doctor and the pharmaceutical company she partnered with (big pharma is such a good samaritan) have her convinced that it really is not her fault and they have the tools to CONTROL her diabetes.

On the Today show article, they also talked to a "nutritionist" and she emphasized that it is really not what you eat but how much.  I have to strongly object to this line of thinking, yes, quantity does have a role but quality is just as important if not moreso.  The hormones of satiation and fat storage behave very differently with different types of food.  Inflammation relating to different food types also plays a role so I find it very sad that supposed experts make such inaccurate statements.  I remember the College nutrition professor that ate a twinkie diet for 60 days in order to show that number of calories is what really counts - sure he lost 20 pounds and his cholesterol improved but I would bet that in about six months of that diet I could find some pretty scary physiologic changes.  You also have to question why a professor of nutrition had an initial BMI of 28.5 (nearly obese) to begin with, that would be like going to an obese personal trainer for exercise advice.

I am sad for Paula Deen because she is a victim of this system of misinformation.  I would love to see her change her lifestyle - cook healthy and exercise - and cure her "disease" of diabetes.  It really is that simple, we see this happen all the time with clients in our practice and do it without medication.

Fat - It does the body good

Ok, vacation is over, it's been 4 months since my last blog post and I am ready to get back at it.  I have been reviewing my  past postings and I noticed that I have not been completely forthright in putting my thoughts to print.  Believe it or not I was actually blunting much of what I really wanted to say.  I know.....gasp...right?  People tell me that I am pretty in your face with my opinions but now I have decided that I really do not care about being PC any more.  Now to inaguarte this new freedom that I am feeling, I thought that I would address a topic that routinely comes up in my discussions with my clients - dietary fat.

 Fat has really been marginalized to the red headed stepchild of the nutrition world but unfortunately it has been wrongly christened.  We can really thank one person for this sin against humanity and that would be a man by the name of Ancel Keys.  Keys compiled a large volume of data but unfortunately he was very biased in his presentation and fat fell victim to the old adage that if you repeat something enough times then you actually begin to believe it.  Funny that keys ate a Mediterranian style diet which typically consists of somewhere between 25-50% of calories from fat.  Over the next few days, I am going to review the physiologic aspects of all the different forms of fat.

What you will come to understand is that it is not necessaily the amount of fat you consume that is important but rather the type of fat you consume.  We are constantly reminded of the French Paradox or the Italian Paradox, or even the Inuit (eskimo) Paradox; where we see fat consumption that far exceeds the typical American diet yet these people have significant lower heart disease rates.  Paradox here means that our observation or intuition seems to defy logic or contradict it.  I love when this is used in science especially in this situation where we refuse to believe our own lying eyes.  None of these observations constitute a paradox if we look at what is going on physiologically or biochemically we have the answer.  Type of fat consumption is the key.

We are in an era of evidence based medicine and we really need to apply this to nutrition.  We see that the cost of medical care is bankrupting society and we see that the "diseases" constituting the highest costs in our medical system are essentially lifestyle diseases; we need to get aggressive in our dietary approaches.  Obesity alone costs $147 billion dollars a year in direct medical costs to the tax payers, that is 9% of our countries medical spending.  Dietary fat reduction recommendations has been a key factor in the deterioration of our public health.

I am not recommending that we adopt an eskimo diet of meat and blubber but we do have to be more sensible about our fat consumption.  Read my previous post on the omega-3/omega-6 ratio and you will get a good idea of where I will be going with this.  So stay tuned over the next week and I will inundate you with good info on fat.

Trans Fat Good for You???

Ok, before you burn me at the stake or take away my medical license, please read on.  What I am talking about is CLA or conjugated linoleic acid not the trans fat from patrially hydrogenated vegetable oils.  Yes, CLA is a trans fat but unlike other trans fat it is not bad for you, in fact, it is full of benefits.  CLA is an omega-6 fatty acid found in grass fed animal products, the trans double bond of CLA occurs at the 11 position on the 18 carbon fatty acid instead of the 9 or 10 position like the partially hydrogenated oils.  Without getting any more science geek on you, suffice it to say that our physiology allows us to metabolize trans fat with the double bond in the 11 position.

CLA has a very strong anticarcinogenic effect in the body.  It actually ihibits each stage of carcinogenesis.  Additionally it is extremely resistant to lipid peroixidation and even inhibits free radical oxidation reactions.  It blocks mutations of DNA.  It blocks proliferation of abnormal cells and even induces cell death in mutated cells.  It has been shown to suppress atherosclerosis and diabetes.  There were some initial indications that it would help promote fat loss but it appears that it primarily suppresses proliferation of fat cells, so it helps keep you slim.

So, where do we find this wonderful fat?  As mentioned earlier, grass-fed animals are your best sources (esp. cattle, goats, and sheep).  You will find it in meat, eggs, cheese, and butter made from our grass-fed friends.  "Grass-fed chickens?"  Actually a grass-fed chicken is a chicken that is allowed to graze on grassy fields and they will usually consume about 30% of their calories from grass but they still require some grains.

One finding about CLA is important to note: studies show that high consumption of fructose will negate benefical effect of CLA on several of these processes.  The average American consumes 60 pounds of fructose a year!!  Good thing none of my readers are desiring to be average.

Awesome Thai Slaw Recipe

Not only does this taste delicious, it has innumerable benefits.  Cabbage has been known for its medical benefits for thousands of years and it has been only recently that science has identified the real reasons for the benefits.  To begin, it is high fiber - we know the benfits of this.  It is also packed with vitamin C, it contains vitamin E as well as a great source of sulfur - helps with wound healing, ulcers, eczema, infections, and indigestion.  One of the greatest benefits comes from a phytochemical called Indole-3-carbinol (I3C).  I3C works as a powerful antioxidant, detoxifier, and anti-cancer chemical.  It stimulates the production of detoxifying enzymes that protect against the carcinogenic effects of pesticides and other toxins.  The anti-cancer effect is a little technical but here goes:  Estradiol (an estrogen in women and men) circulates around our body and gets oxidized in certain tissues to for Estrone.  There are three main types of estrone - 2-OH Estrone, 4-OH estrone and 16 alpha-OH estrone.  2-OH is protestive against several types of cancer (breast, prostate, skin, etc), it stops cell division and blocks receptors that promote cell growth.  4 and 16 alpha are cell division and growth promoters.  I3C pushes the oxidation of estradiol toward the 2-OH estrone balance.  It has also been shown to halt the growth of warts.

So, eat plenty of cabbage and other cruciferous vegetables to get a healthy dose of I3C.

Thai Slaw Recipe

1/2 head of cabbage - cut to your liking

1/4 cup chopped cilantro

1 minced garlic clove

1/4 cup rice vinegar

1 teaspoon of honey

1 tablespoon Tamari (gluten-free soy sauce)

1 tablespoon  of olive oil

1 teaspoon of red pepper flakes

Food Allergies and Sensitivities

How common are food allergies?  This is a topic that is without a good answer at this time.  We do know that the incidence of IgE related food allergies runs around 2-4% of the population.  This is the type of allergy that causes an immediate reaction and involves the release of histamines.  Food "sensitivities" involve a different type of antibodies called IgG, these do not involve the release of histamine but they do involve an immune mediated response.  These food sensitivities can occur within a few minutes or up to three days after ingestion of the food.

 

 

 

 

 

Potential symptoms:

• congestion, runny nose
• muscle or joint aches, muscle cramps
• GI upset, bloating, cramping, diarrhea, irritable bowel
• headache, depression, chronic fatigue
• rashes, eczema, itching

You can see that these symptoms are pretty vague and would be hard to associate with certain foods.  Most of these allergies also appear to be aquired allergies related to "leaky gut" which can occur wih intestinal reactions to grains.  When the grains damage the gut lining, it will allow partially digested proteins from different foods to pass through the intestinal lining and immune cells will identify these partially digested proteins as foreign invaders and create the IgG antibodies, so these are aquired sensitivities.

How do we find out if we have these sensitivities?  One way is the elimination plan, where we eliminate a certain food from the diet for a few weeks, make sure we are symptom free and then reintroduce it and see if we get a response.  This is a sort of shot-gun approach.  Another option is to have an IgG food allergy blod test.  There are 10, 30, and 90 food panels that can be run to look for degrees of antibody reaction.  There is some controversy as to whether these tests are reliable but we have seen pretty convincing clinical results in our practice.  When these tests do come back positive, we can fine tune the food elimination and see if the symptoms resolve.  We had a female that had ongoing problems with patches of dry, red, itchy skin on her face that had started to get worse and nothing was working to treat it.  She had the 90 food panel and found that she had a strong reaction to eggs, milk, and casein protein.  She did not drink milk or take any milk products, limited casein intake, but she had dramatically increased her egg intake.  We eliminated the eggs from the diet and within three days the skin problem resolved.  The true test will be nw to reintroduce the eggs into the diet and see if the rash returns.

In medicine we deal with many unknowns but if we look hard enough, we can frequently find the answers.

Vitamin D - Sunshine hormone

We have been seeing much attention in the news lately directed at vitamin D levels.  The problem is that the medical consensus keeps flip-flopping.  This is not unlike most of the research we encounter these days - one minute we are all lacking something in our nutrition, the next minute it causes cancer.  This is never ending and so most of the time we have to leave it up to our individual physicians to give us their recommendations or just settle for some common sense.

Learn about the inherent flaws in medical research here.

Anyway, back to vitamin D.  In my clinical practice, we routinely check vitamin D levels and we find that over 80% of our clients fall below the 30ng/ml level, which is considered deficient by current laboratory standards.  Why are we seeing this?  First, we have become a sun phobic society, worried more about skin cancer than getting a decent dose of daily sunshine, trading risk of one cancer for a plethora of others.  I am not saying go out and get bronze but 15-20 minutes of sun on the arms and legs daily is a definite benefit.  The other factor is that we are in a northern latitude.  Folks living near the equator tend to have levels in the 50's and 60's.  

We do have a preponderance of evidence that points to certain benefits from an "optimal" vitamin D level.  Improved bone health, improved immune function, improved resistance to flu, decreased cancer mortality (esp. colon and breast), decreased risk of Parkinson's and Alzheimer's disease, and even improved cardiovascular health.  The American Journal of Clinical Nutrition published an article in 2004 from the Boston University School of Medicine which reviewed the many health benefits of vitamin D "....the role of vitamin D deficiency in increasing the risk of many common and serious diseases, including some common cancers, type 1 diabetes, cardiovascular disease, and osteoporosis."  They even mention that many times vitamin D deficiency is misdiagnosed as fibromyalgia.  A randomized study of vitamin D supplementation from Creighton University in 2007  found that improving vitamin D and calcium status in post-menopausal women substantially reduced all cancer risk.  Now the Institute of Medicine (IOM) recently came out with recommendations that say 20-30ng/ml are adequate but really are not supporting this with solid evidence, they are stating mainly that there is not enough evidence that higher levels are of benefit.  However, the National Health and Nutritional Examination Survey (NHANES) found that levels below 18 and above 50ng/ml increased all cause mortality in the general population.  A recent meeting of cardiologists found that the cardiac benefit was optimized in the 40-45ng/ml range.

So we get a good idea that there are benefits, the problem is that we do not have a consensus on the most appropriate level in the blood.  In my practice, I try to keep clients in the 40-50 range, why? Common sense when looking at all of the studies suggests this to be the most "optimal" levels.  So, get your levels checked regularly, get your daily dose of sunshine and supplement when necessary.