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arewetoxicEach year the toxic burden in our air, food and water – and thus our bodies – grows higher than ever before. Companies manufacture 6.5 trillion pounds of 9,000 different chemicals each year. That’s about 3.25 billion tons – enough to fill an ocean supertanker. And the same companies release over 7 billion pounds of 650+ different pollutants into the atmosphere and water.

A recent study by the Environmental Working Group (EWG) found the average person has over 91 toxic chemicals in their body. Some people had as many as 165, including 76 known to cause cancer, 94 known to be toxic to the brain and nervous system, and 79 known to cause birth defects and abnormal fetal development.

Another EWG study found an average of 200 industrial compounds, pollutants, and other chemicals in the umbilical cord blood of 10 newborn babies. Chemicals found in the second study included the organochlorine pesticides DDT and dieldrin, perfluorochemicals, brominated fire retardants, PCBs, polyaromatic hydrocarbons, polychlorinated and polybrominated dioxins and furans, polychlorinated naphthalenes, and mercury.

If that wasn’t enough, the Standard American Diet itself is highly toxic. Processed and refined foods, industrial seed oils, high fructose corn syrup, and even so-called healthy foods like whole grains and soy all have a toxic effect on the body.

How environmental toxins cause diabesity

An increasing amount of evidence has linked exposure to toxins with both obesity and diabetes. Toxins cause inflammation and immune dysregulation. And as you know from reading this series, obesity and diabetes are autoimmune, inflammatory diseases.

I’ve already discussed the role of food toxins in the diabesity epidemic, so in this article we’re going to focus on how industrial chemicals in our air, water and soil contribute.

There are several mechanisms involved. Environmental toxins:

  • interfere with glucose and cholesterol metabolism and induce insulin resistance;
  • disrupt mitochondrial function;
  • cause oxidative stress;
  • promote inflammation;
  • alter thyroid metabolism; and,
  • impair appetite regulation.

There are probably other mechanisms that we don’t yet understand. But the ones I listed above are certainly enough to explain the link between toxins and diabesity.

Evidence supporting the role of toxins in the diabesity epidemic

A while back I wrote about a study showing that a chemical called bisphenol-A (BPA), found in packaged foods and beverages, causes obesity in mice.

A more recent study published in JAMA found that BPA increases the risk of diabetes, heart disease, and abnormal liver function.

A 2010 study in Environmental Health Perspectives found that exposure to organic pollutants leads to insulin resistance and metabolic dysfunction in rats.

A review paper by researchers in Korea reached a similar conclusion:

…the metabolic syndrome is the result of mitochondrial dysfunction, which in turn is caused by exposure to persistent organic pollutants.

A National Health and Nutrition Examination Survey 1999-2002 observed a significant correlation between blood levels of six common persistent organic pollutants and diabetes. Those who had the highest serum levels of pollutants had a dramatically higher risk for diabetes.

Canadian Aboriginals and Great Lakes sport fishermen both have higher rates of diabetes from eating contaminated seafood.

I could go on, but I think you get the point. Toxins are making us fat and diabetic.

Okay, so I’m toxic! What do I do about it?

The most obvious first step is to remove all food toxins from your diet. This means ditching processed and refined foods, industrial seed oils, and high fructose corn syrup, as well as grains, legumes and other foods with toxic effects on the body.

The second step is to take steps to reduce your exposure to chemicals at home. This means choosing non-toxic household cleaning, bath, beauty and hygiene products.

The third step is to support the body’s natural detoxification capacity so you can effectively deal with the toxins you do get exposed to. This is a crucial step, because no matter how careful we are, there’s no way to completely avoid toxins.

Compounds that support health liver detoxification include:

  • Protective compounds like milk thistle and artichoke leaf extract
  • Bile stimulants such as dandelion and curcumin
  • Bile motility enahncers (cholagogues) like dandelion, beet juice and coffee enemas
  • Antioxidants like vitamins C & E, zinc, selenium and lipoic acid

For those of you that would like some support in this area, I’ll be offering a “Paleo Detox” program sometime early next year. It’s a 30-day, supervised detoxification program incorporating a paleo diet, targeted nutrients to support healthy liver function, supportive and educational weekly meetings, and guidelines for integrating the positive changes you’ve made in the program into your day-to-day life. I will offer both local (SF Bay Area) and long-distance (via webinar) programs. Stay tuned for a future announcement on this.

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Need help? I consult with patients locally in the SF Bay Area and around the world via telephone & Skype. Please contact me to learn more.

genesThis turned into a pretty long article, so I’m going to provide a summary up-front for those of you who are time-challenged:

  • Genetics play a significant role in type 2 diabetes and obesity;
  • but, recent evidence shows that genetics alone don’t cause diabetes without environmental triggers and a leaky gut.
  • The bad news is that almost everyone is exposed to these triggers and leaky guts are not uncommon;
  • but the good news is that a leaky gut can be healed, which may slow or even reverse the autoimmune process that causes type 2 diabetes.

So far in this series we’ve looked a model of understanding diabetes and obesity as autoimmune, inflammatory diseases. We’ve explored how obesity contributes to diabetes, and how insulin resistance contributes to obesity. And we’ve seen that, while diabetes and obesity often go hand in hand, that isn’t always the case; even skinny people get type 2 diabetes.

I hope you’re aware by now that obesity and diabetes are not simply diseases of sloth and gluttony. Nor are they caused by eating too many carbohydrates (more on this later). You’ve probably also noticed that some people get fat and stay fat despite exercising regularly and not eating much, while others can eat ridiculous quantities of food, never exercise and stay lean.

Obviously there are other factors at work here, and that’s what we’re going to talk about in this article. Specifically, I’m going to address the role of genetics as a risk factor for diabesity. There’s absolutely no question that genetics do play a significant role in both obesity and diabetes. To some extent genetics explain the apparent paradoxes I mentioned in the previous paragraph. But it’s equally important to understand that being genetically predisposed to develop diabesity doesn’t guarantee that you will. In fact, recent research suggests that other environmental and physiological factors must be present to activate the genetic patterns.

The triple whammy of genes, toxins and a leaky gut

In the second article in this series, I presented evidence that obesity and diabetes are autoimmune, inflammatory disorders. This is important to understand, because it suggests that we can learn more about what might cause these conditions by studying other autoimmune diseases. Autoimmunity is one of the hottest topics in the scientific literature. And although there’s still much we don’t understand, significant progress has been made over the past two decades in illuminating the mechanisms involved in autoimmune disease.

One of the heavyweights in the field is a researcher named Alessio Fasano. In 2009 he published an article in Scientific American called “Celiac Disease Insights: Clues to Solving Autoimmunity“. Fassano argues that all autoimmune diseases – not just celiac disease – involve a triad of factors: genetic susceptibility, an environmental trigger and a gut abnormality. Each of these is a risk factor for autoimmunity on its own, but Fassano’s work shows that those who go on to develop full-fledged autoimmune diseases (including diabesity) almost always have all three.

This theory – which is well supported by the evidence, as we’ll see – makes perfect sense when you understand the principles of epigenetics. Up until very recently, scientists believed that the affects of nurture (environment) on a species’ nature (genes) took generations to develop. Darwin’s Origin of Species taught us that evolutionary changes take place over millions of years of natural selection, not in a single lifetime. But recent work by pioneers like Dr. Lars Olov Bygren of the prestigious Karolinska Institute in Stockwholm has shown that powerful environmental triggers can bypass evolution and pass traits on in a single generation.

Epigenetics is the study of gene activity that doesn’t involve changes to the genetic code, but still gets passed down to at least one successive generation. These inherited patterns of gene expression (known as the “epigenome”) hover above the genome and are what determine whether your genes get switched on or off, and at what intensity. This epigenetic blueprint determines what effect environmental factors like diet, stress and toxins will have on genes passed from one generation to the next.

What this means is that, yes, genes are important. But it also means that the genes that might predispose us to develop conditions like diabesity may only be activated in the presence of environmental triggers like poor diet, toxic chemicals and a leaky gut. In the sections to follow we’ll look at each factor in the “genes-toxins-gut” triad in more detail.

Are there genes for diabesity?

There is no question that genes contribute to both obesity and diabetes. Studies on identical twins have shown an 80% concordance for type 2 diabetes (T2DM). That means that if one twin develops T2DM, there’s a 4 out of 5 chance the other one will too. And lest you think this might be described by something shared in the twins’ environment, there is no such concordance between fraternal twins.

That said, 1 in 5 of those identical twins carrying the same genes didn’t become diabetic, so there is clearly an environmental factor at work as well. This is exactly what you’d expect to see if you’re familiar with epigenetic principles.

There’s now a very long list of genes associated with T2DM and obesity, including TCF7L2, HNF4-a, PTPN, SHIP2, ENPP1, PPARG, FTO, KCNJ11, NOTCh3, WFS1, CDKAL1, IGF2BP2, SLC30A8, JAZF1, and HHEX. (I can’t understand how geneticist’s brains don’t explode from acronym overload.) And studies pretty clearly show that the more of these genes you have, the higher your risk of diabesity. With each abnormal gene, beta cell dysfunction (which in turn compromises insulin production) gets worse. If you’re unlucky enough to have five of them, your beta cell glucose sensitivity and insulin production is likely to be up to 40% lower than a person without those genes. That’s no small difference.

Other studies have shown that genetic abnormalities predict T2DM independently of conventional risk factors, and that genetic defects in mitochondrial function cause insulin resistance in lean, otherwise healthy offspring of type 2 diabetics.

It’s not “nature versus nurture” – it’s “nature plus nurture”

We’ve seen so far that genes are a big factor in type 2 diabetes, but that not everyone with these genes develops diabetes. Environmental factors are the missing link that determine whether these bad genes get switched on and cause full-fledged diabesity.

So what might those environmental factors be? I’m just going to summarize them here, because many of them will be the subject of future articles in the series. They are:

  • Your mother’s diet during pregnancy, as well as her gut flora and whether or not she had gestational diabetes.
  • Your diet. In particular, how much refined carbohydrate, fructose and industrial seed oils you eat.
  • Pesticides, herbicides and PCBs
  • Environmental chemicals like arsenic and BPA
  • Prescription drugs, especially antidepressants (SSRIs) and chemotherapy..

It seems that at least one of these environmental factors must be present for the diabetes genes to be activated. Take a look at that list. Those aren’t exactly rare. They’re ubiquitous. I’d venture to say that all people living in the modern world are affected to some degree by at least one of them. Even those who eat a pristine diet and avoid pharmaceutical drugs can’t escape the toxins in our water, air and (even) organic food. This, my friends, is why we have a diabetes epidemic on our hands.

“All disease begins in the gut.” – Hippocrates

The phrase “leaky gut” used to be confined to the outer fringes of medicine, employed by alternative practitioners with letters like D.C., L.Ac and N.D. after their names. Researchers originally scoffed at the idea that a leaky gut contributes to autoimmune problems, but now they’re eating their words. It has been repeatedly shown in several well-designed studies that the integrity of the intestinal barrier is a major factor in autoimmune disease.

This new theory holds that the intestinal barrier in large part determines whether we tolerate or react to toxic substances we ingest from the environment. The breach of the intestinal barrier (which is only possible with a “leaky gut”) by food toxins like gluten and chemicals like arsenic or BPA cause an immune response which affects not only the gut itself, but also other organs and tissues. These include the skeletal system, the pancreas (hint: diabetes!), the kidney, the liver and the brain.

Researchers have identified a protein called zonulin that increases intestinal permeability in humans and other animals. This led to a search of the medical literature for illnesses characterized by increased intestinal permeability (leaky gut). Imagine their surprise when the researchers found that many, if not most, autoimmune diseases – including celiac disease, type 1 diabetes, multiple sclerosis, rheumatoid arthritis and inflammatory bowel disease – are characterized by abnormally high levels of zonulin and a leaky gut.

They also found that gluten causes excess production of zonulin in certain people with a genetic susceptibility. This could explain why gluten directly contributes to leaky gut in certain populations.

What these discoveries have shown us is that genetic susceptibility and environmental triggers alone may not be enough to explain autoimmune disease. In order for environmental triggers to damage or activate faulty genes, a third factor must be present: a leaky gut.

Recent evidence has also revealed that the gut flora play a significant role in determining the permeability of the gut, and that diabetics and healthy people have significantly different gut flora (suggesting that dysregulated gut flora plays a role in diabetes).

One study showed that showed that the overall number of colonic bacteria between diabetics and non-diabetics was similar, but that the proportion of species was different. Diabetics tended to have higher numbers of Bacteroidetes and Prevotella, which are gram negative bacteria that produce molecules called lipopolysaccharide (LPS). And guess what? LPS is known for its potent stimulation of the immune system.

Consider a hypothetical woman with a few genes that predispose her to diabetes. She eats a typical American diet, which is full of refined flour, industrial seed oils and fructose. Her mother had poor gut flora, and chose to bottle-feed her instead of breast-feed, both of which contribute to poor gut flora and intestinal permeability. This poor woman is now a walking diabetes time bomb. Anytime she ingests a toxin – whether it’s gluten or a chemical – it leaks through her gut and has the potential to activate her diabetic genes.

The bad news is that this is an incredibly common scenario. The good news, however, is that this new theory (that genetic and environmental factors are only problematic in the presence of a leaky gut) has an upside. According to Dr. Fasano:

…once the autoimmune process is activated, it is not self-perpetuating; rather, it can be modulated or even reversed by preventing the continuous interplay between genes and environment. As tight junction dysfunction allows this interaction, new therapeutic strategies aimed at re-establishing the intestinal barrier function offer innovative, unexplored approaches for the treatment of these devastating diseases.

In other words, it’s possible that you can’t get type 2 diabetes without a leaky gut, and that by healing your gut the autoimmune process driving T2DM may be slowed or even reversed.

Pretty cool, huh?

A final note: it’s not exactly true that improving metabolic health by repairing a leaky gut is an “unexplored” approach. Plenty of “alternative” practitioners have been doing this for years. In fact, they pioneered the techniques at a time when researchers were still snickering at the idea of “leaky gut”. Just another reminder of the danger of academic arrogance.

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Need help? I consult with patients locally in the SF Bay Area and around the world via telephone & Skype. Please contact me to learn more.

Although most consumers have heard of grass-fed or pasture-raised animal products, confusion still abounds about what their benefits are and why we should choose them over commercially-raised animal products.

It is important to note that the “organic” label does not have anything to do with whether an animal product is pasture-raised or not. It’s possible, and indeed common, for an organic meat or dairy product to come from cows raised in confinement feedlots. Likewise, it is also common to encounter pasture-raised animal products that do not have the “organic” label. This often occurs when the farm raising the animals is too small to afford the expensive organic certification process. In these cases, if one knows the farmer and his or her practices, it is preferable to choose the non-organic, grass-fed source over the organic, commercially-raised alternative.

Many environmental and ethical objections to eating meat stem from the tremendously destructive and cruel practices of commercial feedlot meat production. When meat and dairy animals are raised in a humane and ecologically responsible manner, these objections (which I entirely agree with in the case of commercial production) are no longer defendable.

In this two-part article I will cover the benefits of pasture-raised animal products. In part I, we’ll examine the environmental and economic benefits, and in part II, we’ll look at the nutritional and health benefits. Information is adapted in part from the Eat Wildwebsite.

Back to the pasture
Pasture-raised animals live on the range where they forage on their native diet. They are not sent to feedlots to be fattened on corn, soy or other grains which they do not normally eat. Pasture-raised livestock are not treated hormones or feed them growth-promoting additives. As a result, the animals grow at a natural pace. For these reasons and more, grass-fed animals live low-stress lives and are so healthy there is no reason to treat them with antibiotics or other drugs.

More Nutritious
A major benefit of raising animals on pasture is that their products are healthier for you. For example, compared with feedlot meat, meat from grass-fed beef, bison, lamb and goats has two to four times more omega-3 fatty acids. Meat and dairy products from grass-fed ruminants are the richest known source of another type of good fat called “conjugated linoleic acid” or CLA. When ruminants are raised on fresh pasture alone, their products contain from three to five times more CLA than products from animals fed conventional diets. Grass-fed meat also has more vitamin E, beta-carotene and vitamin C than grain-fed meat.

Factory Farming
Raising animals on pasture is dramatically different from the status quo. Virtually all the meat, eggs, and dairy products that you find in the supermarket come from animals raised in confinement in large facilities called CAFOs or “Confined Animal Feeding Operations.”  These highly mechanized operations provide a year-round supply of food at a reasonable price. Although the food is cheap and convenient, there is growing recognition that factory farming creates a host of problems, including:

  • Animal stress and abuse
  • Air, land, and water pollution
  • The unnecessary use of hormones, antibiotics, and other drugs
  • Low-paid, stressful farm work
  • The loss of small family farms
  • Food with less nutritional value

Unnatural Diets
Animals raised in factory farms are given diets designed to boost their productivity and lower costs. The main ingredients are genetically modified grain and soy that are kept at artificially low prices by government subsidies. To further cut costs, the feed may also contain “by-product feedstuff” such as municipal garbage, stale pastry, chicken feathers, and candy. Until 1997, U.S. cattle were also being fed meat that had been trimmed from other cattle, in effect turning herbivores into carnivores. This unnatural practice is believed to be the underlying cause of BSE or “mad cow disease.”

Environmental Degradation
When animals are raised in feedlots or cages, they deposit large amounts of manure in a small amount of space. The manure must be collected and transported away from the area, an expensive proposition. To cut costs, it is dumped as close to the feedlot as possible. As a result, the surrounding soil is overloaded with nutrients, which can cause ground and water pollution. When animals are raised outdoors on pasture, their manure is spread over a wide area of land, making it a welcome source of organic fertilizer, not a “waste management problem.”

Make sure to see part II for the nutritional and health benefits of pasture-raised animal products</>

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