I've said it once. I've said it a million times. They haven't found a cure for Alzheimer's Disease because they don't know what causes Alzheimer's Disease. They don't know the cause of AD because there is no one cause. There are genes that make you more prone to the disease (such as ApoE), but there is no AD gene. There is no vitamin deficiency, toxicity, gene or one thing that causes AD. Instead, it appears that AD is a multifactorial disease that is caused by a different mix of things in each individual person.

The only true cause that continues to have overwhelming evidence confirming it's role in causation of AD is inflammation... But that's where the multifactorial thing comes in. Whether it be a bad diet, head injury, drugs, infections, thoughts, toxins or autoimmunity, many things cause inflammation. Therefore, many things can contribute to one developing Alzheimer's Disease. The Alzhimer's Disease brain is a brain on fire, and research continually shows us that the fire starts many, many years before we see the smoke. There is no magic bullet to prevent Alzheimer's Disease; you just have to live a healthy life.

Everybody has heard of heavy metals. The bad guys of the periodic table, heavy metals such as Mercury and Lead have been associated with a wide range of diseases and disorders. But what about other metals? What about the metals we thought all along were good for us? In comes Iron (Fe) and Copper (Cu), two transition metals that may be new culprits in the AD puzzle and inflammation in general. But everybody knows we need iron to make hemoglobin, so having too much couldn't possibly be a bad thing, right? Wrong. The type of Iron or Copper dictates how it functions in the body, and having too much of the "bad" kind can wreak all sorts of havoc on the body.

Transition metals are unique because they exhibit two or more oxidant states (for example, Fe+2 and Fe+3). This is what makes able to participate in chemical reactions and makes them particularly useful in day to day bodily functions. This characteristic also makes them remarkably able to bind with stuff we don't want them to bind to and create free radicals. Free radicals like the hydroxyl ion are then able to scamper about the body binding to molecules and altering their function... This is the hallmark of inflammation- free radical damage that alters the body's normal molecules, and subsequently alters the function of those molecules.

For simplicity's sake, there are two basic types of metals: free metals (inorganic) and metals that are bound to other stuff (organic). Weather or not these metal ions are bound to a molecule (such as a protein) will affect how they are absorbed and processed by the body. Organic Copper and Iron compounds are absorbed a little slower by the intestinal tract, but more importantly they are processed differently than their inorganic brethren. Food Copper (and Iron) must go through additional processing in the liver before it is allowed into systemic circulation (the blood stream). Typically the body keeps most of it's Copper bound to proteins and keeps the more unstable, inflammatory free Copper to a minimum (5-15% total Cu in the blood). When inorganic Copper is absorbed it immediately contributes to the free Copper pool in the blood steam, bypassing the liver and increasing the risk of inorganic Copper induced oxidative stress [1]. Similar is true of Iron's story.

The proposed mechanisms of how inorganic Copper and Iron contribute to the inflammation in AD are numerous, but here are a few:

Copper has been shown to bind with homocysteine (an inflammatory molecule that is related to one's intake of B vitamins) and increase the oxidation of LDL- the so-called "bad" cholesterol [1, 2]. Cu, unlike Zinc, Nickel, Aluminum, or Cadmium, has been shown to compromise the stability of Ubiquitin. The Ubiquitin-Proteasome System (UPS.. haha) is the main pathway by which we eliminate misfolded proteins from our cells such as the notorious Beta Amyloid of Alzheimer's Disease and the Lewy bodies that are seen in Parkinson's Disease [5]. This may result in decreased clearance of these proteins in the brain, eventually leading to a build-up, cellular toxicity and death. Even the so-called AD gene may be related to Cu metabolism! The three different ApoE Alleles differ in the number of cysteine binding sites they posses- the part of the molecule that is able to bind to Copper. ApoE 2 has two binding sites, ApoE3 has one and ApoE 4 has none. This correlates with the risk of AD associated with each of those alleles (2 is protective against AD, 3 is neutral and 4 increases your risk). It has now been postulated that the risk associated with the ApoE alleles is due to ApoE 4's inability to bind and remove Copper from the brain [2]. 

Like Copper, Iron is necessary for human life, but an excess of inorganic Iron may be one of the inflammatory triggers in the AD cascade. Several studies have shown that Fe accumulates in Beta Amyloid plaques [3]. Not only that, but the presence of Iron during plaque formation not only increases the synthesis of Beta Amyloid by it's interaction with PACE, but it has been shown to favor the more toxic form of the plaques [4].

As in all things in life, your current inflammatory status will play a role in how you handle further stressors. Inflammation disrupts the blood brain barrier (BBB) and alters it's ability to regulate the transport of Fe to and from the brain [4]. HAMP, the gene that is responsible for the production of Hepcidin (THE Iron homeostasis hormone in our bodies) is directly influenced by inflammatory cytokines such as IL-1B and IL-6 [4]. Similarly, the mechanism I mentioned above of how Copper binds to homocysteine to produce inflammation would probably not be that big of a deal if you didn't have high homocysteine levels in the first place!

So what can we do to avoid the damage caused by inorganic Copper and Iron?

1. Decrease your inflammatory burden. I've said it once. I've said it a thousand times. This is highly individual, since no two of us have the same health problems. Weather it be being overweight, not exercising, a crappy diet, diabetes, gastrointestinal issues, an autoimmune disease, or whathaveyou, get healthier. If you're not inflamed it appears that these pesky metals won't hurt you as much.

2. Avoid inorganic Copper and Iron. Brewer et al [1] and several others have identified the two major sources of inorganic Copper and Iron as being Copper in our drinking water from Copper pluming and multivitamins (like Centrum). Interestingly, Brewer et al [2] points out in his paper that all of the industrialized countries are dealing with increased rates of AD- Except Japan. This is noteworthy, because Japan is the only industrialized country that does not use Copper pluming. In contrast, about 85% of US homes have Copper pluming [2]. Here's what you can do to minimize the amount of Copper that leaches into your water and avoid inorganic Copper and Iron:
     A. Filter your water. Brita.com does state that their filters filter Copper, but I can not say to what extent. Reverse osmosis is the best at
     filtering things like Cu and Fe, but is more expensive.
     B. Do not get hot water from the tap- Hot water will leach more Cu from the pipes than cold water- Warm the water after it comes out of the
     faucet.
     C. Check the acidity of your water. The more acidic your water, the more it will etch the Copper pipes.
     D. Avoid multivitamins like Centrum. They look like a big ol' piece of metal that they painted red anyway, so who are we fooling when we
     take those? There is no substitute for the vitamins and minerals you get from a healthy diet. Period.

 3. Zinc has been shown to lower levels of free Copper in the blood [2], so making sure you have adequate Zinc levels may be a good idea if you think you're at risk of ingesting too much Copper (perhaps people who have really acidic water at home and can not afford to install a reverse osmosis system).


In health,

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

References:
[1] Brewer, G. Risks of Copper and Iron Toxicity during Aging in Humans. Chem Res Toxicol 2010, 23, 319-326 (PMID 19968254)
[2] Brewer, G. Copper Toxicity in Alzheimer's Disease: Cognitive Loss from Ingestion of Inorganic Copper. J of trace elements in medicine and biology 26 (2012) 89-92. (PMID 22673823)
[3] Batista-Nascimento, L. et al. Iron and Neurodegeneration: From Cellular Homeostasis to Disease. Oxidative Medicine and Cellular Longevity, May 2012 (PMID 22701145)
[4] Mesquita, S. et al. Modulation of Iron Metabolism in Aging in Alzheimer's Disease: Relevance of the Choroid Plexus. Frontiers in Cellular Neurosci. May 2012 (PMID 22661928)
[5] Arnesano, F. et al. Copper-Triggered Addregation of Ubiquitin. PLoS ONE 2009 Sept 16; 4(9) e7052 (PMID 19756145)

As many of you are well aware, the paleo diet is very near and dear to my heart. I'm not a hard-core paleo person, however, and tend to advocate a similar approach to Chris Kresser. I think that there is much to be learned from the paleo world, and the paleo diet is a great starting point for most people. I don't believe that we all need to be 100% grain-free, nor do we all have to avoid lectins like the plague, but the amount and ways in which we can deviate from this basic blueprint are dictated by our individual health, genetics, and environment.

There was a new study recently in which researchers compared metabolic syndrome markets in small groups on the paleo diet and the Dutch healthy diet (similar to the Mediterranean diet). Here are my thoughts on that study.

The Good:
Over the course of the study, the participants on the paleo diet saw change in their metabolic syndrome markers while those on the Dutch diet did not.

The Limitations:
The study only followed participants for two weeks. While this was long enough to see some change, I would have liked to see the study be conducted for much, much longer (a year or more would be ideal).

The authors didn't go into enough detail when explaining the diets they prescribed. Specifically in the paleo group, I would want to know the following:

1. The authors say that "lean meats" were allowed. Does this mean that red meats and other meats were not allowed? Were organ meats consumed?
2. Seafood was not mentioned on way or another. Was is included? Excluded?
3. Were "paleo" sweets and treats limited, or were they fully open-game?
4. Were "paleo" carbohydrate dishes monitored (potatoes, paleo breads, etc)?
5. Was the quality of the meat and eggs consumed monitored or specified? Were the participants eating normal grocery store meats, or grass fed meats and fresh eggs?
6. Were participants allowed to go "meat crazy" (and bacon-crazy), as many in the paleo world do, or was more of an emphasis placed on vegetables? Many of the brightest minds in the paleo world would agree that the later is favorable.

Thoughts for the future of paleo research:
While there is a hand full of studies on the paleo diet (read here, here, and here), most have been very small and short. The obvious way to improve would be to do longer, bigger studies.

I think we can do even better than that, though. I would personally love to see a study comparing two variations of the paleo diet with other diets. I would call those variations the "common paleo diet" and the "ideal paleo diet", keeping in mind that the use of the word "ideal" does not imply that this diet is the ideal diet for everybody.

As you can see, there are actually a lot of ways in which people's execution of the paleo diet can differ, and I think that needs to be accounted for when critically evaluating the diet in research. Similarly, the same argument could be made of the vegetarian diet (below) or just about any other diet.

All that's left is to find somebody to fund this crazy awesome research idea of mine and we'll be good to go!

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

As many of you know, I am honing in on the last few months of my program to become a Nutritional Therapy Practitioner (NTP) through the Nutritional Therapy Association (NTA). But what is an NTP, and how does this credential differ from that of a nutritionist or a dietitian?


Registered Dietitians (RD) must hold at least a bachelor's degree from an accredited program and pass their state dietetics examination. This is a licensed profession in almost every state.

Nutritionists are not licensed, but generally in most states one has to posses a degree in nutrition in order to call themselves a nutritionist. This is not true of all states, however. Some states such as New Jersey have no regulation whatsoever and allow even people with no training to call themselves "nutritionists", so buyer beware.

The down-side to both of these is their training (ironically). Unfortunately, like the pharmaceutical industry and it's influence over most medical school curricula, both of these degree programs are heavily influenced by "big food" (companies such as McDonald's, Coke, and Kellogg's) . After this article went viral last year people are becoming increasingly aware of big food's influence on both professions formal education and continuing education. Much of what is taught in these programs is the same old, ineffective, potentially harmful and just plain old untrue dogma we've been stuck with for years- fat makes you fat, low calorie and low fat is best, cholesterol is the root of all evil (and heart disease), and the pinnacle of a healthy diet is the vegetarian or vegan diet.

That being said, there are more and more forward thinking RDs now,including this woman in Raleigh. She has an article about why one may wish to choose to pursue an RD above another program, available here.

So what is an NTP?

Nutritional Therapy Practitioners (NTP) are not licensed in any state as of yet, but hold a certification from the Nutritional Therapy Association. Having gotten through almost the entire curriculum now, I can honestly say that it beautifully blends the world of holistic, ancestral nutrition with a functional medicine-like mindset. NTPs appreciate the fact that everything starts with the gut, and thus start their work there and work their way out.

Because NTPs don't hold a license, they are not able to order and interpret labs. However, they do an exam and some basic tests that allow them to hone in on what your body needs non-invasively. I am particularly fortunate to be able to blend both functional medicine and nutritional therapy together due to my license as a doctor of chiropractic. If you can't find someone like me with both credentials in your area, partnering with one from each world (an NTP and a functional medicine doctor) is always a good bet, too.


In health,

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

I thought I'd finally write a follow-up to one of my most popular articles, Food Sensitivity Testing: What You Need To Know.

As I stated in that article, I'm actually not a huge fan of IgG food intolerance testing. I do use it occasionally with my patients, but it's never, ever one of the first things I do. This is partially because I have noticed that these tests tend to be very confusing and frustrating for the patient. Also, they tend to produce a high amount of false positives and false negatives, which is all the more frustrating for both doctor and patient.

To show why they can be confusing, I have provided an example of a test run through Genova Diagnostics below. Take a look at the dairy section- notice anything? They break diary down into seemingly random categories (some labs break dairy up even more). How can someone have a sensitivity to cheddar cheese but not cottage cheese? Or yogurt? Isn't it more likely that a patient with 1 or 2 red flags in this section has a casein or a whey sensitivity and should not eat any dairy?

Part of the reason for the high number of false negatives and false positives in this type of testing is because results can be highly dependent on the integrity of the patients gut. If you have a leaky gut, don't make enough stomach acid, or have small intestinal bacterial overgrowth (SIBO) all of those things will likely skew your results. I have seen patients come in with 20 or more "positives" on this type of testing, only to find out later that once we cleaned up their gut and healed their leaky gut, many went away.

This is why this type of testing is always a last-ditch effort in my office. I will only run this type of test once we have accounted for all the myriad of things that can skew the results. If we do all we can possibly do to clean up the gut and the patient still has symptoms, then and only then will I consider running this type of test.

In health,

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

Ah, protein shakes. For some reason or another, you have fooled us for years into thinking you are healthy. Brava, protein shake. Brava.

So here's the thing: It would be super easy for me to get up on my soap box and tell you that you should never, ever drink a protein shake or eat a protein bar... But that is an over-simplified answer to a not-simple problem, and that's not what I'm about if you couldn't already tell.

Ideally, nobody would ever have a need for protein shakes and bars, and it shouldn't be hard to see why I say that. They are both highly processed, and thus don't really qualify as "real food" in my opinion. They are often loaded with scary chemicals and more sugar than you'd think (many protein bars have upwards of 20 grams per bar!) for something touted as being healthy.

In the real world, however, life happens and we get into situations where we are unable to eat something really healthy. If you have a choice between fast food (or worse- gluten! Yikes!) and a protein product, I'd rather you choose the protein product as long as it's good quality. I see protein shakes and bars as a viable emergency food-replacement, but not as real food. It's better than eating something downright harmful, and it's better than starving and getting a hypoglycemic headache, but I can't say much more beyond that for most folks.

General Rules Of Thumb For Consuming Protein Shakes and Bars:
1. Never eat protein bars or shakes for more than 2-3 meals per week.
2. If there is a viable, healthy, real food option available eat that instead
3. Always get a good quality protein shake or bar.
4. Always eat some fat with your protein product. Pack some "fat bombs" to take with your shake and you'll be good to go!

Allow me to elaborate on each point.

1. If you find yourself consuming meal replacements for more than 2 meals per week it's a sign that something in your life needs to change. That may mean that you need to cook more, plan better, or hire a personal chef to cook for you, but something needs to change so that you rely on these items less.

2. Number two needs no further explanation, I hope.

3. By "good quality" I mean you should be able to pronounce everything in the product and having at least a vague idea of why it's there. This basically eliminates anything that you can buy in a store, including Whole Foods. Undenatured Whey can be good if you can handle dairy, but make sure it's from a grass fed source. For those of us who can't do dairy, I recommend (and carry in my office) Thorne's MediPro Vegan, which is a pea protein shake.

4. Fat is needed to properly digest and use dietary protein, and eating a large amount of protein without fat is just asking for trouble. If you don't want to take a shot of coconut oil with your shake "fat bombs" are easy enough to make and there's a million recipes on the internet. Simply search for fat bomb in Pinterest or Google and have at it. If you are sensitive to dairy, you will obviously want to make varieties that use coconut rather than dairy.


Now it's time for you all to spill the beans! Do you feel that you rely too heavily on protein shakes and bars? If so, what do you plan to do about it? If you're in the Raleigh/Durham/Chapel Hill area of North Carolina be sure to check out this paleo-friendly personal chef!

In health,

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.