Microbes : The Gut-Brain-Skin Link

Following up on my previous post in which I wrote of gastrointestinal (GI) microbiota and its role in inflammation, hunger signaling and obesity, I would now like to expand on this area to examine the intricate link between our GI health, our mental and emotional states, as well as the quality of our skin, as influenced by dietary intake.

The gut-brain-skin axis is not a novel hypothesis. As far as 70 years ago, dermatologists John H. Stokes and Donald M. Pilsbury first concluded that emotional and mental distress could upset the delicate balance of microbiota in our digestive tracts, thereby causing inflammation. It was then suggested that bacterial induced inflammation increased GI permeability (what is now known as the "leaky gut"), setting the stage for systemic and local inflammation such as skin problems. 

During that same period, research also showed about 40% of individuals in a study with acne often produced insufficient amounts of stomach acids, which attracted movement of harmful bacteria from the lower GI, i.e. the colon, to the upper parts of the GI, causing an imbalance of beneficial microflora. At the same time, another study found low levels of "good bacteria" in the feces of patients with mental disorders, further substantiating the link between gut and brain health.

Today, this theory is gaining even more momentum as modern day diets wreck havoc in our digestive systems, ruining the natural balance of gut microflora. Consequently, we are seeing rising incidences of gastrointestinal disorders such as bloating, diarrhea, constipation, irritable bowel syndrome, gastric reflux. Through multiple ways, gut health has also been known to cause depression, anxiety, chronic fatigue, as well as skin disorders such as acne vulgaris, rosacea, dermatitis.

According to a recent report published in an issue of Gut Pathogens, underproduction of stomach hydrochloric acid (hypochlorhydria) encourages the growth of bad bacteria, a condition known as small intestinal bacterial overgrowth (SIBO). Manifestations of this condition bear wide-ranging degrees of seriousness, from bloating, diarrhea, constipation, to severe malabsorption (1).

SIBO was also detected in those individuals afflicted with fibromyalgia and chronic fatigue syndrome. Furthermore, SIBO could lead to competition for nutrients from excess bacteria and as a result, cause the malabsorption of macronutrients, B vitamins and other micronutrients. Additionally, SIBO was closely linked to emotional disturbances such as depression and anxiety. It was reported that those who were afflicted with acne rosacea were 10 times more likely to possess conditions of SIBO, when compared with individuals of healthy skin.

Gastrointestinal Permeability, a.k.a. leaky gut, was yet another condition closely associated with acne vulgaris. Bacterial toxins from the gastrointestinal tract were often observed in the blood stream of acne sufferers, strongly suggesting a compromised gastrointestinal tract which allowed such toxic materials to cross the tight junctions lining intestinal walls, over into the circulatory system. Both increased gut permeability as well as irritable bowel syndrome have also been evidenced to associate with depression and anxious behavior. 

According to the report, constipation was considered to be "the rule" in acne sufferers. A longer gut transit time also related positively with depression, which corroborated with an earlier study indicating that bacterial toxins caused depression-like behavior in mice.

Not only have Mental Health patients been reported to posses reduced levels of L.acidophilus, it appeared that the "mental health impairment" scores of mental patients were much higher if they simultaneously possessed conditions of acne vulgaris. Some researchers have also identified a specific group of psychological traits, referring them to what they called "the acne personality" which predicates that anxiety, depression and stress reactivity precedes disease onset of acne vulgaris. Hence, the triangle of influence between our gut-brain-skin can hardly be overstated.

Other observations reflected the direct correlation between increased dietary intake of western "sweet, fried, calorie-rich foods with low nutrient density" with both decreased beneficial microbiota in the gut, together with increased risk of acne. It was also duly noted that incidences of acne were extremely rare in hunter-gatherer communities even though such populations have vastly increased contact with soil organisms. Poor dietary habits such as adoption of the western diet led to the elimination of good bacteria in our digestive systems.

The efficacy of oral Probiotics in attenuating the gut-brain-skin inflammatory processes was also examined in the report. Administration of oral probiotics controlled the release of inflammatory properties in both skin and intestinal tract, and decreased both lesion counts and sebum production.  At the same time, the use of probiotics also increased levels of tryptophan, serotonin, dopamine as well as the production of omega-3 fatty acids in tissue cells, leading to significant improvements in feelings of depression, anger, anxiety as well as lowered cortisol. Application of oral probiotics influenced a peptide known as substance P, which was understood to be the mediator for communication between the gut, brain and skin. 

At this point, I would like to highlight some natural and delicious ways to add "friendly" microorganisms to our guts. In her revealing book Deep Nutrition, the author Dr Catherine Shanahan talked about the many virtues of adding fermented foods to our diets. According to Dr Shanahan, microbes in fermented foods "literally fight for our lives". In our bodies, they act as our defense against pathogens, improving our guts' ability to absorb nutrients. They also neutralize toxins which would otherwise be harmful, and in doing so, they themselves are transformed into nutrient powerhouses for our benefit. Dr Shanahan even mentioned an ancient Egyptian skin treatment using microbe-infused blends of fats as topical application (2).

Of course, this article would not be complete without a big warning on the detrimental effects of sugar consumption on gut microbiota, brain functions, and skin. Indeed, sugar (in ALL forms), is the chow of choice for pathogenic microorganisms. These microbes feasts on sugar, leading to an overgrowth of harmful microflora. Additionally, sugar has been known to be an immunity suppressant, making us susceptible to invading parasites, viruses and bacteria. 

Never mind that it is fine gourmet for germs, turns out that the "icing" on this icky cake also has direct damaging effects on our minds and skin. Sugar messes with the dendrites (branch like arms) on our brain cells and interferes with cell-to-cell communication, leading to Alzheimer's, dementia and learning difficulties.

And to top it all off, sugar glycates with proteins, literally creating a sticky mess in our bodies, causing tissue breakdown all over our bodies i.e. think wrinkly sagging skin, that under chin jowl, foggy brain, creaky joints, stiffening arteries etc. Yes, sugar makes us stupid AND old.

When I speak of avoiding sugar, the common reaction I get is "everything in moderation", as if swinging away to the left or right of some “sugar middle ground” would jeopardize our sensible balanced diets. Well, here’s the thing : First, that phrase is hackneyed, overrated and misused. It would only be meaningful if we applied it to something that is good for us to begin with. As in : Fish is good for us, therefore eat it in moderation. Second, sugar is a surefire way to get bad bugs, bad skin, bad moods (the list is still growing). Therefore, if it is indeed moderately bad bugs, moderately bad skin and moderately bad moods that we want, then I guess a moderate consumption of sugar would be apt! 

One last word, or three. Eat fermented food.

References:

1. Bowe WP, Logan AC. Acne Vulgaris, Probiotics and the Gut-Brain-Skin Axis - back to the future?. Gut Pathogens. 2011 Jan 31;3(1):1.
2. Shanahan Catherine, Shanahan Luke. (2009). Deep Nutrition: Why Your Genes need Traditional Food. Lawai, HI: Big Box Books.

The Ancestral Diet : an excellent model

"What causes fatness?"

Is this some kind of a joke? What kind of moron would ask such a question? Of course, the answer is in overeating and sedentary lifestyles, isn't it? If all fat people simply ate less and moved more, then they would be slim, wouldn't they? Isn't it also true that in order to lose weight, we must impose caloric restriction or increase caloric expenditure constantly (or better yet, do both concurrently)?

Lets do a little quiz here to test your obesity smarts. True or False?

1. All fat people are bad at math and cannot count calories.
2. All fat people are weak and lack the willpower to resist food. 
3. All fat people eat more and move less than all lean people.

If you have answered True to any of the above, I don't need to know. The case I am trying to make is that the causes and hence, the treatment of obesity are greatly misunderstood today. Understanding how we got so fat requires a paradigm shift because conventional wisdom didn't solve anything, and certainly does not look like it is about to provide answers anytime soon. 

In my opinion, Gary Taubes in his book Why we get fat and what to do about it, has struck the nail on the head (1). He states that conventional wisdom as it stands today, has failed miserably to explain the cause of obesity. Citing a "crowded room" example, Mr Taubes points out that saying "overeating causes obesity" is analogous to saying that too many people entered a room therefore it is crowded. It merely states the obvious and offers no meaningful explanation as to what caused so many people to enter the room, making it crowded. Indeed, why do we overeat? According to Mr Taubes, the common wisdom of fatness got it wrong way around, that it is because we are obese that we overeat.

You see, obesity is not just a state of being really fat, and overeating is not just a behavioral aberration. Obesity is characterized by a complex host of metabolic abnormalities and inflammation. These factors mess up satiety signals driving us to overeat and at the same time, they cause abnormal production and accumulation of fats. Therefore, we become obese because we eat the type of food which causes obesogenic conditions in the first place, which then cause us to overeat. 

Now, if the real mischief indeed originated from the type of food consumed, the next question which begs to be asked would naturally be what types of food?

In my attempt to find some answers, I'd like to take us a step back, and first look at the health promoting efficacy of ancestral/traditional diets. A recent paper published in “Diabetes, Metabolic Syndrome, Obesity” comparing western diets with ancestral diets drew the conclusion that ancestral diets consistently produced lean bodies, high level of satiety, and excellent health markers (2).

At this point, I would like to point out that most studies which examine obesity and its dietary causes have done so by isolating a small part of one picture and then analyze that isolated part against the backdrop of existing information. This is akin to running around in the same circle - there is usually a high degree of conformity with the conventions of the day and hardly leaves room for maneuvers in terms of shedding new light on the issue.

Indeed, by researching only the dietary habits of western populations in the hope of singling out one "culprit", most studies have ignored a realm of possibilities which lay outside the western diet. For e.g., studies of western populations have missed the important fact that even the western individuals classified as "healthy" possess dramatically higher levels of leptin (hunger signaling hormone), elevated fasting insulin levels (hormone involved with carbohydrate metabolization and glucose uptake), as well as higher blood glucose, than those on ancestral diets.

In contrast, this report offers a different approach. Comparisons of ancestral diets with the western diet allow us to : (i) get to the source of a good diet which is proven to produce remarkable health, vs one which causes ill health; (ii) distill the relevant dietary differences between the two; (iii) build a coherent theory based on those facts.

Now, let me provide some background on the physiology of food-related inflammation and what it means to be leptin resistant, as they relate to obesity.

Diet-induced inflammation, leptin resistance.

It is well established that obesity is characterized by chronic inflammation and many syndromes of metabolic abnormalities. Severity of these conditions are linked directly to the levels of microbes in our gastrointestinal tract (GI). Bacterial lipopolysaccharide (LPS), a substance that forms the outer membrane of a certain bacteria, causes our immunity to react strongly at high levels. At lower levels, it creates a chronic state of inflammation in our bodies.

Additionally, pathogen-associated molecular patterns (PAMP), which is essentially our innate immune systems's defense response to the shedding of pathogens harbored in our bodies, also plays an inflammatory role. Both LPS and PAMP have been implicated in many modern diseases, including liver toxicity, non alcoholic fatty liver disease and obesity. The gateway to such inflammatory substances is thought to be via our GI tract. Administration of antibiotics to reduce gut microbes in experimental rodents successfully reduced circulating LPS, improved inflammatory markers and glucose tolerance, and caused a reduction in body weight and fat tissue.

Moreover, information on satiety is transmitted via the vagal nerve that innervates our upper GI to the central nervous system, based on the physical and chemical actions of food in our guts. Leptin resistance begins to occur when leptin's ability to regulate the vagal nerve's sensitivity to satiety signals is blunted, while simultaneously increasing appetite-stimulating hormones. At a later stage, leptin resistance progresses to the central nervous system directly, as sensitivity of the hypothalamus diminishes.

What is an ancestral diet?

Data from ten populations of modern day hunter-gatherers, gathered throughout the late 1920s to 2006, consistently showed that those eating ancestral diets possessed lean bodies and virtually no metabolic abnormalities nor cardiovascular diseases. 

Of the ten populations, the Tarahumaras, Mexican Pimas and Arizona Pimas, whose diets included graduating degrees of western foods such as beans, maize/wheat/flour tortillas, processed meats, white bread, cereals, juices etc, saw corresponding increments in obesity, hypertension and diabetes.

Interestingly, ancestral diets that yielded good health outcomes spanned a very wide and different range of macronutrient compositions, dietary fiber, and nutrient density and glycemic index. For e.g., the Kitavans who subsisted on starchy root vegetables, leaves, fruit, with little fish, meat or fat, had a diet high in carbohydrates up to 70%. Conversely, the Masai's diet of cow's milk, blood and unprocessed meat, contained up to 66% saturated fats with cholesterol levels matching those of the U.S. Another important feature to note was the abundance of food available to these populations. There were neither food shortages nor caloric restrictions.

Yet, it did not seem to matter if some diets were high in carbohydrate while others ate mostly fats or protein ; or if one population consumed more calories than another; or if some diets contained little fiber; or even if they consumed foods that were high on the glycemic index. In spite of all these vastly different variables and the abundance of food, they all shared the same undifferentiated outcome - impeccable health markers with no incidences of obesity, hypertension, metabolic syndrome, and heart diseases.

What do genes and physical activity have to do with it?

Apparently, not as much as some of us would like to believe. From research, it appears that Kitavan islanders maintained their metabolic advantage only for as long as they ate their ancestral diets. Those islanders who transitioned into the western diet invariably became overweight.

Furthermore, historical data showed other hunter gatherers populations to develop signs of metabolic diseases once western foods were introduced, even though their physical activity remained high.

Carbohydrate density : the fundamental distinction.

It is quite clear that a western diet causes obesity while an ancestral diet does not. The most fundamental factor that distinguishes the western diet from an ancestral one is the "carbohydrate density" of the foods found commonly in the western diet.

"Carbohydrate density" is independent of the proportion of carbohydrate vs other macronutrients within the diet. It is evidenced that some ancestral diets contained a very high proportion of carbohydrates. However, sources of carbohydrates in these ancestral diet were in the form of tubers, fruits, leaves, stems etc. These cellular carbohydrates are stored within cell walls, and are able to retain most of its integrity throughout cooking and undergoes a longer digestive process. 

In contrast, acellular carbohydrates in the form of flour, sugar and processed foods, do not have the same "walled in" effect and hence, exert a very high concentration of  carbohydrate on our systems when consumed. The carbohydrate density of this new western diet burdens and confounds our GI in a way that ancestral diets do not, instigating the growth of new, harmful microbes in our guts that create toxic waste materials, and causes inflammation on top of leptin abnormalities. 

It should be noted that "carbohydrate density" is entirely different from "glycemic index" which measures the speed in which our blood glucose levels responds to dietary intake of carbohydrates. In fact, some ancestral foods consumed were high on the glycemic index, with no negative metabolic outcomes observed as long as they were cellular.

Although grains are cellular, they are considered a "carbohydrate dense" food. Due to their nature, storage of carbohydrates in grains was created for quick enzymic action to facilitate germination. Elevated levels of insulin and insulin resistance have been associated with obesity and diabetes. Since insulin is primarily mobilized by carbohydrate intake, dietary intake of carbohydrate dense foods might cause insulin irregularities.

Aren't whole grains healthy?

This is a difficult area to navigate where I honestly have no expert authority on. I can only report what I have read. As discussed above, grains are very dense in carbohydrates. There are some literature regarding allergenic and inflammatory properties found in grains (the most common being "gluten", the other being "lectin"). Personally, I exclude grains (even whole grains) from my own diet because I find that I have an adverse reaction to them. However, there are others I know who thrive well on whole grains, so all bets are off on this one. Suffice to say, my sentiments on refined grains and flour are not as flexible because I have absolutely nothing positive to say about them. The same can be said of sugar.

Here is what I have read. First, a study by The Pennsylvania State Universtiy in 2010, had shown only very modest improvements to heart diseases when refined grains were replaced with whole grains (3). This raises the questionability of the benefits of whole grains in this respect.

Second, as mentioned above, grains are "carbohydrate dense" foods, whereas carbohydrate sources of the ancestral diet were exclusively from consumption of vegetables including roots, leaves, bulbs, as well as fruits. In fact, when grains were introduced, signs of overweight or obesity and diabetes appeared.

Third, grain restricted diets have been evidenced to significantly improve metabolic markers and reduce weight. According to the report, these trials are small and few but results have been consistent and unanimous. All ad libitum (i.e. no voluntary caloric restrictions) studies of the modern day "Paleolithic diet", which mirrors the ancestral diet, appeared to be superior to the "Mediterranean diet" in reducing weight and waist circumference, better blood sugar regulation, and increased satiety per caloric intake prompting a voluntary decrease in caloric consumption. 

However, the benefits of the Paleo diet was independent of this spontaneous decrease in food intake and increased weight loss. When energy intake was controlled to be equal across the board, the Paleo diet still produced better markers including lower blood pressure and improved lipid profiles. Both diets similarly emphasize unrefined, whole foods but the fundamental difference lies in "grain restriction" of the Paleo diet.

Fourth, Leptin levels were also found to have fallen by 31% after 12 weeks, in another ad libitum study on the Paleo Diet, which had a linear relationship with decreased consumption of cereal grains. It has been hypothesized that cereal grain causes leptin resistance.

Doesn't dietary fat make us fat?

Without a doubt, dietary fat has some part to play in the obesity epidemic and metabolic disorders. In numerous rodent experiments on obesity, fat intake was elevated specifically to induce that condition. In addition, differing fatty acids have been successfully shown to create inflammatory processes in the body.

Even so, fat in itself is arguably not the primary cause of obesity. In fact, I think dietary fat (including saturated ones) is so important to the human body that, in many cases, insufficient intake is the real issue. But this is a much more complicated subject and warrants a separate discussion (one which I plan to undertake in another blog post). The only exceptions I take are trans fat and poor quality oils, which I can say in no uncertain terms, will not only make us fat but will, in fact, kill us.

According to this paper, the accusation that dietary fat as the primary causative factor of obesity is unfounded. If indeed dietary fat causes obesity, then wouldn’t a diet that is lower in fat eradicate the problem? But surprisingly, in ad libitum studies comparing low fat diets with low carbohydrate one, it is the low carbohydrate ones that emerged ahead with greater weight loss as well as greater improvements to metabolic markers. Low fat diets work as effectively as low carbohydrate diets only when caloric intake was controlled in both diets. The significance here is "satiety". Low carbohydrate diets led to a spontaneous and voluntary reduction in caloric intake whereas the low fat diet did not promote satiety, and hence would work only equally effective if there caloric intake was restricted.

Moreover, as discussed above, ancestral diets that were very high in meat and/or fat intake did not yield any metabolic disorders nor obesity among its consumers. This is inline with the observation that simply a high consumption of dietary fats from unprocessed sources, on its own does not have obesogenic effects on the human body.

However, fat (refined ones) has been implicated to cause a "double whammy" when consumed together with acellular flours, sugars, carbohydrate dense and processed foods, as is the case of the western diet. When ingested in this manner, fat enriches the inflammatory microbes already in place in our guts, and also increases PAMPs and absorption of bacterial LPS, stimulating even more inflammation.

Conclusion

The ancestral diet is one which promotes efficient human energy homeostasis. Historical data shows that those who maintain ancestral diets without the influence of western foods retain leanness of the body and excellent metabolic health markers, even when matched against "healthy individuals" in western populations. 

Since the ancestral diet is strongly distinct from the western diet with regard to "carbohydrate density", acellular refined foods and grains remain implicated as the main causes of inflammation, metabolic irregularities and obesity. The western diet which commonly features a combination of high carbohydrates and refined fats, creates an inflammatory microbiota in the gut and absorption of pathogenic materials, leading to leptin resistance and obesity. 

In addition, consumption of fructose appears to induce de novo lipogenesis (fat generation in the liver), liver toxicity and contributes to non alcoholic fatty liver disease. On the other hand, glucose appears to increase activity in fat tissue. Fructose and glucose are both components of sugar which is also very prevalent in the western diet.

Finally, insulin’s ability to regulate fat accumulation in fat tissue i.e. lipogenisis, from a carbohydrate rich meal that is typical of a western diet, has also been inextricably tied to the obesity epidemic today.

Discouraging as it sounds, maintaining an ancestral-like way of eating is actually within the reach for most folks. I am not suggesting that we all become Flintstones, and acknowledge that it is impossible to eliminate ALL offensive foods. But, I believe that we will reap health benefits even if we can do as much as minimize our exposure to problematic foods and at the same time, including as much as possible of the good stuff to our diets. Improvements will commensurate with the effort one puts in. In other words, it is not all or nothing. And ending on a note of encouragement : studies have shown that just after 7 weeks, the ill effects of the western diet was reversed markedly by consuming an ancestral diet !

References:

1. Taubes Gary. (2011). Why we get fat and what to do about it. New York: Anchor Books.
2. Spreadbury Ian. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota and may be the primary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes. 2012 Jul; 5:175-189
3. Harris KA, Kris-Etherton PM. Effects of whole grains on coronary heart disease risk. Curr Atherosclerosis Rep. 2010 Nov; 12(6):368-376.

Hypothyroidism

The thyroid gland is a butterfly-shaped endocrine gland that sits on the lower front of the neck. It is the body's internal thermostat and produces the thyroid hormones (TH), Thyroxine (T4) and Triidothyronine (T3). T4 is produced solely in the thyroid gland, whereas T3 is produced both from the thyroid as well as conversion from T4.

Thyroid hormones are essential in order for every cell in our bodies to work. They act on cells to control oxygen consumption, heat production, and even protein synthesis (6). Hence, they regulate our body temperature, our caloric burning rate; and also our energy consumption in supporting the brain, heart, muscles and other organs in working condition.   

Production of TH is controlled by interactions between the Hypothalamus (located in the middle of our brains), the Pituitary gland (a pea sized gland at the base of our brain) and the Thyroid gland (5). The hypothalamus releases hypothalamic hormones, called Thyrotropin-releasing hormone (TRH), which signals the pituitary gland to secrete pituitary-thyroid-stimulating hormone (TRH). TRH communicates with receptors on thyroid tissue to stimulate secretion of the TH. About 80% of hormones produced in the thyroid gland are T4, and about 20% are T3. In return, the fluctuating levels of TH circulating in our blood form a "feedback loop" signaling the pituitary gland, and perhaps even the hypothalamus, to release appropriate amounts of TSH, thereby maintaining a stable level of TH in our blood stream.

What is Hypothyroidism and its Symptoms?

Hypothyroidism is a condition where the thyroid gland is under active ("hypo" means "under"); and hence, insufficient TH are being produced to meet the body's needs, causing bodily functions to wind down. 

According to the American Thyroid Association (1), the effects of this "slow down" can be multifold, causing overt symptoms and sometimes, more dangerous but less obvious ones. To give you a few examples, as less heat and energy are produced, our brain and even the bowels might move at a snail's pace. Therefore, problems with memory and depression could set in, or one could become constipated. In addition, one might also experience changes that cannot be sensed, like elevated blood pressure and cholesterol levels, due to a sluggish and backed up blood flow.

Most common symptoms of hypothyroidism include: intolerance to cold, chronic fatigue, low body temperature, slow heart rate. Hypothyroidism could also present itself as: easy weight gains, irritability, loss of appetite, muscle weakness/cramps, dry scaly skin, painful premenstrual syndromes, heavy periods, hair loss, recurrent infections, migraines, even fertility problems, yellow-orange skin, puffiness around face/hands/ankles, carpal tunnel syndrome. 

What could be some causes of Hypothyroidism?

Hypothyroidism can be differentiated into primary and secondary hypothyroidism. Primary hypothyroidism is a direct consequence of a disorder in the thyroid gland causing failure in the synthesis and secretion of TH. 

On the other hand, secondary hypothyroidism is a consequence of the failure on the part of the pituitary gland to release sufficient TSH; OR from the failure of the hypothalamus in producing TRH. Since TSH and TRH regulate the production of TH, decreased levels of either will naturally lead to corresponding decreases in the production of TH (2).

Some causes of primary hypothyroidism include Autoimmune Disease, Thyroiditis (Inflammation of the thyroid), Iodine deficiency or excess, surgical removal of the thyroid gland, radiotherapy, drugs, congenital factors (born with it). The most common cause of hypothyroidism is autoimmune disease, and it affects more women than men (elaboration to follow in later paragraphs).

In this disease, the body is essentially allergic to the TH. Hence, the immune system forms antibodies, which mistakenly attack its own thyroid gland tissues, destroying the gland's ability to secrete hormones. The most common form of such autoimmune disorder is Hashimoto's Thyroiditis.

Other factors hypothesized to cause malfunction of the thyroid gland include: viral/bacterial/Candida infections, pregnancy, trauma, poor diet, radiation from X-rays, alcohol and drugs, toxins especially those created from petrochemicals. 

Many plastics, pesticides, fertilizers, dioxin, body care products etc., contain xenoestrogens (substances that mimic estrogen in our body) which disrupt our endocrine system and therefore, hormonal imbalance. In addition, chronic stress could result in fatigue in our Adrenal glands, interfering with the conversion of T4 to T3 (3).

To offer you a different angle on this matter, eastern medicine believes thyroid disorders to be symptoms of a Heart-Mind connection that is out of sync, a disharmony in yin-yang and blood of the heart.  Another possible cause could be an imbalance in one's kidneys (9). 

The Role of Estrogen in Regulation and Function of the Thyroid.

Thyroid diseases have been known to strike more women than men (Note: Men are not impervious to the disease, just statistically less occurrences relative to women), especially in the period between puberty and menopause, most probably due to the secretion of the hormone Estrogen. Not only are women are more susceptible to disorders related to iodine deficiencies, they are also three times more prone than men, to have cancers pertaining to the thyroid gland (4).

Previous studies have shown the effect that estrogen plays on thyroid efficiency, via its role on T4 binding globulin (a carrier for T4 in our blood stream). However, more recent works have suggested that estrogen also directly affects thyroid function and its growth. Details of this mechanism is summarized in the next paragraph.

Estrogen signaling occurs when the hormone estrogen bonds with its Receptors. Therefore, the presence of estrogen receptors (ER), namely ER alpha and ER beta, is absolutely essential in any direct estrogenic action. It has been discovered that thyroid tissue expresses both ERs. It is also very interesting to note that the binding action between estrogen and its ERs in Thyroid tissue have different effects on the growth of Thyroid cancers: (i) Bondage to ER alpha increases proliferation of cancer cells while (ii) Bondage to ER beta suppresses growth of such tumors.

Iodine's Role in Thyroid Disease

Iodine's role on the health our thyroids requires little introduction. However, lesser is known of its actual effects. Iodine is essential in the formation of TH. Post absorption from our intestines, iodine turns into iodide in our blood, which in turn integrates with another substance, the amino acid Tyrosine, to eventually form TH. A deficiency in iodine will therefore lead to an underproduction of TH (6).

At the same time, lack of iodine also causes Goiter (an enlargement of thyroid gland). It is estimated that about 200 million people worldwide suffers from Goiter (an enlarged thyroid gland) to some degree, and that most of these cases are caused by a deficiency in iodine. 

On the other hand, it is important to note that a diet that is excessive in iodine intake could also cause toxicity and complications of the thyroid such as Thyroiditis (an inflammation of the thyroid gland).

Selenium's Role in Thyroid Function

Another mineral closely linked to thyroid is Selenium. Although less have been heard on this front, it is gaining more attention as recent research confirmed that thyroid tissue comprises more selenium than any other body tissue (7).

Some diseases affecting the thyroid, such as Grave's (a condition marked by over activity in the thyroid a.k.a. Hyperthyroidism, "hyper" meaning "over"), as well as hypothyroidism, have been associated with selenium due to the mineral's impact on the conversion of T4 to T3. In addition, Cretinism (marked by stunted physical and mental growth due to congenital hypothyroidism) is yet another condition that has been linked to combined deficiencies in both selenium and iodine. 

However, studies do not show selenium intake to have any effect on thyroid autoimmunity (cases where the immune system attacks the body's own thyroid gland). Moreover, overdosing on selenium could cause Selenosis (selenium toxicity), which is characterized by diarrhea, fatigue, hair loss and possibly fingernail discoloration.

The Role of some Vitamins in Thyroid Disorders

Some evidence surfaced to show positive effects of vitamins with antioxidant properties on thyroid diseases, while supplementation of vitamin D also appeared to benefit the patients’ skeletal systems. Vitamins B6 as well as B12 have also been shown to play a part in conjunction with disorders of thyroid function. However, there is no information to prove the efficacy of vitamin supplementation in the prevention of thyroid cancers (8). 

Vitamins A, C, E.

This group of vitamins posses antioxidant properties i.e. they limit the damage caused by oxidative byproducts (free radicals) in our bodies as a result of normal metabolism. First, both hyper and hypothyroidism elevate cellular oxidation by intensifying the reactivity of oxygen molecules in the body. Second, both forms of thyroid malfunction exacerbate the problem by decreasing levels of antioxidant vitamins in our bodies, further hampering their abilities to counter free radicals.

So far, research has shown that administration of vitamin E to benefit individuals with either hyper or hypothyroidism. At the same time, treatment with vitamin C, E, beta carotene, selenium, zinc and copper, did reduce symptoms in patients with hyperthyroidism. 

Vitamin A

In animal studies, vitamin A, on its own, appeared to be closely-knitted with the mechanisms of the hypothalamic-pituitary-thyroid triangle described above. When the human body is lacking in vitamin A, thyroid cells' uptake of iodine is reduced, thus depressing TH production and output.

Vitamin B6

A vital co-enzyme for over 100 enzymatic reaction in our bodies, this vitamin also affects communication between the hypothalamus, pituitary and thyroid glands. Contradictory as it sounds, studies have shown that a deficiency in B6 causes hypothyroidism due to reduced hypothalamic expression of TRH, while overconsumption of the same vitamin would result in low levels of TSH from the pituitary gland. 

Vitamin B12

At this point, various studies have shown a relationship between vitamin B12 deficiency in cases of thyroid diseases, particularly in those individuals with autoimmune thyroid disorders. However, it is important to note that where such vitamin deficiency occurs, Gastrin levels (gastrin is a hormone which stimulates secretion of gastric acid) should also be examined at the same time, as fluctuating levels of gastrin might be the cause of B12 malabsorption and thus, low B12 concentration levels in the blood.

Conclusion

As you can appreciate by now, the physiology of thyroid functions and causes of thyroid diseases are complex and intricate. Diagnosis of the disorder could also be difficult and less obvious because of the common symptoms shared with other diseases. But, a disordered thyroid that is left untreated could lead to other health complications including osteoporosis, obesity, hypertension and heart disease (that would be a whole different discussion).

Nutrition and supplementation could possibly be beneficial in cases of deficiency but that has to be determined in each scenario. Clearly, prudence and moderation is the key here and always. Over supplementation would be pointless and wasteful at best; and in the worst case, could become toxic to our bodies. 

If you are already on medication to treat an existing thyroid disorder, do bear in mind that chemicals, drugs and supplementation (yes, even natural herbal ones) will interact and react with each other. It would be wise to check with your health care provider before you embark on a course to ensure your safety.

References:

1. American Thyroid Association (2003), ATA Hypothyroidism Booklet, retrieved Feb 14, 2012 at www.thyroid.org.
2. Kostoglou-Athanassiou I, Ntalles K (2010), Hypothyroidism - new aspects of an old disease, Hippokratia 2010, 14, 2: 82-87
3. Friedlander Jodi, Bauman Edward (2007), Hashimoto's Autoimmune Thyroiditis: Eating for Health, Applications for Recovery, Bauman College Holistic Nutrition ans Culinary Arts, Pp 2-4
4. Santin Ana Paula, Furlanetto Tania Weber (February, 2011), Role of Estrogen in Thyroid Function and Growth Regulation, Journal of Thyroid Research, Vol 2011, Article ID 875125, doi: 10.4061/2011/875125
5. Melish John S., Clinical Methods: The History, Physical and Clinical Examinations, 3rd Edition (1990), Chapter 135: Thyroid Disease, Boston: Butterworth.
6. Hamwi George J., Tzagournis Manuel, Nutrition and Diseases of the Endocrine Glands, The American Journal of Clinical Nutrition, March 1970, Vol 23, No.3, Pp.311-329.
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9. Pitchford Paul, (2002), Healing with Whole Foods, Asian Traditions and Modern Nutrition, 3rd Edition, Pp, 333, North Atlantic Books, Berkeley, California.

Basic Philosophy, Principles and Nutrition in Traditional Chinese Medicine

Prelude

Why are foods classified hot or cold? What does Yin and Yang mean? Traditional Chinese Medicine (TCM) is the cornerstone of nutrition in the east. Yet, it is often misunderstood, or simply not understood, and often times being ridiculed even by the Chinese themselves as "backward" superstitions. As I attempt to gain some insight to this over 2000 year old system of medicine, I consider my mind to be the biggest hindrance of all. 

Repeatedly, I found myself not comprehending what I have just read, then having to reread passages and concepts several times over, not because I was illiterate (at least not more than I already am normally!), and most certainly not because the authors of my reference book were insufficiently eloquent on the subject. On the contrary, I have adapted very closely to the book (at times, to the point of ad verbatim) because I found myself incapable of a more erudite account.

The real difficulty lay in the inability of my westernized mind to grasp the abstract, the circular reasoning, and the auto pilot mechanism to try and file everything into neat, organized categories. I do not consider this is to be a particular shortcoming, or virtue, of mine. It is just an acknowledgement of a fact.

Let me be clear that I do not tout TCM as panacea. At the same time, I would like to add that I have utmost admiration for the advancements and discoveries made within the field of western medicine. I do, however, apply principles of TCM, along with principles of western nutritional science, to my own life and diet. I also admit that I have never felt prouder of my Chinese ancestry than now, given a deeper understanding of the wisdom of my Chinese forefathers.

I hope it will be beneficial to my readers, and especially to those who are keen to integrate TCM into their lives and diets, to approach the subject with an introduction to eastern philosophy, a few basic theories and concepts that could be instrumental in helping you understand TCM, as well as compare and contrast eastern philosophy with the western view, which is more familiar territory to most of us.

I would also like to acknowledge that in assembling this article, my friend and trusted Chinese physician, Jennifer Cheung, was truly invaluable, just as she has always been sending me the proverbial "charcoal in the snow storm", during times of my medical needs. Depth of her knowledge is a humbling reminder that "one mountain is higher than another." Through her treatments, I am reassured that clarity in thought and expression are attainable by all those who aspire for it. I thank her for her openness and generosity in teaching me without ever being condescending. 

Introduction to Chinese Philosophy

While Western philosophy tends to draw clear boundaries between man and nature, mind and body, disease and health, life and death, Traditional Chinese thoughts do not draw such sharp lines of distinction. 

In the practice of Traditional Chinese Medicine (TCM), there is no separation of the objective world from its living subjects, and our universe exist as an interwoven web of processes, linked to each other in circular fashion. In this reality, Mankind are a part of the universe that surrounds them. This unified wholeness is the Tao, where there is no separation of mind from body, and man from nature. Solutions do not exist as fixed answers; the truth is always relational, conditional and contextual.

Traditional Chinese Viewpoints on Healthcare

In TCM, the best cure for sickness is believed to be prevention. The Nei Jing, a medical classic written in the second century B.C. states: 

"Maintaining order rather than correcting disorder is the ultimate principle of wisdom. To cure disease after it has happened is like digging a well when one already feels thirsty, or forging weapons after the war has already begun."

Moreover, Chinese physicians embrace the idea of balancing power between caregiver and receiver. Western medical doctors are usually assigned more powerful, top down roles; and at the same time, their patients are more passive in receiving instructions. In contrast, Chinese physicians believe in enabling ordinary people with the ability to control their own healths; they portray the role of teachers in sharing knowledge and power with their patients and create the favorable conditions in which human life can flourish.

The Body as a Machine in Western Medicine

Western science is premised on analytic, logical reasoning and fixed, unchanging laws. Only tangible and quantified evidence are sought. In addition, man and nature are viewed to be distinctly separate, and there is also a clear division between mind and matter. Everything can be broken down into its individual parts, like machines. Hence, western medicine, accordingly, is the study of the human machinery and how it works; and when people are perceived to be like machines, doctors behave like mechanics.

Western medicine visualized a human body that can be divided into individual constituents, and a diseased component, or organ, as a defective part of the machine that is removed, or can be treated on its own, apart from all other structures of the body. Furthermore, western medicine doctors frequently believe that disease within the human body is caused by an external source, for e.g. germs; and that the cure for such disease should also be applied externally. Thus, there is more focus on intervention rather than prevention. The western doctor, like a mechanic, performs regular maintenance but more often, is being called upon to attend to emergency repairs when things have broken down.

In this schema, both inward self understanding and the body's own healing abilities are often overlooked. People believe that the power to get rid of the disease can only present itself from a foreign source that lies outside of the body, for e.g., drugs or surgery. Moreover, death is seen as an evil that must be overcome. Emphasis is therefore placed on keeping bodies alive rather than on enriching life.

The Body as a Garden in Chinese Medicine

As previously stated, Chinese philosophy envisaged the universe as a circle of life, the Tao, which embodies both the opposing, yet complementary, forces of Yin and Yang. Within the Chinese model, everything is interconnected and interdependent, hence nothing should be considered separately. 

What is good for one is good for all, and vice versa. One damaged organ is bad for the whole body; what is harmful for one person harms everyone; when the earth is injured, then so is the individual. Hence, to bring about well being within one's body and mind equals forging the same on earth and all life surrounding us.

Ancient cultures such as the Chinese, survived by cultivating land, and depended on their harvests for sustenance. They viewed the world, nature and all of its living beings as gardens, and desired peace and balance within. When people are likened to gardens, the role of the doctors is like a gardener's - to cultivate and to enrich life. 

Additionally, nothing is perceived as absolutes in the Chinese purview. Being wholly relative, life and death are not intrinsically good or evil, but simply viewed as an occurrence that happens within the cycle, and along the wave of a continuum that is always in motion.

The Concept of Qi

Life's essence or our life force is known as "Qi" in TCM. Immaterial, yet essential, Qi is the basis on which all material world is formed. It animates life.

Unlike in western science, where the human body is broken down, or made up of, building blocks such as cells, tissues and other structures, chinese medicine regards the body as one large complete system made up of smaller, subunits within. These small subsystem interact within themselves, with each other, and with the larger whole. None of them can perform in isolation.

The body takes the shape of our emotions, while generating feelings. The liver drives the state of our heart, and the heart in turn motivates the expression of one's personality. Thus, within each person as a whole unit, there is a constant flurry of cross relationships between the subunits; and "Qi" acts as the medium linking up these relationships. Consequently, the flow of Qi determines the expression of all physical and mental activity of the human body.

Qi is not air, but air has Qi. Qi is also in food. Upon entry to the body, the Qi of air and the Qi of food together makes up the Qi of the body as one entity. Qi, or life force, can also be defined to include blood and moisture. Just as ice, water and steam are three different states of the same entity, blood, moisture and Qi are three manifestations of the same life force. However, Blood in itself, governs the tissues which form the material body. Qi governs the activity and processes of the body. Moisture, "the ocean of the body", is the intermediary between blood and Qi.

The Theory of Correspondence

Before a larger system can be harmonized, TCM postulates that the smaller units must first be in order individually, and also in synchrony with each other. Health is defined as an individual's ability to respond and adjust to the threats posed which disrupts the body's state of equanimity. 

Disease is symptomatic of a system of subunits that are out of sync with each other. Chinese medicine is of the view that if such disharmonious interactions are rectified to become more balanced and smooth, then the cause of disease would cease, because the breeding ground for disease would not be present. 

Hence, in TCM, "The Man is not sick because of his illness, but has an illness because he is sick": 

Yin and Yang : A Theory of Relativity

Within the unity and completeness of the Tao of life, therein lies the principles of Yin and Yang; its forces swinging to and fro like a pendulum - opposing and canceling each other out. They are as polar as they are mutually dependent; inseparable as they constantly strive to counterbalance each other, in order to reach, or maintain, equilibrium. Therefore, Yin-Yang is, essentially, a symbolism of the Chinese worldview that portrays life as a dynamic, ever-changing, constant flux of motion, rather than a still and fixed frame of picture. 

"If Yin is a noun, then Yang is a verb, and Life would be a complete sentence." Health is optimized when Yin-Yang is in harmony; and disease presents itself when the balance is tilted. Over engaging in Yang forces runs Yin down. By the same token, a person who is well fed and massive (Yin), and yet lacks energy (Yang), will be lethargic, inert. In order to attain balance, one must be flexible, diverse, moderate, adept and in tune with one's own harmony and needs. Chinese medicine makes use of acupuncture, herbs, diet, physical exercise, massage, mental discipline to reach this state of harmony.

Yin-Yang Classification of the Human Body & its Functions

Classification of Yin-Yang is purely relative and depends entirely on the point of view of the observer. Relative to each other, Yin is dense, quiescent, static, and contracting, whereas Yang is dynamic, active, expansive and dispersed. Yang motivates movement and instigates Yin; whereas Yin provides the foundational substance for sustaining the activities of Yang. 

To provide a clearer idea of Yin and Yang principles, here are a few examples of bodily substances and processes that are considered to be Yin or Yang, relatively speaking : 

Generally, people can be classified as being more Yin or Yang, based on the physical forms of their body and character. Yet, it is common to manifest qualities of both, such as inhabiting a relatively Yin body with a more Yang personality. Additionally, we are quicker, more erratic and lighter in our youth, and therefore are more Yang. In our older years, we tend to be more Yin because we are slower, more deliberate, and persevering. The lower part of the body, which is closer and more sunken in the ground, is more Yin, compared to the Yang upper body, which has more mobility. The exposed part of the body (e.g. skin, hair) forms external protection and is therefore Yang, the hidden internal structures (e.g. organs, bones etc) are the basis of sustenance and are therefore Yin. 

Yin or Yang classification should not be taken to mean strength or weakness, health or disease in a person. Being aware of our Yin-Yang tendencies provides some insight as to how we might become ill; and in addition, could help us in applying the right treatment. The real key is in achieving balance - When Yang is in excess, Yin is depleted, and vice versa. Using the analogy of a battle front, Yin is the fort that provides substance that sustains Yang activity. Without substance, activity is weakened; without activity, substance is insecure and unprotected. 

The Five Organ Network

Furthermore, our internal organs can be distinguished according to their physiological functions. Yin organs, i.e. Liver, Heart, Spleen, Lung, Kidney, perform the functions of assimilation (anabolic) and store the energy derived from substances generated from the Yang organs. On the other hand, Yang organs, i.e. Gallbladder, Small Intestines, Stomach, Large Intestines, and Bladder, perform functions of digestion and elimination (catabolic) and transform movement into energy. However, Yin and Yang are relative, and not absolute categories. For e.g., the Heart is a Yin organ and yet, its actions of squeezing blood through the vessels is Yang. This is the definition of "Yang within the Yin".

Paired Yin and Yang organs together make up the Five Organ Networks each identified by names of the Yin Organs. The system consists of Liver-Gallbladder, Heart-Small Intestine, Spleen-Stomach, Lung-Large Intestine, and Kidney-Bladder.

Dissonance in the Organ Network

All Organ Networks are interconnected - hyperactivity in one network will result in depletion of some, and trigger hyperactivity of others. However, an Organ Network that is overly controlled will collapse, and that triggers a different pattern of depletion. 

In the view of TCM, a simple yet chronic state of disharmony of one Organ Network prolonged over time, could develop into more complications, and eventually lead to disease. Furthermore, patterns of disharmonies from one network usually affect another, and often involve a few Organ Networks on top of the one which is primarily out of sync.

The Five Phase Theory

Just as the Yin-Yang theory symbolizes the relationship between bipolar and complementary forces, the Five Phase Theory is a metaphoric representation of the stages of the human life. Five Phase thinking proposes that everything that is created in the body, either physical or otherwise, can be categorized into the following elements : Wood, Fire, Earth, Metal and Water.

In TCM, there is no dissection of the seen and unseen within the human being. Therefore the same forces that manifests as the material and physiology of an individual, also organizes the person’s emotions, intellect, and psychology. Hence, people can generally be classified into different character types according to their Five Phase elements. 

Moreover, each of the five phases can be experienced at any given human life process, and each phase acts as a restraint and yet, gives rise to the next. In our Wood phase, we are expansive and that fuels the Fire phase, which causes energy to spread. Metal is our contraction phase, culminating in the phase of the Water, which in turn control our Fire phase, and yet nourishes germination. Our Earth phase centers and stabilizes us.

The Five Climates : Symptoms and Conditions of Disease

When a person is symptomatic of a state that imitates a particular climate, TCM postulates that a person has that condition, i.e. that climate exists internally within the body. An adverse internal condition may not necessarily correspond to the existing external weather. The Five Climates are:

1. Wind : causing erratic, unpredictable movement and sudden, rapid change in location. 
2. Heat : accelerates metabolic activity, increases circulation, rising and outward movements.
3. Dampness : dense, stagnates, accumulates, feelings of fullness and heaviness that is usually accompanied by Cold, Heat or Wind. 
4. Dryness : dehydrates, withering and shriveling.
5. Cold : decelerates movement by chilling.

Conclusion

As a consequence of differences in world views, philosophy and science, geographical and climatic limitations as well as other factors which affect our food sources, it is no wonder that nutrition would differ between the Western and Eastern world. 

In the west, a food's value and nutrition is determined by individual components of proteins, carbohydrates, fats, vitamins, minerals. Foods that contain similar quantities and proportions of these nutrients are considered equivalents in biological value. Accordingly, a bowl of spaghetti with tomato sauce could be equivalent to a two-egg omelet. In addition, people are assumed to be the same physiologically, so the choice of diet is simply picking within the quantitative boundaries of each nutritional component regardless of who we are. 

In contrast, nutrition in the east adopts the view that who the individual is determines what is most beneficial for that person to eat; and that what we eat becomes who we are. According to the eastern view, there is no universal model of "a good diet". One size does not fit all because each of us have different constitutions and hence, not everyone will benefit in the same manner from similar nutrient intake.

All foods and people have to be considered within the context of Yin-Yang and the Organ Networks. Appropriateness of foods is based on their properties, and how they affect Qi, Moisture and blood, modified by climate, the season, and presence of illness. For e.g. Although the bittergourd is proven to be beneficial for helping with blood sugar control, it might not be suitable for a diabetic individual who also displays a cold-damp condition, because the bittergourd is considered to be a cold food and would exacerbate the adverse climatic conditions in that individual.

Today, many factors, including trade, travel and globalization, have all played a huge and influential role in bridging the divide between Western and Eastern diets. Many eastern traditions have also been eroded. Nonetheless, the perception of food as nourishment for the human body still lies somewhat discrete between the Western view vs the Eastern view. However, I do not view them as contradictions but rather, as two totally different systems with different perspectives.

TCM is not based on western science. It is a completely different practice that exists on its own set of principles and theories. In spite of its many limitations and constraints, it is a complete, wise and coherent system of medicine and healing that has withstood the test of time. Yet, it is more than a system of medicine and healing. It is also a system of philosophy, beliefs and teachings. Indeed, the true purpose of TCM is to teach a way of life, how to live enriched; and not simply to prolong life or the avoidance of death.

Source:

Harriet Beinfield, L.Ac. and Efrem Korngold, L.Ac., O.M.D., (1991), Between Heaven and Earth, A Guide to Chinese Medicine, Ballantine Books, New York.