Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Plant Nutrients can Boost Metabolic Resolve

April Fools’ Day is 3 months after that New Year’s resolution. This is my favorite time of year to help patients succeed with diet and exercise. I reassure them that they were not foolishly ambitious on January 1, nor do they need to add yet more willpower in order to succeed. Integrative health-care practitioners can uniquely help patients improve their metabolic resolve. In this Townsend Letter column, I explain why I think plant nutrients are powerful allies in diet and exercise, and how they can help patients succeed at weight loss.

Resolve to diet and exercise can be difficult to keep. Hindered by food cravings, and too tired to exercise, many cannot diet successfully. Unfortunately, the take-home message from all too many health-care encounters is, “Try harder.” For example, lifestyle medicine is a term in growing use. While the term reminds patients to prioritize health, it also subtly shifts the responsibility of achieving health goals toward patients and away from health-care providers.

Scientific breakthroughs have provided new tools to repair underlying metabolic disturbances which make diet resolve more difficult and sometimes even unsafe. The challenge with willpower is that unrelenting food cravings usually point to a metabolism that is breaking down hard-earned muscle rather than efficiently utilizing the body’s excess fat reserves. And fatigue is usually a bona fide message to reduce aerobic activity. It is therefore not surprising that strategies which diagnose and treat underlying metabolic disturbances first result in greater success.

One cause of metabolic disturbance is that patients are usually low in their body stores of plant nutrients such as resveratrol, lutein, and lycopene. While many practitioners may agree that low levels of plant nutrients are common and treatable, phytonutrient roles in promoting safe and effective weight loss are largely unrecognized.

Early in my career as the winter-over physician in Antarctica, I started appreciating the importance of “freshies,” an Antarctic expression for fruits and vegetables. That’s a supply-chain distance second only to delivering supplies to the International Space Station. Significantly, NASA recently designed a way to grow “freshies” on the space station to improve phytonutrient intake for the astronauts’ diet.

Antarctic research scientists depend on the large team of highly skilled people who make the station operate. These support staff return seasonally, and to do so they need to pass an annual physical. Lab tests such as the cholesterol profile can prevent these vital contract workers from returning to their jobs. But living in Antarctica makes it more difficult to achieve desirable lab tests, one example being blood triglycerides. Triglycerides are fats in the bloodstream, which, when high, increase risk of heart disease. Triglycerides don’t only influence disease risk, they affect how people feel. High levels of triglycerides suggest that the metabolism has difficulty converting fat to energy. The metabolic “traffic jam” leads the body to tap other energy sources, which in turn prompts food cravings and excess calorie intake. The lack of readily available energy is associated with fatigue.

Triglyceride levels are quickly responsive to dietary changes, often in time to pass a qualifying physical. Once triglycerides respond, the scale will often follow. Emphasizing phytonutrient intake pushes refined carbohydrates out of the diet. The glycemic index of the diet becomes more favorable, and the uptake of carbohydrates into the bloodstream is more gradual. In turn, the release of insulin is more gradual and the ability to process the backlog of triglycerides improves. High triglycerides tend to inflame the liver, the organ wherein the metabolic gridlock is the most severe. Phytonutrients reduce the liver inflammation and improve sensitivity to lower amounts of insulin. In sum, phytonutrients improve blood triglycerides in many ways, which include improved food selection, insulin sensitivity, and liver support.

Phytonutrients improve many chronic medical conditions. Most medical conditions either interfere with diet and exercise directly or require medications that can be diet saboteurs. The better controlled these conditions are, the more level the incline to diet and exercise success. For example, dieters may encounter an undesirable double-punch when prescribed corticosteroid medications increase appetite and cause the metabolism to build fat rather than muscle. Phytonutrients have been shown to improve corticosteroid-managed medical conditions including digestive disorders, allergies, asthma, and several skin conditions, to the point that less medication is required.

Research during my 2-year position at the US Food and Drug Administration in the Office of Pediatric Therapeutics underscored that medication-diet interactions in children are clinically under-recognized and that a broader array of medications affect appetite and food selection in children than is usually realized.^1,2 Both research findings imply that interventions which reduce the need for medications, especially in children, indirectly support patient efforts in diet and exercise.

So here is why I especially encourage diet and exercise “re-resolve” in April. Our metabolism “springs” into action. Phytonutrient deficiencies are especially common during winter when we eat fewer plant nutrients. Population testing confirms that the body’s plant nutrient stores are on the rise from their winter nadir by North America’s April. The upsurge is especially important in overweight patients, because dieters with excess body fat average lower blood phytonutrient levels year-round. The biologic rationale is that fat-soluble plant-nutrients are sequestered in body fat, which enables fewer of them to circulate in the blood.

Another reason that April warrants a phytonutrient boost is because it’s when seasonal allergies flare. While the metabolism is ready to spring into action, many patients unknowingly hinder their metabolism in April with allergy medications. Corticosteroid nasal sprays, while not as potent as oral corticosteroids, still reach the body’s appetite centers, where they sabotage diet. Other allergy-sufferers take antihistamines, unaware of the medication’s dehydrating and appetite stimulating effects mediated by leptin. Phytonutrient supplements are proven to reduce allergies by stabilizing mast cells. This is exciting because in clinical practice my patients tell me that they no longer need the allergy medicines once they take phytonutrients. They are providing their metabolism with the very nutrients it needs to restore health. The side effects are improved health and metabolic resolve.

The good news for Antarctic expeditioners and all the rest of us is that “freshies” aren’t the only source of phytonutrients. Often overlooked among dietary sources are sea vegetables (e.g., various kelps), spices, and herbs. The freeze-drying process is food technology poised to improve diets and some of the metabolic benefits of fresh fruits and vegetables are preserved. Some of the research has been with edamame. Those who try to make vegetarian Jell-O with freeze-dried pineapple may find that the Jell-O doesn’t gel because the pineapple’s bromelase enzyme remains active. A novel way to take phytonutrients is from the air, by aerosolizing propolis. Propolis is a phytonutrient blend made by honey bees which use it for repairing the hive and nourishing the brood. And integrative practitioners are well-positioned to guide patients in safe and effective use of dietary supplements.

All the best with that April resolution!

Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Faculty Associate, Johns Hopkins Bloomberg School of Public Health

Executive Director, NutriBee National Nutrition Competition Inc.

Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)

Notes

1. Kohlstadt I, Wharton G. Clinician uptake of obesity-related drug information: a qualitative assessment using continuing medical education activities. Nutr J. 2013 Apr 10;12:44.
2. Kohlstadt I, Murphy MD. Systematic review of drug labeling changes that inform pediatric weight gain. JJ Neur Neurosci. 2014;1(2):013.