NUTRITION WELLNESS

Dietary Fibre and Metabolic Syndrome

9th January, 2016

A Natural Approach Backed Up by Science

Metabolic Syndrome is not an actual disease. It is a group of risk factors that occur together in the same person. A person has “Metabolic Syndrome” if they have any three or more of the following conditions:

Central or abdominal obesity – excess fat in and around the stomach or abdomen
High blood pressure (hypertension)
High blood triglycerides (Cholesterol)
Low levels of high density lipoproteins (HDL) – the ‘good’ cholesterol
Insulin resistance
Metabolic syndrome increases the risk of developing Cardiovascular Disease and Type 2 Diabetes, so it’s increasing incidence in Australia and worldwide is a cause for concern.

Poor diet and lifestyle choices have been identified as a primary cause of Metabolic Syndrome. However there is some very strong evidence emerging for the beneficial role that dietary fibre plays in helping to manage this group of conditions – a relatively simple fix!

Dietary fibre is defined as “the edible parts of plants…that resist digestion and absorption in the small intestine, with complete or partial fermentation in the large intestine”¹. In other words, they pass through our intestines almost untouched, helping to facilitate the process of digestion by influencing the absorption and transit time of the foods that we eat.

There are two different types of dietary fibre: insoluble and soluble.

Insoluble fibre refers to those types of plant fibres that act like a broom in the intestines. They attract water to help provide bulk to and soften the stool making it easier to pass. Insoluble fibre may have a role to play in maintaining the health of the good bacteria in our small intestines as well, further enhancing the digestive process.

Soluble fibre retains water to create a gel like substance. This increases the thickness of the stomach and intestinal contents, slowing down stomach emptying and nutrient absorption and providing a feeling of fullness after we eat.

Each type of fibre has its own individual benefits in relation to the management of the conditions of Metabolic Syndrome but the general consensus is that a mixture of each type in the diet is optimal as most foods contain a combination of both in different quantities. Good food sources of fibre include fruits and vegetables; however the best sources of both types of fibre include whole grains (particularly oats and rye but also wheat and brown rice) and legumes (beans, lentils etc). What is most important is that these grains need to be consumed in their unrefined state. This means that your best choice at the supermarket when keeping fibre in mind is to go for the brown stuff! Whole wheat pasta, brown rice, and whole grain breads contain much more dietary fibre than their white counterparts. In fact, a meta-analysis of 6 population studies has shown that increasing your whole grain intake by as little as two servings per day may decrease your risk of developing Type 2 Diabetes by as much as 21% due to its high fibre content¹.

Fibre may help to regulate and maintain healthy blood sugar levels by bulking and thickening up the foods in the stomach and intestines, thereby slowing down the digestion and absorption of sugars from the foods you have consumed. This creates a “slow release” mechanism for the delivery of sugar into the bloodstream, minimising the negative effects of blood sugar spikes such as high insulin levels, lowered insulin sensitivity and energy crashes.³

Healthy cholesterol, HDL and LDL levels are thought to be maintained by the ability of fibre to increase bowel regularity. The liver will naturally help to regulate cholesterol levels by adding it to bile which is secreted into the small intestine, incorporated into the stool and later excreted when you go to the toilet. By making defecation more regular, fibre may help to reduce and then regulate healthy cholesterol levels in the body¹.

Fibre exerts its beneficial effects on obesity by promoting a feeling of fullness or satiety. It helps to slow down the digestion and movement of food through the stomach and intestines, thereby helping you feel fuller sooner and for longer. This action has shown in numerous long term clinical trials involving high numbers of participants to contribute to weight loss and reduce the chance of weight gain³.

The recommended daily intake of fibre for adults is around 30gms daily to maintain healthy digestive function; however, according to a survey done in Australia in 2016 by the Australian Bureau of Statistics, Australians are falling extremely short of getting this amount each day. Less than 4% of us are meeting the recommended guidelines for the consumption of fruit, vegetables and legumes each day. Two thirds of recommended grain serves are coming from highly refined grains rather than the wholemeal, higher fibre sources. And one third of the fruit serves we are consuming come from juice which contains little to no fibre at all².

It seems almost absurd to think that one of the most concerning metabolic conditions facing us today can be managed by some very simple and for some of us relatively small changes to our diets. Diseases of lifestyle kill more Australians each year than anything else and some small, simple steps may be all it takes to slow the progression of the conditions associated with Metabolic Syndrome. For more information, take some time to chat to your Naturopath or other Healthcare Professional and take control of your health!

¹ https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2903728/ Gastroenterology 2010 Jan; 138(1): 65–72.Dietary Fiber Supplements: Effects in Obesity and Metabolic Syndrome and Relationship to Gastrointestinal Functions. Papathanasopoulos, A. M.D. and Camilleri, M. M.D.
² http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/12E8766EBAB492B0CA257FAF001A3CFD/$File/43640do002_20112012.pdf
³ Journal of Nutritional Biochemistry 2008; 19: 71-84. Effects of dietary fibres on disturbances clustered in the metabolic syndrome. Galisteo, M, Duarte, J and Zarzuelo, A

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Traditional Ayurvedic and Chinese Medicine healers have been using turmeric as a natural remedy for centuries. Today, Turmeric is now one of the most researched herbs in the world and thousands of studies have demonstrated its therapeutic benefits for a wide range of health conditions. Is turmeric a herb or is it a spice? It’s both. Turmeric is a perennial herbaceous plant from the same family as ginger. The underground stems, called rhizomes, are harvested, dried and ground into a powder, which is the golden spice used for medicinal and culinary purposes. What gives turmeric its health benefits? There’s a lot of confusion out there about how turmeric works. Turmeric isn’t just a homogenous powder. Like many natural remedies, it’s made up of a number of biologically active substances. Of these, there is a group of three compounds, called curcuminoids, which make up about 2% -5% of turmeric. They are curcumin, demethoxycurcumin and bisdemethoxycurcumin. Curcumin is the star of the trio. It’s the curcuminoid primarily responsible for turmeric’s anti-inflammatory and antioxidant properties. Curcumin is a natural anti-inflammatory Inflammation can be triggered as the body’s way of defending and healing. In the process of inflammation, the release of cytokines sets off a pro-inflammatory cascade which lead to the production of inflammatory molecules such as thromboxane and prostaglandis. Tissue damage, as in arthritis, causes the release of cytokines and sets off pro-inflammatory processes which lead to the production of inflammatory molecules such as thromboxane and prostaglandins. These inflammatory molecules are produced by enzymes such as phospholipase, lipoxygenase, 5-LOX and COX-2. Curcumin works by inhibiting some of these inflammatory processes and enzymes, and also by down-regulating the activity of some inflammatory molecules. Curcumin also helps to support joint health. Curcumin also helps to protect cells from damage by free radicals Free radicals are highly reactive molecules that roam around the body and can damage cells through a process called oxidative stress. Oxidative stress has been linked to many health conditions, including poor joint health and function, so antioxidants are important to keep our bodies healthy. Learn more about the benefits of Turmeric for joint health, here. Curcumin works by directly scavenging free radicals as well as by inhibiting some of the processes that generate free radicals, so it helps to reduce the damage they can cause to body cells. Can you just eat turmeric powder to get the benefits of curcumin? Not really. Firstly, like we mentioned earlier, curcumin and turmeric are not the same thing. Curcuminoids make up only around 2-5% of turmeric rhizome powder, and of that 2-5%, curcumin makes up about 75%. So that means an average teaspoon of turmeric powder may contain less than 1% of the all-important curcumin. And that’s not the only reason that turmeric powder alone can’t really deliver much in the way of health benefits. To have a therapeutic effect in your body curcumin needs to get into your blood plasma. Once there it can circulate around the body and exert its anti-inflammatory and antioxidant effects. But turmeric, and the curcumin in it, is very poorly absorbed by your body. It is naturally insoluble in water (just check out that yellow gunk at the bottom of your turmeric latte or tea!) Very little remains intact after it gets into the highly acidic stomach environment What does remain isn’t absorbed very well by your digestive system And what is absorbed gets broken down and excreted by your liver really quickly. So consuming turmeric, or even straight curcumin powder, isn’t a very effective way of getting enough bioactive curcumin into your bloodstream. A better way to get the health benefits of curcumin The best way to get the health benefits of curcumin is by taking a high strength supplement which has been formulated for higher bioavailability.

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What is inflammation? The word inflammation is derived from the latin word, “inflammatio”, which translates to ‘ignite’ or to ‘set fire’. During the 1st century AD, the Roman scholar and medical encyclopaedist Aulus Cornelius Celsus described the clinical symptoms of inflammation, as: calor (heat), dolor (pain), rubor (redness) and tumour (swelling). With thousands of years in medical advances, the understanding of inflammation’s pathogenesis has subsequently expanded into a sophisticatedly coordinated cascade of events. The 5 cardinal symptoms are: heat, pain, redness, swelling and a limited range of motion. Inflammation is a defence mechanism and essential component in the healing process where the body attempts to maintain homeostasis by repairing affected structures and restoring function, in order to return the site of damage back to its pre-injury state. Inflammation is produced by the body when it interprets trauma or potentially harmful agents and in response stimulates a series of immune reactions, however depending on the cause of inflammation, the process may slightly differ and involve condition specific immune reactions. For example, inflammation from physical injuries, skin irritation and sinus allergies will have unique immune responses such as the chemicals stimulated and pathways allowed, although the common phases of the inflammation cascade are as followed: Understanding the inflammation process The process of inflammation is initiated by a varying degree of trauma or damage, which can occur either internally or externally. The initial trauma which triggers inflammation can be due to virtually anything that causes damage to our body cells, tissues, organs or other structures. Common causes could include injuries, infections, allergens, certain medications, chronic stress and exposure to harmful pathogens, irritants, toxins or chemicals. There is a diverse range of inflammation causes, examples may range from a paper cut, pollen, certain foods, topical sensitives, sprained ankle, broken bone or underlying health conditions i.e. arthritis. Inflammation is a multi-factorial however the progression has various influences, such as: genetic predisposition, medical history, lifestyle and dietary factors, age, weight, immune function, sensitivities and allergies and current health status. The first response is the immediate recognition of trauma to the cells which is detected by sentinel cells, such as mast cells or macrophages. These immune sentinel cells are often referred to as the body's first line of defence as their duty is to recognise damage or harmful microbes and signal for a recruitment of inflammatory factors to regulate and remove the damage, thereby commencing the immune-inflammation cascade. In this acute phase, there is a stimulation of chemicals and hormones such as histamine which assists in the breakdown of our blood barriers at a microcirculatory level. The release of histamine increases local blood flow and a process of vasodilation takes place where blood vessels dilate and enlarge, resulting in an increased capillary permeability. The vasodilation facilitates the transportation of inflammatory factors including plasma and White Blood Cells (WBC) at the site of injury. This activation causes the presentation of heat and redness and can generally last 2-5 days. In the sub-acute phase, the focus is removing acquired threats and repairing damaged structures. The immune WBC’s migrate towards the affected area where they stimulate the release of inflammatory mediators such as antibodies, immunoglobulins (IgE), cytokines (IL, TNF) and prostaglandins (PGE2). Inflammatory mediators are essentially ‘messengers’ that promote stimulation of immune responses. This stimulation causes an accumulation of various active hormones, chemicals and plasma proteins which then actively work together in removing the damaged cells. The localised concentration of substances is what causes swelling. An additional process in this phase is the production of Nitric Oxide (NO), which is a ‘pain producing’ substance. The local release of NO signals the nervous system for the generation of the pain sensation, which interestingly is a protective mechanism the body makes! If the structure that is inflamed is experiencing pain, we are more likely to protect the area. A fifth symptom is also observed here, a limited range of motion which is another protective method. The repair and removal of cellular waste can have a duration lasting up to approximately 6-8 weeks. Throughout this sub-acute phase, the main pathway involved is the cyclooxygenase (COX) pathway. The final stage is known as the chronic phase, where remodelling and maturation of the original injury or trauma takes place. Once the inflammation inducer has been removed, the process of wound healing and/or tissue repair occurs, where damaged tissue is regenerated or they may be replaced with collagen strands and fibroblasts to begin the remodelling process. When collagen has been generated, the strands are progressively replaced by other materials and they adapt to the original tissue. If the inflammation continues, or the structures further destruct, scar tissue or fibrosis follows. This chronic phase can last months to years, depending on the type of injury and the inflammation. What is the difference between acute and chronic inflammation? Inflammation may present as acute or chronic and the main influence of this is the type and intensity of trauma. In acute inflammation, the onset is rapid with short-term symptoms which may be severe, whereas chronic inflammation has a long-term presentation with a prolonged duration that may last years. In some cases, chronic stressors causing inflammation can have a suppressive effect on the immune system in contrast to the acute stressors which enhance immediate adaptive immunity. In this scenario, sustained stressors may actually over-activate the immune system causing an imbalance of pro-inflammatory and anti-inflammatory mediators in the body, causing chronic inflammation. Chronic inflammation has a negative impact on overall health including our cells, tissues and organs which in-turn can increase the risk of developing disease and poor health states. Tips to help better manage inflammation Just as there are various factors contributing to the progression of inflammation, there are also multiple strategies for the management of symptoms, including pharmaceutical, physical therapies, dietary or lifestyle alterations and other complimentary or alternative medicine modalities. Some natural remedy suggestions may include herbal or nutritional sources with anti-inflammatory actions. The term ‘anti-inflammatory’ relates to a substance which has direct actions in reduces inflammation. Dietary food sources with anti-inflammatory actions can inhibit pathways such as the COX and therefore the inflammatory mediators such as prostaglandins, TNF, IL etc. described earlier also provide benefits to inflammatory conditions. Overall, an anti-inflammatory diet would ideally include higher intakes of antioxidant and fibre rich foods plus ensuring an adequate balance between healthy fats, proteins and carbohydrates. Try to avoid In inflammatory conditions, it is advised to limit the intake of refined carbohydrates i.e. white pasta, trans fats i.e. margarine, processed meats i.e. deli meats and sugars. It is best to avoid these food groups as they aggravate inflammation and contribute to inflammation by producing Advanced Glycation End (AGE’s) and may raise blood glucose levels, with cell damaging effects. Lifestyle suggestions to support the anti-inflammatory diet may include moderate physical activity to maintain a healthy weight range, reducing stress levels, allowing enough sleep for cell repair and recovery and managing any associated pre-existing conditions. It is also recommended to reduce alcohol intake and smoking as they can create inflammation driving toxins in the body. Fun Fact: Conditions ending in ‘-itis’ indicate inflammation of a specific organ, tissue or structure. For example: derma (skin) + itis (inflammation) = dermatitis

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One day your jeans zip up without a problem… the next day you’re undoing the top button or browsing for clothes with elasticated waistbands. Belly bloat, food baby, abdominal bloating, abdominal distension…whatever it’s called it’s uncomfortable! What causes bloating? A bloated stomach is that feeling of pressure or fullness in your belly. It may or may not be accompanied by distension, which is a noticeable difference in the size of your abdomen. A build-up of gas in the stomach and intestines is one of the most common causes of bloating. Intestinal gas can be caused by eating certain foods, particularly beans and cruciferous vegetables such as cauliflower, broccoli, and cabbage. Some foods are high in a type of sugar called FODMAPS. In people sensitive to FODMAP-rich foods, the small intestine doesn't always fully absorb these carbohydrates, and instead passes them to the colon, where they are fermented by bacteria and produce gas. FODMAPs don’t affect everyone equally, so while certain FODMAPs may make you feel bloated, you may be able to process others just fine. Eating too quickly, drinking through a straw, or drinking lots of fizzy drinks can cause you to swallow lots of air and make you feel full. Constipation can cause a build-up of faecal matter in the intestine leading to abdominal distension and bloating. Bloating can also be caused by medically diagnosed conditions such as food intolerances and intestinal disorders such as IBS (irritable bowel syndrome), IBD (inflammatory bowel disease, including Crohn’s disease and ulcerative colitis), and SIBO (small intestinal bacterial overgrowth). Is bloating the same thing as fluid retention? Yes and no. Fluid (water) retention, also known as oedema, is related to the kidneys, while bloating is usually related to the gastrointestinal tract. Fluid retention can make you feel bloated, but it doesn’t usually affect your abdomen as much as bloating caused by intestinal gas. Fluid retention occurs when excess fluid builds up in your body's circulatory system and generally causes swelling in your extremities, such as your feet, ankles, legs and hands. A common sign of fluid retention is when your rings feel tight on your fingers, or your ankles are swollen after sitting down for a long time. A diet high in carbohydrates, sugar and salt can cause your body to retain water, leading to that feeling of puffiness and heaviness. Fluid retention can also be caused by hot weather and hormonal changes. What can I do about bloating? Bloating that comes and goes is usually digestive-related and tends to disappear after a couple of days. It will often help if you cut down on salty foods, carbohydrates and fizzy drinks. If you have a food intolerance, or suspect that FODMAPS might be the issue, try eating less of the problem foods for a while. Keep a food diary for a couple of weeks, noting everything that you eat and drink and when bloating troubles you most. If you find you have a regular problem with certain foods though, you should consult a doctor or dietitian before making any permanent dietary changes. Adopting a few simple lifestyle changes may also help. Avoid chewing gum Eat slowly Avoid drinking from a straw Drink plenty of water If you suffer from constipation, try eating more high-fibre foods, increasing the amount of water that you drink, and exercising regularly. It might also be helpful to try taking probiotics. These can support a healthy gut bacteria population and help your digestive system moderate the effects of a bloated stomach. If bloating or fluid retention persists for more than a couple of days, or is accompanied by pain or diarrhoea, then you should speak to a doctor.

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Dietary Fibre and Metabolic Syndrome

9th January, 2016

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