Lymphatic Drainage and HRV

HRV (heart rate variability) is a hot topic, and for good reason. It’s a measure of your autonomic nervous system which is highly tied to the lymphatic system. The lymphatic system is where immune responses are launched. Lymphatic drainage can help improve heart rate variability (HRV) by reducing stress, enhancing circulation, and promoting parasympathetic nervous system activity. This can have a direct effect on swelling. 

The autonomic nervous system, involves the sympathetic nervous system (SNS) and parasympathetic nervous system (PNS), this is how they affect the lymphatic system:

1. The sympathetic nervous system (fight or flight response) can influence the contraction of lymphatic vessels, increasing lymph flow during times of acute stress.

2. On the flip side, the parasympathetic nervous system (rest and digest) promotes relaxation, potentially helping to improve lymphatic drainage during times of calm or recovery.

Gentle lymphatic drainage techniques stimulate the vagus nerve, which enhances parasympathetic tone and promotes relaxation. Since HRV is a marker of autonomic balance, improving parasympathetic activity leads to a higher HRV, which is linked to better stress resilience and cardiovascular health.

The lymphatic system helps remove metabolic waste and excess fluids. By improving lymphatic flow, the body reduces chronic inflammation, which can lower sympathetic nervous system (SNS) dominance. Since high stress and inflammation are associated with low HRV, reducing them supports better HRV.

Lymphatic drainage also helps improve blood circulation and oxygen delivery by preventing stagnation and fluid retention. Better circulation supports cardiac efficiency, which contributes to a more adaptive HRV response.

Better lymphatic function can improve detoxification in the brain (via the glymphatic system), reducing stress and improving sleep quality which is a key factor in HRV improvement.

Athletes and individuals recovering from illness or intense physical activity often use manual lymphatic drainage (MLD) to accelerate recovery and reduce stress load, leading to a higher HRV over time.

Here are some ways to incorporate lymphatic drainage into your routine to support HRV and overall well-being:

1. Self-Lymphatic Massage

• Here’s a quick video on how to do this on your own:

2. Deep Breathing (Diaphragmatic Breathing)

• Breathe deeply into your belly (not your chest).

• Inhale for 4 seconds, hold for 4 seconds, exhale for 6-8 seconds.

• This helps move lymph fluid and activates the parasympathetic nervous system, improving HRV.

3. Movement & Exercise

• Rebounding (mini-trampoline) is great for lymph flow. 

• Gentle yoga, walking, or stretching also promote lymphatic circulation.

• Leg elevation for 10-15 minutes can help lymphatic drainage.

• Here is a way to rebound without a trampoline:

4. Hydration & Electrolytes

• Drink plenty of water to keep lymph fluid moving.

• Adding electrolytes (like potassium & magnesium) can enhance hydration and nerve function, supporting HRV.

5. Cold Exposure & Contrast Therapy

• Alternating hot & cold showers stimulates circulation and lymphatic flow.

• Cold exposure also improves HRV by increasing vagal tone.

• Here is a video explaining how to use cold plunges for either sympathetic or parasympathetic stimulation:

6. Lymphatic Drainage Massage (Professional)

• A certified lymphatic drainage therapist can provide a specialized massage to reduce fluid retention and activate the parasympathetic system.

• Learn more about our Lymphatic specialist here

7. Sleep & Stress Management

• Prioritize 7-9 hours of quality sleep.

• Use meditation, mindfulness, or vagus nerve stimulation to enhance HRV.

• Here’s a free pdf on 12 ways to improve sleep

Lymphatic drainage is conventionally used post surgery. However, it can be as effective for any athlete that likes to train hard. By improving lymphatic flow, reducing swelling, and supporting overall detoxification, lymphatic drainage can accelerate recovery and help you feel refreshed and ready for your next workout. 

Hormones and Bone Loss: How Parasympathetic Breathing Can Improve Bone Density

Bone is a living tissue that constantly undergoes remodeling, with old bone being broken down and new bone being built. This delicate balance is regulated by various hormones, and when imbalances occur, bone loss can accelerate, leading to conditions like osteopenia and osteoporosis.

Key Hormones That Influence Bone Loss

1. Parathyroid Hormone (PTH) – When calcium levels drop, PTH stimulates bone resorption to release calcium into the bloodstream. Chronic overactivity of PTH (hyperparathyroidism) leads to excessive bone breakdown.

2. Cortisol – Known as the stress hormone, elevated cortisol levels (due to chronic stress or conditions like Cushing’s syndrome) suppress bone formation and increase bone breakdown, weakening bone density over time.

3. Thyroid Hormones (T3 & T4) – Hyperthyroidism accelerates bone turnover, causing net bone loss when resorption outpaces formation.

4. Estrogen – This hormone plays a protective role by inhibiting bone resorption. Its decline during menopause results in increased bone loss, making postmenopausal women more susceptible to osteoporosis.

5. Testosterone – Essential for both men and women, testosterone helps maintain bone density. Low levels can contribute to bone thinning.

6. Vitamin D & Calcium-Regulating Hormones – Vitamin D enhances calcium absorption in the gut. Deficiency triggers compensatory PTH release, increasing bone resorption.

Given the strong connection between hormonal balance and bone health, it's essential to explore holistic ways to counteract bone loss. One promising approach is parasympathetic breathing.

The parasympathetic nervous system (PNS), often called the “rest and digest” system, counterbalances the stress-induced effects of the sympathetic nervous system (SNS). Chronic stress activates the SNS, elevating cortisol levels and increasing bone loss. By engaging the PNS through specific breathing techniques, we can reduce stress, lower cortisol levels, and create a more favorable environment for bone formation.

Benefits of Parasympathetic Breathing for Bone Density

1. Reduces Cortisol Levels – Deep breathing techniques stimulate the vagus nerve, shifting the body into a parasympathetic state and reducing cortisol production, which helps protect bone mass.

2. Enhances Calcium Absorption – A relaxed state optimizes digestion and nutrient absorption, including calcium and magnesium, which are critical for bone health.

3. Improves Sleep Quality – Better sleep regulates growth hormone and melatonin, both of which support bone remodeling and repair.

4. Lowers Inflammation – Chronic inflammation can accelerate bone loss. Deep breathing has been shown to lower inflammatory markers, aiding bone preservation. 

Effective Parasympathetic Breathing Techniques

Incorporating daily breathing exercises can have profound effects on bone health. Here are three simple techniques:

1. Diaphragmatic Breathing (Belly Breathing): Sit or lie down comfortably. Place one hand on your chest and the other on your abdomen. Inhale deeply through your nose, allowing your abdomen to rise while keeping your chest still. Exhale slowly through your mouth. Repeat for 5–10 minutes daily.

2. 4-7-8 Breathing: Inhale deeply through your nose for 4 seconds. Hold your breath for 7 seconds. Exhale slowly through your mouth for 8 seconds. Repeat for 4–5 cycles to activate the PNS

3. Breathing Spin Down: See it here.

Dizziness and the Vestibular Ocular Reflex (VOR)

There are a lot of causes of dizziness. Dizziness is a vague word though, and can be used to describe a variety of symptoms. So when a patient tells me they are dizzy, I first clarify what type of dizziness because that gives me good insight to the problem at hand. There is the room-spinning dizziness that is most commonly associated with BPPV (the crystals in the ear). Then there is light-headed dizziness which may be a blood pressure issue, amongst other things. Then there is that feeling of being “off-kilter”, or a “wooziness”. This is the type of dizziness this blog will address. 

The vestibulo-ocular reflex (VOR) plays a crucial role in maintaining stable vision, particularly when the head moves. Imagine you're riding in a car, and you’re looking out the window at a tree. Now, when the car turns, you can still see the tree clearly, right? That’s because your eyes quickly adjust to keep the tree in focus, even though your head is turning. This reflex allows your eyes to adjust quickly and accurately in response to head movements, helping you maintain focus on an object despite the changes in your head's position. When there’s an issue with this reflex, it can lead to a condition called VOR hypofunction. 

VOR hypofunction refers to a decrease in the function of the vestibulo-ocular reflex. In simpler terms, it means that the system responsible for stabilizing your gaze during head movement isn’t working properly. This results in blurred vision, dizziness, and difficulty focusing on objects when you move your head.

The VOR works by detecting head movement via the vestibular system, which is part of the inner ear. By the way, this has nothing to do with hearing. The vestibular system sends signals to the eye muscles to adjust the position of the eyes, helping you maintain a stable visual field. When this process is disrupted, you may experience a variety of symptoms, especially when turning your head or performing activities that require quick eye movements.

I often liken this to a boat with 2 engines, one is 150 horsepower and the other is 50 horsepower. It would be hard to drive that boat straight. VOR hypofunction is a miscalibration of the reflex. This can cause blurred vision, difficulty focusing on an object, motion sensitivity, nausea, and impaired balance. You may even notice that you are veering to one side when walking. 

VOR hypofunction often occurs secondary to another issue. It can be as simple as dehydration. It often happens with someone who has been dealing with BPPV for a long time. Or, if you’ve become sedentary and are just not using the reflex much. Like a muscle, it atrophies in a sense. The good news is that it’s just a matter of recalibrating the reflex to fix it. This can be done with some simple exercises called “gaze stabilization”. 

If this sounds like you, I’d recommend getting on a call:

We’ve also built an at home, DIY program. You can learn more about it here: 

Understanding GLP-1 Agonists: What They Are and How They Work

In the world of diabetes and obesity management, GLP-1 agonists have emerged as an innovative class of medications that help improve blood sugar control and, in some cases, assist with weight loss. But what exactly are GLP-1 agonists, and how do they work in the body? In this blog, we’ll explore the science behind GLP-1 agonists, their mechanism of action, and how they’re changing the landscape of treatment for conditions like Type 2 diabetes.

What are GLP-1 Agonists?

GLP-1 stands for Glucagon-Like Peptide 1, a hormone naturally produced in the intestines. Its primary role is in regulating glucose metabolism and promoting insulin secretion in response to food intake. GLP-1 agonists are synthetic medications that mimic the action of this natural hormone, and they are used primarily to treat Type 2 diabetes and obesity.

Commonly prescribed GLP-1 agonists include drugs like liraglutide (Victoza), semaglutide (Ozempic, Wegovy), exenatide (Byetta), and dulaglutide (Trulicity). These medications are typically injected, though oral formulations are also becoming available.

How Do GLP-1 Agonists Work?

GLP-1 agonists work in a variety of ways to help manage blood sugar levels and support weight loss:

1. Enhancing Insulin Secretion
   GLP-1 agonists stimulate the release of insulin from the pancreas when blood sugar levels are elevated. Insulin is the hormone that helps regulate blood sugar by promoting the uptake of glucose into cells. The key here is that GLP-1 agonists only enhance insulin secretion when glucose levels are high, helping prevent low blood sugar (hypoglycemia) – a common concern with other diabetes medications.
   

2. Suppressing Glucagon Release
   Glucagon is a hormone that has the opposite effect of insulin. It signals the liver to release stored glucose into the bloodstream. By suppressing the release of glucagon, GLP-1 agonists help prevent the liver from releasing excess glucose, which can be particularly useful in controlling blood sugar levels during fasting or between meals.
   

3. Slowing Gastric Emptying
   One of the reasons GLP-1 agonists are effective for weight loss is that they slow down the rate at which food leaves the stomach. This leads to a prolonged feeling of fullness and satiety, helping to reduce appetite and decrease overall calorie intake.
   

4. Promoting Weight Loss
   Through a combination of reduced appetite and slower gastric emptying, GLP-1 agonists help many people lose weight. They influence the brain’s hunger signals, leading to decreased food intake. This is particularly beneficial for those with Type 2 diabetes, as obesity is a major contributing factor to insulin resistance.
   

5. Improving Beta-Cell Function
   Beta cells in the pancreas are responsible for producing insulin. GLP-1 agonists have been shown to support the function of these beta cells, helping the pancreas better respond to glucose fluctuations. Over time, this can lead to improved overall insulin sensitivity and better long-term control of blood sugar.
   

Benefits of GLP-1 Agonists

• Better Blood Sugar Control: GLP-1 agonists are highly effective at lowering HbA1c, a long-term marker of blood sugar levels, making them an essential tool for managing Type 2 diabetes.
  

• Weight Loss: Many patients experience significant weight loss while on GLP-1 agonists, which can be an additional benefit, especially for those dealing with obesity-related diabetes.
  

• Cardiovascular Protection: Some GLP-1 agonists, such as semaglutide and liraglutide, have been shown to reduce the risk of heart attacks, strokes, and other cardiovascular events in people with Type 2 diabetes.
  

• Lower Risk of Hypoglycemia: Unlike some other diabetes medications, GLP-1 agonists don’t usually cause low blood sugar unless used in combination with insulin or sulfonylureas.
  

Side Effects of GLP-1 Agonists

Like any medication, GLP-1 agonists come with some potential side effects. The most common are gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation. These effects often lessen over time as the body adjusts to the medication. However, in rare cases, more serious side effects like pancreatitis or thyroid cancer have been reported, though these are considered uncommon.

Other options to improve blood sugar regulation

There are lots of ways to improve blood sugar regulation and lose weight without the use of drugs. If you want a free PDF on 11 tips to improve blood sugar, get it here. There is also a stack of supplements you can take that include the ingredients to naturally produce GLP-1 without having to take an injection. We’ll be releasing the details on this soon in a podcast. Stay tuned and sign up for our email newsletter to be informed when it gets released.

The Surprising Link Between Grip Strength and Lower Blood Pressure

When we think about ways to lower blood pressure, we often imagine activities like jogging, cycling, or practicing yoga. However, there’s an underrated and often overlooked method that can help: training your grip strength. Building a stronger grip can actually contribute to lowering your blood pressure. Let’s dive into how this works and why incorporating grip strength exercises into your routine might be a game-changer for your cardiovascular health.

The Science Behind Grip Strength and Blood Pressure

Grip strength is commonly associated with muscle health and performance, but emerging research suggests that it may have a significant impact on our cardiovascular system. Grip strength correlates with overall strength, cardiovascular health, and even mortality risk. So, how does something as simple as squeezing a handgrip or performing deadlifts with a strong grip lead to lower blood pressure?

1. The Role of Isometric Exercise

Grip strength exercises, such as squeezing a handgrip, are a form of isometric exercise. Isometric exercises involve contracting muscles without changing their length (think holding a plank or pushing against a wall). When you engage in an isometric exercise like grip training, your body goes through a temporary spike in blood pressure due to muscle contraction. However, regular practice leads to improvements in blood vessel flexibility and function, which can result in a long-term reduction in resting blood pressure.

2. Activation of the Sympathetic Nervous System

Strength training activates the sympathetic nervous system (SNS), which is responsible for the “fight or flight” response. While this activation might sound counterintuitive to lowering blood pressure, it’s a crucial part of the adaptation process. The key here is that regular, controlled activation of the SNS through strength exercises (like grip training) can help regulate blood pressure over time by improving vascular function, making the body more resilient to stress.

3. Improved Vascular Health

Regular grip strength training improves blood flow and helps enhance the elasticity of blood vessels. This is important because stiff, inflexible arteries are a primary contributor to high blood pressure. The increased blood flow generated from exercises that involve grip strength can reduce the workload on the heart and lower the resistance in the arteries, resulting in healthier blood pressure levels.

4. Reduced Stress and Better Cardiovascular Function

Stress is a known contributor to high blood pressure. Many grip strength exercises require focus and controlled breathing, which helps reduce mental stress and anxiety levels. Additionally, building strength through gripping movements (such as holding heavy weights or performing farmer’s walks) can release endorphins, the body’s natural stress relievers. Over time, this leads to both physical and emotional benefits, including lower blood pressure.

Practical Ways to Train Grip Strength

You don’t need to spend hours at the gym to benefit from grip strength training. There are simple exercises you can incorporate into your daily routine that don’t require fancy equipment or a lot of time. Here are some practical ways to get started:

1. Hand Grippers

Hand grippers are inexpensive tools that can be used to perform targeted grip strength exercises. Start by squeezing the gripper for short intervals (e.g., 10-15 seconds), then rest and repeat. Gradually increase the duration as your grip strength improves.

2. Farmer’s Walks

Grab two dumbbells or kettlebells, and walk for a set distance or time while holding the weights with a firm grip. This exercise strengthens the hands, wrists, forearms, and even the core, contributing to improved overall strength and blood pressure regulation.

3. Deadlifts

Deadlifts are a fantastic compound movement that naturally engages the grip. The challenge of holding the barbell while lifting weights helps improve grip strength, which benefits the entire body, including cardiovascular health. Start with lighter weights and gradually increase as your strength improves.

4. Towel Pull-Ups

For those who want to challenge their grip strength further, try towel pull-ups. Hang a towel over a pull-up bar, and grip each end to perform pull-ups. The thicker grip forces your forearms and hands to work harder, increasing grip strength while also strengthening the upper body.

5. Finger Curls

Sit down and hold a barbell or dumbbell with your palms facing up. Slowly curl your fingers to lift the weight, then lower it back down. This exercise isolates the muscles of the forearm and fingers, helping to increase grip endurance and strength.

How Much Grip Training Do You Need?

The beauty of grip training is that it doesn’t take long to see benefits. Just 5–10 minutes a few times a week can be enough to improve your grip strength. Combine grip strength exercises with other forms of exercise like walking or resistance training for maximum cardiovascular benefits. Over time, this will not only enhance your ability to lift and perform various tasks but also help regulate your blood pressure.

Building grip strength is a simple yet powerful way to support your heart health and manage blood pressure. While it might not be the first thing that comes to mind when thinking about lowering blood pressure, training your grip can have significant, long-lasting effects on your cardiovascular function. So, if you’re looking for a low-impact, efficient method to improve your blood pressure and overall well-being, start incorporating grip strength exercises into your fitness routine.

Isocapnic Training for Asthma

Asthma is a chronic respiratory condition that affects millions of people worldwide, leading to symptoms such as shortness of breath, wheezing, chest tightness, and coughing. While medications like bronchodilators and corticosteroids are the primary treatment options, new techniques are emerging that may help people better understand and manage their condition. One such method gaining attention is isocapnic hyperventilation, an approach that uses controlled breathing to improve lung function and reduce asthma symptoms.

Isocapnic is a term derived from two Greek words: "iso," meaning "equal" or "constant," and "capnia," meaning "carbon dioxide." Therefore, isocapnic refers to a state in which the carbon dioxide (CO2) level in the blood remains constant or is kept at a stable level.

In the context of breathing techniques, isocapnic conditions are often used to describe situations where breathing patterns are designed to maintain stable levels of CO2 despite changes in other aspects of respiration, such as the rate or depth of breathing.

For example, in isocapnic hyperventilation, a person breathes more rapidly than normal, but the goal is to prevent the typical decrease in CO2 levels that usually accompanies rapid breathing, ensuring that the CO2 concentration remains steady. This is important in various respiratory therapies, as CO2 levels influence several bodily functions, including the regulation of breathing and the acid-base balance in the blood.

In the context of asthma, this technique has been studied for its potential to help strengthen respiratory muscles, improve lung function, and increase the body’s tolerance to breathing challenges that often trigger asthma symptoms.

The benefits of isocapnic hyperventilation for asthma can be understood in the following ways:

1. Improved Respiratory Muscle Strength

Asthma often causes the muscles around the airways to constrict, making it harder to breathe. Controlled breathing exercises like isocapnic hyperventilation help strengthen the respiratory muscles, allowing for better airflow and lung expansion. The practice involves rapid and forceful inhalation and exhalation, which can improve muscle endurance and resilience, both of which are crucial for asthma management.

2. Increased CO2 Tolerance

Asthma attacks often cause the airways to constrict, leading to a drop in blood CO2 levels. Through isocapnic hyperventilation, individuals are trained to breathe in a way that maintains normal CO2 levels even while breathing rapidly. This training enhances the body’s tolerance to slight fluctuations in CO2 levels, which can reduce the likelihood of panic-induced hyperventilation or excessive airway constriction during an asthma attack.

3. Better Control of Breathing Patterns

Many individuals with asthma experience disrupted breathing patterns during attacks, often hyperventilating in an attempt to compensate for insufficient air intake. By practicing isocapnic breathing, patients can learn to maintain controlled and efficient breathing patterns, which help prevent over-breathing or inefficient airflow. This technique can help reduce the anxiety and panic that often accompany asthma attacks, ultimately leading to a more relaxed and controlled breathing state.

4. Improved Gas Exchange

For those with asthma, the process of oxygen and carbon dioxide exchange in the lungs is often impaired during an attack. Isocapnic hyperventilation exercises can help improve the efficiency of gas exchange by allowing for better ventilation and perfusion matching. This means the lungs are better able to deliver oxygen to the blood and remove carbon dioxide, promoting better overall lung function.

Here’s a basic outline of how this technique is practiced:

1. Find a Comfortable Position: Sit in a relaxed position with your spine straight. Breathe calmly and naturally before starting.
   
   
   

2. Controlled Breathing: Begin by taking deep breaths at a steady pace. Gradually increase the frequency of inhalations and exhalations, aiming for a rapid breathing pattern but ensuring that you do not experience a sensation of light-headedness or discomfort. The goal is to increase the rate without causing an imbalance in CO2 levels.
   
   

3. Focus on the Exhalation: Focus on forceful exhalations to expel as much air as possible from your lungs. This helps in strengthening the muscles involved in exhalation.
   
   

4. Monitor CO2 Levels: Advanced isocapnic techniques involve using equipment to monitor CO2 levels, ensuring they stay within normal ranges. However, for beginners, simply focusing on controlled, rapid breathing while avoiding hyperventilation (excessive breathing that lowers CO2 levels too much) is key.
   
   

5. Gradual Increase: Start slowly and increase the duration of the practice over time. Always listen to your body and stop if you feel dizzy or light-headed.

Isocapnic hyperventilation is a promising technique that could offer significant benefits for people managing asthma. By training the body to maintain controlled breathing and increase CO2 tolerance, patients with asthma may experience improved respiratory muscle function, better breathing patterns, and reduced asthma attacks. As with any therapeutic approach, it's important to combine isocapnic breathing with traditional asthma management methods, including medication and regular medical check-ups.

I personally have been using this tool by a company called Isocapnic. It comes with an app that allows you to follow along to different protocols. It’s an exciting product and was designed for optimization in sports, but it has promise for rehabilitation as well. 

I interviewed the owner of Isocapnic, Luke Way, on my podcast. If you’d like to hear it, click below:

How Sleep Apnea Affects Your Blood

Sleep apnea is a largely overlooked problem, and I can’t emphasize enough how important it is to address it. It causes all kinds of nasty stuff like blood sugar dysregulation, weight gain, stroke, heart attack, etc. if left unchecked. The loss of oxygen that occurs at night can have an impact on your blood markers. This means that your routine bloodwork can potentially pick up on an undiagnosed sleep apnea problem. 

With the chronic sleep disruption that occurs with apnea, hypoxia occurs (low oxygen). In response to low oxygen levels, as a way to compensate, the body stimulates the production of erythropoietin, a hormone produced by the kidneys that stimulates red blood cell (RBC) production in the bone marrow. This is called polycythemia, so you’d see a rise in RBCs in your bloodwork. 

Because the RBCs rise, so does hemoglobin (which is transported by RBCs). Hematocrit is the blood volume, or as I like to think of it, density; how thick your blood is. When you are dehydrated, your hematocrit rises. Since RBCs rise, so does hematocrit. 

MCV stands for mean corpuscular volume. This is the average size of your blood cells. Blood cells are born large, and die smaller. Blood cells typically live about 120 days, but that can vary depending on the health of the individual. In an environment where chronic elevation of blood sugars occur (as it typically does with sleep apnea), blood cells will die younger. In other words, the higher the MCV, the sooner the blood cells are dying; so you’d expect elevated MCV with sleep apnea. 

Sleep apnea has a known correlation to cardiovascular disease, largely because of its contribution to developing diabetes. So if you see these indices rising, it’s important to follow up on it and find out why these numbers are rising.

To summarize, you may see:

1. Elevated RBCs

2. Elevated Hemoglobin

3. Elevated Hematocrit

4. Elevated MCV

If you feel you need help with interpreting your bloodwork, let’s get on a call:

Understanding Reactive Hypoglycemia

Blood sugar can rise and fall for some individuals and can feel like a terrible roller coaster ride. Reactive hypoglycemia, also known as postprandial hypoglycemia, is when blood sugar drops after a meal. While it's not as widely known as diabetes, it can still significantly impact an individual’s daily life. 

Hypoglycemia refers to a condition where blood sugar (glucose) levels drop below the normal range, typically below 70 mg/dL. While many people are familiar with hypoglycemia in the context of diabetes and insulin management, reactive hypoglycemia occurs in individuals without diabetes. It specifically happens after eating meals and usually within a few hours (1-4 hours) post-consumption.

In a healthy person, after eating, blood sugar rises, prompting the pancreas to release insulin. This process helps bring glucose into cells for energy. However, in people with reactive hypoglycemia, the body overcompensates by releasing too much insulin, which causes blood sugar levels to drop too low, resulting in the symptoms of hypoglycemia.

The symptoms of reactive hypoglycemia can be quite distressing and may vary from mild to severe. Common symptoms include:

• Shakiness: A feeling of trembling, often in the hands.

• Sweating: Excessive perspiration, especially cold sweat.

• Dizziness: Lightheadedness or even fainting in extreme cases.

• Hunger: A strong desire to eat, particularly for sugary or carbohydrate-rich foods.

• Heart Palpitations: A racing or pounding heartbeat.

• Confusion or Difficulty Concentrating: Mental fog or trouble focusing.

• Irritability: Mood swings or feeling unusually anxious.

• Fatigue: Feeling unusually tired or weak, sometimes even after a meal.

These symptoms occur after meals, typically 1 to 4 hours after eating, and may vary depending on the individual and the size or type of meal consumed.

The exact cause of reactive hypoglycemia can vary, but here are some common factors:

1. Excessive Insulin Release: In some people, the body overreacts to food intake, especially high-carbohydrate meals, by releasing too much insulin. This sudden drop in blood sugar can lead to hypoglycemia.
   

2. Impaired Hormonal Regulation: Some individuals may have an imbalance in hormones, particularly insulin and glucagon, that normally help regulate blood sugar levels. This dysfunction can cause glucose levels to fluctuate erratically after eating.
   

3. Insulin Resistance: In some cases, the body may become less responsive to insulin (insulin resistance). This can lead to an overproduction of insulin after meals, which eventually results in hypoglycemia.
   

4. Gastric Bypass Surgery: People who have undergone weight-loss surgeries such as gastric bypass may experience reactive hypoglycemia as a result of changes in how food is digested and absorbed.
   

5. Other Underlying Conditions: Conditions like pancreatic tumors (insulinomas), adrenal insufficiency, or certain endocrine disorders can also cause episodes of reactive hypoglycemia.
   

6. Dietary Factors: Large amounts of refined carbohydrates or sugary foods can cause a spike in blood sugar followed by a rapid drop, triggering hypoglycemia in susceptible individuals.
   

If you experience symptoms of reactive hypoglycemia, it's important to consult a healthcare provider for a proper diagnosis. A doctor may perform tests, including:

• Blood Glucose Monitoring: Measuring blood sugar levels after fasting and after meals helps identify abnormal fluctuations.

• Oral Glucose Tolerance Test: In this test, you drink a sugary solution, and your blood sugar is monitored at various intervals afterward to observe how your body reacts.

• Continuous Glucose Monitoring: For more detailed tracking, some individuals may wear a continuous glucose monitor (CGM) to track fluctuations in blood sugar throughout the day.

While there is no one-size-fits-all approach to managing reactive hypoglycemia, there are several strategies that can help alleviate symptoms and prevent episodes from occurring.

1. Eat Smaller, Balanced Meals

• Frequent Meals: Instead of three large meals, aim to eat 5-6 smaller meals throughout the day to keep your blood sugar levels stable.

• Balance Carbohydrates: Focus on eating meals that include a balance of complex carbohydrates, protein, and healthy fats. This helps to regulate blood sugar levels more evenly. 

2. Avoid High-Sugar and Refined Carbs

• Limit Sugary Foods: Foods like candy, soda, and pastries cause rapid spikes in blood sugar followed by crashes. These should be avoided, especially if you're prone to hypoglycemia.

• Opt for Low Glycemic Index (GI) Foods: Choose foods that are digested slowly.

3. Include Protein in Every Meal

Protein-rich foods, like red meat, eggs, chicken, fish, tofu, or legumes, help slow the absorption of sugar from carbohydrates into the bloodstream, reducing the risk of blood sugar spikes and crashes.

4. Stay Hydrated (don’t forget electrolytes)

Dehydration can exacerbate symptoms of hypoglycemia, so it’s essential to drink plenty of water throughout the day. Avoid excessive caffeine, as it can cause blood sugar fluctuations.

5. Monitor Your Blood Sugar

Using a blood glucose monitor at home can help you track your blood sugar levels and identify patterns, such as when your blood sugar drops after meals.

6. Exercise Wisely

Exercise can help improve insulin sensitivity and overall blood sugar control. However, intense physical activity, especially on an empty stomach, can cause blood sugar levels to drop. It’s best to eat a balanced snack before exercising if you’re prone to reactive hypoglycemia.

7. Cold Plunge or Exposure Training

Consistent and progressive exposure training has been shown to help balance blood sugar levels. Combine this with wearing a CGM to see how you react as there can be individual differences. 

Reactive hypoglycemia can be a frustrating condition, but with the right management strategies, it is often manageable. By eating a balanced diet, staying hydrated, and monitoring your blood sugar levels, you can reduce the frequency and severity of symptoms. 

If you want to learn more about continuous glucose monitoring: 

How to Vacation Right (In My Opinion)

Do you feel like you need another vacation when you get back from vacation? I certainly have, and have learned from this. In my opinion, this is a sign you’re doing it wrong. Chances are, you’re doing way too much.

I’m currently writing this blog from my in-laws house in Brazil. I love coming here because it is so relaxing. It would be easy to just fall into a rhythm of doing nothing, watching tv/movies, staying up late and partying. These are the behaviors that lead to feeling like you need another vacation when you get home. Don’t get me wrong, there is some of that, but it’s not the center or the priority of my vacations now. It’s the exception, not the rule. 

I’ve shifted my mindset, over the years, of how to maximize my down time. I think of it as similar to having an injury. Many people wrongly think you just need to rest. While rest is good, it doesn’t mean you should do nothing. You’re still supposed to move, just not in ways that aggravate the injury. This is what we mean by ‘active recovery’. This is how I see vacations now, active recovery. 

This brings me to a great quote by the stoics: 

“Leisure without study is death - a tomb for the living person.” 

• Seneca

Modern life is hectic. Especially if you have kids, a business or job, difficult family dynamics, etc. We live in a constant state of sympathetic activity. It’s even in our language, “my nerves are fried”. This is accurate, the nervous system is chronically in overdrive. This has consequences, it inhibits our sleep, makes us short tempered, drives up blood sugar, inhibits wound healing, and leads to burn out. Like an injury, it can take you out. 

So now, when I vacation, I try my best to flip the nervous system switch. I seek as much parasympathetic stimulation as possible. Again, this doesn’t mean do nothing; there are tons of behaviors that are active and parasympathetic such as going for a walk, or reading a book. This becomes my time to catch up on those books I’ve been meaning to read, or to actually pay attention to my step count. 

Cold plunging, saunas, and massage are all amazing options too. So I try to spend the majority of my time in a parasympathetic state. I think of it as rebalancing the nervous system. However I do spend some time doing “eustress” activities. Eustress is something that pushes you a bit, and you come back stronger. Lay outside in the sun for 30 minutes or so, you get a tan. That tan is like a defense to the sun. This is eustress. A distress would be to lay out in the sun for hours and get burned. This is damaging and not useful. 

Much like riding a bike, it initially raises your heart rate, but then you get to enjoy a lower average resting heart rate. Cold plunges work this way too. It technically initially is sympathetic, but as soon as you get control of your breath, it becomes parasympathetic. 

I always want to include some form of movement on my vacations. I usually bring my suspension straps and a couple of exercise bands. You can get a lot done with those items and they take up minimal space in your luggage. I’m not trying to be covered in sweat, rather I think of it as joint lubrication, blood flow, and just generally feeling good. 

There are activities that I have to do when I’m home that I know are not great for long term health that I try to avoid as much as possible. This includes avoiding cell phones and tvs when eating (inhibits digestion), rushing around, and being under slept. I do my best to catch up on sleep (this is priority number 1), eating with family and connecting, and to try to do less in a day. I enjoy writing, so this has become a bit of a daily habit. This is my time to do what makes me happy, and drops my blood pressure. 

Often my patients ask what exercises they should do while on vacation. I think the KISS principle works well here. Keep it simple, keep it realistic. I generally recommend picking one thing to focus on. Have a hamstring that’s extra tight? Make that your one movement priority. I don’t recommend aiming for hour-long workouts and then getting upset with yourself when you don’t do it. That sets you up for failure. I’d rather have more little bouts of movement then chunking it into one sweaty hour. I like the idea of “exercise snacks”. Doing a set of 20 air squats after a meal is a great example, and a great way to improve insulin sensitivity. 

Or, one of my favorite options is the 27 squat drill. This is quick and easy, works on ankle and hip mobility, and you get 27 squats in. See below: 

In fact, the last time I visited Brazil, I made a suspension strap program because it piqued my creative interest. If you want to check it out, click below:

Once I shifted my mindset to a “do less” principle, I noticed that I was able to reflect on my life more. Similar to looking at the horizon rather than being fixated on a phone; you get the big picture view. You come to understand what is of value this way. It reminds me of when I used to work in a scuba shop. The boat would take us and some tourists to the desired location. Then we would just shake our heads as all the new divers would just swim around as fast as possible to cover as much territory as they could, soaking up their air and only seeing more sand. The more experienced divers knew that the boat took you to that location for a reason. Once the boat cuts the engine and the sand settles, all the eels, lobsters, octopus, and beautiful fish come out from their respective hiding places. 

A little quote I came up with: 

“Life is simple. We make it complicated and then we are surprised that it’s complicated.”

The bottom line is be gracious with yourself. Use your down time wisely and treat it like a neurologic reset. Come home rested, and a better version of yourself, and you won’t get that feeling like you need a vacation from vacation.

What Does it Mean if You Have High Creatinine?

Creatinine is often associated with kidney function, and for good reason; it's a waste product filtered out by the kidneys. When creatinine levels rise, it typically signals that the kidneys might be struggling. However, high creatinine levels don't always indicate a serious health problem. In fact, there are several instances where elevated creatinine levels are perfectly normal or simply a reflection of factors unrelated to kidney disease.

So, how can high creatinine levels be not so bad? Let’s dive deeper into this concept.

Creatinine is a byproduct of the normal breakdown of muscle tissue. As muscles use creatine (a molecule that helps supply energy to muscles), creatinine is produced and then filtered from the blood by the kidneys. It is excreted through urine. Under normal circumstances, creatinine levels in the blood should remain relatively stable, as the kidneys filter it efficiently.

However, when kidney function declines, creatinine can build up in the bloodstream, signaling that the kidneys are not working as they should. This is why elevated creatinine levels are often considered a potential marker of kidney problems. But while high creatinine levels are often seen as a red flag, there are many instances where this is not necessarily the case.

One of the primary reasons for naturally higher creatinine levels is muscle mass. The more muscle mass a person has, the more creatinine their body produces. This is because creatinine is generated from the breakdown of creatine, which is stored in muscles. Therefore, individuals who are naturally more muscular will tend to have higher baseline creatinine levels.

Another factor that can raise creatinine levels is diet, particularly a high intake of animal protein. Creatinine is produced as a byproduct of muscle metabolism, and when you consume large amounts of protein (especially red meat), your body breaks down more muscle tissue and produces more creatinine.

While this increase in creatinine can sometimes be mistaken for a sign of kidney dysfunction, it’s typically temporary and can be reversed by adjusting your diet. This is why healthcare providers will often ask patients to fast for 8–12 hours before a blood test to ensure the creatinine level is not artificially elevated due to a recent meal.

Dehydration can cause a temporary spike in creatinine levels. When you're dehydrated, your blood volume decreases, leading to higher concentrations of creatinine in the bloodstream. This is a temporary situation, and once you rehydrate, your creatinine levels should return to normal. It’s an important distinction because dehydration is often easily reversible with increased fluid intake.

Some medications and supplements can increase creatinine levels, either by temporarily affecting kidney function or by increasing muscle breakdown. Nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and blood pressure medications like ACE inhibitors can influence creatinine levels. Additionally, supplements like creatine, used by bodybuilders or athletes to enhance performance, can also increase creatinine production because creatine is converted into creatinine in the muscles.

A common misconception is that taking creatine is bad for the kidneys. It can raise your creatinine, but creatinine is simply a marker. This is guilt by association. Similar to blaming a firefighter for creating fires simply because they are always at the scene. Creatinine is a result of kidney disease, not the cause. 

Strenuous exercise, particularly activities that involve heavy lifting or intense muscle use (like weight training or sprinting), can cause a temporary increase in creatinine. This happens because exercise causes muscle tissue breakdown, which leads to increased creatinine production. In most cases, this is a short-term spike that will return to normal within a day or two after the exercise.

While high creatinine levels can sometimes be perfectly normal, it’s important to be cautious and consult a healthcare provider if the levels are consistently high or if other symptoms of kidney dysfunction are present, such as:

- Fatigue

- Swelling (edema)

- Frequent urination issues

- Shortness of breath

- High blood pressure

However, if you experience persistent high creatinine levels or other signs of kidney dysfunction, it’s important to consult with your healthcare provider to rule out kidney disease or other serious conditions. Regular monitoring of kidney function, particularly if you have risk factors for kidney disease, is a proactive way to maintain your health.

The Metaboreflex: The Body's Hidden Cardiovascular Response

When we exercise, our body undergoes a series of remarkable physiological changes to ensure that our muscles get the oxygen and nutrients they need to perform efficiently. One of the most fascinating and lesser-known processes behind this adaptation is the “metaboreflex”. The metaboreflex is an essential cardiovascular reflex that plays a crucial role in regulating blood flow and maintaining homeostasis during physical activity.

What Is the Metaboreflex?

The metaboreflex is a type of autonomic reflex that primarily affects the cardiovascular system. It’s triggered by the build-up of metabolic byproducts, such as carbon dioxide, and hydrogen ions (which make muscles feel fatigued during intense exercise). When these byproducts accumulate in the muscle tissue during prolonged or strenuous activity, the metaboreflex kicks in to regulate blood flow, ensuring that the body can continue to function efficiently despite the increasing demand for oxygen.

The key role of the metaboreflex is to increase heart rate, blood pressure, and respiratory rate in response to metabolic stress, specifically to redirect blood to active muscles. It’s part of the body’s overall strategy to deal with exercise-related stress, along with other mechanisms like the baroreflex (which regulates blood pressure in response to changes in body posture) and the chemoreflex (which responds to changes in blood gas levels).

How Does the Metaboreflex Work?

The metaboreflex is activated by receptors in the muscles, specifically metaboreceptors. These receptors are sensitive to changes in the metabolic environment of the muscles, including levels of CO2, and other byproducts of cellular respiration.

When these metabolites accumulate during exercise, they signal the brain (particularly the cardiovascular centers in the medulla) through afferent nerves, such as the group III and IV afferents. These signals tell the brain that the muscles need more oxygen and nutrients. In response, the brain initiates the sympathetic nervous system, which increases heart rate, cardiac output, and vasoconstriction (narrowing of blood vessels in non-essential areas) to prioritize blood flow to the working muscles.

The Role of the Metaboreflex in Exercise

The metaboreflex plays a critical role in endurance and strength training. During exercises like running, cycling, or weightlifting, it ensures that your muscles receive a steady supply of oxygenated blood, allowing you to perform for longer periods without fatigue. 

Without the metaboreflex, your muscles could quickly become oxygen-deprived, leading to a rapid build-up of metabolic waste products and a corresponding decrease in performance. The reflex helps to delay fatigue, enabling you to exercise harder and longer, which is particularly valuable for athletes looking to improve endurance and cardiovascular fitness.

Metaboreflex and Blood Pressure Regulation

One of the most important functions of the metaboreflex is to regulate blood pressure during exercise. As muscles work harder and demand more oxygen, the metaboreflex helps to maintain adequate circulation by increasing heart rate and vasoconstriction. This ensures that blood pressure stays within an optimal range, preventing excessive strain on the heart and reducing the risk of injury or cardiovascular events during physical exertion.

The metaboreflex also interacts with other reflexes in the body, such as the baroreflex, which helps to maintain blood pressure during postural changes (e.g., standing up quickly). This interaction between reflexes helps to balance the body's immediate needs for oxygen and nutrients during exercise while maintaining overall cardiovascular stability.

Implications for Health and Fitness

The metaboreflex is an essential mechanism for keeping the cardiovascular system adaptable and responsive during physical activity. Regular exercise strengthens the metaboreflex, improving blood flow and oxygen delivery to muscles. This can enhance overall cardiovascular health, reduce the risk of heart disease, and help in the management of conditions like hypertension, diabetes, and obesity.

For athletes, especially those engaged in endurance sports, training can help "fine-tune" the metaboreflex, allowing for better blood flow regulation under stress. This could translate into improved exercise tolerance, faster recovery, and the ability to perform better in high-intensity training or competition.

The metaboreflex can also influence how people with hypertension respond to exercise. Those with high blood pressure might experience a heightened metaboreflex response, which could lead to spikes in blood pressure during physical activity. For these individuals, monitoring exercise intensity and working with a healthcare provider to manage their exercise regimen may be important.

The metaboreflex is a vital component of how our body handles physical stress. By ensuring that muscles get the oxygen and nutrients they need during exercise, it plays a crucial role in supporting endurance, strength, and overall cardiovascular health.

Orthostatic Hypotension and the Metaboreflex

Orthostatic hypotension is a condition characterized by a sudden drop in blood pressure when transitioning from a lying or sitting position to standing. This can result in dizziness, lightheadedness, fainting, or even falls. It occurs when the body's compensatory mechanisms (like the baroreflex and other autonomic responses) fail to adequately increase heart rate and vascular resistance to maintain stable blood pressure in an upright position.

How Metaboreflex and Orthostatic Hypotension Might Be Connected

The metaboreflex and orthostatic hypotension involve the autonomic nervous system (ANS), which controls involuntary functions like heart rate, blood pressure, and vascular tone. The metaboreflex increases heart rate and blood pressure in response to metabolic stress during exercise. In contrast, orthostatic hypotension reflects a failure of these autonomic responses to compensate when standing up.
If there is dysfunction or impaired responsiveness of the autonomic nervous system (including the metaboreflex), it could lead to issues with both exercise tolerance and postural blood pressure regulation. Some studies suggest that autonomic dysfunction is a contributing factor in orthostatic hypotension, meaning that individuals with impaired reflexes—whether due to aging, disease, or other factors—might experience both an impaired metaboreflex and a greater risk of orthostatic hypotension.

Chronic conditions like diabetes, neurodegenerative diseases, or chronic hypertension can impair autonomic function in general. These conditions are associated with both impaired metaboreflex sensitivity (leading to reduced exercise capacity and endurance) and increased risk of orthostatic hypotension. This suggests that individuals with these conditions might experience a blunted response to exercise (weak metaboreflex) and may also be prone to drops in blood pressure upon standing.
While the metaboreflex and orthostatic hypotension may seem unrelated at first glance, they share underlying mechanisms involving autonomic control over blood pressure and cardiovascular responses. Dysfunction in the metaboreflex could exacerbate orthostatic hypotension, and vice versa, particularly in individuals with autonomic dysfunction due to age, disease, or other factors. 

To hear more on this reflex, and a strategy to improve it, check out this podcast I did with Luke Way, owner of Isocapnic.

If you’re interested in this product:

What Happens if You Ignore Sleep Apnea?

If you wake up in the morning and you find your significant other sleeping in the next room, you probably have sleep apnea. Or, if like me, you think that your superpower is to be able to fall asleep instantly, you also likely have sleep apnea. That’s what is known as ‘sleep pressure’ and is a sign you are poorly rested.

Sleep apnea is estimated to affect 2-4% of the adult population, however many people are undiagnosed so the true numbers are likely much greater. It’s a very serious condition, and unfortunately many people ignore it. 

Perhaps it’s the annoyance of wearing a CPAP, or just not wanting to face your issues. Or perhaps most do not fully understand how devastating it can be for your health. It must be addressed because these are just some of the things sleep apnea can do you left untreated:

• Weight gain

• Diabetes

• Stress

• Alzheimer’s

• Chronic fatigue

• Metabolic dysfunction

• Heart attack

• Stroke

• Oxygen depletion

Fun list, right? There is one common thread amongst all of those complications; insulin resistance. If you feel like insulin resistance, aka diabetes, seems to cause every known chronic condition, well you’re right. Every cell in your body has insulin receptors. Insulin is a very potent hormone that instructs the cell to behave in certain ways. The way the body works is that hormones have certain roles. Once your body stops responding to the signal of the hormone, it has the opposite effect. For example, one role of insulin is vasodilation. So when your body stops responding to it, your blood vessels constrict. That’s just one way it affects the cardiovascular system. 

So what is the relationship between insulin resistance and sleep apnea? Breathing is directly tied to your nervous system. Breathing through your nose is parasympathetic, breathing through your mouth is sympathetic. When you snore, your mouth is open. So you’re in a sympathetic state all night. The sympathetic nervous system causes cortisol to be released. This is a hormone that instructs the liver and muscle to release glucose into the bloodstream for quick energy because the body thinks it’s in a flight or fight mode. 

Over years of sleeping this way you maintain chronic elevated blood sugars. The pancreas tries to balance the elevated blood sugar by secreting insulin which does the opposite of cortisol. The cells stop responding to insulin. Now you are developing metabolic problems and becoming diabetic. Next comes weight gain and fatty liver. Later in life it turns into Alzheimer’s which has become known as type 3 diabetes. This is when blood sugar starts to affect the brain. 

The body has 4 main homeostatic regulators, pH, O2/CO2, temperature, and blood sugar. All of these are tightly regulated and if they go off a bit, things go wrong. The good news is that blood sugar can relatively easily be influenced by diet and lifestyle choices. However, you can do all the right things with diet, exercise, cold exposure, etc; if you have sleep apnea, you’ll be fighting against the current. 

Get it checked out. There are now home sleep studies that can be ordered by a pulmonologist. Find out how severe you are and get it addressed. Your best bet is a CPAP. However, if you have mild sleep apnea, or until you get a CPAP, there are devices that may help.

We’ve had good results using a combination of this mouthpiece, and this mouth tape. The mouthpiece pushes your tongue forward, and the mouth tape forces you to breathe through your nose. 

Here is a quick quiz you can take which is a sensitive screening tool for sleep apnea.

The Relationship Between Insulin and Cancer

Cancer is a complex and multifaceted disease, influenced by a wide array of genetic, environmental, and lifestyle factors. Among these, insulin, a hormone primarily known for regulating blood sugar levels, has emerged as a key player in cancer research. The relationship between insulin and cancer is multifactorial, involving metabolic pathways, cellular growth, and inflammation. 

Insulin is a hormone that is released by the pancreas when blood sugar levels are elevated. It pushes the glucose in the muscle and liver (much more so in the muscles). When you have a diet high in processed sugars, it takes more and more insulin to be secreted by the pancreas for your cells to respond. This is the essence of diabetes; insulin resistance. Insulin also is a builder, similar to an anabolic steroid. 

When insulin levels stay elevated as seen in insulin resistance, it can promote the growth of cancer cells. It can cause cancer cells to proliferate, and inhibit apoptosis (programmed cell death). This is due to insulin’s role in cell growth and division, as it can activate signaling pathways that are also involved in cancer progression.

Insulin also interacts closely with the insulin-like growth factor (IGF) system, which includes IGF-1 and IGF-2. These growth factors have similar effects to insulin and are involved in cellular growth and development. Elevated levels of IGF-1 are associated with an increased risk of several types of cancer, including breast, prostate, and colorectal cancer. Like insulin, IGF-1 promotes cell proliferation and inhibits apoptosis, contributing to tumor growth and cancer progression.

Elevated insulin can also cause chronic low-grade inflammation. Inflammation is a known risk factor for cancer, as it can create a microenvironment that promotes tumor development and progression. This, in turn, can lead to DNA damage and mutations, further increasing cancer risk. There is also a bit of a vicious circle effect that occurs. High insulin causes weight gain. Adipose tissue secretes pro-inflammatory cytokines making matters worse.

Conversely, there has been some research that suggests that medication for diabetes, such as metformin, can slow tumor growth. There are several proposed mechanisms. Metformin enhances insulin sensitivity and lowers blood glucose levels. It activates AMPK (AMP-activated protein kinase) which blocks the mTOR pathway. This pathway promotes cell growth and proliferation so when it’s blocked, it can suppress tumor growth. Metformin can also lower IGF-1. It may also promote apoptosis in cancer cells, blocking their proliferation. So it basically does the opposite of everything mentioned earlier in the article. This is not to say go get a prescription for metformin; rather that it’s just evidence that insulin resistance can be a key player in cancer development. 

So what to do? You know the answer. It’s all the diet and lifestyle choices. Sleep well, reduce stress, eat a whole foods diet, avoid high fructose corn syrup and processed foods, and exercise. These are all the things you need to do to stay insulin sensitive. 

References:

Algire C, Zakikhani M, Blouin MJ, Shuai JH, Pollak M. Metformin attenuates the stimulatory effect of a high-energy diet on in vivo LLC1 carcinoma growth. Endocr Relat Cancer. 2008 Sep;15(3):833-9. doi: 10.1677/ERC-08-0038. Epub 2008 May 9. PMID: 18469156.

Jiang, N. F. T., Liu, L. S., Zhang, S. H., et al. (2011). Type 2 diabetes and cancer risk: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 93(2), 118-126. https://doi.org/10.1016/j.diabres.2011.05.001

An Overview of Autoimmune Disease

Autoimmune disorders were once thought to be uncommon, but they currently impact 3%–5% of the world's population, with autoimmune thyroid disease and type 1 diabetes mellitus being the most common. Some are organ-specific, such as Hashimoto's thyroiditis, and others that involve multiple organs, such as systemic lupus erythematosus (SLE). It currently affects over 80 million people (1 in 5 people), which makes it more impactful than diabetes, heart disease, and cancer combined. This is the biggest threat to western culture. 

The immune system's ability to recognize “foreign” antigens was first proposed in the early 20th century. However, until the early 1950s, it was not widely accepted that an immune response could be developed against “self” antigens. Paul Ehrlich identified nearly a century ago the immune reactivity against one's own body, which he named “horror autotoxicus” and is today recognized as autoimmunity. Therefore, autoimmunity is characterized by abnormal lymph responses to pathogens.

So what is it exactly? The definition is when the immune system mistakenly attacks healthy, functioning parts of the body. The tissue attacked and the symptoms that develop determine the name of the disease. There are 80 types of autoimmune disease that we know of, and there is speculation that there may be 100’s of types. Any body part can be affected. 

Autoimmune disease is characterized by four components:

1. An imbalance between effector T cells (turns on defense, and regulator T cells (turns off defense).

2. Defective elimination of self-reactive immune cells

3. Chronically alert immune system

4. Widespread inflammation

There are 3 stages:

1. Antibodies, no symptoms or tissue damage

2. Antibodies, symptoms, no tissue damage

3. Antibodies, symptoms, tissue damage

What are the causes? We commonly ask, is it nature or nurture? The answer is, yes. It’s both; it’s an interplay between genetics and environmental exposures, otherwise known as epigenetics. This is a good time to introduce the idea of the exposome. The exposome refers to the totality of exposures from a variety of external and internal sources including chemical agents, biological agents, or radiation, from conception onward, over a complete lifetime.

A good acronym for this is TIGER, which is from a book by Akil Palanismy

T: toxins

I: infections

G: gut health

E: eat, what to eat or not eat

R: rest and rebalance

TOXINS:

Toxins can include heavy metals which could be from seafood or dental amalgams. It can come in the form of plastics (which interfere with cytochrome P450, an important part of detoxification). When you start to pay attention to how much plastic we touch and put in our mouth, it’s frightening. From the water bottles, to take out food (including plasticware), our toothbrush bristles, the lining on paper plates and cash register receipts, etc. It’s even worse when you heat up plastic in ready to go foods. It’s not just the BPAs, but also a ‘forever’ chemical called phthalates. Chemicals such as nail polish remover, detergents, cleaning products, and fragrances can all initiate an inflammatory reaction. Last, but not least, pesticides such as glyphosate can be highly inflammatory. 

INFECTIONS:

Certain infections can trigger autoimmune responses. For example, some viral infections may initiate autoimmune reactions in genetically predisposed individuals. Tick borne illness and viruses such as Epstein-Barr are highly associated with autoimmunity. 

GUT HEALTH:

Our bodies contain more bacterial cells than human cells, so it would maintain that the health of our gut microbiome would greatly dictate the health of the entire organism. The gut is a semi-permeable membrane, similar to our skin. There is a protein called zonulin that holds the barrier together. There are many things that can affect this protein and allow the gut to be more permeable, allowing larger molecules to pass through such as food particles. The immune system recognizes this as a threat and starts to attack. Toxins, oxidative stress, psychological stress, antibiotics, NSAIDs, and additives from processed foods can all negatively affect the membrane. 

EAT: 

This is a big one. Many people develop food sensitivities, intolerances, and allergies from specific foods. This can be due to the pesticides, weakened immune system, molecular mimicry, or gut dysbiosis. Unfortunately, our food supply is not what it was even a few decades ago and it’s damaging our health. 

REST AND REBALANCE:

This is the lowest hanging fruit, and somehow the one that gets missed the most. It’s somewhat cultural; we are grossly sleep deprived. Our go-getter culture and stress is partly to blame. But it also has to do with disrupted circadian rhythms, too much blue light exposure, and not enough sunlight. It’s also a mindset shift. So many of our athletes and clientele try to solve a stress issue by adding more stress, when what they really need is recovery. If this is you, we have a free ebook on sleep optimization here.

To hear what you can do about autoimmune disease, listen to our podcast:

How Hydration Effects Swelling

Hydration plays a crucial role in managing swelling (edema) in the body. It helps with fluid balance, the lymphatic system, and electrolyte balance.

Fluid Balance: Swelling often occurs when there is an imbalance of fluids in the body, typically caused by factors like poor circulation, injury, or underlying health conditions. Proper hydration helps maintain the body's fluid balance, which can prevent excessive fluid retention that contributes to swelling.

Lymphatic System: The lymphatic system, which helps remove excess fluid from tissues, relies on adequate hydration to function effectively. Dehydration can impair lymphatic drainage, leading to fluid buildup and swelling in affected areas.

Electrolyte Balance: Electrolytes like sodium and potassium are essential for regulating fluid levels in cells and tissues. When you're properly hydrated, electrolyte balance is easier to maintain, reducing the risk of fluid accumulation that can cause swelling. We recommend LMNT because it does not have sugar, and it tastes great. 

Inflammation Control: Chronic dehydration can contribute to inflammation, exacerbating conditions that cause swelling. Staying hydrated helps support the body's natural anti-inflammatory processes, potentially reducing swelling associated with inflammation.

Prevention of Complications: In some cases, swelling can lead to complications such as skin breakdown or impaired wound healing. Proper hydration supports overall health and can help prevent these complications from arising.

Tips for Maintaining Hydration:

- Drink water with electrolytes regularly throughout the day, especially in hot weather or during physical activity.

- Monitor urine color; pale yellow generally indicates adequate hydration.

- Be mindful of medications or medical conditions that may require adjustments in fluid intake.

Maintaining adequate hydration supports the body's natural mechanisms for managing fluid balance and can help alleviate swelling or edema by reducing fluid retention and supporting lymphatic function.

-Dr. Amanda Salazar

Diaphragmatic Breathing and The Lymphatic System

The lymphatic system is a vital system of the body that is often overlooked. For some reason, in every textbook it is depicted as green. In actuality, it is clear or murky white from proteins and lipids. It looks a lot like the vascular system and that is no mistake. Its main function is filtration of blood plasma in the capillary beds. So where the vascular system goes, so does the lymphatic system. It returns 3 liters of fluid to the blood every day. In this process, cellular debris and waste is filtered out. The lymphatic system also has a role in immune response, releasing T-cells from the bone marrow to the thymus to neutralize pathogens. 

The lymphatic system is one continuous system, and if something is dysfunctional in the system, you get back up in the form of swelling. Muscular contraction causes movement of the lymphatic system. That is why when you are sedentary, like on an airplane, your socks leave indentations. Because of gravity and the lack of movement, your ankles swell. 

One key difference between the lymphatic system and the cardiovascular system is the heart. The heart is a pump that facilitates the circulation of blood. The lymphatic system does not have a pump. On top of that, the lymph is drained in the chest so it has to move against gravity. More specifically, the right upper quadrant drains in the upper right chest, and the rest of the body drains in the left upper chest. 

There is a specialized part of the lymphatic system called the cisterna chyli. It is the most common drainage trunk of the lymphatic system and facilitates drainage for the whole body besides the upper right quadrant. It resides in the upper lumbar vertebrae. This is a good thing because as you inhale, the abdominal cavity and lungs fill, and press on the cisterna chyli and the thoracic duct, pushing excess fluid off to be drained. In other words, breathing (particularly diaphragmatic breathing) is one of the key ‘pumps’ of the lymphatic system. 

Another way to facilitate lymphatic drainage is through movement. As stated above, muscular contraction pushes fluids through the system. If you’ve ever seen someone in a shoulder sling, there is usually a ball at the end of it for them to squeeze. It’s not about strengthening the grip, it more acts as a mechanical pump for a swollen shoulder. Vertical movement is particularly good, and I recommend jumping rope for lymphatic movement. 

So if you just banged your elbow and it is swollen, go for a walk. Maybe lay down afterwards and work on some breathing. These simple things can have a dramatic effect on swelling. 

Muscle Cramps? It May be a Magnesium Deficiency

We’ve all been there; having a good night’s sleep and suddenly an extreme cramp in the calf. They can be excruciating and it’s hard to know what to do about them. While cramps can stem from various causes, one frequently overlooked factor is magnesium deficiency. Magnesium plays a crucial role in muscle function, and inadequate levels can lead to increased susceptibility to cramping. Here’s a closer look at the connection between magnesium deficiency and muscle cramps, along with practical steps to address and prevent them.

Magnesium is an essential mineral involved in many physiological processes, including muscle contraction and relaxation. It works with calcium to regulate muscle contractions by controlling the movement of ions across the cell. When magnesium levels are low, this regulation can become impaired, potentially leading to muscle cramps and spasms.

Some deficiencies go unnoticed for years, quietly affecting our well-being in profound ways. Magnesium deficiency typically slips under the radar. Despite its critical role in numerous bodily functions, magnesium deficiency remains prevalent across various demographics worldwide. So, why is this essential mineral so often lacking in our diets?

Our dietary habits have shifted significantly in recent decades. Processed foods, refined sugars, and PUFA rich diets have become commonplace, often at the expense of nutrient-dense foods like leafy greens, nuts, and seeds—excellent sources of magnesium. This dietary shift means that many people simply aren't consuming enough magnesium-rich foods to meet their daily requirements.

Magnesium content in our food is directly influenced by the magnesium content in the soil where crops are grown. Modern agricultural practices, including the use of chemical fertilizers, have depleted soils of essential minerals like magnesium. As a result, even if we consume vegetables and fruits, their magnesium content may not be as high as it once was.

Stress has a direct impact on our nutrient absorption. In our fast-paced, stress-filled lives, our bodies may require more magnesium than usual. Stress, both physical and emotional, depletes magnesium levels in the body. Factors like excessive alcohol consumption, certain medications (e.g., diuretics, PPI’s), and even intense exercise can increase the body's demand for magnesium, further exacerbating deficiency.

Hydration is obviously important, particularly for those in warm climates that are active. Most athletes are aware of the importance of hydration, however fail to replace the electrolytes. Magnesium is one of these electrolytes. When we sweat, we lose both water and electrolytes. Replacing the water is a great idea, but if the electrolytes are not replaced, the kidneys will just continue to excrete the water to maintain balance. So, adding electrolytes to water is a sneaky way to get hydrated faster. 

Even if we consume magnesium-rich foods, factors such as gastrointestinal disorders (e.g., Crohn's disease, celiac disease, low stomach acid) or aging-related changes in digestive efficiency can impair magnesium absorption. This means that individuals with these conditions may need to consume higher amounts of magnesium to achieve adequate levels in the body.

Magnesium deficiency often presents with subtle symptoms or mimics other health issues, making it challenging to diagnose without specific testing. Symptoms such as muscle cramps, fatigue, and irregular heartbeat can easily be attributed to other causes, delaying proper identification and treatment of magnesium deficiency.

Encouraging a diet rich in magnesium-containing foods such as leafy greens, nuts, seeds, is important. Magnesium content for animal meats can vary depending on what they are fed. For example, grass fed grass finished beef has about twice as much magnesium as soy and corn fed beef. For those at risk or with confirmed deficiencies, magnesium supplements can be an effective way to bridge the gap.

Advocating for sustainable agricultural practices that prioritize soil health can help restore the nutrient content in our foods. Research into the optimal levels of magnesium intake for different demographics and health conditions is also essential to guide clinical practice.

So the key takeaways are:

1. Increase your intake of magnesium-rich foods such as leafy greens (spinach, kale), nuts and seeds (almonds, pumpkin seeds), and grass fed beef.

2. If you struggle to meet your magnesium needs through diet alone, consider taking a magnesium supplement. Magnesium glycinate is the best one. 

3. Maintain a balance of water and electrolytes.

4. Manage stress as much as you can. When we are in a sympathetic state, we have poorer nutrient absorption.

5. Don’t watch TV while you eat. TV is stimulating and therefore sympathetic. You’ll literally absorb less nutrients.

Do you suspect you have a nutrient deficiency? Let’s get on a call and we can see what type of test you may need:

What Really Causes Gout?

Gout is a type of inflammatory arthritis that typically attacks the big toe and ankle. Gout primarily occurs when there is an accumulation of uric acid crystals in the joints, leading to inflammation and intense pain. Uric acid is a normal waste product that forms when the body breaks down purines, substances found in certain foods and also produced by the body. Normally, uric acid dissolves in the blood and passes through the kidneys into the urine. However, if too much uric acid is produced or if the kidneys do not eliminate enough of it, uric acid can build up, leading to gout.

It tends to attack the feet and toes because of temperature and gravity. The peripheral parts of the body are cooler than the core which allows uric acid to crystalize. It’s classically called a “disease of kings” because of the association of rich diets and alcohol. How accurate is this? Like most conditions of the body, there is more nuance to this. Research has confirmed that purine rich foods can contribute to the development of gout, but many of these foods are animal products such as red meat, turkey, organ meat etcetera, that are nutrient dense. Do we need to give these foods? This is a classic case of correlation does not equal causation. 

Some studies have found that ingesting high levels of purines is not enough to provoke a gout attack (Zhang, 2021). Other studies found that consumption of purines and proteins increases the excretion of uric acid and is associated with increased inflammatory markers such as CRP and IL-6 (Urano et al., 2002). So what is going on here?

This is a bit of an innocent bystander effect and is similar to the sugar and salt debate as it pertains to high blood pressure. Salt does increase blood volume but normally the kidneys are able to regulate salt levels. However, in the context of a high sugar diet and insulin resistance, the kidneys lose this regulating ability and retain too much salt. So salt takes the blame, when insulin resistance is the real problem. This is more or less the same situation, and it appears, possibly the same culprit; insulin resistance. Hyperinsulinemia causes a decrease in urinary excretion of uric acid (Galvan, 1995). So it appears that high levels of purines result in elevated uric acid which the kidneys will normally excrete. In an insulin resistant state, we do not excrete adequate levels of uric acid leading to a “back up” effect.

There are some other players that may be contributors to gout flare ups. Fructose (as in high fructose corn syrup) appears to have a role. It can increase serum uric acid levels by enhancing the production of purines and reducing uric acid excretion. Iron is another marker that tends to be elevated which is no surprise given the correlation between increased iron and diabetes.

So what can we do about this? Lowering sugar levels and alcohol intake will certainly help. Vitamin C increases the excretion of uric acid and this is part of why cherry juice is recommended for gout. Blood donation reduces iron levels, so it would stand to reason it would reduce gout. In 2003, a study by Facchini found that phlebotomy to a near iron deficient state affected gout ranging from a complete remission to a marked reduction of incidence and severity of gouty attacks.

So if you do get a gout attack, it’s probably a good idea to get a blood panel. Besides uric acid, I’d be looking out for blood sugar markers, as this may be a sign of insulin resistance. I’d look at inflammatory markers, and iron/ferritin levels. 

Want more help? Let’s get on a free consult call:

References:

Facchini FS. Near-iron deficiency-induced remission of gouty arthritis. Rheumatology (Oxford). 2003 Dec;42(12):1550-5. doi: 10.1093/rheumatology/keg402. Epub 2003 Jun 27. PMID: 12832712.

Quiñones Galvan A, Natali A, Baldi S, Frascerra S, Sanna G, Ciociaro D, Ferrannini E. Effect of insulin on uric acid excretion in humans. Am J Physiol. 1995 Jan;268(1 Pt 1):E1-5. doi: 10.1152/ajpendo.1995.268.1.E1. PMID: 7840165.

Wako Urano, Hisashi Yamanaka, Hiroshi Tsutani, Hiroshi Nakajima, Yuko Matsuda, Atsuo Taniguchi, Masako Hara, Naoyuki Kamatani

The Journal of Rheumatology Sep 2002, 29 (9) 1950-1953;

Zhang WZ. Why Does Hyperuricemia Not Necessarily Induce Gout? Biomolecules. 2021 Feb 14;11(2):280. doi: 10.3390/biom11020280. PMID: 33672821; PMCID: PMC7918342.

Running and Anemia

For many, running is not just a form of exercise but a way of life—a pursuit that brings physical fitness, mental clarity, and a sense of accomplishment. However, beneath the surface of this seemingly straightforward activity lies a lesser-known phenomenon: foot strike hemolysis. This condition, though relatively rare, sheds light on the intricate relationship between endurance sports and the human body's physiological responses. Let's delve into what foot strike hemolysis entails, its causes, and its implications for runners.

Foot strike hemolysis, also known as runner's anemia or foot strike anemia, is a condition where red blood cells are damaged or destroyed due to the repetitive impact forces experienced during running or other high-impact activities. The term "hemolysis" refers to the breakdown of red blood cells (erythrocytes), leading to the release of hemoglobin into the bloodstream.

During running, each foot strike generates a significant amount of force, which is transmitted through the legs and feet. The repetitive pounding on hard surfaces, such as pavement or trails, can cause microtrauma to red blood cells passing through capillaries in the feet. This mechanical stress can result in the rupture or deformation of red blood cells, leading to hemolysis.

Several factors can contribute to the development of foot strike hemolysis:

Running Distance and Intensity: Long-distance runners and those who engage in high-intensity training are more susceptible to foot strike hemolysis due to the increased number of foot strikes and higher impact forces.

Running Surface: Hard surfaces like concrete or asphalt can amplify the impact on red blood cells compared to softer surfaces like grass or dirt trails.

Running Technique: Some runners adopt a heel strike pattern which can create more damage to red blood cells.

The symptoms of foot strike hemolysis can vary and may include:

- Fatigue

- Pale skin

- Dark urine (due to the presence of hemoglobin breakdown products)

- Mild jaundice (yellowing of the skin or eyes)

So if you’ve had recent blood work and been told that you are anemic, this is one factor to consider. 

HPA Axis Dysfunction

In the intricate web of our body’s hormonal system lies a crucial regulator known as the HPA (Hypothalamic-Pituitary-Adrenal) axis. This axis plays a pivotal role in how we respond to stress, regulate mood, and maintain overall health. However, when the HPA axis becomes dysregulated, it can lead to a cascade of symptoms and health issues. Let’s delve into what HPA axis dysfunction entails, its causes, symptoms, and how it can be managed effectively.

So what is the HPA axis? The HPA axis is a complex interplay between three major glands, the hypothalamus, pituitary gland, and adrenal glands. The hypothalamus is located in the brain, it releases corticotropin-releasing hormone (CRH) in response to stress. The pituitary gland, also in the brain, secretes adrenocorticotropic hormone (ACTH) in response to CRH. The adrenal glands situated atop the kidneys, produce cortisol and other hormones in response to ACTH.

When everything is running smoothly, a person experiences a stressful situation which triggers the HPA axis, with an end result of cortisol secretion. That, in turn, releases glucose into the bloodstream for quick energy.

Problems arise when we start to live out of balance. If we start spiking the stress response without enough recovery, or we just have chronic stress, HPA dysfun.ction sets in. In a sense, we become cortisol resistant. Do you have difficulty falling asleep? Cortisol is the hormone that starts off our day and should decline at night (opposite of melatonin). If you have difficulty falling asleep, this may be a sign of HPA dysfunction. See below:

And the corresponding podcast:

When we say stress, we don’t just mean perceived stress, although that plays a crucial role. There are many forms of stress, and it can be helpful to categorize it into two categories; eustress and distress. Eustress is the ‘good’ stress. It’s the right amount of stress that we can recover from and come back stronger. Exercise is a form of eustress. The right amount of sun exposure is a form of eustress. Distress is a level of stress that we don’t respond well to; it’s too much. Something bad happens before we recover. A muscle tears, you get sick, or in the example of sun exposure, you get a bad sunburn. This is important to keep in mind because many of us try to mitigate stress with more stress, when sometimes we need the opposite. 

Some stressors that you may not consider, but certainly are, stressors:

• Blood sugar dysregulation

• Autoimmune disease

• Chronic inflammation

• Dehydration 

• Nutrient deficiency

• Poor sleep (this is a big one)

• Environmental exposures such as mold and endocrine-disrupting chemicals such as plastics

• Dental amalgams 

The body can only take so much stress, and when that overflows, symptoms develop. Then there tends to be a bit of a downward spiral. For example, chronic inflammation can trigger HPA axis dysfunction, and vice versa. So it becomes compounding. 

Managing HPA axis dysfunction can be tricky. It’s all about eliminating the stressors you have control over, and mitigating the ones you don’t. This is a challenging process, but the good news is that you don’t have to do it alone. Schedule a free call with us and we can help you sort this out.