Practitioner Corner: Tackling Leptin Resistance
This is part two of a two-part series on how the health of the gut microbiome influences the hormones ghrelin and leptin. Part 1 talked about how these hormones can impact your clients in regards to their appetite control, weight, and long-term health. Part two will discuss the primary causes of leptin resistance and what you can do to help your clients.
If you missed the earlier article, please check it out – Part 1 – Leptin, Ghrelin, and Insulin Resistance.
Any number of lifestyle considerations can create leptin resistance. Many of them can also result in insulin resistance and pre-diabetes, or even diabetes for your clients.
Here are a few heavy hitters contributing to leptin resistance and what you can recommend to your clients to help them.
Gut health is key
It's all about good bacteria versus bad. Having bacteria diversity is important. The reason for this is that different bacteria are specialized for different health benefits. The different bacteria are also at greater risk due to various environmental factors. For example, some bacteria are more prone to die-off with antibiotics or environmental toxins.
Additionally, some people will just do better with one bacteria family than another. More and more practitioners are “customizing” probiotics for their clients – tweaking the perfect set of bacteria for a client based on that client's specific set of symptoms, test results, as well as their genetic profile.
For a more in-depth dive into this topic, listen to this interview I did with Donna Gates last year on the topic of the alphabet soup of genes that impact digestion and your gut health – NERF-2, FUT, VDR, NAT, TAS1r3, MTHFR, and many more. The study of nutritional genetics has shown us that the “perfect foods” for each of us may be somewhat different. For example, if your client has a methylation issue or a FUT2 SNP like I do, you may find certain foods – and certain bacteria – help them more than others. This also will introduce “Nutrigenomics” to you, which is the intersection of nutrition, genetics, and lifestyle factors, including stress management. More and more you will see the need to become familiar with these concepts if you aren't already. The benefit you can bring to your clients will exponentially help them with their health.
All of these topics are separate articles in themselves that I could write about! In our Nutritional Endocrinology Practitioner Training and in our SHINE conferences, we go into much more detail about nutrigenomics and the influence genetics has on your clients' endocrine system.
Bacteria related to appetite and metabolic control
When looking generally at improving leptin resistance, there are a few bacteria I take a look at. In particular, bifidobacteria are markers for gut hormone health. Bifido are related to appetite control and metabolic control. Interestingly, bifidobacteria levels are often low when I do testing on clients who I suspect have leptin and/or insulin sensitivity. This is likely because bifido are very sensitive, and easy to destroy with sugar, gluten, and other dietary and lifestyle choices. Lactobacillus plantarum are also good bacteria that are found in fermented foods. They help promote gut health, and are not as easily destroyed by antibiotics and other environmental factors that might be a part of your client's life.
Assessing your client's microbiome health
There are some simple assessments you can use to determine the likelihood that your client might be deficient in important bacteria such as bifido. These may point the way to a poorly balanced gut microbiome, which lends itself more prone to leptin resistance.
Ask your clients these questions:
- How were they born? If C-section, research has shown that the newborn does not pick up the healthy microbiome bacteria from their mother's GI tract and rectum.
- Were they breastfed? Again, research has shown that breastfed infants have a reduced incidence of gastrointestinal issues, autoimmune issues, along with other possible health consequences. On top of that, many infant formulas contain sugar which feeds the “bad guys”.
- Were they exposed to antibiotics at a young age? In studies, this has been linked to increased risk of obesity and chronic gastrointestinal diseases.
- Medications they have taken or still may take: Pain killers (opiates), non-steroidal anti-inflammatory drugs (NSAIDs), etc., have been shown to cause changes in the health of the gut microbiome, as well as leaky gut. (By the way, here are more “gut microbiome friendly” pain/inflammation alternatives you can share with your clients).
- Are they overweight? Obese? What is their waist size? Women are at risk if their waist size is greater than 35″, men at 40″.
- Diet: A diet that includes a lot of processed foods, saturated fats, sugar, etc., will result in an imbalance in the gut microbiome. Doing a simple review of your client's dietary habits, as well as an overall lifestyle assessment can help identify those at risk. Go over the different areas of their life, including drinking, smoking, sleep, exercise, stress management, along with food, to get a better idea of the big picture.
- Fructose: In particular, fructose seems to induce leptin resistance. Fructose is found in so many packaged foods! Learn more about the many health dangers of sugar and fructose in this article, which also talks about alternatives your client might choose as they make changes in their meal planning and recipe selections.
Testing your client's gut microbiome
You can also get your client tested. BioHealth and Doctor's Data are labs that I often recommend. Before I recommend a test, I ask myself, “Would the results of this test change the treatment protocol I would recommend for this person?” I like this approach because it instantly rules out unnecessary testing. If you spend money on a test that doesn’t give you enough information to change any plan you would suggest, it’s basically wasting your time, along with your client's time and money.
First, I might have them order the #401H from BioHealth. This is a stool culture test. The test uses 3 stool samples, one each day for three days, and cultures the samples in a lab to see what grows.
Next, if they are able to, I might have them order a second test along with it, and that would be the Doctor’s Data Parasitology x3. This is also a growth-based culture, the standard of practice in clinical microbiology. It also uses sensitive biochemical assays and microscopy, and thoroughly evaluates the status of beneficial and pathogenic microorganisms, including aerobic and anaerobic bacteria, yeast, and parasites.
General recommendations to improve your client's gut health
I would recommend your client remove all typical food allergens from their diet, such as dairy, gluten, eggs, and processed foods. This will assess any food sensitivities that may be causing disruption to their gut lining. Cyrex has Array 3, which is their gluten/wheat sensitivity panel. If your client shows positive to that, and maybe even if they don't, I would run an Array 4 panel to see if they have intolerance of other food proteins. People who either have celiac or non-celiac gluten intolerance are more likely to react to dairy proteins, along with proteins in some other foods like coffee and alternative grains and yeast, etc. So I would do Array 4 to see if they have intolerance of these other proteins.
Cyrex also has Array 10, which looks at intolerances to many other foods. Array 10 looks at all kinds of other foods, fruits and vegetables, meats, and things that people typically eat. You would have your client usually only order this if you’ve addressed gut issues and other underlying issues, but they are still having problems that seem to be related to food.
Along with improving the diet to restore gut health, I strongly recommend the use of probiotics. Best dosage level to start is 30 million CFU with a diverse bacteria population. Look for a probiotic that contains Bifido. I also suggest increasing fermented foods in the diet. Here is an excellent article on my favorite fermented foods and why you also need prebiotics.
Berberine, oil of oregano, caprylic acid, and peppermint oil are all helpful in restoring gut health. Berberine research shows its usage results in a positive release of hormones, a positive impact on both metabolism and fat burning, and that it balances blood sugar as well. I use berberine a good deal when focused on insulin resistance, and insulin and leptin issues usually go hand in hand. Read my detailed article on a type of berberine here.
Have your client eat a lot of colorful foods. When you look at processed foods and bland foods, notice that they are “white” and pale! Have them include lots of healthy spices with their meals as well. There are many spices that offer a wide array of health benefits. Here is just one article on a few spices that aid with digestive health.
Meal spacing is also important. Leptin levels are optimized when you space your meals 5 – 6 hours apart and avoid snacking. Also important is to stop eating within 3 hours of bedtime; ideally leaving about 12 hours between the previous night's dinner and breakfast. Eating high calorie foods or carbs late in the day can contribute to leptin resistance, as well as eating carbs in the morning. It's best to eat a high protein breakfast instead.
In general, snacks should be avoided, but if necessary, they need to be nutrient-dense, and calorie and carb sparse! Provide your client with lists of suggested foods. Have this list be one that reiterates healthy eating habits, such as adequate chewing, mindfully eating, etc.. Fiber is also important, and many of your clients probably don't get enough in their diets.
Green veggies are not only important from a nutrient perspective, but also provide digestive support and fiber, which is important for gut health and key to addressing leptin resistance. Here are some great cleansing foods that provide digestion support.
Just as important as fiber is water! Make sure your clients are drinking enough each day.
Special nutrients that can help increase leptin sensitivity
In particular, foods containing polyphenols are important for increasing leptin sensitivity. This includes curcumin, which is from the spice turmeric, blueberries, resveratrol, and catechins. Plant foods in general contain a wide variety of polyphenols, so this is yet another reason to eat a variety of fruits and vegetables.
Circadian rhythm is incredibly important
The body's internal clock is important for supporting healthy insulin and leptin levels, maintaining a strong immune system, ensuring natural detoxification as well as reducing inflammation.
WOW! Pretty important and often overlooked as a key component of addressing leptin and insulin resistance issues.
Sleep is an important part of setting the internal clock, but just as important as sleep is the awake signal. Its the 24 hour biological clock that creates the rhythmic release of key hormones, like cortisol and ghrelin. Read the linked article above for ways to help your client reset his/her natural rhythms. In the same article, I've also included information on some supplements that may help.
In particular, please note the importance of “light” and sleep/wake consistency in establishing and maintaining a healthy 24-hour internal clock!
To support healthier insulin and leptin levels, encourage your client that the best time to exercise is in the morning on an empty stomach. This will more likely also result in reduced body fat. Strength training in particular is good to increase leptin sensitivity.
Frankly, any movement is better than being sedentary! Burst training has been shown to be more beneficial with respect to blood sugar balance than aerobic or intense lengthier exercise. Burst training is short intervals of high-intensity exercise followed by rest.
Stress can have a huge impact on the development of both leptin and insulin resistance. Have them use stress reduction techniques like HeartMath™, meditation, yoga, deep breathing, or just focusing on a favorite hobby or recreation. You can talk to your client about having an adrenal stress test that tests cortisol and DHEA levels if you want more details about what is going on with them relating to their overall stress level.
I talk about adrenal fatigue a lot, so you can search my blog for other info on stress and adrenal fatigue, as well as some recipes you could suggest to your clients.
To deepen your understanding of the hormones and nutritional management of them, download a free set of videos and handouts from The Institute of Nutritional Endocrinology.
If you're looking to go even deeper to learn about leptin and leptin resistance so you can better serve your clients with insulin resistance and blood sugar issues, my Insulin Resistance Practitioner Training program is worth checking out.
COMMENT: What are some of the challenges you're facing with clients in the realm of hormone balance, blood sugar, and weight? Please share.