The topic covered in this article is relevant to practitioners of all disciplines, particularly those who are providing health care services to people who suffer from conditions as diverse as chronic inflammatory conditions, autoimmune diseases, neuropathic pain, obesity, diabetes, thyroid hormone resistance (e.g., unexplained hypothyroidism), many cardiovascular diseases, syndrome-X, food cravings and more. Before getting to the unlikely link that can connect these apparently unrelated diseases and conditions, a background setting is called for.
An image I like to use when explaining contextual issues in relation to health is that of an iceberg floating in the ocean. The visible portion of the iceberg – perhaps 20 percent of its total mass – simplistically can be seen to represent those aspects of the patient that we observe, palpate, assess, discuss and evaluate. These divinations result in a greater understanding of the unseen inner workings of the patient – equivalent to aspects of the unseen, underwater portion of the iceberg.
And then there is the ocean itself, in which the ice mountain floats. In relation to the iceberg, this would include elements such as the relative salinity, temperature and pH of the water, as well as the weather, currents and more. In relation to the patient, the context includes multiple influences – environmental; psychosocial, biochemical and biomechanical; past and present; intermittent and constant; acute and chronic – that affect the individual from cradle to grave.
The complexity of such interacting influences, overlaid on the person’s genetic and acquired characteristics, as well as the symptoms being manifested, often seem too daunting to make sense of. Hence, the reductionist approaches of so much of health care, whereby modifications of single aspects of this confusing edifice are attempted in order to nudge it toward more normal function. This may be done via diet, medication, nutritional supplements or herbs, needles, manual treatment, exercise, hydrotherapy, better breathing or posture, homeopathy, and many other options. Any of these interventions might modify etiological features sufficiently to encourage the self-regulating functions and systems of the body toward better health.
Lifestyle changes might be suggested that appear to offer more fundamental health-enhancing possibilities. Here, treatment is not a feature, but rather the initiation of changes that aim to align the individual more closely with evolutionary imperatives – offering a chance for homeostatic functions to operate more efficiently. Such changes might involve reforming nutritional, exercise, sleep and other basic behavior patterns.
Many such changes are common sense. Practical lifestyle modifications have been demonstrated to lead to profound influences on well-being and health enhancement. These suggestions range from more exercise, adequate sleep, balanced/reformed dietary habits (avoiding or modulating intake of high-sugar, high-fat junk food and stimulants such as caffeine and alcohol), as well as better breathing and relaxation methods. Other simple choices also are now available, backed by solid scientific evidence; much of it relating to hormones produced by white adipose tissue (fat), such as leptin.
The Leptin Story
I am grateful to Judith DeLany, LMT, with whom I have happily co-authored three books, for drawing my attention to the rapidly-evolving area of leptin research and putting together a summary for use in one of our revisions. Credit for collating a great deal of the information outlined below belongs to her. Recent research points toward basic lifestyle changes that can have profound influences on the evolution of diseases. Due to space constraints, I will outline only some of the most pertinent information, with appropriate references that can be used to expand on the summary below:
- White adipose (fatty) tissue (WAT) produces hormones that are active participants in regulating physiological and pathological processes, including immunity and inflammation.1
- Some of the hormones produced by WAT, including leptin, play crucial roles in the development of type II diabetes, obesity and artherosclerosis.2
- WAT plays a primary role in the development of hormonal imbalance (leptin resistance, adrenaline resistance, insulin resistance), with many significant health consequences.
- Weight gain in the abdominal region is a primary indicator of accumulation of WAT, associated with the hormonal disorders mentioned above and with high risks of developing cardiovascular disease.
- One of the main features of visceral adipose tissue is an inflated waistline, apple-shaped figure (android body type), and increased systemic inflammation.3
- Fantuzzi4 notes that WAT produces both pro- and anti-inflammatory factors, as well as chemicals such as tumor necrosis factor alpha (TNF-a) and interleukin 6 (IL-6). “The current view of adipose tissue is that of an active secretory organ, sending out and responding to signals that modulate appetite, energy expenditure, insulin sensitivity, endocrine and reproductive systems, bone metabolism, inflammation and immunity.”
- One of leptin’s primary roles is to communicate with the hypothalamus regarding fat storage, which affects the metabolic rate. When working normally, leptin levels rise when adequate food has been consumed, signalling the brain to stop eating and increasing metabolism. When leptin levels drop because food is not being consumed, appetite is stimulated. If food is still not consumed (skipped meals, for example) and leptin levels continue to drop, this signals metabolism to slow down to conserve body fat.
- Wilding5 has stated that one purpose of leptin is to coordinate metabolic, endocrine and behavioral responses to starvation.
- Budak, et al.,6 suggest that leptin and ghrelin (another hormone produced by fat, and an appetite stimulator) strongly influence reproduction.
- The range of diseases and processes influenced by leptin and other hormones produced by WAT runs from inflammatory diseases in general, through cardiovascular disease (atherogenic effects), obesity, neuropathic pain, cancer, autoimmune diseases, cravings and much more. There are leptin-receptor sites on the liver, kidneys, ovaries, adipose tissue and the gastrointestinal tract.
- A study of more than 1,000 people concluded that people getting less than the optimal number of hours of sleep (i.e., eight hours) show a rise in ghrelin levels and a drop in leptin levels.7
A simple plan has been devised8 to help regain normal leptin levels and thereby, balance the hormonal cascade discussed above. Although this plan may not be ideal for every one, it is presented here for the majority who it is suggested should benefit from its use. The foundation of the plan contains five basic rules. Breaking any of the rules or guidelines (below) can lead to setbacks.
Rule 1: Never eat after dinner, not even a snack or glass of wine or juice. Allow 11-12 hours between dinner and breakfast. Generally, finish eating dinner at least three hours before bed. This rule is designed to allow leptin, melatonin, cortisol and other chemicals to balance during the night. Individuals with night-eating syndrome have abnormal hormonal patterns apparently associated with nocturnal eating.9
Rule 2: Eat three meals a day. Allow 5-6 hours between meals. Timing is crucial, so that insulin levels can drop, glucagon (produced by the liver) can rise, and fat metabolism can kick in. If this occurs a couple of hours before more food is eaten, fat stores can be utilized until the next food is eaten. Snacking between meals sends the insulin back up and fat stores remain untapped. Therefore, snacks are to be avoided. Protein and carbohydrate portions are the size of the palm of the hand and most vegetables can be eaten as desired. Peas, carrots and corn are taken in moderation.
Rule 3: Do not eat large meals. Eat slowly and, if overweight, always try to finish a meal when slightly less than full. Eating slowly allows time for hormonal signals to reach the brain before overeating occurs. Smaller meals allow for better digestion. Do not overstretch the stomach and reduction in overall caloric consumption can be achieved.
Rule 4: Eat a breakfast containing protein. This helps set the hormonal cycles for day and night. Compromising this can have hormonal effects during the day and into the night, disturbing sleep. Weigle, et al.,10 showed that an increase in dietary protein from 15 percent to 30 percent of energy produced significant weight loss, presumably “mediated by increased central nervous system leptin sensitivity.”
Rule 5: Reduce the overall amount of carbohydrates eaten. Unless one already is on a low-carb plan, chances are that too many carbohydrates are routinely consumed. Regarding carbohydrate influences, Garg, et al.,11 note, “Compared with the low-carbohydrate diet, the high-carbohydrate diet caused a 27.5 percent increase in plasma triglycerides and a similar increase in [very low-density lipoprotein]-cholesterol levels; it also reduced levels of HDL cholesterol by 11 percent.”
This brief summary suggests that eating regular, balanced (low-sugar, for example) meals, including a protein breakfast; avoiding snacking between meals and reducing overall carbohydrate intake; and getting enough sleep can beneficially impact a huge range of diseases, including those that involve excessive inflammation.
If you or your clients are overweight, suffering from inflammatory conditions and/or any of the long list of conditions mentioned by researchers investigating leptin, these simple changes could offer a way of beneficially influencing health. When they do, this represents an example of contextual health care, as discussed at the start of this article.
- Juge-Aubry C, Henrichot E, Meier C. Adipose tissue: a regulator of inflammation. Best Pract Res Clin Endocrinol Metab, 2005;19(4):547-66.
- Reilly M, Rader D. The metabolic syndrome: more than the sum of its parts? Circulation,2003;108(13):1546-51.
- Berg A, Scherer P. Adipose tissue, inflammation, and cardiovascular disease. Circ Res,2005;96:939-49.
- Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol,2005;15(5):911-9.
- Wilding J. Leptin and the control of obesity. Curr Opin Pharmacol, 2001;1(6):656-61.
- Budak E, Fernandez Sánchez M, Bellver J, et al. Interactions of the hormones leptin, ghrelin, adiponectin, resistin, and PYY3-36 with the reproductive system. Fertil Steril,2006;85(6):1563-81.
- Spiegel K, Tasali E, Penev P, Van Cauter E. Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med, 2004;141(11)846-50.
- Richards B, Richards M. Mastering Leptin: The Leptin Diet, Solving Obesity and Preventing Disease! Minneapolis: Wellness Resources Books, 2005.
- Geliebter A. Night-eating syndrome in obesity. Nutrition, 2001;17(6):483-4.
- Weigle D et al. A high-protein diet induces sustained reductions in appetite, ad libitum caloric intake, and body weight despite compensatory changes in diurnal plasma leptin & ghrelin concentrations. Am J Clin Nutr, 2005;82(1):41-8.
- Garg A, Grundy S, Unger R. Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes,1992;41(10):1278-85.