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May 2013 – Hashimotos Healing

Archive Monthly Archives: May 2013

Food Sources of Vitamins & Minerals

Veggies - artichoke tomato greens

Wouldn’t it be great to have a list of food sources of vitamins? Well, look no further! In our continuing effort to provide you with all things healthy and beneficial here’s a pretty comprehensive list.

A word of caution: If you are following an autoimmune protocol there will be some foods here that you can not eat. However, I wanted to provide a pretty comprehensive list so that you can get a sense what’s available outside of a multi-vitamin.

VITAMIN A: red pepper, dandelion greens, carrot, apricot, kale, mustard greens, watercress, sweet potato, parsley, spinach, turnip, swiss chard, cantaloupe, broccoli

VITAMIN B1: rice bran, wheat germ, sunflower seeds, peanut, soybean, pinto bean, peas, millet, lentils, almonds, turnip greens, collard greens, kale, asparagus

VITAMIN B2: salmon, trout, cod, mackerel, perch, oysters, mushrooms, almonds, hijiki

VITAMIN B3: rice bran, peanuts, red pepper, wild rice, kelp, sesame seed, peaches, brown rice, mushrooms, barley, almonds, apricot

VITAMIN B5 (PANTOTHENIC ACID): beef, chicken, salmon, mackerel, sardines, barley, rice, avocado, plums, raisins, almonds, dates

VITAMIN B6: banana, barley, brewer’s yeast, molasses, soybeans, wheat bran, brown rice, liver, beef, cabbage, carrots, potato, yams

VITAMIN B12: beef liver, beef kidney, ham, sole, scallops, eggs, oats, soybean

miso, soy sauce, tempeh, pickles, amasake, nut and seed yogurts, sourdough bread, algae, spirulina and chlorella, brewer’s yeast

BIOTIN: beef liver, peanuts, eggs, peas, cauliflower, mushrooms, filberts

VITAMIN C: red pepper, currants, kale, parsley, turnip greens, mustard, spinach, green bell pepper, broccoli, Brussels sprouts, cauliflower, lemon, orange, red cabbage

VITAMIN E: soybean oil, corn oil, navy bean, oatmeal, green peas, brown rice, turnip greens, sweet potatoes, parsley

VITAMIN K: spinach, cauliflower, cabbage, carrots, soybeans, liver, oats

BIOFLAVONOIDS: lemon, lime, grapefruit, orange, red pepper, prune, parsley, apricot, plum, cherry, walnut, buckwheat

BORON: soybeans, prunes, raisins, almonds, rosehips, peanuts, hazelnuts, dates, honey, wine

CALCIUM: sesame seed, kelp, agar, dulse, collard greens, kale, turnip greens, almond, soybean, mustard greens, filbert, parsley, dandelion greens, brazil nut, spoon cabbage, watercress, chickpea, white bean, pinto bean, horseradish, pistachio, red pepper, figs, sunflower seed

CHROMIUM: beer, brewer’s yeast, brown rice, beans, mushrooms, potatoes

COPPER: oysters, liver, chocolate, cocoa, mushrooms, almonds, pecans, avocado, rye, walnuts

FLOURIDE: seafood, seaweed

FLOURINE: tea, sardines, salmon, mackerel, shrimp, kale, potatoes, spinach, apples

FOLIC ACID: liver, asparagus, lima beans, spinach, swiss chard, kale, cabbage, sweet corn

IODINE: kelp, dulse, agar, swiss chard, turnip greens, summer squash, mustard greens, watermelon, cucumber, spinach, asparagus, kale, turnip

IRON: dulse, kelp, rice bran, pumpkin seeds, beans, lentil, parsley, walnut, apricot, almond, raisins, swiss chard, spinach, dates, fig, kale, cucumber, cauliflower, cabbage

LYSINE: chicken, yoghurt, ricotta, cheese, avocado

MAGNESIUM: kelp, wheat bran, wheat germ, almonds, cashews, soybeans, brazilnut, dulse, peanut, walnut, filbert, sesame seed, lima beans, peas, millet

MANGANESE: oatmeal, whole wheat, peas, beans, egg yolk, spinach, kale, bananas, nuts, pineapple, sunflower seeds

MOLYBDENUM: buckwheat, eggs, oats, soybean, lima beans, barley, lentils, sunflower seeds, liver

PANTHOTHENIC ACID: liver, broccoli, mushrooms, eggs, peanuts, oils, peas, soybeans, sweet potatoe

POTASSIUM: dulse, kelp, soybean, lima bean, rice bran, banana, red pepper, white bean, pinto bean, apricot, peach, prune, sunflower seed, chickpea, lentil, almond, raisin, parsley, sesame seed, avocado

SELENIUM: brazil nuts, brown rice, brewer’s yeast, eggs, garlic, liver

SULFUR: kale, watercress, brussels sprouts, horseradish, cabbage, cranberry, turnip, cauliflower, raspberry, spinach, red cabbage, kelp, parsnip, leek, radish, cucumber, celery

ZINC: oysters, herring, liver, oatmeal, wheat bran, maple syrup, brewer’s yeast, sunflower seeds, soybeans, mushrooms, sardines, pecans, pumpkin seeds

How to Exercise with Hashimoto’s

Portrait-Photo-Exercising-on-the-Beach

There is no question that exercise is a very important part of any healthy lifestyle. This is especially true if you have an autoimmune disease. However, when you exercise with Hashimoto’s you must be careful to do it properly or you can wind up doing more harm than good.

In this post we examine new research on exercise and look at the best type of exercise program for people with Hashimoto’s.

 Exercise with Hashimoto’s Has Many Health Benefits

Exercise has many health benefits and many of these are hugely important if you suffer from Hashimoto’s. In my last post, I mentioned a lecture I attended that was taught by Dr. Datis Kharrazian, here is some additional information I learned and how I think it applies to Hashimoto’s people. According to Dr. Kharrazian, the benefits of exercise include:

* Growth Hormone Release

* Opioid Response

* Nitric Oxide Synthase (eNOS) Responses

* Brain-Derived Neurotrophic Factor Release

* Insuline Receptor Sensitivity

* Immune Enhancement

Growth Hormone

Growth hormone stimulates cell reproduction and regeneration, and growth in our bodies. It also has a number of positive effects on our nervous, endocrine, and immune systems

A lot of growth hormone’s effects are felt in the liver where it can improve the burning of body fat, improve blood glucose levels and increase protein synthesis.

It also has important effects on the nervous system where it can improve synapses in the brain. It also improves heart function, immune function and decreases recovery time.

In addition, it has been found to increase calcium absorption and improve bone density.

Studies have shown that growth hormone release is increased with increased exercise intensity. (So walking on a treadmill and watching t.v. probably won’t result in much being released.)

Hypothyroidism can cause increases in body fat and alter lipid metabolism, and can lead to poorer absorption of calcium and protein. So these effects can be very beneficial for Hashimoto’s patients.

Opioid Response

Exercise has been found to release the body’s natural opioids called endorphins and enkephalins. This is commonly known as the “runner’s high” or that blissful feeling that you get after certain kinds of exercise and sports.

Endorphins have many positive effects including pain relief, stress reduction, and improving our moods. Exercise can also result in the release of more dopamine and serotonin both of which are responsible for happiness and satisfaction with life and relationships.

Studies have shown that moderately high to high intensity exercise stimulates the release of these natural proteins. It also seems to depend on the individual with some people needing to do more than others.

Hypothyroidism can lead to declines in dopamine and serotonin and to feelings of depression and overwhelm. Some of the most widely prescribed drugs for Hashimoto’s people are anti-depressants, so exercise can have huge benefits for these people, as well.

Nitric Oxide Synthase

Nitric Oxide Synthases (NOS) are enzymes that can do both good and bad things in the body. Increased eNOS (endothethelial NOS) increases blood flow which can get more blood to the brain, can improve heart health and can get more nutrients and oxygen to our bodies’ cells. This results in tissue repair and more energy.

Increased nNOS (neuronal NOS) causes more muscle contraction and brain focus which results in improved performance in various activities.

On the other hand, increased iNOS (inducible NOS) can result in a host of bad things like: surges in destructive immune cells called cytokines, damage to mitochondria and inflammation. Too much of this can lead to injury, muscle wasting and breakdown and pain.

(Arginine is an important nutrient for iNOS and should be avoided before exercise.)

NOS plays a key role in cardiovascular, immune and brain function. All things that can be compromised in Hashimoto’s people.

It seems that the right amount of exercise is key for getting the right amounts of the right kinds of NOS. Too little and you won’t get the benefits, too much and you get the damaging consequences mentioned above. One again, the key is high intensity, but not for too long.

Brain Derived Neurotrophic Factor (BDNF)

BDNF helps with nerve growth and differentiation in the brian. It is very important in building new nerve pathways and preserving and keeping healthy old ones. So it is critically important in maintaining a healthy brain and in slowing the destruction of nerves in the brain that can lead to dementia and Alzheimer’s.

Exercise increases levels of BDNF and also improves brain function. Once again (are you seeing a trend emerging?), the amount released is dependent on the intensity of the exercise.

Brain fog and neuro-degeneration are very common complaints from people with Hashimoto’s. This is caused by numerous things, but the underlying mechanism is inflammation caused by immune cells and the destruction of brain cells.

Insulin Receptor Sensitivity

Problems with insulin resistance are very common in today’s society and are a driving force in the initiation of Hashimoto’s. It can also prevent people from getting any better once they have developed the disease.

Insulin normally helps sugar get into cells, when people become insulin resistant because they are exposed to too much sugar, the cells of the body start blocking insulin because they can’t deal with so much sugar.

This person feels like she needs to nap after every meal, and may actually fall asleep after eating a carbohydrate rich meal. This person will also have belly fat and will complain of insomnia.

Insulin resistance can drag down thyroid function and contributes to diabetes, heart disease, sleep apnea, hormone problems, obesity and certain types of cancer.

Aerobic and strength-training exercises improve insulin sensitivity by increasing the number of protein molecules called glucose transporters (GLUT), which allow your cells to better respond to insulin.

Immune Enhancement

Hashimoto’s is an autoimmune disease. The immune system has short circuited and attacks the thyroid as if it were a foreign invader.

Exercise can be very beneficial for improving immune function. The right kind of exercise can be helpful in healing the gut and in improving gastrointestinal immunity. Since 70% of the immune system lives in the gut, this can be very beneficial.

But, excessive exercise can actually cause major problems with immune function. And if you have Hashimoto’s it is very important not to overtrain or you can wipe out all of the benefits and actually make many things worse.

What Kind of Exercise Is The Right Kind?

It is clear that exercise can be very beneficial for Hashimoto’s patients, but what is the right kind and the right amount?

According to research, the optimal exercise level to achieve all the health benefits described above is high intensity: when doing this you will:

* Break a sweat after 3-5 minutes

* Breathe deeply and rapidly

* Only talk in short phrases while you are doing this.

You want to go hard enough to achieve 70% or greater of your maximum heart rate. This can be calculated by this simple equation: 220 – your age in years = your maximum heart rate.

Fine Line Between Just Right and Too Much

There is a fine line between the right amount of exercise which can really improve health and too much which can actually cause more health problems.

The key point is this: The more intense the exercise, the greater the potential for health benefits that include everything mentioned above, but also the greater risk of doing too much and this results in the loss of all those benefits.

This is especially true if you suffer from an autoimmune disease like Hashimoto’s because you may not be able to exercise like a normal person and you may reach the threshold of maximum benefit sooner than people who do not have this condition.

Certain Factors Can Make You More Vulnerable to Overtraining

Dr. Kharrazian also noted that there are a number of things that can make exercise not work for you. If you have any of these conditions, you must be very careful not to overdo it when working out.

These conditions include:

* Pre-existing high or low cortisol levels

* Pre-existing systemic inflammation

* Pre-existing immune weakness

* Pre-existing intestinal permeability

* Pre-existing hormone imbalance

* Pre-existing nutrient deficiencies

* Pre-existing obesity

People who suffer from Hashimoto’s often have a majority of conditions from that list, which means they are very vulnerable to getting worse as the result of exercise.

How Do You Know If You are Doing Too Much?

There are a number of signs and symptoms that can help you identify if you are working out too much.

Performance Signs and Symptoms

If you have a hard time recovering from workouts, can’t complete your workouts, notice your performance is declining or that you have more injuries then you may be doing too much.

Psychological Signs and Symptoms

If you are exercising frequently and you notice a loss of motivation and enthusiasm, a loss of competitive drive, depression, irritability or aggression for minor reasons then you may be doing too much.

Physical Signs and Symptoms

If you are exercising regularly and you notice that you have a weakened immune system, a loss of libido, loss of menstrual cycle, decreased muscle strength or unexplained increases or decreases in weight then you may be over doing it.

The Best Workout: Maximum Results With Minimal Energy Expenditure

An article in the May-June issue of the American College of Sports Medicine’s Health & Fitness Journal offers an example of an optimal 7 minute workout that can be used as a starting point for Hashimoto’s patients and can be utilized to achieve all the health benefits without causing any of the negative effects of overtraining.

I really like this workout because it can help you achieve all the health benefits we have discussed in a very short time, it works on your entire body and it can be modified so that you can do more or less.

This entire workout can be done at home, in a hotel room or anywhere that has an open room and a chair. You don’t need to purchase any equipment and you can do it by yourself without having to hire a personal trainer or therapist.

The entire workout is 7 minutes and you can repeat the circuit up to 3 times. It consists of 12 different exercises each done at high intensity for 30 seconds.

For people with Hashimoto’s, I recommend starting with one cycle and seeing how you feel. For some, even a 7 minute workout will prove to be too much. If that is the case, cut the 30 second intervals in half.

If you are able to do all 12 exercises as suggested for 30 seconds then do one interval for one to 2 weeks (a minimum of 4 times per week). Repeat the entire sequence after 2 weeks and then add a third repetition after an additional 2 weeks. If pressed for time, you can simply do 1 round of 7 minutes.

When Is The Optimal Time to Exercise?

The optimal time to get most benefit is within 10 minutes after you wake up, before you have had breakfast. This is the perfect time to exercise because you can take advantage of your body’s natural cortisol surge and exercising before breakfast will also help you burn fat more efficiently and help reduce insulin resistance.

Nutritional Support Before and After You Workout

For my patients and myself, I recommend taking a drink that provides electrolytes (not Gatorade – which is loaded with sugar). Here’s a recipe for a simple Electrolyte Lemonade:

Electrolyte Lemonade:

3 organic lemons, peeled, but leave white pith intact

3 tablespoons coconut oil, olive oil or flax oil

1 organic pear, cored

1 tablespoon Celtic sea salt or Himalayan Salt

6 cups filtered water

Blend everything well in a Vitamixer, makes 1 pitcher

Drink 1 glass before your workout.

It is also recommended to support nitric oxide synthase production. The following nutrients and co-factors can do this: ATP, N-Acetyl L-Carnitine, Huperzine A, Alpha-GPC, Vinpocetine and Xanithol Nicotinate. This will help boost eNOS and nNos.

After the workout take something that will reduce inflammation and support the immune system like turmeric and/or resveratrol and another glass of electrolyte lemonade.

The 5 Elements of Thyroid Health System

Hashimoto’s is a complicated condition that can impact all the major systems of the body. In order to treat it effectively, you really need to adopt a lifestyle that supports you with the right kind of diet, exercise and supplement regimen to get you feeling your best and to slow or stop the destructive progress of the autoimmune disease.

Would like help in designing the right kind of diet, exercise and supplement regimen from someone who has worked with over 2,000 people with Hashimoto’s?

I offer a free 30 minute Hashimoto’s Healing Strategy Session. In it you can share where you are, where you want to be and I can give you some recommendations that will help right away.

Book your session now: https://hashimotoshealing.as.me/strategy

Resources:

The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013

Relationship between exercise intensity and growth hormone intensity, Journal of Applied Physiology. 1999 Aug.; 87(2):498-504

Opioids and Exercise. An Update. Sports Med. 1989 Feb;7(2):109-124

Effect of different intensities of exercise on endothelium-dependent vasodilation in humans: role of endothelium-dependent nitric oxide and oxidative stress. Circulation. 2003 Aug. 5; 108(5):530-535

The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function. Med Sci Sports Exerc. 2007 Apr;39(4):728-34

Intense physical training decreases circulating antioxidants and endothelium-dependent vasodilation in vivo. Atherosclerosis, 1999 Aug. 145(2);341-349

http://journals.lww.com/acsm-healthfitness/Fulltext/2013/05000/HIGH_INTENSITY_CIRCUIT_TRAINING_USING_BODY_WEIGHT_.5.aspx

Life Food Recipe Book, Annie Padden Jubb and David Jubb, North Atlantic Books, 2003, page 186, Electrolyte Lemonade

4 Secrets to Weight Loss with Hashimoto’s

Overweight_Women

Hashimoto’s is the most common autoimmune disease in the United States. And one of the most common complaints for people with Hashimoto’s and hypothyroidism is that they have difficulty with weight loss.

This is even true for people who are taking thyroid replacement hormone (especially T4), exercising and eating well. It seems that no matter what they do they just can not get the weight off.

There are many reasons for this and in this post I will explore 4 secrets to weight loss that new research has revealed.

The Old Metabolism Model Is Outdated

The old model of your metabolism and hormone levels, alone, being the reasons for success or failure of your weight problems is proving to be outdated.

In the old model, the primary reasons for difficulty with weight loss are: eating too much, or eating too much food laced with sugar, fat and salt ( this is a still a real problem for many). In addition, a lack of exercise and hormone related problems like not enough thyroid hormone or excess cortisol.

While these are very real issues and should be considered in any weight related treatment, they have been shown to not be the answer for many women (and men ) with Hashimoto’s struggling with their weight.

New Research Shows Immune System Is a Big Factor As Well

I recently attended a seminar taught by Dr. Datis Kharrazian, one of the world’s leading experts on the treatment of thyroid issues with functional medicine, called The Neuroendocrine Immunology of Exercise and he taught us about this new research that has discovered an entirely new model of causes for stubborn weight gain.

This model involves causes of weight problems that are related to the immune system. And this makes sense for people with Hashimoto’s because it is an autoimmune disease and a thyroid disorder.

If blood tests show that your TSH and T4 levels are “normal”, you are eating well and exercising and you still can’t lose weight, then this may be exactly what is going on with you.

4 Reasons for Weight Gain Related to the Immune System

According to Dr. Kharrazian, in the immune system model, there are 4 main reasons for stubborn weight gain.

They are:

* The mix of bacteria in your gut

* Intestinal permeability (also known as leaky gut)

* Low grade inflammation

* Immune reactive dietary proteins

Let’s explore each one of these in more detail.

The Mixture of Bacteria in Your Gut Matters

An important thing to understand is that your body is an ecosystem, or really, a lot of interconnected ecosystems. And the digestive tract is one of the most complex and dynamic of them all.

Each one of us has their own unique mix of bacteria and other organisms that live in our guts. This mix is determined by our genetic profile, our diets, what medications we have taken and our environment.

There are an estimated 100 trillion different cells and over 1,000 different species of bacteria. 90% of these species belong to 2 families: Firmicutes and Bacteriodetes.

The Balance of Bacteria Can Make You Unable To Lose Weight

New research has shown that the balance of these 2 bacterial species matters for whether or not you are able to lose weight.

In obese and overweight people, there is more Firmicutes than Bacteriodetes. The balance between these 2 species of bacteria generates certain signals to specific genes in the intestines that produce more fat cells.

It is also interesting to note that, according to the research, Lactobacillus bacteria (the most common species sold in over the counter probiotics) actually increases body weight. Both dairy and non-dairy sources.

What that means is that while probiotics may be beneficial for the ecosystem of your gut they are not that helpful in helping you shed the pounds.

Increase Bacteriodetes and Lose Weight

Firmicutes really like junk food. To feed them and gain weight, eat like your average American. To starve them and lose weight, read on.

The more important question is: how do you increase the Bacteriodetes? It seems these little critters really like plants. And the best way to increase their number is to increase the amount of plant based foods and fiber in your diet.

Especially oligosaccharides (found in Jerulsalem artichokes, and onions, leeks, garlic asparagus and jicama, etc.) and monosaccharides (found in pears, grapes, peaches, apples, pineapples, apricots, bananas, yams, carrots, onions, and sweet potatoes). And other plant based fibers that come from green leafy vegetables, green tea, etc.

These get fermented in the colon by the good guys and help you to become a mean, lean weight loss machine! But, just so you know, this is not something you can change in 5 minutes or 5 days. It may take a few months to alter this environment.

Leaky Gut Leads to a Bigger Gut

While it is true that people with Hashimoto’s often suffer from intestinal permeability or leaky gut syndrome, new research shows that this can also lead to fat around the organs.

In leaky gut, the intestines lose their ability to keep tiny particles of all sorts of stuff out of the bloodstream. It turns out that there may be a connection between a fatty liver and the breakdown of the gut barrier system.

In addition, zonulin, a protein that is used by the intestines to bind tight junctions, leaks into the blood stream when people have a breakdown of this barrier. It is also increased with obesity associated insulin resistance.

Finally, the toxins that are produced by bacteria known as lipopolysaccharides have also been linked to obesity and the onset of diabetes.

Bottom line: If you want a smaller gut, you need to heal your leaky gut.

Low Grade Inflammation: The Chicken or The Egg?

Autoimmune disease is a disease that is closely linked to inflammation. So is type 2 diabetes, so is eating a lousy diet and eating too much sugar, salt and fat.

What research is now showing us, is that obesity is also an inflammatory condition. It is becoming less clear which came first. One thing we now know is that adipose tissue (fat tissue) produces inflammation in the body all by itself.

So you have the creation of this destructive cycle of abnormal gut bacteria and leaky gut leading to a process (insulin and leptin resistance) which makes glucose not able to enter cells. When glucose can’t enter cells it gets converted into fat in the liver (triglycerides). These fat cells start the whole process all over again.

Leptin and Insulin Resistance Are Similar

Leptin is one of the main hormones involved in hunger, metabolism and the control of how energy from carbs and fats get stored and used. It comes from the Greek word ‘leptos’ meaning thin.

The amount of leptin produced directly correlates with weight loss or weight gain. (Women have significantly higher circulating leptin than men).

Leptin resistance is very similar to insulin resistance. With insulin resistance, long term elevated levels of insulin make your muscle and fat cells more resistance to the action of insulin.

Chronic elevated levels of leptin end up making you eat way too much. And abnormal gut bacteria and leaky gut feed this process as well (pun intended ;)).

Its A Vicious Cycle That Makes It Harder to Lose Weight

This whole process creates more fat tissue which causes more inflammation, and on and on it goes, snow balling and making it harder and harder to lose weight.

So you can see, while this is kind of complicated, it is hugely important to do everything you can to reduce inflammation that is the root cause of everything that we have just examined.

Immune Reactive Dietary Proteins

Certain proteins can also add gasoline to the flames of inflammation.

Everything that is living in our world is made of proteins. With autoimmune disease the immune system confuses our own proteins with that of an invader like a virus or a food we are allergic to.

There are some proteins in our diet that can cause an immune response that can also lead to inflammation and add more insult to injury.

These proteins are found in gluten, dairy and soy and in some other foods called cross reactors. You can learn more about them in this post.

These need to be eliminated from the diet if you want to lose weight because this will begin to unwind the vicious cycle of inflammation at the root of the immune system’s influence on weight gain.

Bottom Line

Bye bye inflammation, bye bye weight.

rosie

Have you had trouble losing the pounds even though your lab test numbers look “normal”?

Do you eat well and exercise, but still can’t lose the pounds?

Do you experience the common symptoms of inflammation like brain fog (inflammation of the brain), joint pain (inflammation of the joints), thyroid nodules (inflammation of the thyroid) and weight gain (body wide inflammation).

Need help? Schedule a 30 minute Hashimoto’s Healing Discovery Session: Click here to set up a time to chat.

 

Resources: 

The Neuroendocrine Immunology of Exercise, Dr. Datis Kharrazian, 2013

Nature. 2012 Sept. 13: 489(7415): 242-249, Functional interactions between gut microbiota and host metabolism.

Chem Biol Interact. 2011 Jan 15; 189 (1-2): 1-8, High polyphenol, low probiotic diet for weight loss because of intestinal microbiota interaction

Nature. 2006 Dec. 21; 444 (7122): 1022-1023. Microbial ecology: human gut microbes associated with obesity.

Obesity (Silver Spring). 2011 Nov ; 19 (11): 2280-2282. Intestinal permeability is associated with visceral adiposity in healthy women.

Diabetes. 2007 Jul; 56(7): 1762-1772. Metabolic endotoxemia initiates obesity and insulin resistaence.

PLoS One. 2012; 7(5):e37160. Circulating zonulin, a marker of intestinal permeability, is increased in association with obesity-associated insulin resistance.

J Transl Med. 2011 Nov 24; 9:202. Gut microbiota and sirtuins in obesity-related inflammation and bowel dysfunction