Mast Cell Activation Syndrome

Mast Cell Activation Disorder incudes: macrocystosis (an increased number of mast cells) and MCAS (Mast Cell Activation Syndrome).

Mast Cell Activation Sydrome (MCAS) is not rare, occurring in 10-17% of the population!

Mast Cells are the first responders in the immune system defense against pathogens and play an important role in wound healing and immune tolerance. Mast Cells have an important role in the immune system in responding to certain bacteria and parasites. They help control other types of immune responses. They contain: histamine, heparin, cytokines, and growth factors. Degranulation of these preformed substances- over 200+ substances including: histamine, tryptase, etc. occurs rapidly- within seconds!

Mast Cell Activation Syndrome is a chronic inappropriate production and release of the mast cells' large inventory of potent mediators, which upon interaction with other cells throughout the body, cause most of the symptoms.

People who have mast cell activation syndrome often have repeated episodes of the symptoms of anaphylaxis:  allergic symptoms such as hives, swelling, low blood pressure, difficulty breathing, tachycardia, skin turning red/flushing,  and severe diarrhea. High levels of mast cell mediators are released during those episodes.

Mast cells are found in highest concentrations in the skin, airway, lungs, and intestines, as well as the mouth and nose. Mast cells are also found in the brain.

Mast cell triggers can be: heat/changes in temperature, stress, mold, heavy metals, viruses, lyme disease, exercise, foods (cheese, spices, cumin, fish, etc).

Neuropsychiatric disease associated with mast cells: Fibromyalgia, Migraine, Neuropathic pain, CRPS, Vulvodynia, Autism, MS, Alzheimer’s, Parkinsonism, Neurofibromatosis, Depressive episodes, ADHD, anxiety, PTSD, panic attacks, difficulties in concentrating (and many many more conditions).

Testing/diagnosis of MCAS can be done through Blood by: Serum Tryptase, plasma histamine elevation. 24-hour Urine tests are: N-methylhistamine; Prostaglandin D2, Leukotrienes, and heparin. The third way is pretty invasive, it is a bone marrow biopsy for systemic Mastocycosis (aspirate is analyzed for tryptase, CD117, CD25, CD2, CD30 and KIT mutation.

Mast cells in the brain are activated by Cortisol Releasing hormone (Stress destabilizes mast cells!), etc- which releases inflammatory mediators, causes hyperpermeability (leaky brain) and neuroinflammation.

Mast cell activation Syndrome often is a tough condition. Symptoms can be mitigated by a low histamine diet, DAO enzyme with meals; as well as some of my favorite supplements that moderate mast cells including: Quercetin, Luteolin (found in celery and parsley), Vitamin C, and Magnesium. Environment is also looked at including: mold removal and other environmental toxin reductions. Since MCAS symptoms are severe often H1 and H2 blockers are helpful.

Mycotoxins (mold toxins) have a detrimental and dramatic effect on the body, often inflammatory, immune suppressive, etc. Running a mycotoxin urine profile is often helpful in finding if mycotoxins are compounding the problem.

Diabetes- the danger of high blood sugar

In October we learned how insulin is connected to American’s expanding girth. Blood sugar plays a large role, followed by increased secreted insulin, which allows for blood sugar to be stored as fat. But what if insulin isn’t produced and therefore doesn’t control blood sugar, then what?

As one of my undergraduate professors would say, “we live in a Goldilocks world,”  having some blood glucose is vital, but too much is detrimental. Too much blood sugar is called hyperglycemia and often occurs in Diabetes type 1 (autoimmune condition) or Diabetes type 2 (insulin resistant, linked to extra weight). Classic signs of diabetes are: frequent urination, intense thirst, and ravenous hunger. High blood glucose, when filtered through the kidney allows for glucose to spill over from the blood into the urine, pulling water along with it. This causes frequent urination and dehydration, which accounts for increased thirst.

Insulin is important because it allows glucose in the blood to enter cells, cells need glucose for energy. Most cells in the human body require insulin before glucose can enter. Insulin effectively removes excess glucose from the blood. Excess blood glucose (especially greater than 400 mg/dL) is dangerous. Conversely, blood sugar too low (less than 40 mg/dL) is dangerous and can render a person comatose, cause brain damage, and result in death.

Uncontrolled high blood sugar leads to degenerative cardiovascular and neurological diseases. It damages small to medium blood vessels and peripheral nerves. Nerve damage (neuropathies) are the most common complication of diabetes leading to impotence, incontinence, and loss of sensation. Neuropathies can be severe, resulting in gangrene and need for amputation. Hyperglycemia decreases immunity, slows wound healing, increases likelihood of infections. There is evidence that diabetes (elevated blood sugar) increases dementia risks by 2 times. High blood glucose promotes high triglycerides, high LDL cholesterol, atherosclerosis (thus cardiovascular disease), and poor circulation. Degenerative changes may occur within the small vessels in the eye and in the kidney (renal damage).

What is your fasting blood sugar? Fasting blood sugar, ideally is between 80-90 mg/dL (the conventional normals are between 65-110 mg/dL). It is often a good idea to screen for pre-diabetes or diabetic changes by testing fasting blood glucose annually. I believe it is a good idea to order a fasting insulin test; this is a sensitive test which indicates future insulin resistance, allowing us to make proactive life and treatment changes preventing insulin resistance and diabetes (type 2) in the future.

The Insulin-Fat Connection

Carbohydrates are the primary source of body fat for most, not fat. Which is probably why the ketogenic diets work so well.

Insulin is the main fat-building hormone. After consuming a plate of pasta (or other high carb meal), your blood sugar will rise and your insulin level will rise as well (unless you are a type 1 diabetic and do make insulin), to prevent a jump in blood sugar. All the blood sugar that is not used as energy or stored (as glycogen) is turned into fat.

Fatty acid building blocks of fats can be metabolized (burned), stored, or converted by your body into other compounds (depending upon what is required). Fat is always in flux in the body, being stored, put into the blood, and being converted to energy. The amount of triglycerides (storage form of fat) in your bloodstream at any time is determined by your heredity, your level of exercise, your blood sugar levels, your diet, your ratio of abdominal fat to lean body mass (muscle), and especially by your recent consumption of carbohydrates! Dietary fat can’t be converted into blood sugar, therefore fat doesn’t cause serum insulin levels to rise.

Slim and fit people tend to be very “sensitive” or “responsive” to insulin and have low serum levels of triglycerides and insulin. Even the slim and trim will have higher triglyceride levels from excess blood sugar after a high-carbohydrate meal (this is why lipid and glucose blood panels often require 12 hours of fasting). The higher the ratio of abdominal fat to lean body mass, the less sensitive to insulin you will be, and the more insulin your body needs to produce. In the obese, triglycerides are ususally present at high levels in the blood stream all the time. High triglyceride levels are a direct cause of insulin resistance and they contribute to fatty deposits on arterial walls (atherosclerosis, as well as cardiovascular diseases).

If you become (or are) overweight, you will enter the vicious cycle: you will produce more insulin, become insulin-resistant (which requires you to make even more insulin), and become more overweight because the body will create and store more fat. This can be reversed by eating less carbohydrate, normalizing blood sugars, and slimming down.

In theory . . . you could acquire more body fat from eating a high-carb fat-free dessert than you would from eating a tender steak (marbled with fat). However the fat in the steak is more likely to be stored if it is accompanied with bread, potatoes, corn, or other high carbohydrate foods.

You control your health. Talk to your naturopathic doctor or nutritionally minded health practitioner today about a healthy diet full of vegetables, quality proteins, and essential fats; as well as screening lab tests (fasting glucose, triglycerides, insulin, etc.), an exercise program, and weight loss. If you believe you need help with label reading, food recommendation, healthful recipes, and shopping advice there are professionals to help.

The Bad, Bad, Bad Fats

Just as some fats are vital to life and help us heal. There are fats that must be avoided because they contribute to degenerative disease conditions.

Frying and deep-frying are two of the most popular methods of fast food preparation, they are also the most damaging to health. Deep-frying exposes oils to light, which causes free-radical reactions; oxygen, which leads to oxidation rancidity; and heat, which leads to heat-twisting which synergize the destructive nature; these are three of the most damaging influences to fatty acids. Frying and deep-frying also produce some trans-fatty acids.

Consider Free-Radicals. They serve some normal functions, but injure, age, degenerate, and kill cells and tissue. Our body produces free-radicals every second which are neutralized by antioxidants: Vitamins C, B3, E, carotene, cysteine, selenium, bioflavenoids, and CoQ10, as well as several enzymes containing zinc, manganese, and copper. If deficient in antioxidants, free radical reactions occur, leading to biologically unsuitable biochemical reactions, abnormal and toxic substances, and disease.

The following oils should not be used for frying: flax seed oil and hemp seed oil. These fresh, unrefined, mechanically pressed, light- and oxygen- protected EFA-rich seed oils can support and improve health. EFA rich oils help bring oxygen into cells which is necessary for health and life.

I’m sure you have heard of Trans-fatty acids. Frying and deep-frying produces trans-fatty acids, which are damaging to health. Recall the chemistry of unsaturated fats and the cis configurations vs. trans configurations . . . cis- fats are bent, once altered to trans- they are straightened. Shapes alter fats melting points, chemical activities and enzyme fit. Trans-fats are altered and break down slower than cis-fatty acids, putting holes in cell membranes, impairing immune function and increasing allergic phenomena. They disrupt the flow of energy (electrons) through the body and disrupt Essential Fatty acids by interfering with prostaglandins (hormone-like substances that regulate arteriole muscle tone, blood pressure, platelet stickiness, inflammatory response, etc.). Trans-fats are detrimental to the cardiovascular system, reproductive system, energy metabolism, fat and essential fatty acid metabolism, liver function, and cell membranes.

Frying and deep-frying destroy ALL oils and can’t be recommended for health. They are prohibited if optimum health is what you are after. But, if you insist on frying or deep-frying use refined oils that contain the lowest amount of EFA’s  and the greatest amounts of saturated fatty acids and monounsaturated fatty acids. Use sulfur-rich foods (garlic and onions) to help minimize free-radical damage. Oils least damaged by high temperatures and oxygen include: butter, tropical oils (coconut, palm), and peanut oil.

Consuming fried-fats and trans-fats rarely may not kill us and may appear harmless. However, as they body copes with toxic substances over 10, 20, or 30 years, our cells accumulate altered and toxic products which the body can’t efficiently detoxify. These altered and toxic substances interfere with the bodies life chemistry (aka: bio-chemistry) causing degenerative processes and cellular degeneration, which manifest as degenerative diseases.

Dietary Fat- What does Fat Do?

So, if fat doesn’t necessarily make you fat . . . what does fat DO in your body?

Fat is absolutely necessary for survival. Your brain is primarily constructed from fatty acids. We cannot survive without essential fatty acids, which we can’t make and must get from our diet.

Essential fatty acids

Make up cell membranes, hemoglobin production, energy production, oxygen transfer, recovery from fatigue, precursors of prostaglandins (hormone-like substances that regulate cellular function), enhance growth, help with cell division, skin health, speeds wound healing, neurotransmitter production (brings a feeling of calmness), necessary for brain development and function.

Saturated Fatty Acids

Found in all cell membranes, but are primarily used for fuel to produce the energy necessary to drive chemical reactions and make life possible. Important for bone health, allowing for calcium to be incorporated into your skeletal structure. Protect your liver from alcohol and other toxins (such as Tylenol and other drugs). Saturated fats enhance your immune system. They are needed for proper utilization of essential fatty acids. Short and medium chain saturated fatty acids have antimicrobial properties.

Triglycerides

Triglycerides are excellent insulation material which dampen shock waves, protecting delicate internal organs. They form a layer beneath our skin to help keep us warm. Triglycerides are how we store energy reserves which we can use between meals, during exercise, while asleep, during famine, and when pregnant. Our body converts the toxic excess of the sugars required for brain function into the less harmful triglycerides. Excess Triglycerides cause health problems.

Cholesterol

This plays both vital and detrimental roles to our health. Cholesterol is essential to our health; so essential, that our body can make it and we do not need to obtain it from food. The more stress we are under, the more cholesterol our body produces, because cholesterol is the precursor to stress hormones. 999 out of every 1000 people can control their cholesterol level and cardiovascular health by nutrition alone.

Cholesterol allows cell membranes to adjust their fluidity for optimal membrane function. Steroid hormones; male and female sex hormones, including testosterone, estrogen, and progesterone are all made from cholesterol. Adrenal corticosteroid hormones are made from cholesterol, as is the very important Vitamin D. Bile acids are derived from cholesterol. Cholesterol is secreted by glands in our skin to protect our skin against dehydration, cracking, and wear and tear from wind, water, and sun. In a pinch, when mineral and vitamin antioxidants are low, cholesterol acts as an antioxidant!

How did we get so fat?

According to Dr. Bernstein, if you want to fatten yourself up, just start indulging on bread, pasta, potatoes, cake, and cookies- all high carbohydrate foods. If you want to hasten the fattening process, consume dietary fat with your carbohydrate. Two studies showed that dietary fat, when consumed as a part of a high-carbohydrate diet, was converted to body fat. Fat consumed as part of a low-carbohydrate diet was metabolized and burned off. . . . Interestingly and conversely, eating fat with carbohydrate slows the digestion of carbohydrate, thus the jump in blood sugar level isn’t as dramatic.

High lipid profiles (Triglycerides, LDL Cholesterol, lipoprotein A) often indicate high blood sugar from a diet with excess carbohydrates and sugars. Consumption of fat has very little to do with lipid profiles.

The primary source of body fat for most Americans is not dietary fat but carbohydrate, which is converted to blood sugar and with insulins help-to fat. Insulin is our main fat building hormone.

Fat is not evil.

It is the way our bodies store energy and maintain essential organs.

Udo Erasmus, a well known nutrition expert writes, “Next to water, which makes up about 70% of the total weight of a human adult, and 84% of that of a newborn infant, fat is the most abundant substance found in our body. We may not like that, but it is there.”

(Eat, Drink, and Be Healthy by Walter Willett MD; Dr. Bernstein’s Diabetes Solution; The Mood Cure by Julia Ross MA; Fats that Heal, Fats that Kill by Udo Erasmus; The Truth about Saturated Fat by Mary Enig PhD and Sally Fallon; Eat more Saturated Fat by Dr. Mercola.)

About Dietary Fat- and a short history lesson

We are getting fatter. The newest, The Lancet study statistics are that 7 out of 10 Americans are overweight or obese . . . thats 68% of us that could stand to lose a few pounds.

If you ask the typical person on the street they will probably tell you that eating fat makes you fat and that saturated fat causes heart disease. This is what the experts have been saying for the past 50 plus years or so.

It’s astounding, despite all the evidence to the contrary, that the government still stands by their guidelines recommending that Americans ought to consume less than 10% of their calories from saturated fatty acids replacing them with monounsaturated and polyunsaturated fatty acids. As well as limiting daily dietary cholesterol to 300 mg or less. They also recommend limiting total fats to 25-30% of the daily caloric intake - which is only about 5 tablespoons a day for a diet of 2400 calories.

Coronary heart disease used to be so rare in America, that when Paul Dudley White introduced the German electrocardiograph in 1920 to colleagues at Harvard, he was advised to concentrate on a more profitable branch of medicine. During the next 40 years, coronary heart disease incidence rose so dramatically that by the mid 1950’s it was the leading cause of death among Americans!

Fat became an enemy in the late 1950‘s after Ancel Keys proposed a direct relationship between saturated fat and cholesterol in the diet and the incidence of coronary heart disease. Keys research received substantial publicity despite the many subsequent studies that questioned his data and conclusions.

Today, 40% of US deaths are attributed to heart disease. But, if heart disease is from the consumption of saturated fats, wouldn’t you expect a corresponding increase in animal fats in the American diet? Between 1910 and 1970, traditional animal fat in the American diet declined from 83% to 63%; butter consumption dropped from 18 pounds per person per year to only 4 pounds per year. Dietary cholesterol intake has only increased 1%.

Between 1910 and 1970 the consumption of dietary vegetable oils (margarine, shortening, and refined oils) increased 400% and consumption of sugar and processed foods increased about 60%.

Gary Taubes writes in the journal Science of March 30, 2001, titled “The Soft Science of Dietary Fat":

"Since the early 1970’s for instance, American’s average fat intake has dropped from over 40% of total calories to 34%; average serum cholesterol levels have dropped as well . . .

"Meanwhile, obesity in America, which remained constant from the early 1960s through 1980, has surged upward since then - from 14% of the population to over 22%. Diabetes has increased apace. Both obesity and diabetes increase heart disease risk, which could explain why heart disease incidence isn’t decreasing. That this obesity epidemic occurred just as the government began bombarding Americans with the low-fat message suggests this possibility . . . that low-fat diets might have unintended consequences - among them, weight gain. Most of us would have predicted that if we can get the population to change its fat intake, with its dense calories, we would see a reduction in weight, admits [Bill] Harlan [of the NIH]. Instead we see the exact opposite.”

(Eat, Drink, and Be Healthy by Walter Willett MD; Dr. Bernstein’s Diabetes Solution; The Mood Cure by Julia Ross MA; Fats that Heal, Fats that Kill by Udo Erasmus; The Truth about Saturated Fat by Mary Enig PhD and Sally Fallon; Eat more Saturated Fat by Dr. Mercola.)

Back to School & Brain Health

It's back to school for most within the next couple of weeks. Brain health and mental focus is important and of interest to many students and parents. The brain and nervous system need healthy fats, quality proteins, and vitamins for peak performance.

Protein. . . fish, beef (grass-fed), chicken, lamb, buffalo, turkey, and eggs contain the necessary amino acids for proper neurological functioning. All protein isn’t the same! Corn-fed Beef and Chicken meat is low in Tryptophan. Tyrosine is the building block of dopamine, epinephrine (helps focus) and Tryptophan is the building block of serotonin (for the happy feelings) & melatonin (vital for sleep and anti-cancer). Taurine, Glycine, and GABA are amino acids which decrease stress, soothe, and help relaxation.

We need fat. Omega 3's, omega 9's, and saturated fats are essential for brain health (You read that right . . . saturated fats). Your brain is essentially fat and it needs healthy fats for proper repair and function. Fish (pharmaceutical grade fish oil), butter (grass-fed cows), avocado, olive oil, coconut oil, and some nuts (walnuts) are wonderful for brain health. Fish is full of EPA and DHA which help transmit molecular messages. Omega 3's help raise dopamine levels! Grass-fed (Kerry Gold) butter's butyrate helps make GABA and is protective from colon cancer.

The SAD (standard american diet) is too high in omega 6's (french fries, chips, fried foods, fast foods, farmed fish, non-organic beef, canola oil) which are not conducive to health. Trans-fats and high diet of omega-6 leads to depression, heart disease, and cancer rates.

Sugar, flour, caffeine, drugs (tobacco, marijuana, etc.), and alcohol deplete the body of important amino acids and neurotransmitters which lead to inability to focus, apathy, irritability, anxiety, worry, obsessive compulsiveness, low energy, etc. None of these feelings work for you in school or work. It may appear that tobacco, caffeine, and sugary snacks help focus and stress, but those qualities are short-lived and do not serve you in the long-term.

B-vitamins, vitamin D, magnesium and calcium are necessary in changing amino acids into neurotransmitters. A B-vitamin can be a great stress buster. Take it in the morning since some B's can keep you up if taken late in the day.

School can also bring tears to young children when Mom or Dad drop them off. Flower essences can help tone down the tears, stress, or trauma. Bach Rescue Remedy liquid (2-3 drops) or a pastille (alcohol-free) can help alleviate the stress of the temporary separation.

Should you go gluten free?

Gluten-free stores, bakeries, and products are popping up all over the Northwest. Everywhere seems to offer gluten-free options. Gluten-free products include crackers, pasta, breads, and beer. Gluten is found in wheat as well as, barley, rye, spelt, and some times oats (often from field contamination). Gluten contains gliadin, which is a mixture of proteins and is rich in glutamine.

Reactions to gluten are often inflammatory in nature with vague symptoms such as joint pain/arthritis, ADD, constipation, depression/irritability, skin rashes, fatigue, mental fog. In some people, gluten acts as a neurotoxin. Most people with thyroid conditions react to gluten. Avoiding gluten helps with weight control since most gluten containing foods are high carbohydrate, high sugar and few nutrients.

Often people who are sensitive to gluten in the U.S. find that if they travel to Europe they can enjoy bread without any symptoms. Reportedly, US grains have been altered and now contains about 3x the gluten found normally in bread.

There appears to be confusion between celiac disease and a wheat food allergy/sensitivity. Immunologically wheat allergies and celiac disease involve a different response. People with a wheat allergy do not develop severe intestinal damage nor the manifestations of celiac disease which are: weight loss, abdominal distention, flatulence, fatigue, nutrient deficiency from intestinal damage, and diarrhea. Celiac is gluten-sensitive enteropathy (intestinal villi atrophy and damage), which is linked to autoimmune diseases including, type 1 diabetes and psoriasis.

If your body doesn’t tolerate gluten, it is best removed from your diet. Removing gluten can be challenging since it hides in many prepackaged products and restaurant foods. Food services are now aware of those going gluten free and can often direct you to suitable foods on their menu’s. Even if your body tolerates gluten people find they feel best when they eat gluten containing foods in moderation.

Yoga: Downward Dog

Downward-facing Dog, Qi, & Acupuncture meridians

Resting in Downward-facing Dog pose strengthens the musculature of the arms, shoulders, chest, and upper back. It stretches the muscles in the ankles, calves, thighs, and low back. The forward bend affects the stomach and intestines, helping improve digestion. Deep resting breathes in Downward-facing Dog can alleviate anxiety, sadness, and agitation, and fatigue; allowing the mind to feel calm and the body to feel energized.

Downward-facing Dog, sometimes referred to as “Down Dog,” activates the bladder meridian which is the longest meridian in the body. It has 67 acupuncture points and runs from the inner eye, up and over the head, down the entire spine and posterior leg, along the side of the foot, ending at the small toe (pinkie toe).

The back of the body is the most yang (external, superficial), acting as the initial connection with the outside world. It is considered the first line of defense against invaders from the external environment (cold, wind, pollens, microbes).

Downward-facing Dog allows for elongation of the bladder channel, encouraging the flow of qi (energy) and strengthening the primary immune defense.

Keep in mind, Downward-facing Dog is not for everyone (i.e. the pregnant, the carpal-tunnel sufferers, and those experiencing diarrhea, etc.)

I recommend showing up or signing up for a class at a local yoga studio near you. The art and practice of yoga is not a competition, work within the means of your own body and ability. The instructor will guide you in keeping good form which protects you against injury during class.

Movement is an important part of your heath maintenance lifestyle.

Be Well.

A Weighty Problem

America’s waistline is expanding! 42% of American adults are classified as obese.  71.6% of adults are overweight, including obesity. In the 1950’s only 10% of adults were classified as having obesity. What has changed?

It is generally thought that weight gain- thus obesity, is from eating too much and moving too little.

When the body becomes obese other health issues often follow: painful joints, most often the knees; high blood pressure; Insulin resistance; Fatty Liver Disease, Cardiovascular issues; and Insulin resistance Diabetes. Obesity can take 3 to 10 years off someone’s life span.

Why do some people struggle in maintaining a healthy weight despite diets and exercise programs?

Weight gain may involve genetic and even prenatal factors!

Cortisol (aka: stress) changes the DNA! High levels of chronic stress (i.e. from high levels of the hormone cortisol) can “turn off” genes having to do with inflammation, sleep, metabolic function, and cardiac control!

Women who gain excessive weight during pregnancy are more likely to have heavy 3 year olds. Children born via C-section seem more prone to obesity later in life (thought to be related to the microbiome of the intestines).

Medical conditions treated with pharmaceuticals can lead to obesity. Antidepressants and antipsychotics can lead to weight gain by increasing appetite and reducing metabolism.

Other medical conditions that require treatment with steroids like prednisone can lead to weight gain. Hypothyroidism slows the metabolism, weight gain is often a symptom.

High sugar foods alter brain pathways that feel rewarding. These pathways are often the same ones that addictive drugs activate! Which is why many nutritional programs have people avoid sugary products.

The busy working lifestyle that plagues modern humanity leads to lack of sleep, sedentary working environment, fast food and easy packaged meals, and self medicating at the end of the work day with an alcoholic beverage and a T.V. program or two. This high stress lifestyle often leads to weight gain.

What to do about the growing waistline?

Start simply. Set a bedtime and stick to it! Even adults need a bedtime. Without adequate sleep, all the “hunger hormones” are high. Cravings for high carbohydrate food and sugary coffee drinks. It is easy to overeat without a good night’s sleep!

Drink some water between meals. Often we may feel hunger when we are thirsty.

Many people have watches or wearables that count steps. The 10,000 step goal is not a bad place to start. 3000-4000 steps is not enough!

Talk to your physician about ruling out hypothyroidism and other conditions that promote weight gain. Look into possible food sensitivities. Discuss testing for salivary cortisol throughout the day and finding healthy ways to manage your stress. Looking into the microbiome of the intestines can be helpful for stubborn metabolisms.