WRITING ABOUT THE SEASONS AND THEIR AFFECTS ON OUR personal health has been part of my medical message for most all of my 40 years of practice. Connecting to Nature and our own true nature is a key to good health, learning and evolving as we become more self aware and also sensitive to all life on this planet, and our future. Eating from the Earth's bounty with simple foods from our gardens, farms and farmer's markets, and our local stores is principle number one of nutrition. A quote from my book suggests, "Every step away from the garden and orchards is a loss of vitality and nutrition."

I am so happy to see that my first book, Staying Healthy with the Seasons, initially published in 1981, has been influencing the public's health education with this simplest of natural messages. Hippocrates purported to "Pay attention to the seasons of the year and what affects they have on our health." Ideally, we pay attention to the times of seasonal change and look ahead to adapt to this ongoing cycle that has been around since the beginnings of life as we know it.

We have been enjoying the most playful of Seasons this Summer, except for these huge damaging hurricanes and rains in the south. The waters and the fires of this season are clearly out of balance. Is this a unique and isolated problem or one of the many signs of a changing planet in a bit of trouble? Please give it some thought and see if your behaviors can shift to support your best health and then extend that to your family and friends and the entire planet.

My Seasons book and writings involve multiple aspects of our health—as with physical, mental, emotional, and spiritual—along with many disciplines of health, such as Natural and Eastern medicines, foods, herbs, and lifestyle care combined into a Western medicine framework and mindset. I call this NEW Medicine. My 10 tips for Autumn follow and include ideas in many of these areas.

Attuning To Each Part Of The Year And Making appropriate lifestyle changes is key, but the ancient Chinese system also focuses on the time between the seasons—known as the Doyo. This is the period 10 days before and 10 days after each solstice and equinox, when we begin to adapt and make the appropriate changes to step forward into the new season, often with subtle shifts in our diet, exercise program, sleep, and work. Do-Yo literally means "All Have" and these 20-day periods contain a little of each element.

1. As with the gardens, open up to the harvest of your year from the seeds you have planted for your life, and be willing to work hard and discipline yourself as you head into a new season. If you are a student (we are all students of life), get back to your studies. Yes, it is time to shift from the fun and laziness of summer. Nature is so giving, and it helps to be receptive to her and what the Earth has to offer. What do we have to give to life for all the energy, love, and beauty I hope we all receive?

2. Relationships are important to all of us. This is a good time to deepen and clarify our love and family connections. This helps us discover more about our own needs and those close to us, as well as learn to listen to them (both the needs and the people). Also, learn to be alone and listen to your inner guidance and truth. Some folks focus relationships on their computers and TV, car or other electronic devices. Can you still your mind chatter, and let your body breathe deeply to your soul? Give it a try and your spirit will be calmed and can also fly free of the burdens of time.

3. Open to the creative Spirit. We can receive new ideas and actions necessary to fulfill our purpose and move us forward in our life. This can help to improve motivation with new energy and excitement for life. This could be writing about past experiences or our future goals, working on a book or personal story, reading a self-help book and applying it to improve our life, or taking up a new exercise. In other words, start a program now that you can develop and work on into the colder, darker months.

4. The foundation and fortification with our Foods and Diet is an important focus now. Again, this is Harvest time and there are a great many foods—apples and walnuts, sunflower seeds, zucchini and other squash, cabbages, peppers and tomatoes, plus many grains and beans. Learn some new recipes and enjoy good foods. Most of us need more protein and heat generating foods in the colder months, even the energizing spicy peppers such as cayenne and chilies. This will keep our blood and energy moving.

5. Exercise activity is crucial now as in any season. As the weather cools, stretching is even more important, as is having indoor exercises we can do. Yoga and other flexibility-enhancing movements are helpful at keeping us youthful. Remember, we feel as young as our spine is flexible. Our weight work and aerobic activities are vital to staying fit and toned, and strong to support our immune function and circulation. A vital body rarely gets sick.

6. Nutritional supplements are often useful this time of year. Many of my patients add some nutrients that support immune function so as not to pick up whatever is going around. Taking some Echinacea now is helpful as is the Chinese herb, astragalus. Some people prefer the use of mushrooms for immune support, as with maitake and reshitake. Maintaining daily vitamins C and E along with selenium and zinc is also immune protective and helps clear our body of certain toxins. Roots are helpful at tonifying our body at this time. Ginseng is quite good for building strength and endurance. Burdock root is good for the skin and lungs, an area of focus for this season. See the Autumn section of Staying Healthy with the Seasons book for further information.

7. Detoxification is a good idea for early autumn. I am doing a whole month myself and creating a 3-week program in September can provide a great benefit. Can you take a break from some of your routine habits, like caffeine, alcohol, sugar, or cannabis? Doing an effective Detox Diet or avoiding sugar, wheat and dairy for a couple weeks (as I write about in The False Fat Diet book) is often quite revealing and helps us to feel better, lighter and more youthful with greater energy. Since it is getting cooler this season, we will need to exercise and sauna or steam as a means to sweat to clear toxins. Regular sweating is important to health and longevity.

8. Prepare for the cold season. Gather your fuel and food, breathe, and exercise, as you should. In Chinese medicine, the fall season focuses on the lungs and large intestine. Overdoing it can lead to congestion and toxicity, as well as constipation and the clogging of the nose and sinuses. This leads then to upper respiratory infections as the germs grow in the mucus and then inflame the membranes. Staying clean and clear this season along with a healthy immune system will help keep you well. Try a facial steam and breathe in the herbal mist (you can use mints, rosemary, chamomile, lemon verbena, and other herbs) to help clear the sinuses.

9. Should you get any colds or flus, it is best to jump on those immediately. I start with hourly vitamin C of 500–1,000 mg, increased doses of vitamin A (not beta-carotene) 25,000– 30,000 IUs three times daily for just 3–4 days and then lower that dosage to 10–20,000 IUs twice daily for about a week (then take a break since excess vitamin A can be toxic if taken too long). I also use fresh garlic as several cloves at a time dipped in honey and chew them; I may repeat this several times the first day. That is a spicy and aromatic natural antibiotic and immune defender; you can alternately use the odorless garlic caps, several three times daily if you do not want to smell, but they are not quite as effective. You can alternatively press several cloves of garlic into your bowl of soup before you eat, instead of eating the garlic straight. Echinacea and goldenseal alcohol extract can also be used to support immunity and cleanse and disinfect the membranes. Some help may be achieved with olive leaf extract as a mild anti-viral herb. Of course, drink lots of water, herbal teas, and hot soup.

10. Take a rest now because the demanding holiday season is just around the corner. Do not burn your batteries out before November. Kindle your inner flame and firepower, which is protective from the invasion of harsh climates and germs. The winter blues comes partly from a loss of this fire energy. Shifting and balancing with the Seasons is vital to Staying Healthy

Often times after summer, we fall out of the fitness mentality and into the warm comforts of autumnal bliss. Sitting in front of the fire, we forget to move, and the idea of body awareness, movement and breath falls out the window. Instead of playing sports, we begin to watch them.

This fall, what can we do differently? How can we break our habits and increase our mindfulness, and mind-body relationship with itself and our environment?

Below are several ways to keep fitness at the forefront of your mind and body this fall with mindful meditation, exercise for the brain, body and breath.

Each morning, wake up 10 to 15 minutes earlier and spend a little extra time with yourself, focus on your breathing, how the breath enters the body, how it makes you feel as you breathe, and how it exits the body. Pay attention to what happens to the rest of the body as you continue to breathe and continue to do the exercises, playing with the lengths of the inhales and exhales. Make it an enjoyable experience, So that it is an opportunity to learn more about your breath, your body and yourself. There is always an opportunity to expand our mental, physical and emotional selves. And this is one of them.

Meditation is exercise for our brains. The central nervous system, which is run by the brain, controls our body and how it functions, making it a crucial element of our fitness regimes.

Taking care of our brain IS taking care of our body. A study led by Harvard researchers at Massachusetts General Hospital, found that meditating for only eight weeks actually changed the brain’s grey matter. Grey matter is associated with processing information as well as providing nutrients and energy to its neurons. This is why it is said that mediation has shown to improve memory, empathy, sense of self and stress relief.

When school is in session, mental acuteness is just as important for the parent as it is the child. Meditation is proven to sharpen the mind’s focus, lower stress levels and help manage anxiety for the student and teacher, and ultimately the parents. Meditation is key to prepare and react to your children’s energies. When sitting in the car line to pick up the children from school, arrive 20 minutes early to prepare mentally for the sprightly youth to jump into cars with inquisitive and ever-so exuberant minds and bundles of energy bouncing off the walls and in the car seats. Meditation lowers our stress, raises our endorphins and prepares us for anything that will ensue.

For those that require more of a structured schedule to hold us accountable, one can begin a yoga practice. It is a great mental and physical exercise that improves balance. Yoga, meaning union of the breath with the body, brings self-awareness, acceptance and peace with our body-mind relationship, and with our body and mind relationship with it’s surrounding environment. One can begin to practice at home or in a studio with others. The beauty of yoga and life is that the choice is ours. Yoga provides us the freedom to practice it anywhere: outside, inside, by ourselves or with others. And, it all begins with the breath. Yoga begins with the relationship of the breath and body. We clear our minds on the mat and nothing else matters nor does it have to even exist. Only the here and now matter with our body and breath. This form of meditation is a beautiful practice synchronized with movements, certain “asanas” or poses that have specific benefits, depending on what we need during that moment. Yoga is a mental, physical and even for some, spiritual exercise that provides balance for our habitual imbalances, whether that imbalance is in our bodies or minds.

The beauty of yoga is that there are different kinds for different people. The type of yoga that is most fitting at that moment is the type that works for the individual. There is no right or wrong answer. There is what is right now. We are blessed being of this technological age where knowledge is literally overflowing at our fingertips. With the touch of a button, all our questions can be answered. However, with such over saturation and access to knowledge, we can often get overwhelmed and weighted down with all these external stimuli being thrown at us. Which type of yoga is most fitting for us, for me, for you? There is meditative, spiritual, physical, hot, Bikram, Iyengar, Kundalini, power, restorative and many, many more. Thus, we stop searching and go within. We go back to the breath. Let’s keep it simple to keep us moving forward. Keeping it simple is essential moving forward. "One breath at a time" is an inviting and achievable place to start; it is a great motto to adapt so that we can reach our goals and keep moving, keep living and keep breathing. With the breath we remember that, although it appears simple, the benefits greatly outweigh it’s simplicity. Remember that breathing keeps us happy, lowers our stress, focuses our mind, and energizes our body. It is an empowering notion. So much can come from so little.

So this fall, sitting in front of the fire, we can gaze into the golden embers, get lost in their glow and begin to focus solely on our breath and body. As we cherish the relationship with our mind, body and breath, everything else fades away and out of existence. We can ignite life in our bodies, blood cells and brains by a single breath. The only constant in life, that ever present ebb and flow of air, we can begin to improve our relationship with ourselves and those that are around us by beginning a journey of mindful meditation. Exercising our brains and bodies, we fall in love with the mindful meditation, our mind, our bodies and ultimately ourselves. Thus, this fall we begin our fitness journey and the rest of our lives with one breath at a time.


  1. http://www.news-medical.net/health/What-is-Grey-Matter.aspx
  2. http://www.medicaldaily.com/mental-health-benefits-meditation-itll-alter-your-brains-grey-matter-and-improve-319298
  3. http://www.princeton.edu/~achaney/tmve/wiki100k/docs/Grey_matter.html
  4. http://www.webmd.com/mental-health/features/meditationheals-body-and-mind
  5. http://www.yogajournal.com/article/beginners/which-yogais-right-for-you-2/
  6. http://chemistry.about.com/od/chemistryfaqs/f/aircomposition.htm
  7. http://www.teachpe.com/gcse_anatomy/respiratory.php

Assess your health, your strengths, as well as your problems and bad habits, and look for (ask yourself and take time to listen) the causes or basis of each concern. What are your issues? It’s best to ask for this deeper information and healing in your quiet, meditative place or before sleep to ask your dream imagery to come forth. (Review my Staying Healthy Tips on The Nature of Healing.) This is a time to work on solutions.

Make a list of your goals. What are you willing to work on, work out, and achieve? Do you need to lose weight; have more energy; or find a new doctor/practitioner to help you resolve a problem or illness? Or would a therapist or intuitive be more helpful? For example, you could assess your teeth in January, schedule a Thai massage and an acupuncture or chiropractic session in February, and a five-day health retreat in March. First assess your health budget and see what is covered by insurance if you have it, but also look at what you are willing or able to invest into the health of you and your loved ones.

Review your SNACC habits (sugar, nicotine, alcohol, caffeine, and chemicals). These are common substances that undermine most people’s health, and dealing with them is often the beginning of life improvement. Clearing the daily use (even temporarily) of these habits/abuses/ addictions that takes your vitality is often my first step in the Purification Process (see my book, The New Detox Diet). January is a perfect month to take a vacation from these habits. You may also choose two or three habits to get started. Rather than attempting too much at once, do what you know you can. Step by step still gets you along the health path.

Next, look at your food habits and what you may be overusing that stresses your body and causes reactions. Is it breads and baked goods, refined sugars, or a dependency on drinking cow’s milk or eating cheese? You may not be able to tell this unless you take a break and re-check your response again later. Most of us aren’t fully aware of how specific foods or meals effect us, but we know when we don’t feel fully alive or well, or maybe we want to digest better or reduce some aches and pains or sinus congestion, or just lose a few pounds. Here then, the ideas of The False Fat Diet book can guide you in this important process. A reminder is that this process is more difficult with a stress-filled schedule; thus, you may need to carve out some time both physically and mentally. I like starting my program on a Friday to have the weekend to adjust to the new plan.

Exercise your body, keep it moving! Just because it’s winter, don’t get lazy. Get your activity, but get your rest and sleep as well. Stretch that body and don’t let it get old, get it pumping, and tone those muscles. Cleanse and brush your skin daily as well. Inner clean creates outer sheen. Stay fit and stay healthy.

Do some positive therapies. There are many that can be of help, such as massage and other body therapies; acupuncture, counseling, or a personal reading for guidance. Sometimes merely a walk and talk in the trees with a good friend is all you need to set things right. Try something new or go back to something you liked. New experiences are helpful to growth and healing.

What is your spiritual practice? This may be prayer, religious studies, or meditation. We all come from different backgrounds and beliefs. Our reverence for life, our own and others, is the basic premise for a spiritual life. Treating our body as a temple of Living Spirit provides a motivation to treat ourselves as special and thus feed and care for ourselves in a loving and healthful way. It’s the base and the beginning of a healthy life.

Your career or work is often a core area for your well-being. Are you doing something that is important to you? Do you have a plan for life? Some jobs are what you wish for, others are on the way to somewhere else, and still others are there just to support you and your family. These are all important reasons. If you are not pleased with what you are doing, ask why and what can be done differently. Do you need to review this with a professional counselor? Do you need more education and training? Or will a shift in attitude help you to feel better about your work?

What can you complete this year? What’s been on your mind or sitting around your house? Make a list of a few or more areas that could use some of your valuable energy. (Add these to your list of goals.) This may involve old health habits, a messy room to clean up or rearrange, stuck areas in a relationship, or letting go of old patterns at work. Don’t be afraid to go for it this year.

Make your resolutions and commitments. Begin by looking at the key areas of your life. Health and personal habits, love and relationships, and career or work. And if LOVE moves into all those areas, that’s all the better as you’ll care for yourself and your life, plus your relationships in a positive way. Make more room for love to fill your daily life, and let it be the higher Love. Human love is temporal for many, yet love in the Spirit is everlasting. We are all blessed to share this garden, this Earth, which needs our love and protection. We must take the time to nurture nature, to nourish and flourish.

For Sports and Health

Most readers who have heard of ketosis and ketogenesis likely associate the concepts with dieting and the works of Dr. Robert C. Atkins (Dr. Atkins’ Health Revolution, 1989; Dr. Atkins’ New Diet Revolution, 1992) that launched a bit of a movement in the 1990s. Much less well known is the role of ketosis in sports and the importance of being able to enter ketosis as an aspect of metabolic flexibility, meaning the ability to rapidly and easily shift between carbohydrates and fats as fuel substrates to match, on the one hand, dietary sources of calories and, on the other hand, particular physical demands for energy. In fact, the health implications of metabolic flexibility are significant and are related to the body’s degree of insulin sensitivity and thereby to the components of the metabolic syndrome. The latter condition often is defined as being based on insulin resistance and associated with abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides and low high-density lipoprotein (HDL) levels. This way of looking at matters makes ketogenesis and metabolic flexibility major determinants of health. One does not need to be diabetic or even pre-diabetic for these issues to be important, a point that Harry Preuss, MD and various coauthors, including myself, make in a recent article intended for practicing physicians, “Importance of Fasting Blood Glucose in Screening/Tracking Overall Health.”1,2

Not only athletes for reasons having to do with competition, but also non-athletes for reasons of health likely would benefit from some form of supplement protocol or other approach that can achieve ketogenesis and maintain metabolic flexibility without depending entirely on the diet. Indeed, achieving ketosis via diet alone is hard to maintain over the long haul for a variety of reasons. Eating mostly protein and fat may sound like a treat at the beginning, but highly restricting all sources of carbohydrates quickly leads to a boring diet and even limited social interaction because few social events are built around ketogenic snacks! It also means avoiding many or most sources of phytonutrients, not eating adequate fiber for gut health and bowel regularity, probably inadequately eliminating toxins via the bile route in the stool, and even ramping up production of the hormone cortisol.3 Extreme ketosis leads to unpleasant breath (acetone breath) although this is not an issue with moderate and healthy ketogenesis.

Background on Ketosis and Ketogenic Diets
There are only two primary sources of energy, carbohydrates and fats. If needed for energy, protein can be broken down to yield a carbohydrate component, not a fatty acid component. Ketosis refers to the state in which the body meets its energy requirements largely through the oxidation of ketone bodies. These build up in the blood when glucose is not being used for energy and even the brain can run on ketone bodies. Glycolysis is the opposite number to ketosis in that it refers to the oxidation of glucose, for which all carbohydrates ultimately are a source, for energy. People sometimes associate ketosis with diabetes, but ketosis is a nutritional process whereas in diabetes the body either lacks sufficient insulin or cannot respond properly to insulin and therefore builds up ketone bodies due to a failure of metabolism while at the same time not properly harnessing fats for fuel. There is plenty of evidence to the effect that ketogenic diets can be healthful. Traditional Eskimo diets consisted almost entirely of raw meat and blubber (fat) and yet the Eskimos did not exhibit diabetes. Similarly, for certain neurologic conditions children are raised from early life into their thirties or later with completely normal physiologic and mental development without eating any carbohydrates at all.

Athletes and some "paleodieters" speak of keto-adaptation, which means simply moving the metabolism to preferentially accessing stored fats as fuel sources rather than depending on glucose. The body has quite limited stores of glycogen or "animal starch" stored primarily in the liver in contrast to virtually unlimited calories stored as fats. A quite standard assessment is that there may be 400 grams of glycogen in the liver and another 100 grams in the muscles. Glycogen is associated with water on a 1:3 to 1:4 ratio. A major problem in achieving keto-adaptation by diet alone is that most individuals who have been raised on Western-style diets can take six months or more to make the shift and this shift becomes ever more difficult as we age. Studies examining the role of carbohydrates in the metabolism with roughly 30 year old males in good physical condition have revealed, for instance, that even transitioning from a high glycemic index diet to a low glycemic index diet while maintaining the same ratio of carbohydrate, fat and protein can take more than four weeks. Shifting to fatty acid metabolism for energy can be difficult.

High fat diets were employed at the turn of the century to treat Type I diabetes, the form that begins in childhood with the destruction of the insulin-producing cells of the pancreas. Since the body can and will produce its own blood sugar from protein in order to feed the brain, there is always some role for insulin in the body regardless of the diet followed. Needless to say, those with juvenile diabetes almost invariably died young until the discovery of insulin.

In adult-onset or Type II diabetes, which typically begins fairly late in life and with those already overweight, diet and exercise often can completely control the problem. This and other clues have led a number of researchers to suspect that excess weight gain is related to insulin production either directly or indirectly, as discussed briefly above. Dr. Robert C. Atkins was one of the first to popularize the notion of dieting by bypassing the insulin mechanism through eliminating most carbohydrates from the diet while continuing to consume both proteins and fats. Atkins' Diet is both high in protein and high in fat.

High protein, low fat/very low carbohydrate diets have been common for some time, but not with the particular justification that they bypass the insulin mechanism. Generally the justifications have had to do with energy production, or rather the lack of it on these diets. In the Stillman Diet, for instance, it was argued that protein molecules are so large that they use up extra energy as a food for the body. This diet calls for the drinking of at least eight glasses of water a day, which truly is necessary to remove the waste products of excess protein consumption and from the oxidation of the body's own fats.

Very similar is the famous Scarsdale Diet, designed for use for only two weeks at a time. Both strictly limit carbohydrates and, somewhat less strictly, fats. Both do reduce weight in the short term, but such large amounts of protein are hard on the body. In contrast to these, the Dr. Atkins' Diet allows for unlimited amounts of both proteins and fats, but for restricted amounts of carbohydrates according to the theory that a faulty insulin mechanism is the cause of excess weight. A more limited form of this ketone-based diet popularized at about the same time as the Atkins Diet is presented by Dr. Calvin Ezrin in The Endocrine Control Diet (1990).

Athletes long have experimented with ketogenic diets. For instance, during the 1990s a number of top bodybuilders in the World Bodybuilding Federation adopted a diet similar to the one Atkins uses (roughly 40 percent of calories from protein and 60 percent from fat) in order to cut body fat and build muscle. These individuals were all undertaking extremely hard physical labor, so the diet itself cannot be a source of fatigue, but must in fact supply considerable energy.4 Nevertheless, even major competition class athletes ultimately generally give up on strict ketogenic diets. As admitted by Ben Greenfield, a serious triathlete who was tested with regard to the ergogenic benefits of a ketogenic diet, "after the study at University of Connecticut, I personally quit messing around with ketosis and returned to what I considered to be a more sane macronutrient intake of 50-60% fat, 20-30% protein, 10-30% carbohydrate."5

Ketogenesis with Supplements
Can ketogenesis be achieved using a more normal diet with the help of supplements? The answer appears to be "yes." Nevertheless, there are important considerations, among which are the following:

  • The diet should not be high in simple sugars, fructose or refined carbohydrates. For non-athletes and those looking primarily to increase metabolic flexibility, the diet should resemble a modified Sears Diet, meaning approximately 20¨C 30 percent protein, 30¨C40 percent carbohydrate and 30¨C40 percent fat. For athletes and individuals who seriously want to initiate and maintain a fat-adapted diet, Ben Greenfield's suggestion is more in order: "50-60% fat, 20-30% protein, 10- 30% carbohydrate."
  • It is helpful to support fat metabolism directly such as through improved transport of fatty acids into the mitochondria for oxidation.
  • Insulin sensitivity must be improved and maintained and insulin levels kept low.
  • The release of fatty acids from fat cells likely is less important than is disinhibiting fatty acid metabolism. The first is accomplished with caffeine, yet often with a downside such as increased cortisol levels, hence alternatives to caffeine and other similar stimulants are needed.
  • Inclusion of substances that actively promote fatty acid oxidation is important to help kick-start the body's ability to metabolize fats.
  • Excessive gluconeogenesis by the liver (creation of glucose from glycogen in response to the release of glucagon) should be inhibited to promote fatty acid oxidation as the alternative.
  • With diets that are heavy in alcohol and fat, potential "reverse" effects must be prevented.

A small number of supplements, especially if taken together, may fulfill the above requirements and actually have been tested successfully in a pilot case. The subject in question was able to consume a normal diet, indeed one that included quite a bit of alcohol, by relying on only four supplements to remain in moderate ketosis during much of the day: hydroxycitric acid, wild bitter melon extract, sesame lignan extract and green coffee bean extract. The sources of these supplements were not generic and this should be kept in mind because different production methods lead to different products with different results. Published comparative trials, for example, with hydroxycitric acid have shown this definitively.

Potassium-Magnesium Hydroxycitrate
The key component in supplement-support ketogenesis is (-)¨Chydroxycitric acid (HCA). That some forms of properly manufactured HCA can be used to encourage ketogenesis has been known at least since 2000. In that year, Ishihara published that HCA ingestion for 13 days increased fat oxidation and improved endurance exercise time to fatigue by 43 percent compared to a placebo in mice.6 Over the following few years, three studies by Lim and others in trained athletes demonstrated that ingestion of HCA enhances endurance performance via increasing fat oxidation and sparing glycogen utilization during moderate intensity exercise. In fact, in trained athletes HCA ingestion for five days shifted fuel selection to fat oxidation at both 60 percent and 80 percent VO2max during exercise.7 Lim further demonstrated a number of significant findings. First, using mice as his model, he showed that chronic HCA ingestion alters fuel selection rather than the simple release of fat from stores as is true of lipolysis, i.e., mechanism for HCA is not the same as with caffeine, capsaicin, etc. Second, Lim's review data that showed that the combination of HCA plus L-carnitine improves glycogen status in liver and various muscle tissues versus placebo in exercised-trained rodents. Since the publication of Lim's papers, this finding has been repeated more than once with human athletes. Although L-carnitine improves the effect, it is not necessary.8 Third, Lim in his studies employed a pure synthesized trisodium hydroxycitrate salt rather than commercial calcium or calcium-potassium HCA salts, which did not yield his results. As is true of many herbal products, the benefits of HCA are highly dependent upon how the item is prepared. The acid must be stabilized by the addition of high pH ions (basic or alkali), such as those of potassium, magnesium or calcium. Using the wrong stabilizing counter-ions results in little or no activity. In the case of the acid derived from Garcinia cambogia and related sources, adding any calcium at all reduces some desired benefits and blocks other benefits entirely.9 This fact has been verified by more than one comparative trial.

Another benefit of HCA that supports ketogenesis is its impact on insulin sensitivity. At the 2005 Annual Meeting of the American College of Nutrition for the first time it was reported that the potassium-magnesium HCA salt in an animal model gave the same blood glucose regulation as found in the control arm of the test while almost literally cutting insulin levels in half.10 The same study demonstrated that this salt dramatically improved glucose clearance from the blood, lowered systolic blood pressure and also lowered several key indicators of inflammation, including C-reactive protein and tumor necrosis factor-alpha (TNF-alpha). In contrast, the potassium-calcium salt exerted no effect upon insulin and blood sugar regulation and only very poorly influenced blood pressure.11 In the areas of insulin metabolism, glucose regulation and blood pressure, the proprietary potassium-magnesium salt was between five and seven times as active as the potassium-calcium salt of the fruit acid. A paper just published this year also indicates that HCA may help to regulate thyroid hormones and promote muscle protein synthesis.12

Wild Bitter Melon Extract and Sesame Lignan Extract
As indicated above, HCA appears to be extremely useful in freeing the body's metabolism regulators to allow a shift towards preferentially oxidizing fatty acids for energy. Increasing insulin sensitivity and reducing insulin levels removes one of the primary brakes on fatty acid metabolism. A complement to these actions is direct activation of fatty acid oxidation. Both wild bitter melon and sesame seed lignans help to do just this. Bitter melon previously has been discussed in these pages under the title, "Going WILD with Bitter Melon for Blood Sugar Support."13 As noted in that article, it has been found that extracts of bitter gourd activate cellular machinery to regulate energy production (technically, AMP-activated protein kinase or AMPK) and the way that fats are handled by the liver. These components can account for as much as 7.1 g/ kg of the dried wild material.

The sesamolin lignan found in sesame seeds (but not in most extracts) likewise increases fat metabolism. As pointed out in an important study, the "[e]ffects of sesamin and sesamolin (sesame lignans) on hepatic fatty acid metabolism were compared in rats. Sesamolin rather than sesamin can account for the potent physiological effect of sesame seeds in increasing hepatic fatty acid oxidation observed previously. Differences in bioavailability may contribute to the divergent effects of sesamin and sesamolin on hepatic fatty acid oxidation. Sesamin compared to sesamolin was more effective in reducing serum and liver lipid levels [with]sesamolin more strongly increasing hepatic fatty acid oxidation." "Sesamolin rather than sesamin can account for the potent physiological effect of sesame seeds in increasing hepatic fatty acid oxidation observed previously."14 "...gene expression of hepatic enzymes involved in fatty acid oxidation [was] much stronger with episesamin and sesamolin than with sesamin¡­[serum] half lives of 4.7±0.2, 6.1±0.3 and 7.1±0.4 h for sesamin, espisesamin and sesamolin, respectively...15

Green Coffee Bean Extract
After meals, up to 70 percent of the glucose from food is stored in muscle and other lean tissues. However, moment-to-moment regulation of blood glucose typically is handled by the liver. It does this via two processes, both of which are highly regulated. Gluconeogenesis generates glucose from certain noncarbohydrate carbon substrates, including certain amino acids and lipid components, such as triglycerides. Glycogenolysis is the freeing of glucose from glycogen stores. In the liver, but not the muscles, the hormone glucagon is involved. The liver also uses the enzyme glucose-6-phosphatase. With aging and as the metabolic syndrome develops, regulation of these two processes becomes impaired. Dysregulation is a particularly significant issue in diabetes.

Coffee, especially green coffee extracts, supply chlorogenic acid, which inhibits the glucose-6-phosphatase enzyme.16,17 Chlorogenic acid also inhibits glucose absorption from the intestinal tract and thus reduces after meal blood glucose spikes.

Ketogenesis requires that the body preferentially use fatty acids for fuel. This cannot happen if either gluconeogenesis or glycogenolysis is not under proper control.

L-Carnitine and Astaxanthin
L-carnitine is a nutrient that, among other things, helps to shuttle fatty acids into the mitochondria for oxidation. In the discussion of HCA above it was noted that the combination of HCA and L-carnitine greatly improves the replenishment of glycogen stores after exercise. Unfortunately, tissue levels of L-carnitine are highly regulated and difficult to elevate to the extent necessary for ergogenic benefits in athletes. HCA improves L-carnitine metabolism by increasing uptake.HCA is an insulin memetic as well as an insulin sensitizer. HCA also shifts the body towards metabolizing fats, which makes L-carnitine's job easier. Another approach is to supplement with astaxanthin. Astaxanthin (≥4 mg/d) has been shown to reduce lactic acid accumulation during exercise, improve fatty acid oxidation and maintain better blood glucose levels while improving endurance. The mechanism may involve carnitine palmitoyltransferase I.18,19

Studies have demonstrated the importance of metabolic flexibility for maintaining cardiovascular health and reducing the risk of developing metabolic syndrome components. Likewise, studies have shown that the related ability to enter ketosis as needed for athletic purposes can render rich ergogenic rewards. Nevertheless, enabling ketogenesis or keto-adaptation, however desirable this might be, through dietary measures alone under modern circumstances in Western countries is not only inconvenient, but downright difficult. Fortunately, it is possible to enable keto-adaptation through the use of appropriate supplements. These include properly manufacture HCA salts, wild bitter melon extract, sesame lignans and green coffee bean extracts. L-carnitine and astaxanthin are two more supplements that fit into this schema.

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