Iron Is Essential to Your Wellbeing: Are you Getting Enough?

Iron is an essential mineral that helps maintain many vital functions in the body. This includes the production of hemoglobin, a protein in red blood cells that helps transport oxygen throughout the body. Consuming enough iron is important. Without it, your body will struggle to produce enough healthy red blood cells. Iron levels impact many aspects of your health, including:

• Energy

• Ability to focus

• Gastrointestinal health

• Your immune system

• Regulation of body temperature

• Skin, hair, and nails

Heme vs. Non-Heme Iron

Dietary iron comes in two forms - heme and non-heme. Heme iron is only found in animal proteins such as meat, poultry, and seafood. Heme iron is more easily absorbed into the body and is thus a significant source of dietary iron for many. 

By contrast, non-heme iron is present in plant-based foods such as grains, beans, vegetables, nuts, and seeds. It is also present in dairy and eggs. The body processes non-heme iron differently and has to alter non-heme iron to absorb it fully. This means that a lower percentage of non-heme iron is absorbed.

Iron Deficiency is Common: Know The Symptoms

Ideally, there is a healthy balance between the supply of iron through the diet and the body’s demand for iron. However, if demand outweighs supply, the body starts to use up iron stored in the liver, which can lead to iron deficiency. When the body has used the iron up, it cannot produce more hemoglobin. This condition is called iron deficiency anemia.

Iron deficiency is very common. Symptoms of iron deficiency include:

• Fatigue

• Shortness of breath

• Cold hands or feet

• Lightheadedness or dizziness, particularly when standing up quickly

• Pale or sallow skin, nails, or gums

• Headache

• Irregular heartbeat

• Unexplained irrational cravings - the desire to consume things like ice or paper is a sign of anemia

• A sore or swollen tongue

• Hair loss

• Restless legs

• Unexplained itchiness

Who is more likely to suffer from iron deficiency?

Certain demographics are more likely to deal with iron deficiency than others. 

• Women of childbearing age are especially at risk, because their bodies use and require a great deal of iron during menstruation, pregnancy and breastfeeding. Women with fibroids or other conditions that cause heavy periods are at increased risk.

• Young people undergoing puberty are also disposed to iron deficiency since rapid growth necessitates a higher intake.

• Vegetarians or vegans also tend to be at a greater risk for iron deficiency, since their diets often exclusively contain non-heme iron which is absorbed less easily than the heme iron found in meats.

• Iron deficiency is also commonly present in people who have recently undergone major surgery or physical trauma, and in those with gastrointestinal disorders such as Crohn's.

• Some studies have found that people dealing with a lot of stress are at higher risk of anemia.

• High-level athletes or people who exercise a lot also have a higher risk. Because iron deficiency impacts athletic performance, athletes must pay close attention to their iron levels.

• Regular blood donors should monitor their iron levels and work with their healthcare practitioner to work out a donation schedule that works for them.

• People who abuse alcohol can deplete their iron levels, in part because alcohol can inhibit the body’s ability to absorb iron.

Preventing Iron Deficiency

If you fit into one of these categories, or if you are generally concerned about your iron levels, do not fret. There are simple steps you can take to increase your iron absorption and ensure you are feeling your best.

Ultimately, it is important to consume foods that contain iron, as your body does not produce the nutrient on its own.  Add these iron-rich foods into your diet to prevent/treat iron deficiency:

• Red meat is known to be the most easily accessible source of heme iron. It also contains B vitamins and quality protein.

• Fish also contains numerous health benefits, including being high in iron. The omega 3 fatty acids found in fish like salmon, tuna, and haddock are great for brain health. And just one serving of canned tuna can provide 8% of your daily value of iron.

• Turkey is another healthy source of iron. It also is a great source of protein. Dark turkey meat tends to contain more iron than white, with a 3.5 ounce portion containing 8% of the daily value.

• Shellfish, particularly clams, mussels, and oysters, are good sources of heme-iron.

For vegetarians:

• Spinach is a great source of non-heme iron for vegetarians; 100 grams of raw spinach provides 15% of your daily value.

• Legumes are another nutrient-packed option for vegetarians trying to increase their iron intake. Black beans, kidney beans, and lentils can all help raise iron levels.

• Pumpkin seeds are an easy snack and a great source of non-heme iron. A one-ounce serving contains 14% of your daily value of iron.

• Tofu is a popular staple in vegetarian diets and happens to provide 3.4 mg of iron in a half-cup serving. This amounts to 19% of your daily value.

Vitamin C helps your body to absorb iron. Including a source of Vitamin C, like broccoli,  with your iron-rich meal will help maintain iron levels. Beta carotene, which is found in brightly colored produce like peppers, carrots, and apricots, can also boost absorption. 

You should also examine your diet for foods and drinks that can lower iron levels, including coffee, tea, many sodas, alcohol and some dairy products.

Treating Iron Deficiency

Identifying the causes of iron deficiency is the first line of defence. From there, increasing the iron consumption in your daily diet is an important next step. 

Depending on your iron levels and diet, supplements may also be necessary, but it’s important to work with a healthcare practitioner. Too much iron can be harmful to your health, so you need to find the right levels for you. As well, many people find iron supplements can lead to an upset stomach and constipation, so you may have to make dietary changes at the same time. 

Iron deficiency can cause serious complications for your health if left untreated, so it is important to get a proper assessment of your iron levels and create a treatment plan to help raise them. Let me know if you need help addressing iron deficiency - I’m here to help!

Sources

Wei C, Zhou J, Huang X, Li M. Effects of psychological stress on serum iron and erythropoiesis. Int J Hematol. 2008 Jul;88(1):52-56. doi: 10.1007/s12185-008-0105-4. Epub 2008 Jun 11. PMID: 18543064. 

Damian MT, Vulturar R, Login CC, Damian L, Chis A, Bojan A. Anemia in Sports: A Narrative Review. Life (Basel). 2021;11(9):987. Published 2021 Sep 20. doi:10.3390/life11090987

Shuchman M. Frequent blood donors risk iron deficiency. CMAJ. 2014;186(11):817. doi:10.1503/cmaj.109-4807

Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(2):164-174.

U.S. Department of Agriculture, Food data central 

Carmen Lúcia de Almeida SantosI, II; Marco AkermanIII; Odival FaccendaIV; Lourdes Conceição MartinsV; Lígia de Fátima Nóbrega Reato,, Iron defici,  2012/01/01

Food Intolerances Are Becoming More Common: What You Need To Know

A growing number of people suffer from food sensitivities - by some estimates, more than one in five people experience uncomfortable symptoms after eating certain foods. Yet, despite their prevalence, many of us don’t realize we have a food sensitivity. Instead, we assume the common symptoms, like bloating, fatigue and “brain fog,” are just normal results of our busy lives.

It doesn’t have to be that way. Many patients tell me that they are surprised by a remarkable improvement in their quality of life after identifying and eliminating dietary triggers. 

Symptoms of Food Sensitivities

Simply put, when you have a food sensitivity or intolerance, your gut doesn’t produce the right enzymes to digest a certain food or group of food. As a result, you can experience wide range of symptoms like:

• Acid reflux

• Bloating

• Diarrhea

• Unexplained fatigue and brain fog

• Pain in the abdomen

• Problems with rashes and skin redness

• Headaches

• Sinus issues

These symptoms can appear shortly after eating the food, and shockingly as many as several days later. Whether or not you react to a food can also vary by how much of it you eat, and even the circumstances around your meal time. Some people find they react more when they are stressed and eating on the go, for example.

Food Sensitivity, Intolerance, Allergy or Disease?

It’s important to distinguish between food sensitivities, food intolerances, food allergies, and diseases that can be triggered by certain foods.

Food sensitivities and food intolerances are similar. Sensitivities may cause inflammation in the body and result in fatigue, bloating and even headaches up to 48 hours after consuming the offending food.

Intolerances are characterized by the body lacking proper chemicals or enzymes to digest a food properly. Digestive upsets are common after consuming a food one is intolerant to. Sensitivities and intolerances can often be pinpointed in order to avoid symptoms caused by ingestion of certain foods or food additives. Working with a practitioner is recommended - I can help!

A food allergy is an issue rooted within the immune system. An allergic reaction happens when your immune system mistakenly perceives something in a food as a threat, and produces antibodies in an attempt to fend off the threat. Food allergies are typically diagnosed at a young age and these foods should be avoided.

A disease such as celiac disease also originates in the immune system. Celiac disease causes the body to fight against gluten in a manner so strong that the lining of the small intestine is damaged, so the symptoms are typically more severe than that of food intolerances. As well, celiac disease differs from a wheat allergy because a wheat allergy is triggered by proteins in wheat, while celiac disease is a reaction to proteins in gluten. 

Common Food Sensitivities and Intolerances

Here are the most common food intolerances experienced today:

Lactose intolerance

People who are lactose intolerant lack the enzyme lactase, so they can’t break down the lactose found in dairy products. This is the most common food intolerance, and it’s often characterized by indigestion and bloating. Several tests can determine if you are lactose intolerant. People who are lactose intolerant should avoid all foods containing dairy, although some are able to consume aged cheese or fermented products like kefir without difficulty. Fortunately, many great dairy substitutes are available today. 

Gluten intolerance 

If you experience symptoms after eating gluten, but tests confirm you don’t have a gluten allergy or celiac disease, you could be suffering from a gluten intolerance or non-celiac gluten sensitivity. Gluten is found in grains such as wheat, rye, kamut, couscous, and barley. 
People who can’t tolerate gluten also need to be aware of hidden sources. Soy sauce, many vegetarian meat substitutes, granola bars, beer, and even processed cheeses can contain gluten, so it’s important to read food labels carefully.

In recent years, scientists have theorized that it may be glyphosate, a commonly used weed killer sprayed on crops, that many are reacting to and not gluten itself. Although research is ongoing, anecdotal evidence shows many people who experience gluten intolerance in North America can tolerate eating bread and pasta while abroad in Europe and other countries that have banned the use of glyphosate.

Eggs
Eggs are one of the most common food sensitivities. Symptoms include eczema, itchy skin, nausea and bloating. For most, egg whites are more likely to be reactive than egg yolks.

Corn

Corn is a common food sensitivity that can also lead to chronic symptoms like fatigue, brain fog, bloating, irritable bowel symptoms, headaches, joint pain and more. Corn is a common ingredient in many processed foods so it’s important to keep an eye out for it if you are experiencing symptoms of sensitivity.

Soy
Soy protein is a common food allergy and sensitivity which may lead to headaches, joint pain, acne, eczema and more. Fermentation helps to break down soy protein, therefore fermented soy products like miso and tempeh may be better tolerated by some.

FODMAPs

FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols” That’s basically a scientific way of saying foods that cause gas. These carbohydrates aren’t absorbed well by the small intestine. When they arrive at the large intestine, bacteria break them down and form gas, which in turn leads to uncomfortable digestive symptoms. 
Avoiding FODMAPs can be tricky to navigate since they are found in a variety of food groups. Some common FODMAP foods include apples, bread, many kinds of beans, some cheeses, garlic, onions, and many milk products. Once you have determined which foods are triggers, however, it’s certainly possible to have a well-balanced diet. 

Caffeine
Researchers say many people can drink up to five cups of coffee a day without experiencing negative effects or getting that over-caffeinated, jittery feeling. For people with a caffeine intolerance, however, those signs appear with just a small amount of caffeine, leading to heart palpitations, anxiety, and insomnia. Some evidence suggests caffeine intolerance has a genetic component. 

Sulfites

Sulfites are chemicals found naturally in some foods, such as salmon, lettuce, and tomatoes. They’re also commonly used as preservatives for many common foods, including baked goods, dried fruit, pickled foods and wine. The FDA requires that food labels must indicate the presence of sulfites if the level exceeds 10 parts per million (ppm). 

People with asthma are more prone to sulfite sensitivity, with about 3-10% of asthmatics experiencing adverse reactions to foods with sulfites. These reactions can include wheezing, coughing, and digestive problems and many also experience rashes and hives. 

Sugar alcohols

Sugar alcohols are considered a healthier alternative to sugar, however, they can be an intolerance for many. Commonly used sugar alcohols include xylitol, erythritol, sorbitol, and maltitol. Sugar alcohols do contain fewer calories than sugar, and they aren’t as harmful to your teeth. As well, they don’t tend to cause the same extreme blood sugar spikes as regular sugar. But, for some people, they can cause digestive problems, including bloating, gas and diarrhea. Because they can’t be easily digested, they travel to the large intestine, where your gut bacteria breaks them down, in a similar process to the digestion of FODMAPs. In fact, people who are intolerant of FODMAPs often also experience difficulties with sugar alcohols.

In general, smaller amounts are less likely to cause reactions. As well, many people find erythritol is the safest sugar alcohol when it comes to digestive upset. If you have difficulty digesting food with sugar alcohols, try to choose foods with erythritol instead of others. 

How To Identify Food Intolerances

Most people eat a wide range of foods on any given day which is great - but it can make it difficult to track down food sensitivities if symptoms are creeping up.

To pinpoint a food intolerance, keeping a detailed food journal is essential. Note exactly what you ate every day, and how you felt including your energy levels and trips to the bathroom. If one food seems to be a trigger for symptoms of food intolerance, eliminate it for two or three weeks to see if it makes a difference. 

This process is often most straightforward when working with a healthcare practitioner who can help with food sensitivity testing to get to the bottom of the culprits causing you daily digestive upset as well as help you rebuild your diet to ensure your gut is functioning the way it should be. Getting to the root cause of your health concern is always our biggest goal, whether it's the foods or something else causing your body to react to your daily nutrient intake. Proper assessment and testing is critical in the role of outlining a customized treatment plan for wellness. Give me a call to get started at (905) 388-3151. 

Sources

Zopf Y, Baenkler HW, Silbermann A, Hahn EG, Raithel M. The differential diagnosis of food intolerance. Dtsch Arztebl Int. 2009 May;106(21):359-69; quiz 369-70; 4 p following 370. doi: 10.3238/arztebl.2009.0359. Epub 2009 May 22. PMID: 19547751; PMCID: PMC2695393.

Oku T, Nakamura S. Threshold for transitory diarrhea induced by ingestion of xylitol and lactitol in young male and female adults. J Nutr Sci Vitaminol (Tokyo). 2007 Feb;53(1):13-20. doi: 10.3177/jnsv.53.13. PMID: 17484374.

Dietary Guidelines Advisory Committee. 2015. Scientific Report of the 2015 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.

Landolt HP. "No thanks, coffee keeps me awake": individual caffeine sensitivity depends on ADORA2A genotype. Sleep. 2012 Jul 1;35(7):899-900. doi: 10.5665/sleep.1942. PMID: 22754033; PMCID: PMC3368971.

Vally H, Misso NL. Adverse reactions to the sulphite additives. Gastroenterol Hepatol Bed Bench. 2012 Winter;5(1):16-23. PMID: 24834193; PMCID: PMC4017440.

Mäkinen KK. Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals. Int J Dent. 2016;2016:5967907. doi: 10.1155/2016/5967907. Epub 2016 Oct 20. PMID: 27840639; PMCID: PMC5093271.

10 Ways to Improve Insulin Sensitivity & Your Metabolism

Insulin resistance can be difficult to detect without medical tests. However, its effects can be dangerous if left unchecked. I test for this often in my practice to help patients get to the root cause of their metabolic symptoms. 

This month we are taking a look at the risks and symptoms of insulin resistance, plus 10 preventative measures you can take to reduce your risks of insulin resistance and increase your insulin sensitivity.

What Is Insulin Resistance?

Insulin is a hormone produced by the pancreas which allows blood cells to absorb and use glucose. When a person experiences insulin resistance, their cells are unable to use insulin effectively. Consistently high levels of glucose develop, which can lead to prediabetes or type 2 diabetes if left untreated.

In order to prevent insulin resistance and its progression to diabetes, you must increase your insulin sensitivity. Insulin sensitivity means that your cells respond well to insulin—the opposite of resistance.

Who Is At Risk of Insulin Resistance?

Certain factors increase your likelihood of developing insulin resistance:

• Being overweight or obese, especially when excess weight is around the midsection

• A sedentary lifestyle or lack of exercise

• Smoking

• Consuming large amounts of alcohol

• Lack of sleep or sleep issues

• High levels of cholesterol

• High blood pressure

• A history of gestational diabetes

• A family history of diabetes

• A high-carbohydrate diet

• Sleep apnea

While it may not be possible to eliminate all risk factors as some are genetic, most are avoidable and doctors typically recommend lifestyle changes to prevent the condition.

What Are The Symptoms of Insulin Resistance?

Insulin resistance is difficult to detect without medical testing, as major symptoms don’t usually present until the condition has progressed into diabetes. The CDC has reported that over 85% of people with prediabetes do not know they have it. That’s unfortunate since lifestyle changes can reverse the development of diabetes.

High insulin and blood sugar levels are the hallmark symptoms of insulin resistance. Your health practitioner can use several methods to measure your blood sugar and insulin levels, such as a HOMA-IR test. Waist measurements in excess of 40 inches for men and 35 for women can also indicate insulin resistance.

In addition, there are links that have been drawn between insulin resistance and other health conditions:

• Acanthosis nigricans. This skin condition causes dark spots on the groin, armpits, and back of the neck. It can be an indicator of insulin resistance.

• Polycystic ovary syndrome (PCOS). There is often an overlap between PCOS and insulin resistance. The symptoms of PCOS can include irregular menstruation, infertility, and painful periods.

• Major depressive disorder. High levels of insulin in the blood have also been associated with an increased likelihood of depression.

If you are experiencing any of these conditions or conditions, it may be worthwhile to seek a test for insulin levels and insulin resistance.

How To Prevent Insulin Resistance

There are numerous natural and science-backed ways you can increase your insulin sensitivity:

1 - Sleep more

Getting enough rest is important for your health in many ways. A lack of good sleep has been linked to reduced insulin sensitivity, so be sure to catch up on your Zs.

2 - Fit movement into your day

Regular physical activity is a major key to increasing insulin sensitivity. Exercise will move sugar into the muscles for storage and promote insulin sensitivity immediately. This can also help keep off excess weight, which is another risk factor for insulin resistance.

3 - Reduce stress

Recurrent stress keeps hormone levels high and increases blood sugar. Stress also makes the body more insulin resistant.

Practicing meditation, getting regular exercise, and other stress-reduction techniques like conscious breathing will help lower your stress and increase your insulin sensitivity.

4 - Choose your drinks carefully

Even seemingly “healthy” drinks like kombucha can be loaded with sugar. Limit alcohol including beer, spirits and wine, especially pre-made cocktails with added sugar.

Hydrate well with water, at least 2 L a day, and choose herbal or green tea which has been linked to improved sensitivity.

5 - Eat more fibre

Studies have found strong links between fibre intake and insulin sensitivity. Incorporate fibre-rich foods into your diet such as legumes, oatmeal, fruits, and lots of vegetables.

6 - Add high-antioxidant foods to your diet

A diet that includes a variety of plants is highly beneficial for health. The antioxidants in brightly coloured produce prevent inflammation in the body and boost insulin sensitivity. However, be sure not to eat too much fruit at once, as many types of fruit are high in sugar.

7 - Reduce carb intake

Carbohydrates are the primary stimulus of rising insulin levels. High-carb diets tend to lead to blood sugar spikes. Spread out your carb intake throughout the day to prevent this, eating smaller portions at regular intervals.

8 - Supplement wisely

In addition to a well-rounded diet, certain supplements can help increase insulin sensitivity. Magnesium, chromium, berberine, and resveratrol have all been studied for their effects on insulin, with positive results. It is best to seek the care of a health care professional who can choose which supplements are best for YOU and can monitor your progress. 

9 - Cut back on processed sugar

The two major processed sugars are high-fructose corn syrup and sucrose. These are different from the natural sugars found in nutrient-dense foods like fruits and vegetables. Many studies have found that high doses of fructose and sucrose increase insulin resistance. It is best to avoid candy, sugary beverages, cakes, and cookies.

10 - Cook with herbs and spices

The medicinal properties of herbs and spices have shown good potential for increasing insulin sensitivity. Cinnamon, ginger, and garlic are some popular and flavourful ingredients that have been shown to increase insulin sensitivity.

If you’d like to learn more about developing lifestyle habits for healthy insulin levels, don’t hesitate to reach out. Together, we can address your symptoms, run the appropriate tests, and develop a plan. 

Sources 

Attvall S, Fowelin J, Lager I, Von Schenck H, Smith U. Smoking induces insulin resistance--a potential link with the insulin resistance syndrome. J Intern Med. 1993 Apr;233(4):327-32. doi: 10.1111/j.1365-2796.1993.tb00680.x. PMID: 8463765.

Borghouts LB, Keizer HA. Exercise and insulin sensitivity: a review. Int J Sports Med. 2000 Jan;21(1):1-12. doi: 10.1055/s-2000-8847. PMID: 10683091.

Donga E, van Dijk M, van Dijk JG, Biermasz NR, Lammers GJ, van Kralingen KW, Corssmit EP, Romijn JA. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010 Jun;95(6):2963-8. doi: 10.1210/jc.2009-2430. Epub 2010 Apr 6. PMID: 20371664.

Liu CY, Huang CJ, Huang LH, Chen IJ, Chiu JP, Hsu CH. Effects of green tea extract on insulin resistance and glucagon-like peptide 1 in patients with type 2 diabetes and lipid abnormalities: a randomized, double-blinded, and placebo-controlled trial. PLoS One. 2014 Mar 10;9(3):e91163. doi: 10.1371/journal.pone.0091163. PMID: 24614112; PMCID: PMC3948786.

Medagama AB. The glycaemic outcomes of Cinnamon, a review of the experimental evidence and clinical trials. Nutr J. 2015 Oct 16;14:108. doi: 10.1186/s12937-015-0098-9. PMID: 26475130; PMCID: PMC4609100.

Jalal R, Bagheri SM, Moghimi A, Rasuli MB. Hypoglycemic effect of aqueous shallot and garlic extracts in rats with fructose-induced insulin resistance. J Clin Biochem Nutr. 2007 Nov;41(3):218-23. doi: 10.3164/jcbn.2007031. PMID: 18299719; PMCID: PMC2243241.

Li Y, Tran VH, Duke CC, Roufogalis BD. Gingerols of Zingiber officinale enhance glucose uptake by increasing cell surface GLUT4 in cultured L6 myotubes. Planta Med. 2012 Sep;78(14):1549-55. doi: 10.1055/s-0032-1315041. Epub 2012 Jul 24. PMID: 22828920.

Guerrero-Romero F, Tamez-Perez HE, González-González G, Salinas-Martínez AM, Montes-Villarreal J, Treviño-Ortiz JH, Rodríguez-Morán M. Oral magnesium supplementation improves insulin sensitivity in non-diabetic subjects with insulin resistance. A double-blind placebo-controlled randomized trial. Diabetes Metab. 2004 Jun;30(3):253-8. doi: 10.1016/s1262-3636(07)70116-7. PMID: 15223977.

Anderson RA, Cheng N, Bryden NA, Polansky MM, Cheng N, Chi J, Feng J. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. 1997 Nov;46(11):1786-91. doi: 10.2337/diab.46.11.1786. PMID: 9356027.

Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008 May;57(5):712-7. doi: 10.1016/j.metabol.2008.01.013. PMID: 18442638; PMCID: PMC2410097.

Guerrero-Romero F, Tamez-Perez HE, González-González G, Salinas-Martínez AM, Montes-Villarreal J, Treviño-Ortiz JH, Rodríguez-Morán M. Oral magnesium supplementation improves insulin sensitivity in non-diabetic subjects with insulin resistance. A double-blind placebo-controlled randomized trial. Diabetes Metab. 2004 Jun;30(3):253-8. doi: 10.1016/s1262-3636(07)70116-7. PMID: 15223977.

Anderson RA, Cheng N, Bryden NA, Polansky MM, Cheng N, Chi J, Feng J. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. 1997 Nov;46(11):1786-91. doi: 10.2337/diab.46.11.1786. PMID: 9356027.

Paul-Labrador M, Polk D, Dwyer JH, Velasquez I, Nidich S, Rainforth M, Schneider R, Merz CN. Effects of a randomized controlled trial of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. 2006 Jun 12;166(11):1218-24. doi: 10.1001/archinte.166.11.1218. PMID: 16772250.

Caminhotto Rde O, Lima FB. Impaired glucose tolerance in low-carbohydrate diet: maybe only a physiological state. Am J Physiol Endocrinol Metab. 2013 Dec;305(12):E1521. doi: 10.1152/ajpendo.00580.2013. PMID: 24336921.