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Ballerina Syndrome - Teri Cochrane

Ballerina Syndrome

Fat malabsorption. Every day, we see clients who present with a reduced ability to process fats, in everything from foods to essential oils.

Consequently, the ability of their bodies to process hormones - which are fat soluble - is also compromised, resulting in a slew of downstream complications. Our practice first began to notice this pattern in our athletic clients, particularly ballerinas, hence the term “Ballerina Syndrome". 

These clients, who were generally tall and lean, were producing excess levels of the stress hormone epinephrine in response to their rigorous training schedules, which often took place daily and for several hours at a time.

Epinephrine has been clinically demonstrated to decrease the tight junctions of the intestines and contribute to the rise of pathogenic bacteria in the gut (1). What we discovered was that excess epinephrine in our ballerinas was causing a loosening and/or weakening of the tight junctions of their intestinal walls, allowing food particles and bacteria to be released outside of the digestive tract, and creating excess inflammation in the body. 

Additionally, the excess epinephrine was congesting the liver. The liver is responsible for breaking down toxins and fats. When the liver is backed up or compromised, it becomes much more difficult for the body to process fats and other fat-soluble molecules, such as estrogen. 

The Epigenetic Pirouette:

Individuals more susceptible to fat malabsorption most likely have genetic SNPs (single nucleotide polymorphisms) or epigenetic expressions that make them more prone to liver congestion and the inability to metabolize fats efficiently. Individuals with SNPs that impair methylation pathways are also less likely to synthesize choline and digestive enzymes as efficiently as others.

Choline and digestive enzymes are needed to help metabolize dietary fats and, in turn, hormones. Excess estrogen, for example, when left unprocessed by the liver will re-circulate in the body via the bloodstream, causing additional problems such as weight gain and acne.

It is important to note that certain prescription and over-the-counter drugs are also anti-cholinergic, which can slow the liver’s function (2). These include certain anti-depressants, anti-histamines, anti-psychotics, gastro-intestinal medications, and urinary incontinence drugs. In order for the body to process these chemicals, the body needs to use its available store of choline, which, after continued use, may result in a choline deficiency. The systemic presence of these medications may therefore contribute to a feedback loop, and the body will have a harder time metabolizing fats in the presence of these drugs.

What To Look For:

Common indications of fat malabsorption include bumps on the back of the arms, an itchy scalp, light colored or floating stools, referred pain from gallbladder in the right scapula, or pain in the right side of the abdomen, near the liver. Additional symptoms may include a yellow coloring to the face or skin, acne on the face, chest or back, milia, and light sensitivity in the eyes. Low energy may also indicate an inability to break down fat, as the mitochondria (our cellular powerhouses) need triglycerides to provide energy and burn fat.

An additional condition resulting from fat malabsorption is ligament laxity. When the body is not processing fats efficiently, connective tissues cannot get the essential fatty acids needed to form adequate levels of collagen. As a result, the ligaments are not as rigid as they should be, and knee or shoulder ligament tears can occur. In extreme cases, a clogged fatty liver can put pressure on the thoracic lumbar junction, which in combination with ligament laxity can pull other parts of the back or ribs out of alignment. Yikes!

Our Solution:

By muscle testing the individual, we are able to determine which types of fats the individual is and is not capable of processing. Some individuals are so fat-sensitive that even certain vegetables (e.g. Swiss chard & carrots) that contain high levels of vitamin A, vitamin K and beta carotene, which are all fat soluble, are too fatty for them to eat and process. Most fat-malabsorbed individuals may also experience a relief from symptoms when they limit their intake of nuts and dairy.

The best fats to consume are primarily short chain fatty acids, like those found in avocados, coconut oil, and grass-fed butter. Grass-fed butter (esp. Kerry Gold) is best sourced from cows that, ancestrally speaking, have not been industrially-bred, as they have healthier DNA. The butyric acid contained in this butter is healing for the gut, and the high butterfat can work to blunt the insulin response from the other foods it is eaten with.

Butter also helps with colonic balancing that would normally be disrupted by milk. A2-casein cows produce easier-to-digest dairy proteins than A1 cows. Butter can be added to milk to help you digest it and even added to coffee to help dampen the epinephrine-boosting effect. 

Supplements that may be helpful for those with fat malabsorption include L-Carnitine, TMG (Tri-Methyl Glycine), Choline, Yucca, and Spirulina. Spirulina supplementation has been shown to improve exercise performance, fat and carbohydrate processing, and liver detoxification - an excellent choice for young athletes (3,4). 

To The Tru Of You,

1) Cogan TA, Thomas AO, Rees LE, Taylor AH, Jepson MA, Williams PH, Ketley J, and Humphrey TJ. Norepinephrine increases the pathogenic potential of Campylobacter jejuni. Gut. 2007 Aug; 56(8): 1060–1065.
2) Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, Kirshner MA, Sorisio DA, Bies RR, Gharabawi G. Anticholinergic activity of 107 medications commonly used by older adults. J Am Geriatr Soc. 2008 Jul;56(7):1333-41.
3) Kalafati M1, Jamurtas AZ, Nikolaidis MG, Paschalis V, Theodorou AA, Sakellariou GK, Koutedakis Y, Kouretas D. Ergogenic and antioxidant effects of spirulina supplementation in humans. Med Sci Sports Exerc. 2010 Jan;42(1):142-51
4) Fujimoto M1, Tsuneyama K, Fujimoto T, Selmi C, Gershwin ME, Shimada Y. Spirulina improves non-alcoholic steatohepatitis, visceral fat macrophage aggregation, and serum leptin in a mouse model of metabolic syndrome. Dig Liver Dis. 2012 Sep;44(9):767-74.
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