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Healthy Aging

AS WE embrace fall and the bounty of summer begins to wilt and wither it makes me think of the aging process normal and natural to all living things. It is not a fact of life many of us enjoy exploring but being prepared for the course of aging can benefit our quality and quantity of life. Understanding that there are too many specific health challenges to cover in this article, I hope I can touch on some basics, which I expect will apply to most.

Digestion…I will repeat what I’ve said before…this is the cornerstone of health. As we age so does this valuable system. The release of stomach acid decreases and with it the cues to pancreatic and gall bladder function begin to weaken as well. Individuals may have a lessening appetite, eat fewer and smaller meals, clearly this varies but is not uncommon. As digestion starts to deteriorate a vERY common symptom that arises is heartburn, for which acid-reducing medication is regularly prescribed. Sadly this quick fix is not a healthy long-term solution as the acid is required for essential vitamin and mineral absorption as well as overall digestive flow. Instead I would suggest a strong lemon or lime and water mix, or apple cider vinegar before or with your meals. This naturally acidic solution will instead strengthen the innate digestive function creating better health.

Inflammation…This is the root of disease, it’s really that simple. So logically if we can support the inflammatory pathways in a healthy and beneficial manner we can reduce the progression of diseases that deteriorate our health. The theory is simple it’s the practice that is a challenge, and again as individual lifestyles, genetics, etc vary there is no one simple way to assist this. One no brainer, however, is to reduce your stress or at least learn techniques to manage it. Stress is pro-inflammatory, but when managed can lessen its impact on your overall health.

I think as our world has become more stressful we see activities like Yoga, Tai Chi and meditation gaining popularity because they offer natural stress reduction. Really any kind of exercise will count here, but if you are a go-go-go, anxious, or putting others before yourself type personality then a high impact workout would not necessarily be as nourishing as a slow-down, self-reflective one. Food choices are another must in this category. Quality fresh foods will be less inflammatory than highly processed foods…seems obvious. Foods that may be affecting our gut health and immune health are also worth avoiding or at least eating as conscientiously as possible. Other wise known as food allergies or intolerances these foods are an irritant to the system, and constant irritation can over time cause inflammation. There are a variety of ways to discover what these foods may be if not obvious already, a great reason to seek the attention of your local naturopath or health care provider. Anti-inflammatory nutrients come from fish oils, turmeric, bromelain, alpha-lipoid acid and fresh fruits and vegetables.

Cognition…For many memory, thinking and speaking clearly are extremely important indicators of the aging process. Without touching on any one condition I think there are some terrific everyday tools, and nutrients that can support good cognition.

variety is not only important but also more fun. New foods, books, games, puzzles, routes to work, exercises, all increase the pathways in the brain. Doing some activity in your life where you are moving with your eyes closed is also great for the brain and your balance too. Learning in any way, like a language, artistic skill, craft or hobby can improve both the quality of your life and your brain function. One nutrient essential to brain function is B-12, remember to compliment any one B vitamin with a B complex to assure you are not creating deficiency elsewhere.

I know you’ve likely all heard about Gingko, wonderful for helping to open and access those small blood vessels and capillaries throughout the body, especially prevalent in the brain. Ginger is another circulatory tonic that I would combine for brain function, along with Gotu Kola an herb full of antioxidants to assist in blood vessel damage and repair. A basic multivitamin would cover many of the nutrients discussed here, in addition a sublingual B-12; the herbs can be added if this is an area of special concern.

Appearance…the way we look can create much apprehension for many aging adults. This is not only our skin, and hair, but the way we move and carry ourselves. For both men and women it is extremely valuable to build muscle mass before our 50’s; this means performing weight bearing exercise in addition to cardiovascular or the more stress alleviating exercises discussed above. After menopause women have a more profound shift in their physiology which includes muscle and bone loss. This occurs in men too, just not a dramatically. Keeping our musculoskeletal systems well nourished and flexible helps with ease of movement and long-lasting strength.

Our skin is not so unlike this system as it is made of many of the same basic building blocks, namely collagen and muscles. Since the skin is such a rapidly growing organ, it shows the signs of aging more readily. The skin as a whole benefits greatly from the use of antioxidants… vitamins C,D,E, bioflavonoids like rutin, quercitin, resveratrol, and foods like blueberries, acai berries, pomegranate, dark leafy greens and green tea. These antioxidants are a valuable toolbox which enhance the health of our aging bodies, they are incidentally also useful anti-inflammatory agents.

This month I am turning 40 and feel as healthy as ever! I’m sure as I continue to age my opinions may shift, but for now I am not in the anti-aging camp, as with all things naturopathic I believe in supporting the natural processes of the body…of which aging is part. I certainly do support any efforts to age in a healthy and vital way and hope these simple reminders can help you to achieve a bounty of health throughout your life.

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREAThE deeply and MOvE your body EvERY- DAY!

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Adrenals…The Stress Responders

Ever been in a near accident on your bike, in your car, or just tripping over the curb? You feel a rush of ‘adrenaline’ your heart rate increases and you may feel flushed or sweaty…that’s your adrenals at work. The adrenal glands, which sit above each kidney, are responsible for the output of hormones that are active throughout the body and help modulate our response to stress. We all have stress in our lives from our jobs, our families, our finances; you name it. But other areas that create stress are less recognized; things like allergies, poor quality sleep, chronic pain, anxiety and depression. All these factors can add up, affecting our adrenal health.

When stress continues long-term the adrenals begin to tire out and make inappropriate levels of hormones which can negatively affect our overall health. Although these glands produce a whole list of hormones the two I am focusing on are cortisol and dehydroepiandrosterone (DHEA). In a stressful situation cortisol is released to enhance our alertness and ability to deal with the situation. Once the stressful situation abates DHEA comes in to calm the waters and reset the body back to equilibrium. These two hormones like to be in balance, but under chronic stress DHEA becomes outweighed by cortisol. Long-term, high cortisol levels cause unwanted symptoms including weight gain, water retention, suppressed immune function, poor blood sugar control, weakened skin and bones, and altered moods and behavior. High cortisol levels also decrease the active form of thyroid hormone (T3) and therefore may be another treatment option for those with little relief from conventional thyroid replacement.

I think the best type of testing for adrenal health is salivary testing. It is used less frequently by the medical community but is an invaluable tool for looking at adrenal function. Blood testing is another option but blood levels of adrenal hormones tend not to show the subtleties of adrenal health until disease is very advanced. The salivary test looks at cortisol release throughout a day as well as it and DHEA’s total output. I will mention again that salivary testing is not readily available through most medical professionals BUT if there is significant adrenal disease conventional blood, urine or other standard tests may be more suitable.

So what are the treatment options? The most obvious are to decrease or eliminate as many stressors as possible. Sometimes this may mean re-evaluating a job, asking for more responsibility sharing from the family, getting some time alone, taking a vacation, etc. Identifying more subtle stressors like poor sleep or allergies, and treating them is also a necessary addition to the treatment plan. But as with all things easier said than done we cannot always quit our job or find a better family. So then the discussion turns not so much to eliminating stressors but how you manage stress.

Stress management is an art unto itself and in our hustle bustle world it is a challenge to many. The adrenals love routine which makes sense since they are one of the key players in helping the body to maintain balance. I encourage my patients to get routine in the following ways. Eat regularly this ensures that the body is being consistently nourished and able to handle blood sugar challenges appropriately. Sleep between the hours of 10pm and 4am, again easier said than done for some but if you are at least attempting to do something relaxing and restful in those hours your adrenals will thank you. Exercise regularly, not only will this assist with energy and fitness it is also a terrific way to recharge the adrenals. Lastly do something relaxing everyday, I love the evening bath, others enjoy crafting, music, a good book, journaling; whatever it is it should be something that gets you out of that hustle bustle mentality.

After proper evaluation your health care provider may opt to supplement with DHEA. This is a hormone that should not be taken unless it has been determined that you are deficient; and although it is widely available does not mean it is appropriate for everyone. There are other supplements that support adrenal function, which may be safer options for those who have not been evaluated and are under chronic stress. Vitamin C is highly concentrated in the adrenals; taking 2-3 grams a day in divided doses may improve function. Vit. C at this dosage could be aggravating to the stomach causing gurgling and looser stools however, so take to your tolerance, even smaller amounts will be beneficial. B vitamins are essential for the metabolic pathways of many hormones the adrenals produce. Especially important are B5 and B6, but as always, take a B complex when taking any one B vitamin therapeutically. B vitamins are water-soluble and should be taken in divided doses throughout the day with food. Minerals such as Zinc, Potassium and Magnesium are also necessary for the adrenal’s metabolic pathway.

There are some terrific herbs for adrenal health. They work on a variety of levels from enhancing the life of adrenal hormones to nourishing the glands themselves. My top picks for adrenal health are Ginseng and Rhodiola. Ginseng has a variety of types there is American and Korean and really either/any of them are going to be fantastically helpful for adrenal health. Rhodiola is a Siberian herb which I like for use in stressful situations. I find it well suited to someone who is going through a particularly challenging time as opposed to Ginseng which is a more broadly useful herb for general adrenal health all the time…they work well together!!

Stress is a reality of living in our modern world. Remember to nourish your adrenal glands by taking time to relax and work on your stress management techniques, it will contribute to a body in balance.

DO something you LOVE, BE with someone you LOVE, EAT your vegetables, DRINK clean water, BREATHE deeply, and MOVE your body EVERYDAY!!

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Movement, Muscles, Minerals, and More…

Now that summer is here our motivation to get out and move our bodies is dramatically increased. The concert of movement includes muscles, tendons, joints, bones, and nerves. It is the health and coordination of these players which allow us to hike, bike, swim, kayak, and so on and so forth. So let’s check out this system of movement and explore ways to keep it healthy.

When we exercise, our goal is to achieve leaner muscle mass and increased endurance…in fact a complete exercise program should include strength, endurance and flexibility. In the initial stages of a new exercise routine there is a normal process of muscle fiber damage and repair; and this process often creates soreness, cramps, or stiffness. As we continue to use and overuse this system more complex problems including worn or degenerative joints may arise. Keeping the musculoskeletal system in balance is not easy, but movement is essential so don’t take it’s health for granted.

Our muscles are an intricate organization of cells specifically designed for energy use in order to create movement of joints and bones. The energy necessary for muscular contraction and relaxation ideally comes from a nutritious diet of adequate and balanced fats, proteins, and carbohydrates. The muscles prefer a fuel source of complex carbohydrates (whole grains and vegetables), although proteins are essential for muscle fiber building and repair. Vitamins and minerals also aid in cellular energy production. If you think of muscle cells as mini-factories, which take in carbohydrates to produce movement, vitamins and minerals are the factory workers making sure the process runs smoothly.

Two minerals essential for the contraction and relaxation of muscles are Calcium and Magnesium. When Calcium flows into muscle cells they begin to contract; with muscle relaxation (another key element to movement), Calcium flows out and is replaced with Magnesium. If you are experiencing muscle fatigue or cramping during or after exercise you may benefit from these minerals. Calcium can be found in leafy greens, grains, shellfish (especially clams and oysters), salmon and dairy products. Magnesium is rich in nuts and seeds, soybeans, grains, fish, blackstrap molasses and dairy products. If you use supplements you should be getting a 1:1 ratio of Calcium to Magnesium. Calcium is a widely promoted and often overused and unbalanced mineral; its suggested use for bone health is fairly one-sided overlooking the rich matrix of other minerals. Looking for a nutrient to help increase muscle energy? CoQ10 would be a good choice. This nutrient is an essential source of ATP production within all cells throughout the body, and although the body can produce it, deficiencies are possible. I recommend 100mg of CoQ10 in the morning with food.

Another essential to avoid muscle aches and pains is making time to stretch (flexibility). The most ideal time to stretch is when your muscles are already warm. Some gentle stretching can be done prior to a strength or endurance program. Once complete, however, those muscles are primed for a good round of stretching, so don’t forget to budget time at the end of your workout for this important aspect of movement. Never force or bounce a stretch, instead move into a position where you begin to feel tension or tugging and then use breathing and time to go further, not force. If you are unsure about the best stretches for you, there are many great classes, books, and professionals available to guide you.

A commonly recommended soothing treatments for ailing muscles that is both easy and safe is an Epsom salt bath. Epsom salts are rich in Magnesium and by pouring two to four cups into a hot bath and soaking for 20 minutes you can relax both body and mind. If you have access to a sauna or steam room they are also an excellent deep acting treatment for muscle pains. If you are not at risk for stroke or have significant heart troubles, try alternating from the hot sauna to a cold shower to really get the blood moving. For an acute muscle injury or ache try rubbing some Arnica cream on the affected area and/or take a supplement called Bromelain. Bromelain is a pineapple enzyme which when taken away from food can break down inflammatory proteins, like those found in sore muscles. And as always drink plenty of water.

Let’s not overlook the joints; this is a point where two bones meet. There a variety of joints throughout the body. Some are simple like the attachment of the ribs to the breast bone, which experience relatively little movement. Some are complex like shoulders and hips which have a wide range of movement and responsibility. Joints are cushioned with fluid filled sacs, discs and cartilage depending on the joint. The ease and fluidity of movement of a joint is also assisted by good food choices, adequate water intake and proper movement. A top choice nutrient for joint health is omega 3 fatty acids, they help lubricate and reduce inflammation, a win-win. Adding 1000mg of a good quality fish oil can be an excellent therapy for joint problems.

When starting any new exercise routine set realistic goals and recognize your limits. If you do experience an injury, which does not resolve within three to five days, don’t suffer through it; go see someone who can help you heal. When you spend too long compensating for an injury it only compounds the problem. Exercise is a rewarding fountain of youth so get out and experience the benefits of movement today! Because as I like to say…DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!!

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Lively Livers

fatty-liver-painSpring is that time of the year when life is rejuvenating, Chinese medicine recognizes this as the season of the liver, and the vibrant greens of Spring remind us of good health…seems like an excellent time to review the strength and well-being of our livers. Ever experienced constipation, varicose veins, hemorrhoids, intolerance to fatty foods, alcohol, or caffeine? These may all be signs of sub-optimal liver function. If you’ve never thought of your liver, well then today’s the day!

The liver is a large organ located on the right side of the abdominal cavity; it resides under the ribcage just below the lungs and diaphragm. It has an enormous assortment of functions. It detoxifies, meaning it clears out unwanted materials in the blood. These materials are either made in the body (hormones, metabolic waste products, dead cells, etc.) or environmental/exogenous chemicals (pharmaceutical drugs, cleaning products, smoke, pesticides, etc.). It helps manage metabolism by creating and storing energy sources, namely glycogen, which can then be converted to blood glucose. The liver makes and manages blood cholesterol which helps the body to repair damage within the vasculature. It assists in digestion by creating bile, which emulsifies fat for its absorption into the blood. And this is only the big picture, this organ is the home of over 200 chemical reactions, which help our bodies survive and thrive in this world.

So what things adversely affect liver function? There are some common diseases which contribute to liver disease namely hepatitis, alcoholism, and kidney disease. There are many chemicals including pesticides, herbicides, and pharmaceutical drugs, which can be toxic to the liver when exposed in large quantities. There are lifestyle choices including the obvious of drug and alcohol abuse as well as poor dietary choices which can overburden the liver making for some types of liver disease. Other assailants to liver function may include sluggish digestion, poor nutrition, food intolerances, and infections. Your health care provider should be useful in ruling out the obvious causes with a thorough history, physical exam and simple blood tests.

What are some of the symptoms to watch for which may indicate liver dysfunction? Digestive troubles including constipation, excessive burping, or nausea may be noticed. The gallbladder which holds the bile can become inflamed or gallstones may form. Gallbladder conditions are often exacerbated by fatty foods causing right sided pain or nausea. For those who have poor tolerance to alcohol or caffeine or chocolate this may be a sign of sluggish detoxification. When the liver is not working up to speed there can be a backup of blood in the venous system causing varicose veins or hemorrhoids. Finally the most concerning signs of a more advanced liver condition would be jaundiced (yellowing) skin, pale stools or brown urine, these folks should seek medical care as soon as possible!

All livers can benefit from improved nutrition. Increasing fresh foods in the diet is an excellent source of nutrients to assist the liver in its many functions. Be inspired by the rejuvenating springtime to try a mini-cleansing diet. This is a diet of only fresh fruit, vegetables and fish, try it for a week and see if you experience any changes. Others may gravitate to the idea of fresh juicing, there are a variety of fruits and vegetables which can make delicious juices giving the liver some much appreciated nutrition and the digestion a little break. Some stimulating liver foods include lemons, beets, beet greens, radishes, leafy greens, grapefruit, artichoke, asparagus, and of course liver itself especially if it is from a reputable clean living animal. Water! This liquid of life is essential to many important enzymatic reactions in the liver. Water can help to dilute chemicals and assist the liver to detoxify. Try consuming half your body weight in ounces daily for a week (math: if you weigh 150 lbs drink 75 oz water daily) and see what a well hydrated liver can do for you.

There are a plethora of supplements that can be useful to the liver. Vitamin C and Antioxidant blends are helpers in the fight against free radicals and promote quality detoxification assistance. Other helpful detoxifiers are Alpha Lipoic Acid and Glutathione. When these nutrients are rich in the body they are doing work that helps take the load off the liver. A fiber supplement will assist with proper elimination. When the body is not eliminating daily the liver is further stressed with recirculated toxins from the bowels. Therefore adequate fiber will assure proper binding of toxins as they are eliminated from the liver and help reduce potential reabsorption. A fiber supplement should always be consumed with a large (greater than 8 oz) glass of water, so as not to create constipation.

Almost all herbs work on the liver in some form or another, since the liver is the organ that metabolizes many of them. There are, however, some shinning stars. Milk Thistle is the first. This herb has been shown to protect the liver from hepatitis and cirrhosis, which inflame and destroy liver tissue. Dandelion and Burdock roots, both common edible herbs, promote proper liver function. They stimulate the production of bile, which is the end product of liver metabolism. Nettles, a common local plant, is a gentle liver stimulant which is quite useful in the area of food intolerances and seasonal allergies. Of course the golden glow of Turmeric cannot be overlooked as both a terrific antioxidant and amazing anti-inflammatory. And finally Green Tea can be added for its powerful antioxidant effect as well. All of these herbs are safe and gentle, but as always if you have questions or concerns seek the guidance of a trained professional.

The liver is an organ to embrace; care for it and it will care for you. So please take some time this spring to enliven your liver!

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!!

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Lyme: US #1 Vector Borne Disease

lymeAs summer approaches and we begin to make plans to tromp around in the woods I thought it a good time to put Lyme’s Disease on your radar. AND as I have just attended an informative conference on this topic I wanted to give credit where credit’s due. I have utilized information presented by Dr Stacey Rafferty and Dr Daniel Neuman who have proven they are by far more the experts than I. So read on and be educated about a growing health concern here and throughout the country.

Why should we be thinking about Lyme’s Disease? Well it is THE number one vector borne disease in the US affecting a reported half million people across the country. It is estimated that for every one person reported, however, there are another 6-12 who are not…noteworthy indeed! Although many of you are thinking “that is a disease of the North East” I am here to dispel that myth and inform you that in fact Lyme’s Disease has been reported in all 49 continental states. There is no true endemic area of Lyme carrying ticks.

How does one acquire Lyme’s disease? The tick, specifically the Ixodes genus. These ticks carry a spirochete in their saliva and once bitten that spirochete (Borrelia sp.) is transmitted into your blood. These are interesting bacteria in that they are a corkscrew shape with a flagella (little tail). These features allow them to easily leave the bloodstream and bore into a variety of tissues throughout the body. BUT not only do we get Borrelia; along with the spirochetes come other co-infections with other organisms (Babesia, Bartonella and Ehrlichia) which infect our red blood cells. This variety of potential infectious organisms can make treatment particularly tricky! Interestingly the other spirochetsial disease you may be familiar with is Syphilis, which has a similar disease pattern and a variety of overlapping symptoms with Lyme.

Why now, are there more cases of Lyme? One is a warming climate which has contributed to increasing habitat for the hosts. There is indeed a reported increase in host populations; and the hosts are deer, Western Grey Squirrels, N. Pacific sea birds and Canadian song birds like robins and sparrows. This is coupled with a speculated inferior ability to adequately fight this infection by us the victims. As we eat less nutritious foods are exposed to more toxic pollution and have seemingly more stressful lives we weaken. As the Lyme infection festers it can potentially create further susceptibility to other infectious agents like fungi, yeasts, viruses and bacteria…a complicated picture to sort through. In fact Lyme experts see this disease potentially re-titled as Multiple Chronic Infectious Disease Syndrome due to this long-term immune deficiency to multiple organisms.

So what kind of symptoms should we be watching for? Obviously a tick bite; common symptoms following a bite are a rash at the bite site, fever, fatigue, headaches; generally flu-like. As the disease becomes more chronic there are more and more potential symptoms, up to 40!! But most common are persistent fatigue, roaming musculoskeletal pain, sleep disturbances, cognitive dysfunction and any combination of neurological symptoms. This disease has some seasonal cycling being worse in winter and better summer. Also noteworthy that many Lyme sufferers are diagnosed (or mis-diagnosed) with Fibromyalgia or Chronic Fatigue Syndrome.

Lyme Disease, as true with many complex conditions, may take months or years to diagnose. Yes, there are tests for Lyme, namely the Western Blot. But there seems to be 2 camps of diagnostic criteria so depending on your doctor’s training and/or lab standards these test may be falsely negative. Treatment is complex, beyond the scope of this article, but can involve a variety of therapies from herbs, homeopathy and nutritional supplementation to numerous anti-biotics and pharmaceuticals. The more complicated and long-standing the infection the longer and more intensive the therapeutic options. But the aforementioned docs seem to have had many successes regardless of these complexities.

So let’s go back to something we can all do which is prevention. The nymph stage of tick growth is when ticks are most infectious, ironically when they are also most tricky to detect as they are quite small. But this stage occurs in the months of June/July…a time to be most vigilant of tick bites and infectious symptoms like rashes and flu-like illness following that great camping trip!?! Ticks are most prevalent in wooded areas, tall grasses and shrubby environments. Locally the areas of greatest concern are the Columbia Gorge, Mt Hood, and Southern Oregon. If you are going to be in these areas in June/July consider adding an insect repellent to your supplies! After your outdoor experience check yourself, your kids and your pets for ticks. IF you find a tick remove it with some tweezer type instrument grabbing it as close to the head as possible and pulling directly out. And if, heaven forbid, the head remains in the skin use your best techniques to remove that as well. Finally be brave and ignore your instinct to get it as far away from you as possible, but instead KEEP YOUR TICK! You can put in a dry plastic bag in the freezer for any length of time. Then they can be easily tested for Borrelia and we practitioners can implement treatment if necessary.

I was pleased to learn more about this clearly serious disease and am now excited to be able to do my part to educate my faithful readers and potentially prevent Lyme’s disease in my community. So pass along to the campers, hikers, mountain bikers, fly-fisherman and general outdoor lovers in your life, and of course enjoy the approach of SUMMER!

ONLINE RESOURCES: www.ILADS.org, www.lymediseaseassociation.org, and www.lymedisease.org.

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body everyday!!

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Contraception: Supporting a Woman’s Right to Choose

Since we are in an election year and this always seems to be a hot topic in the media I thought it a good time to revisit contraception. It is a wonderful and amazing option for women and men to be able to choose children, and to me quite disappointing that as a country we cannot come together to promote the ideas of family planning. Because the topic of abortion is so politically charged I think we forget that a secondary casualty of anti-abortion policy is the basic right and access to birth control. Preventing unintended pregnancy is a communal effort, so please pass along any or all information to someone who would benefit from being informed of their choices.

Most of us are familiar with the trusty old birth control pill. There are two main hormones in most birth control pills. Estrogen in the form of ethinyl estradiol and a progestin (a synthetic form of progesterone) of which there are a great variety, and each has a slightly different activity. There are also a variety of choices with the amount of hormones in pills. Some are the same all month long, some get stronger as the month progresses which somewhat mimics our natural rhythm; and then there are some pills which have no estrogen at all and just use the progestin. All these choices give both the patient and the provider a nice variety of options to create a workable match. The major downside of pills are the side-effects (which of course all methods have), and the fact that you have to remember to take it daily.

Some of the newer contraceptive methods have unique delivery  systems, and are invaluable for those who have trouble remembering a daily pill.  My personal favorite is the NuvaRing (www.nuvaring.com).  This is a small (2 inch diameter, 4mm thick)  flexible ring made of an ethylene vinylacetate polymer impregnated with ethinyl estradiol and a progestin (desogestrel) which is inserted into the vagina for 21 days and removed for 7.  It delivers a steady release of low-dose hormones throughout the 21 days.  Side-effects seem to be minimal with complaints of increased vaginal discharge/ irritation, and sexual partners being able to feel it during intercourse.  Another method which offers a unique delivery option is the patch OrthoEvra (www.orthoevra.com).  The patch is a nude colored adhesive impregnated with ethinyl estradiol and a progestin (norelgestromin).  With this method one patch is applied weekly for 3 weeks, and week four is patch free.   Common complaints with this method are irritation/rash at the  adhesive site, breast tenderness, and trouble with patch staying full adhered to the skin.  This method has the potential for higher estrogen levels than most others, which for some women can be a problem, so consult your provider. The next method is Depo-Provera (www.depoprovera.com).  This is a progestin-only method; a small intramuscular injection of medroxyprogesterone acetate is given once every 12 weeks.  There are often complaints of irregular bleeding (especially the first 6 months), significant weight gain, depression, and resuming fertility can take up to 18 months after discontinuing use.   The FDA placed a black box warning on this method to inform patients and clinicians of the risk of bone mineral density loss while using this method for more than 5 years. Finally, there is once again a contraceptive which can be implanted under the skin via injecting a small rod (3mm by 40mm) into the inner upper arm. Called Implanon (www.implanon.com) this is a 3 year progestin (etonogestrel) only method.

IUD’s (Intrauterine devices) are experiencing a come-back, and the interest in these small T-shaped systems of contraception continues to rise.  The use of IUD’s were often recommended to women who had already had children, but new guidelines have broadened potential recipients.   There are currently 2 types available.  The first is the copper IUD (ParaGard, www.ParaGard.com) this is a completely hormone free method offering 10 years of contraceptive protection.  The second is a progestin only containing IUS (Mirena an Intrauterine System, www.mirena.com) which offers 5 years of contraceptive protection.  The IUD/IUS must be inserted into the uterus by a licensed practitioner.  Most common complaints are discomfort during insertion, and irregular bleeding. These devices are easily removed in advance of recommended use.

The final birth control option worth mentioning is continuous use birth control.  Continuous use can be recommended for those who have problems with heavy bleeding, cramping or other PMS type issues, as well as for athletes and special occasions like a honeymoon. Continuous use can be achieved with some pills or the NuvaRing, and is basically the idea that there is no 7 day break between taking hormone containing pills or changing rings.  Research shows that this method of use is safe and effective, as well as FDA approved.  Using your contraceptive method in this manner should be done only with the approval of your health care provider.  For more information consult with your provider or visit www.noperiod.com.

Now for you men, there is indeed a method for you too…vasectomy! And guess what? Federal dollars from the family planning department now include a way for you to receive a free or reduced fee vasectomy, check with your local health department or planned parenthood for details. Yes this is a permanent method. It involves a simple outpatient procedure which severs the vas deferens, stopping semen from exiting during ejaculation. There is still an ejaculatory fluid released, but no sperm. What happens to them? They get stuck at the dead end and are reabsorbed into the blood stream.

As a naturopath I get two common questions regarding birth control. What are the hormone free options and what do I recommend to women taking hormonal birth control? Hormone free options are condoms, diaphragms, ParaGard IUD, vasectomy, and Cycle Beads (these are pretty cool, an easy way to track your fertile cycle days IF you have regular periods…check out their website www.cyclebeads.com). Any hormonal birth control method can deplete B vitamins, so I recommend a good multi or B complex vitamin to be taken daily with food.

All of the aforementioned methods have their own risks and necessary screening before use.  And of course none of these are protection against STD’s (now called sexually transmitted infections, STI‘s); for that use a condom!  If any of the aforementioned contraceptive methods are of interest to you check into the websites given as well as seeking the guidance of a health care professional versed in their use.  Two other websites worth mentioning are www.plannedparenthood.org and www.fwhc.org, they both give a comprehensive overview of the options available. Be thankful for your right to choose!

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

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Diabetes, Am I At Risk?

Last month I reviewed the definition and disease process of Diabetes. This month I would like to personalize this subject a bit more and explore whether you are at risk. I would also like to share some tests that are important when assessing Diabetes. My focus this month will be Type II Diabetes, since it is more common as we age and has a greater chance of prevention. Being informed is one of the best ways to reduce you risk and control this disease…so use this information wisely.

Although I have classified this as an American disease it affects all races and genders. American ethnic minorities seem to be hardest hit, especially African Americans, Native Americans, Asians and Hispanics who have a risk two to six times greater than the average Canadian or Caucasian American. Other risks include increasing age, obesity, sedentary lifestyles, history of gestational diabetes and family history of diabetes. Studies also show that those who are not breast fed and given cow’s milk (or milk based formula) instead have a greater risk. Body types that are Apple shaped (carry their weight in their abdomen/above the hips) and those who have a Buffalo hump (fatty accumulation at the top of the spine/base of the neck) are at greater risk. BMI’s of 30 or greater, or a high waist hip ratio are numerical guidelines to assess risk. Skin tags, those fleshy growths of skin commonly found on the neck and armpits are a sign of trouble with blood sugar control, not necessarily a tell-tale sign of Diabetes, but a clue that it is time to pay attention to your blood sugars. Those individuals who are already having trouble tolerating glucose in that their insulin response is not appropriate or their blood sugar levels do not return to fasting levels quickly enough; or those that have a history of hypoglycemia (low blood sugars) may all be at risk of moving towards a Diabetic state as well.

So maybe you have a few of the above risk factors, how do you know if you have Diabetes? Certainly if you are overweight and fit some of the numerical criteria a screening should be done. As we discussed last month, when the blood sugar levels remain high they begin to affect the blood vessels and organs they supply. Poor/blurry vision, recurrent vaginal yeast infections, or fungal infections causing itchy skin may be some early signs. The classic presentation is frequent urination with increased thirst, hunger as well as weight loss and fatigue; but at this stage the disease is well underway. Diabetes may diagnosed on a routine visit for other reasons. Diabetics frequently suffer from high blood pressure or high cholesterol and triglyceride levels, so if you have either of these very common conditions it may be a good idea to request some routine testing.

The most standard test for Diabetes is a fasting blood glucose level. The diagnosis of Diabetes may be made if there are one or more fasting blood glucose readings greater than or equal to 126mg/dL. Or if there are any of the classic symptoms along with a blood glucose over 200mg/dL. A second standard test is the Oral Glucose Insulin Tolerance Test. This test screens the body’s reaction to glucose and insulin over a two hour period, thus getting a thorough picture of this relationship, diagnostic criteria for this test is blood glucose over 200mg/dL two hours after a glucose challenge. Finally, a test which is useful in assessing blood sugar management over a longer time frame is the glycosylated hemoglobin test (HgA1c). If glycosylated hemoglobin is over 6.5% it is considered diagnostic of diabetes. HgA1c levels are also an effective way of monitoring whether blood sugar management has been good. Since this disease is at such epidemic proportions, most recent guidelines are encouraging practitioners to screen for borderline diabetes. Here lab values are fasting blood sugars between 100-125, or HgA1c of 5.7-6.4%, or glucose tolerance of 140-199mg/dL…enough numbers!?!

Naturopathically we are seeking to look at the body as a whole. With that in mind, and also considering the pancreas as part of the endocrine system, it is of great value to assess overall endocrine function by concurrently screening the thyroid and adrenals. These glands have a profound effect on how and why the pancreas is functioning as well. For example when we are experiencing stress cortisol is released from the adrenals which delivers a message to the pancreas to release insulin. When an overworked overweight individual’s pancreas is getting this message over and over again outside of meals you can see where the body is tempted to stop listening. Sadly this whole-body type of view is not often embraced in conventional practice, so I encourage you to ask!

Hopefully this has been some useful information in regards to the risks and diagnosis of Diabetes. Next month I will explore some preventative lifestyle suggestions and treatment options outside the norm…so stay tuned. Best wishes for a healthy 2012!

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

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Understanding THE American Disease, Diabetes

DIABETES IS a disease that affects close to 19 million people (2010) in the United States alone. This is an increase of approximately 4 million cases since I first wrote this article in 2006. But the 19 million only account for those who have seen a doctor and been diagnosed, it is estimated that another 7 million remain undiagnosed. Diabetes continues to be a leading cause of death by disease and remains a growing health care epidemic across this country. Understanding this disease, its long-term consequences, risk factors, diagnosis and treatment is no small endeavor. Therefore I have chosen to dedicate the next three Bodies in Balance articles to this topic.

This disease is known by a more formal name, Diabetes Mellitus, and by definition is a metabolic disease in which blood levels of glucose are abnormally high because the body does not release, use or respond to insulin adequately. There are two distinct types; Type I is characterized by an absence of insulin production. Type II is different in that there may still be insulin production but the body becomes resistant to its message. Type I accounts for approximately 10% of all diabetics and its onset is commonly before age 30. Type II therefore accounts for the other 90% and is more common in those older than 20, BUT sadly numbers in young people are currently rising dramatically. Here is an update on the numbers affecting young people. 1.9 million new cases were diagnosed in people aged 20 and older in 2010, with a total of 11.3% of this population affected. For those under 20 it affects 1 in every 400 or 0.26% and rising!

Let’s talk about the pancreas. This is a digestive organ lying across the width of the abdomen just below the ribs. To simplify, this organ does two jobs; it releases enzymes into the small intestine which digest food and it releases insulin into the blood to regulate blood sugars. The release of insulin is triggered via the nervous system (seeing and smelling food) as well as the digestive system (digestive enzymes) and blood sugar levels. The pancreas is busy monitoring all these stimuli to read the needs and assess the balance between what’s available from our food in the gut and what is needed in the blood…no small job! Once insulin is released it binds to cells throughout the body signaling them to store away the digestive breakdown products (glucose, lipids and amino acids). If insulin is working correctly those digestive bi-products will be stored away and blood sugars will return to pre-consumption levels within 2 hours. When there is insulin resistance (i.e. the cells are not responding to insulin‘s message) blood sugars remain high, which over time can begin to cause damage throughout the body.

The long-term consequences of diabetes is what makes it such a concerning disease. Over time the continuously heightened blood sugars are especially hard on the blood vessels causing inflammation, micro tears, thinning of vessel walls, weakness, and leaking. Throughout this process the body attempts to heal the damage by laying down a protective layer, otherwise know as athreosclerotic plaques. Think of high blood sugars like rust in the pipes of your house; at first the thin, most delicate rusted pipes will give out, although over time all pipes will likely suffer damage. Likewise, blood vessel damage is the key to consequences throughout the body. It starts with the smallest vessels in places like the eyes, kidneys, and nerves. Early damage can result in poor eyesight, increased urination, and poor sensation in the feet. Eventually if left untreated problems can exacerbate to blindness, kidney failure and numbness or weakness of the limbs. When larger blood vessels supplying the heart, liver, and skin begin to suffer, we begin to see skin ulcerations, and heart and liver disease. And secondary to poor blood health and damaged vasculature the body is slow to heal, which clearly just compounds these problems.

So wondering why the body stops producing insulin or receiving its message in the first place? Good question! For those who have Type I, studies find that 75% of these people have antibodies to the cells that produce the insulin, i.e. their own immune system is attacking the pancreas. Genetics may also play a role in Type I, but that role is even more profound in Type II. Theories about insulin resistance in Type II abound; again the immune system may play a role in that antibodies to foods, virus’, bacteria, etc. may be obscuring or damaging the receptor sites where insulin should be binding. But more noteworthy is the link between Type II diabetes and western lifestyle, in my opinion this connection is paramount. Obesity is found in 90% of those with Type II making it the greatest risk factor for the development of diabetes. Type II diabetics often have poor quality diets with little fiber, excessive simple carbohydrates, and little to no activity or exercise. But as with all disease it is a complicated multifactorial process.

To summarize what we’ve covered here, there are two types of diabetes, the second of which is far more common and an ever growing health crisis. Our overworked pancreas’ are trying as hard as they can to keep up with our over-processed carbohydrate rich diets but for those affected the message is not being heard. This is causing damage throughout the body as the blood vessels are the primary target. In the next episode we will explore risk factors, signs and symptoms and what tests to talk to your doctor about regarding diabetes…so stay tuned…

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

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Screening 101

One of the accomplishments of modern medicine is our ability to screen for common diseases.  Whether we are monitoring blood pressure as a screen for cardiovascular disease or getting a colonoscopy to screen for colon cancer, we are faced with many opportunities to be screened for disease.  Many of my patients as well as those in the medical community itself are beginning to ask questions about the appropriateness of all this screening.  So my goal for this article is to review a handful of screening tests and help you to consider whether they are of value to you or not.

First let me define a screening test.  This is a test designed to detect a disease in people who do not have any signs or symptoms of the disease.  For the most part it is not a diagnostic test in and of itself.  For example high cholesterol does not mean you have cardiovascular disease but may warrant further testing to rule out other signs of the disease.  Whereas a biopsy done during a colonoscopy may indeed produce a diagnosis.

Cardiovascular disease…this disease remains the number one killer worldwide.  We have developed some fairly inexpensive, non-invasive testing for this disease including: blood pressure, BMI (body mass index=weight in pounds x 703/(height in inches)²), ECG, Stress Test (aka treadmill test) and the following blood tests: cholesterol panel, C-Reactive protein, and homocysteine.   There are of course more specific imaging tests like CT and MRI when increased suspicion based on the more basic screening tests warrants them.  Some of these screens are low cost and minimally invasive which are indicated for everyone like blood pressure, BMI and some blood testing.  Other more comprehensive testing is more costly and likely reserved for those at greater risk.  Another group who is at a much higher risk for cardiovascular disease are those with Diabetes.  And screening for Diabetes is extremely routine, non-invasive and low cost.  The simple measurements of BMI and WHR (waist hip ratio) can be used as a preliminary marker for further testing.  Routine blood work to evaluate fasting blood glucose and insulin as well as a more long-term view of blood sugar maintenance with a HgA1c (hemoglobin A1c) can all be of value.  Making this diagnosis with these simple tests can set a Diabetic or pre-diabetic on a treatment protocol and reduce long-term disease risk significantly.

Cancer…Cancer is more complex to screen for as it is a disease with many types and locations.  Therefore more and more screening tests continue to emerge as we continue to understand cancer in greater depth.  Recommendations continue to change as these tests improve; and another factor which I believe more indirectly affects recommendations is the cost of the tools or machines used to detect cancers.  Diagnosing cancer is certainly not my specialty so I will cover a few basic screens I am asked about, and utilize most frequently.  First is the Pap smear.  This is a screen of the cervical cells within the vagina.  Abnormal results indicate a change in the cells which may or may not be cancerous.  This is one of those true screens and further testing with a procedure called a colposcopy is necessary to determine the diagnosis.  In the grand scheme of cancers, cervical cancer is relatively inexpensive to diagnose and treat AND the treatments are extremely effective…so get your pap smears!  For men the equivalent would be a prostate exam and PSA (prostatic specific antigen) blood test.  Both the exam and blood test are screening only and relatively inexpensive.  Many practitioners skip the exam portion and just do the PSA, but I consider that a mistake.  From a practitioners’ point of view when you couple a blood test with a hands on exam there is much more information to work with rather than just a number.  Pap smears are indicated in women in their early to mid-reproductive years whereas prostate exams are indicated in men in their mid to elderly years.  For both sexes don’t forget a good skin check to screen for skin cancers while you have the attention of your physician!

Next the Mammogram…I would say this is one of THREE screens necessary for breast cancer; the other two being regular self-exams and yearly exams with your clinician.  Mammogram has lots of controversy…I could likely do a whole article just on this, but for this article it is the screening test of choice.  Again like the pap smear, mammograms can pick up abnormalities but are not diagnostic.  Follow up testing likely involves needle biopsies, lump removals, lymph node removals, etc. to reach a conclusive diagnosis.  There are many nuances and decisions to breast cancer diagnosis and treatment and clearly the costs are high.  Finally the Colonoscopy.  This is the most invasive and most expensive of the cancer screens covered here.  This is basically a look and see procedure which, if an abnormality is found and biopsied, can lead to a diagnosis.  Again a screening test reaching higher levels of controversy due to global recommendations for screening in adults 50 or over.  This is a change from previous recommendations which reserved this screen for those with symptoms or strong family or personal risk factor history only.

Screening for disease is a recommendation, a choice for YOU to make.  One point to add is the question what would you do if something is found?  OR on the flip side what could you be missing by not screening?  The answers are unique to your philosophy on health, the risks (both of the procedure and your personal risk factors), and certainly the cost. These considerations all come into play when deciding whether or not to follow the recommendations.  When faced with your next screening test; use your resources wisely, including this 101, to further guide your decision.

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply, and MOVE your body EVERYDAY!

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Bones: Invest Now or Pay Later

Our skeletal system is what structures our bodies. It is a major influence on our height, build and movement. Our bones are not only building blocks, however, they are indeed a living and dynamic part of our physiology as well. As we age so do our bones, and bone loss can leave people more vulnerable to fractures, immobility, and death. Ways to influence our bones can of course be affected by our lifestyle choices, but there are many natural medicine options as well…so let’s get those skeletons out of the closet and talk about bones.

First we should cover some basic bone physiology. Bones are made up of 35% organic tissues and 65% minerals. The minerals in bone include calcium, phosphorus, magnesium, potassium, sodium as well as trace minerals boron, manganese, zinc and copper. In the organic tissues there are blood vessels, nerves and cells which both build and destroy the mineralized bone matrix. Two important cells within the bone that are of note here are osteoblasts and osteoclasts…in short blasts ‘build’ and clasts ‘chew or destroy’ bone. They are both fundamental to bone health as the destruction of old bone makes room for new bone to be built but also maintains calcium and other bone minerals available for the blood and therefore other tissues in the body. The organic tissue is also the source of our blood cells. All blood cells arise from the primordial stem cells which are formed in the bone marrow. Stem cells can mature to a white blood cell, a red blood cell or a platelet.

Next let’s talk about the normal lifecycle of the bones. Clearly in our early years from birth to mid-late teens we are building bone. Osteoblast activity is high so it is an ideal time to start paying attention to bone mineral intake, especially for young girls who have a family history of osteoporosis or severe digestive disorders which impair mineral absorption (also see risk factors listed below). Ideally in this phase of life we are building healthy bones which are dense and active. At about age 30 a shift occurs from build to break-down, therefore more osteoclast activity. This scenario begins to get much more significant in women who have stopped menstruating for more than 6 months (i.e. menopause). Thankfully this menopausal shift begins to level off after the first 3-5 years into menopause but overall decline in bone mineral density continues after 30 in both men and women for the rest of our lives. Note here: women who for any number of reasons have a break in menstruation for 6 or more months will also experience this physiological shift…pregnancy, eating disorders, athletes, DepoProvera use, complete hysterectomies, etc. some of which may be reversible when menstruation resumes. Other risk factors include smoking, heavy alcohol use, corticosteroid medications, being small and thin, family history and sedentary lifestyles.

But dear readers do not fear…there are ways to invest early or now to ensure long-term bone health. Weight bearing exercise! This encourages bone growth by stressing the bones which sends the message ‘make me stronger’. Now I know not all of you are gym people but there are certainly alternatives. I have read an article which touted the bone building results of one legged standing. Yep the forces transferred to the standing leg are enough stress on the bones of the hip and femur to result in bone formation. I then translate that as an example of the benefit of yoga poses done on hands and forearms, think of the possibilities. Of course the gym works too, as does walking with weights, but the bottom line is doing nothing will invest nothing. Yes calcium, but not ONLY calcium. As you can see the matrix is rich with many minerals, and is also influenced by two fat soluble vitamins: D and K. Vitamin D3 helps the minerals access bone tissue; gives them a ticket to get on the bone train. Vitamin K2 helps to keep that bone tissue more flexible so that the matrix is better able to bend rather than break. With all this in mind I am encouraging my female patients to choose a bone formula versus just calcium to ensure all these other aspects of bone nutrition are applied. Essential fatty acids are a must here too as they like Vit D assist mineral access to the bones…so those fish oils, cod liver oil and/or flax seed oil all contribute to better bone health.

For those who are already facing decisions about how to treat osteopenia (a precursor to osteoporosis) or osteoporosis itself the above nutrients are a must. I also recommend looking at hormone levels as they do indeed have an appreciable influence on bone health and may be overlooked by conventional practitioners. But most certainly what your medical doctors are recommending are biphosphonate drugs among other things. My concern with this classification of drugs is that yes they are helping to build bone, but not in a physiological manner. It’s true that when you take these medications and have follow up testing that there is more bone mass, BUT the basic mechanism of ‘break down old and then build new’ is not followed. To simplify this means that osteoblasts are stimulated to build, build, build but since there is only fragile bone as a foundation it makes for an overall weak combination…strong sturdy cement structure on old rotting wood. That’s not to say it’s a terrible choice for everyone, just one to weigh carefully, and as always with any medication ask about side-effect as there are some to consider here! Osteoporosis should certainly not be ignored as studies show that once the bones become weak enough and DO fracture; our life span decreases significantly.

Hope I have inspired you all to invest in your bone health…your stability and longevity will be your thanks!

Do something you love, Be with someone you love, Eat your vegetables, Drink clean water, Breathe deeply, and Move your body EVERYDAY!

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Healthy Aging

As we approach fall and the bounty of summer begins to wilt and wither it makes me think of the aging process normal and natural to all living things. It is not a phase of life many of us enjoy exploring but being prepared for the course of aging can benefit our quality and quantity of life. Understanding that there are too many specific health challenges to cover in this article, I hope I can touch on some basics, which I expect will apply to most.

Digestion…I will repeat what I’ve said before…this is the cornerstone of health. As we age so does this valuable system. The release of stomach acid decreases and with it the cues to pancreatic and gall bladder function begin to weaken as well. Individuals may have a lessening appetite, eat fewer and smaller meals, clearly this varies but is not uncommon. As digestion starts to deteriorate a VERY common symptom that arises is heartburn, for which acid-reducing medication is regularly prescribed. Sadly this quick fix is not a healthy long-term solution as the acid is required for essential vitamin and mineral absorption as well as overall digestive flow. Instead I would suggest a strong lemon or lime and water mix, or apple cider vinegar before or with your meals. This naturally acidic solution will instead strengthen the innate digestive function creating better health.

Inflammation…This is the root of disease, it’s really that simple. So logically if we can support the inflammatory pathways in a healthy and beneficial manner we can reduce the progression of diseases that deteriorate our health. The theory is simple it’s the practice that is a challenge, and again as individual lifestyles, genetics, etc vary there is no one simple way to assist this. One no brainer is to reduce your stress or at least learn techniques to manage it. Stress is pro-inflammatory, but when managed can lessen its impact on your overall health. I think as our world has become more stressful we see more activities like Yoga, Tai Chi and meditation gaining popularity because they offer natural stress reduction. Really any kind of exercise will count here, but if you are a go-go-go, anxious, or putting others before yourself type personality then a high impact workout would not necessarily be as nourishing as a slow-down, self-reflective one. Food choices are another must in this category. Quality fresh foods will be less inflammatory than highly processed foods…seems obvious. Another must for almost anyone is a good quality fish oil. A 500mg dose is ideal for healthy individuals…for those already suffering from inflammatory conditions a higher dose may be indicated, but check with a knowledgeable professional if you are uncertain what is safe for you.

Cognition…For many memory, thinking and speaking clearly are extremely important indicators of the aging process. Without touching on any one condition I think there are some terrific everyday tools, and nutrients that can support good cognition. Variety is not only important but also more fun. New foods, books, games, puzzles, routes to work, exercises, all increase the pathways in the brain. Doing some activity in your life where you are moving with your eyes closed is also great for the brain and your balance too. Learning in any way, like a language, artistic skill, craft or hobby can improve both the quality of your life and your brain function. One nutrient essential to brain function is B-12, remember to compliment any one B vitamin with a B complex to assure you are not creating deficiency elsewhere. I know you’ve likely all heard about Gingko, wonderful for helping to open and access those small blood vessels and capillaries throughout the body, especially prevalent in the brain. Ginger is another circulatory tonic that I would combine for brain function, along with Gotu Kola an herb full of antioxidants to assist in blood vessel damage and repair. A basic multivitamin would cover many of the nutrients discussed here, in addition a sublingual B-12; the herbs can be added if this is an area of special concern.

Appearance…the way we look creates much apprehension for many aging adults. This is not only our skin, and hair, but the way we move and carry ourselves. For both men and women it is extremely valuable to build muscle mass before our 50’s; this means performing weight bearing exercise in addition to cardiovascular or the more stress alleviating exercises discussed above. After menopause women have a more profound shift in their physiology which includes a muscle and bone loss. This occurs in men too, just not a dramatically. Keeping our musculoskeletal systems well nourished and flexible helps with ease of movement and long-lasting strength. Our skin is not so unlike this system as it is made of many of the same basic building blocks, namely collagen and muscles. Since the skin is such a rapidly growing organ, it shows the signs of aging more readily. The skin as a whole benefits greatly from the use of antioxidants…vitamins C,D,E, bioflavonoids like rutin, quercitin, resveratrol, and foods like blueberries, acai berries, pomegranate, dark leafy greens and green tea. These antioxidants are a valuable toolbox which enhance the health of our aging bodies.

I am not in the anti-aging camp, as with all things naturopathic I believe in supporting the natural processes of the body…of which aging is part. I certainly support any efforts to age in a healthy and vital way and hope these simple reminders can help you to achieve a bounty of health throughout your life.

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

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Prioritize your Health…Take a Vacation!

SUMMER IS an ideal time to vacation, the days are long, the weather pleasant, kids are out of school, and our dispositions are generally upbeat and energetic. A vacation can be anything from taking time off to stay home, flying to the Caribbean, or hiking deep into untouched land; spending time on vacation can honestly contribute to a positive effect on your health. Many other cultures have figured this out, allowing for weeks of vacation time, and really taking them. Sadly our American work ethic is lacking in this priority. So if your vacation time has racked up read on, get inspired, and start planning!!

Refocus. As we progress through a typical day we are constantly thinking ahead, what to wear, how to get through the to do list, what to make for dinner; it is a rare event that we sit and enjoy a moment in this day. Vacation, however, allows for a better concentration on the moment. Enjoying a sunset, listening to the sounds of birds, or smelling the delicious scents of a street vendors cuisine; those simple moments are so much a part of what we focus on in a typical vacation day. This refocusing allows the right ‘in the moment’ side of the brain full pleasure while insisting that the overworked left side relax and take a load off.

Relax. Certainly we can all relate to being more relaxed when on vacation. The phone call are fewer, the expectations little to none, the plan more flexible. This allows for the body to recharge the adrenals, bet- ter preparing them to act and react in the future. There are more chances to walk on the beach, hike a mountain, rent a bike for the day, move the body in ways that may not be as familiar or routine. Breathing deeply, when relaxed the body naturally breaths slower and deeper exercising more lung capacity and therefore supplying the body with even more oxygen. All aspects of relaxation rejuvenate the body, mind and spirit.

Rejuvenate. Where you go, who you see, what you choose to do on vacation replenishes the spirit. Whether that is family, friends, mountains, tropics or foreign adventure there is an enrichment that is a key component of vacationing. There are lessons you learn about yourself and others that are gathered in no other way then in the unique elements of your vacation. For families and couples this is often a chance to bond more deeply, sharing laughter, adventure, romance or passion. Conversations are richer and the concentrated time with others is often irreplaceable. Even those you meet on vacation are unforgettable… they excite us about the human spirit.

Refresh. Although routine is one of my favorites health tips, and something I highly encourage people to follow in their typical lives, when on vacation the tides turn. It is a chance to get out of those ruts no matter how good or bad. This is enlivening to the brain turning on new pathways, firing neurons and enhancing blood flow in places that may have been dark and unused. This forces you to think in new ways, opening the mind to new possibilities…ah how refreshing.

Remember. I find when on vacation I have the most terrific dreams, and memo- ries. Not only can we get more in touch with our deeper selves, we can establish new things to remember. There are new photos to hang on the fridge, and new stories to tell at work. People around you feel lifted by the experiences you’ve had and you have a new outlook on life. Not to say the novelty of a vacation sticks around long, and that old habits and routines don’t return…but the memories are forever.

Repeat. A good vacation doesn’t have to be exotic (although one of those every decade or less doesn’t hurt) to be important to your health and overall well-being. It just takes a little forethought and planning to prioritize this very pleasurable celebration of life. Vacation may not be a priority for all you readers, but I am here to say it is a necessity…so practice often.

Spin the globe, or get out your road maps and pick your destination to embrace this essential prescription for health!

Do something you love, be with someone you love, eat your vegetables, drink clean water, bBreathe deeply and move your body everyday.

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Gluten-Free…Is It For Me?

Go ahead honey, it's gluten freeFOOD HAS become an increasingly complicated topic in our country and the world.  Despite the fact that we have a seeming abundance of choices here in the U.S., really when you study the ingredients in most packaged foods you will likely find either wheat, dairy, corn, soy or sugar on the list.  It is therefore no wonder that these foods are causing increasing issues in our bodies and our health.  And it now seems that most of us are trying to avoid one or more of these food groups in an attempt to address our health concerns.  So let‘s explore gluten shall we?

First of all what is gluten?  It is the protein element of a group of grains which include wheat, barley, rye, spelt and oats (oats have a minimal amount of gluten in comparison to others listed, so are tolerated by some who are otherwise gluten-sensitive).  When you look at a grain it’s basically a seed structured kind of like an egg.  There is the outside portion (the shell) which is fibrous and protective…this is called the bran or husk.  Then there is a large inside portion, the endosperm (the white), which contains protein and carbohydrate; this is where gluten is found.  And finally the germ (yolk) which is the fatty portion where new plant growth would initiate if it were planted.  It is a perfect package of growth potential and nutrients all protected and awaiting its destiny to create more…

So how did this perfect package transform into the beast of gluten wreaking havoc on our bodies?  Well sadly that’s our fault.  Basically we are impatient with our food supply and want to pick it earlier and make it into something easier than a whole grain.  Traditionally harvested grains would have been cut and let to sit in the field to ‘mature’ allowing the process of germination to occur.  During germination the little germ would consume the endosperm in its attempt to initiate growth which would in turn lower gluten content.  Along we come with our combine harvesters which pick and process the grain so efficiently that this development never gets a chance.  Next we mill these somewhat immature grains often removing the husk (fiber) and germ (fat) so all we are left with is the endosperm; this carbohydrate and protein portion is ground into a fine white powder which is now…flour.  This highly processed flour is a tiny chopped up particulate of its original form and without the fiber and fat the absorption is much faster and far less balanced.  Those admirable people who soak and grind their own grains are returning to the old tradition, which is entirely possible for you too!  For most, however, this is far too arduous a way to get that loaf of bread, tortilla, cracker or other staple we seek…we simply don’t have the time to eat this way.  So now we just simply avoid it!?!  And what about other grains like rice, corn, quinoa, amaranth, and buckwheat?  Yippee they’re gluten-free!

OK so the processing sounds a bit un-natural but why gluten?  Well proteins are what the immune system recognizes when roaming the body looking for invaders.  AND the reaction of gluten in the digestive system can cause an inflammatory response in the cells, among other things.  Once you have gut inflammation the chances for ideal digestion declines; more gluten passes between the inflamed cells rather than through them and therefore the chance for immune dysfunction increases due to increased exposure…voila leaky gut, gluten-intolerance, auto-immunity, etc, etc, etc.  And I’m picking on gluten here but I could easily be writing this article about casein in dairy, albumin in eggs, soy, corn, you get the picture?

So gluten-free, that’s the answer?  Yes and no.  For those with Celiac disease yes.  For the rest of us, maybe, for some time.  There are a variety of tests both conventional and not that can identify the severity of the problem and the road to recovery…so seek some advice if you need more guidance.  I think the conversation we are not having in this gluten-free craze is what about healing the gut?  What are we doing to correct the improper digestion and inflammation?  Did you know that the cells of the entire digestive tract regrow every 120 days?  That means that in 3 months there is a distinct possibility of having a whole new digestive system!  Sadly in my experience it’s not usually that fast, but I think regrowth and regeneration are absolutely possible.  But yes to heal the gut we have to remove the offenders at least for some time.  We also need nutrients like l-glutamine, antioxidants, probiotics, and herbs like slippery elm powder, turmeric and elderberry.  We all need to eat more mindfully both in our food choices and sitting, chewing, tasting, and assimilating our food as best we can.

Another tool to enlist is stress reduction as any one of you I’m sure can attest; high stress makes for troubled digestion.  It’s summer!  Enjoy time at the beach with your family or your dog.  Putter around the yard in awe of the growth that surrounds us here on the coast.  Go camping and leave your cell phone off and just enjoy the stars.  These are the things that will heal your spirit and your body.  This is all just scratching the surface in terms of healing modalities available, but I hope I have shed some light on gluten and gut health because gluten-free may not be the only key.

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

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Got Questions?

This month I want to take time to answer a few questions.  These are either from you, my readers, or frequently asked from my patients.  I always welcome questions and comments as they often give me great ideas for upcoming articles, so keep them coming to erflingnd@hotmail.com

What are the best sweeteners?  Many of us are turning up our noses at artificial sweeteners (thankfully), and so what should we use instead?  There are indeed a litany of options from table sugar to honey so let’s go through some of these ‘sugars’ to find out what they are and which suits our health best.

Let’s begin with the sources that are least refined and closest to how nature intended…honey, maple syrup, fruit and fruit juices.  In my mind these are the ideal sugars to utilize in our diets because they are food and take little to no refining from their natural form to make things a little sweeter.  Honey quite specifically has some wonderful health benefits in that it contains vitamins and minerals, antioxidants, enzymes, and can improve immune function in conditions like allergies.  Similarly maple syrup and fruits offer some terrific health benefits.  Along with molasses (a refined product from sugar cane which is incredibly nutritious), these are my sugars of choice!

Now there are many refined sugars which are touted to be more natural and healthy than table sugar…some examples are turbinado, agave syrup, brown rice syrup, and fructose.  The similarities with these is that they are all refined sweeteners, the difference is their source.  Turbinado comes from sugar cane (like white table sugar) but is a little more raw (less processed) therefore has larger crystals and is a tan color due to the retention of some of the molasses within the cane itself.  The syrups come from the plants mentioned and fructose is the sugar within fruits, which is refined into a powder.  There are pluses and minuses to each of these so my advise would be to use sparingly.

White table sugar, commonly from sugar cane or sugar beets, is the most refined sugar product, and while if given the choice of this over aspartame I would choose this every time it is still not a nutritious option for our bodies…so I put it on the generally avoid list.

The newest member to the sweetener family is Stevia, a plant which has an extreme sweetness concentration.  The interesting thing about Stevia is its positive effects on blood sugars despite its sweetness; BUT mind you these studies were done with crude herb not stevia sweetened blueberry muffins, so while I am considering this to be a worthwhile option I am keeping a scrutinizing eye on this trend.  You can find Stevia in powdered form and in lots of prepackaged products.

Remember the big picture here is our obsession with sweetness not solely the sweetener itself.  So yes for those with an extreme sweet tooth finding healthier options is worthwhile, but appreciating other flavors (bitter, savory, spicey, etc.) is key!

Antibiotics, I get a lot of questions about antibiotics.  If they’re needed, dangerous, what other things can be used instead of them and how to recover from their use.  All good questions!  Without getting too specific, there are indeed some situations where antibiotics are absolutely warranted, and that is best evaluated in a doctor’s office.  Yes, naturopaths can prescribe antibiotics.  No, antibiotics are not inherently dangerous, it is their overuse which is concerning; and I’m not talking solely about those that are prescribed, but those that are also in our food supply/farming practices, and homes (i.e. hand sanitizers).  Our microbe paranoia is making our medicines weaker and them stronger, and that is concerning.  Yes!  There are situations where natural medicines can certainly be employed, again under the guidance of a licensed professional.  Herbal medicine and nutritional supplements can create weakness in microbial growth along with immune strengthening to make for a powerful healing combination.  Making sure that there are adequate levels of good/normal microbes in the digestive system is a key to avoiding infection as well as recovering from antibiotic use.  I’m talking probiotics here, you can take these with your antibiotics and definitely following.  Yes, there are so many choices (get something with multiple organisms on the list of contents, and refrigerated…take more than once a day) and yes there are foods, which when eaten regularly, can enhance your probiotics status (yogurt, miso, tempeh, raw sauerkraut, kim chi, Kombucha, Kefir, etc).

Insurance coverage is certainly a common question I get regarding my care.  Thankfully many insurance companies are carrying plans that cover naturopaths.  BUT those same companies usually have a variety of different plans with a variety of coverage options.  So it’s not always as simple as asking ‘do you take such and such a company?”.  I always advise my new patients to call their insurance company and ask whether naturopathic care is covered under their plan prior to our initial visit.  Another thing to remember is that many plans have a deductible, a set amount of money that must be spent by you BEFORE the insurance company begins to pay anything; yet another detail to understand prior to an office visit.  This may mean that the insurance accepts the visit and applies it to the deductible but you are still responsible for paying the doctor.  Remember that insurance is a contract between you and the company, that we the doctors are dealing with multiple companies so are not going to be nearly as well versed in the language of your insurance plan as the company itself.  And a final note is that Medicare does not recognize naturopathic physicians at all, so this means they will not cover our care and often the secondary or supplementary insurance will not either as they are generally abiding by the same rules as Medicare.  It is a confusing and convoluted system, and you the consumer have more power to change it than me the doctor, so make sure and speak up about what type of coverage you would spend your dollars to use…change is slow but possible!

Hope that clears the air a bit at least for these few questions…again keep them coming and remember…DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!!

Categories
Bodies In Balance COLUMNS HEALTH

Spring Cleansing

Spring is here!?! So I thought it time to revisit the idea of cleansing, a must for me this time of year, hope you will consider it for your health too.  Spring is a time of change and transition.  The ground is warming, new green growth is emerging and the winds are gently turning over wintered waters – so it is in the body as well.  The forces of nature are at work in us too, and the body needs our help to clean the waterways of the blood.  So let’s talk about cleansing, as it is a fundamental of health and naturopathy.

There are many words to describe what I am talking about – detoxification, purification, cleansing, and there is also fasting so let’s clarify.  Cleansing, detoxification and purification are all focusing on clearing certain organ systems of toxins in order to help them function better – kind of like changing the oil, cleaning out the junk drawer or sweeping the chimney. Ideally the major organs of detoxification are supported:  liver, kidneys, lungs, colon, and skin.  Cleansing commonly involves herbal or nutritional products to promote the pathways of detoxification along with dietary restrictions.  Fasting has some of the same ideas in mind but is most commonly focused on food restriction.  Water or juice fasts can give the body a needed rest from digestion, therefore lowering the demand for those functions for a finite period of time. Either system can tune up your body but some methods are likely a better fit than others depending on the individual – so seek guidance from a knowledgeable health care practitioner before launching into your program.

Tracy ErflingWho might need to cleanse? Well frankly we all do.  If you live in a city, eat packaged food, drink alcohol, coffee or tap water, smoke, are around chemicals, car exhaust, the list is sadly endless; then you are a candidate.  Some of the signs from the body that the detox pathways are overworked and undernourished are fatigue, poor sleep, digestive problems, foggy thinking – sounding familiar? Even if you live as pure as you possibly can, I would guess that your body would still reap some benefits from a cleanse.

So what are some elements to a cleanse? Let’s start with the food component. While cleansing it is ideal to break from packaged/processed foods – this would include most grains, dairy, soy, corn, sugar, alcohol, caffeine, and processed, highly preserved meats.

What does that leave?  The basics, vegetables and fruits, a single serving of a whole grain daily, legumes (that’s beans), clean (organic, free-range, grass-fed whatever this may mean to you) lean (fish, poultry and eggs) meats if you desire more protein, otherwise vegetables and fruits only are fine. Watch condiments, sauces and dressings as they commonly contain some unwanted additions.

I would also recommend a meal replacement mix, as whole food based as possible, and without any of the aforementioned no-nos. Fiber is a must; bowels should be regular if not increased during a cleanse…this means going daily or more than once a day.  Antioxidants are also a must, as the body needs that extra help to neutralize toxins as they are cleared. Filtered or purified water, at least half your body weight in ounces. Lastly be gentle with yourself, don’t plan a cleanse during a high stress event, vacation, or important holiday.

Make sure your exercise is gentle and supportive, spark up the sauna for a low temperature sweat or fill the tub for some Epsom salt and baking soda baths.  I also encourage cleansers to set up some regular massage or acupuncture to promote good lymphatic flow throughout the body.

The lungs are yet another organ of elimination and deserve some attention here as well.  Breathing is a mindless act we perform 24/7 but the irony is that despite the fact that we don’t have to think about breathing – we still don’t do it right.  We tend to be shallow breathers only using the upper lobes of the lungs. So here’s a deep breathing exercise that I encourage you to introduce into your daily routine, especially during this cleansing time. While lying, place your hands over your lower abdomen (around the belly button). Take a deep complete inhalation into your belly so that you feel your hands rise, exhale and feel your hands descend. Count as you inhale (1,2,3,4) and exhale (1,2,3,4) and work towards having the same number for each. After you can achieve that work towards increasing that number, and then begin to focus on the transition between in and out breaths. I recommend trying this when lying in bed; do at least 5-10 repetitions and let your thoughts focus entirely on the breath.

This exercise will not only cleanse the lungs but the mind; setting aside time to be introspective is a key element to involve mind and spirit!

These are the basics of the program I recommend (although there are many others out there), even though it may sound complex; it’s all about simplifying.  Each time I cleanse I learn about my world, and myself so I encourage you all to do the same.  I can think of no better way to celebrate spring, the natural world, and your health.

Categories
Bodies In Balance COLUMNS HEALTH

Weighing in on the Problem of Weight

Tracy ErflingTHERE IS NO MORE concerning issue facing my patients, our country and the world than our increasing weight. It is a complex and multi-faceted issue, which is by no means solved with a single recommendation, but instead a careful evaluation of the individual. I would like to attempt in this article to shed light on some of the contributing factors and potential solutions. Some of you will relate, others will continue to be perplexed, but my hope is that everyone will see the possibilities for success.

Starting with the obvious, diet and exercise is a must. When counseling people on weight control it is imperative that this issue is explored in detail. Just laying out the basics is often an eye opening experience for many, especially if they have never been given some simple guidelines, which frankly are rarely addressed. Let’s first look at eating patterns…do you regularly skip meals, go long periods of time without eating, or frequently go without breakfast? Now by the calorie only theory this method would seemingly work because we are using more calories than we are consuming. Indeed a useful thought, unfortunately there is a big BUT here (unintended pun). When there is no fuel coming in we have to create it from within and this happens by means of cortisol, our adrenal stress hormone. When we overproduce this hormone there are many consequences, one of which is the release of insulin, our storage hormone, so fat storage begins. When insulin is released in this way (as opposed to the increase of blood glucose from food digestion) we begin to become less sensitive to its message, which then compounds the whole problem.

Another important question is not so much what you eat but what are you drinking? Many are consuming high amounts of sweet beverages – sodas, juices, flavored waters, sport drinks, and the ever popular coffee drinks. Now granted many of these drink may be sugar free or have low calories, but even so they are sweet! Just having something sweet sets off this whole insulin cascade; add to that the fact that beverages are fairly instantly absorbed into the blood stream (no fat, protein or fiber to slow the digestion) means they almost immediately affect the blood sugar/insulin system. So back to plain old boring water huh? Yep! OR make sure your sweet beverages are consumed with a meal versus alone, AND set some limits on this treat for your taste buds. Also worth checking out are beverages that aren’t sweet, green or herb teas, black coffee, or mineral waters (for those who like the bubbles) are some ideas to try.

Exercise (like water) is just a must, I can’t think of any way around it. These bodies are meant to move, they were not designed to sit all day! This is where we return to calories in calories out. It is indeed an important balance of weight maintenance. So for a very sedentary person there are WAY fewer calories necessary than for a more active person (regardless of weight). There are some terrific websites or apps for your smartphone to help track this balancing act, and of course this is also the keystone for many popular weight loss programs. I will add that exercise is very different from an active job/lifestyle. There are some very essential reactions from a vigorous walk as opposed to running around after your toddler. One of which is the effect on blood sugars, so yes I am saying that if you have that double mocha latté AND go to your spinning class you’ve created far more balance than without…FIND THE TIME!!

So you knew this already, many of you did and hopefully you are employing that knowledge! The connection recently made to me, and hopefully a new insight for you, was related to estrogen. This is a powerful hormone which although associated primarily with women is also pro- duced in small amounts by men and is certainly a player in weight management for both sexes. Estrogen and cortisol are in cahoots with one another, meaning when one is high it can increase the other. Estrogen is also increased with inflammatory conditions again through this cortisol connection. What are some other sources of estrogen? Well if you are already overweight it is stored in and released from your fat cells, and sadly much comes from our environment. Plastics, skin care products, food additives (i.e. dairy and meat) to name a few; it is an incredibly prevalent hormone which is creating some unfortunate consequences in our health. What’s the answer? Good quality dietary fiber, cruciferous vegetables (broccoli, cauliflower, kale, brussel sprouts and cabbage), and progesterone balance. But as with all hormones this is not a solution to take lightly, whenever I suggest hormones I can only recommend doing it under the supervision of a qualified professional as all too often I see self administration of hormones causing as many problems as it can potentially solve.

Sleep! A good night’s sleep will help to clear many of the problematic hormones mentioned above. Good elimination, this is something to optimize from the bowels, liver, skin and kidneys. If you are not pooping, peeing, sweating or detoxifying properly, weight loss will be more difficult. And how can we ignore the ever important endocrine glands, especially the thyroid and adrenals. There are of course some great lab tests available to evaluate these, but a simple in home test would be to average your first morning temperatures for 5-7 days. If you are averaging below 98 degrees Fahrenheit then you may be a good candidate for professional evaluation and treatment.

Phew, weight loss is exhausting and for many a life-long pursuit. I hope I have shed light on some new food for thought, or better yet action against this weighty concern.

Do something you love, Be with someone you love, Eat your vegetables, Drink clean water, Breathe deeply, and Move your body EVERYDAY!!

Welcome Back Hipfish! Thanks to all who helped contribute to the return of this fabulous monthly.

I am delighted to be sharing my health musings once again…
Cheers!