Bright Light: Depression, Insomnia, and the sleep/wake cycle


I recently wrote an article for the Natural Medicine Journal about a study that showed the positive effects of wearing bright light glasses to treat depression. Bright light therapy has been popular for the past few decades to treat seasonal as well as non seasonal depression, but this is the first study to utilize a device that is worn like a pair of glasses and shines light down into the eyes of the wearer. In the past, subjects have used light boxes which work equally well, but the glasses have the advantage of allowing the wearer to be able to do other things during treatment.

While this study is interesting in itself, it brings up some fascinating questions about the role of light and dark, the sleep/wake cycle, and the establishment of a healthy circadian rhythm in mood regulation.

In this particular study, the participants (who were all teenagers receiving inpatient treatment for depression) were asked to complete a “Chronicity” questionnaire to establish their most productive time of day. None of the participants were found to be strongly morning people. There are many studies that have found a link between “eveningness” and depression. Additionally, insomnia (which is associated with eveningness) has been found to have an even greater impact on negative emotions.

So how does bright light impact the body to influence emotion and the circadian rhythm? In studies of bright light therapy, the light used emits 10,000 lumens, which is roughly equivalent to sunlight 40 minutes after sunrise on a clear day. When light hits the retina of the eye, the retina itself actually produces serotonin and dopamine, which help to maintain a good mood. The glasses in particular (as well as sunlight) emit blue light, which is the part of the visible light spectrum that is most stimulatory. We can surmise that if a person is spending the majority of their most wakeful hours when it is dark, it is possible that they aren’t making as much of these chemicals.

Conversely, blue light in particular suppresses retinal production of melatonin, which is one of the primary neurotransmitters responsible for sound sleep. Most of us have heard that watching screens such as the computer, TV, or phone before bed can impact sleep. This is because blue light emitted from these screens prevents the body from making melatonin which is necessary for sleep. Studies have found that people who wear blue-light blocking glasses for three hours before bed can correct insomnia and have more restful sleep.

Regardless of your light source, starting the day with exposure to healthy bright light will help you to make the chemicals you need to keep your mind feeling happy and at ease. At the end of the day, minimizing exposure to bright light and blue light in particular will help your body fall asleep more easily and have a more restful night!

“We Think What We Eat?” How the Health of the Gut Impacts the Health of the Mind

We have all heard of the “mind-body connection.” This is the theory that the way we think (positive, negative, anxious, relaxed etc) influences the health of the rest of the body. Our thought patterns initiate a cascade of neural and hormonal signals that have the potential to impact how all the systems of the body function; anyone who has ever gotten a stomachache from worrying about something has first hand experience of this.

However, what about the opposite? We are finding that more than we ever realized, the health of the digestive tract can profoundly impact our mental health.

Going back to the stomachache example, there is a fascinating interplay between our digestion and mood, referred to as the “gut-brain axis”. Stress hormones and neurotransmitters produced during times of anxiety and stress can alter the integrity of the digestive system, which can lead to chronic GI problems such as IBS or other inflammatory diseases. Going the other way, the function of the gut generally, and the makeup of the microbiome specifically (the bacteria that normally live in the digestive tract) can have a profound impact on symptoms of depression and anxiety.

Studies are suggesting that major stressors early in life can predispose a person to inflammatory bowel disease (IBD). The two types of IBD can also be called Ulcerative colitis or Crohn’s disease; these are long-lasting, possibly lifelong conditions that break down the walls of the gut and can profoundly impact a person’s digestive capacity. Those damaged intestinal walls release a variety of chemicals that trigger similar inflammatory responses in the nervous system, causing anxious and depressive symptoms. Similarly, in Irritable bowel syndrome (IBS) cells from the walls of the intestines have been found to produce lower amounts of serotonin, one of the primary neurotransmitters that helps us feel happy and balanced. This leads to increased sensations of discomfort in the gut, but also communicates with the brain to decrease the mood.

Even beyond the signals sent by an inflamed gut that can irritate the brain, the makeup of bacteria living in the digestive tract (what we call the “microbiome”) also significantly impact mood. The bacteria in the microbiome produce many of our neurotransmitters, such as GABA, serotonin and dopamine. These chemical signals impact mood by traveling from the gut up the vagus nerve to the brain. Particularly in IBS, many studies have found that reestablishing a healthy microbiome will improve digestive as well as emotional symptoms. A new class of drug has even been introduced, called a “Psychobiotic”. The idea behind these is that the patient ingests probiotic bacteria designed to produce mood enhancing neurotransmitters in the gut, thereby improving mental health.

Athletes in particular have been found recently to have increased rates of digestive concerns along with increased anxiety and depression. It is theorized that intense training for elite athletes causes stressors that deplete the lining of the digestive tract along with changing the makeup of the microbiome. Additionally, many elite athletes are counseled to eat diets that are very low in starch, which is the primary food source for most of the “good” bacteria that lives in the gut. This further attenuates the microbiome, which causes more digestive disturbance and lower production of neurotransmitters and can result in IBS, anxiety, and depression.

So what can we do every day to improve the health of our digestion and our mental health?

  • Stress management: stress (fight or flight) hormones suppress our rest and digest hormones. This means your digestive tract does not rejuvenate itself when we are stressed out which can make it sick.
  • Eat a healthy variety of plant based foods to replenish healthy bacteria to the gut. This includes organically grown produce, healthy complex carbohydrates such as whole grains, root vegetables, and winter squash, and naturally fermented foods such as sauerkraut and pickles.
  • Eat in a relaxed manner to engage your rest and digest hormones.  No standing at the sink or eating on the run!
  • If you are having trouble digesting your food, Warming foods such as soup and steamed veggies are easier to digest than cold foods like salads and veggie sticks.
  • Adequate sleep also gives the digestive tract time to rejuvenate itself.  If your brain needs more sleep so does your gut!
  • If you are training for an athletic event, make sure to include rest days and rejuvenating activities such as restorative yoga, stretching, breathing exercises, or tai chi to help the digestive tract restore itself.

Good luck and happy eating!

IgG Food Sensitivity Testing and Reducing Inflammation

Food Antibody testing is one of my favorite tools for helping patients take charge of their own health, especially if there is a chronic inflammatory concern such as eczema, joint pain, digestive upset, or even mental agitation. Virtually all chronic disease has an underlying inflammatory component–that is, any long-term health issue, regardless of what system of the body it effects, is the result of ongoing inflammation.

So what is inflammation?  

It is the natural process the body uses to repair damage to the system and get rid of organisms that make us sick.  When an infectious agent such as a virus or bacteria enter the body, our immune system will recognize that foreign agent and attack it.  White blood cells are our immune cells that mount this attack. Specialized white blood cells will make a “flag”, called an antibody, that recognize certain proteins as foreign.  When they recognize a protein, those antibodies will attach themselves to those proteins (that often are part of a virus or bacteria) and signal the rest of the immune system to eradicate it.  Other white blood cells will engulf the protein, digest it, and then spit out the remains of that protein to be eliminated by the lymph system. This process produces inflammation, which we experience as redness, swelling, heat, and the production of mucus.  

How does this relate to foods?  

Well, in some cases, the body will recognize other proteins that come into the system as foreign.  This can include things like pollen, cat dander, mold spores, or proteins in foods. The body will mount a similar type of attack as described above on these proteins in the body even though they aren’t necessarily pathogens (bugs that will make us sick).  Instead, we call them allergens. If we are continually exposed to these allergens, the body will chronically produce inflammation. While a food may not be the agent that initially triggered the inflammatory response, the body may continue to have an inflammatory response if the food is eaten regularly.  Although foods may not be the only cause of chronic inflammation, they are one factor that can easily be changed without medication that can make a great impact on reducing the inflammatory response.

So what is IgG testing?  

IgG is a type of antibody–the “flags” the body uses to tell the immune system to make inflammation in a specific place.  Our body makes a range of types of antibodies that all do something slightly different. For instance, IgE antibodies are associated with immediate sensitivity reactions–if you know anyone allergic to peanuts or shellfish, for example, you may have seen that type of immediate reaction where the body reacts right away. IgG is a delayed antibody that may take several hours or even a couple of days to react, so it can be quite difficult to pick it out which food is causing the inflammatory response.  For this reason, a delayed food sensitivity can manifest as some of the more ongoing types of reactions, such as joint pain, IBS, eczema, chronic sinus issues, asthma, autoimmune thyroid disease, and even chronic mental agitation. Of course, we can eliminate and reintroduce foods to our diet without any testing, but elimination diets can be laborious and confusing. When we test first, it gives us an idea of the best foods to eliminate first instead of choosing blindly.  Several clinical trials in recent years have found that using IgG testing to guide food elimination can have a positive impact on many chronic issues, including inflammatory bowel disease, eczema, and migraine headaches.

Once I find out which foods I’m reacting to, what do I do?  

This is my favorite part, because it allows us to be scientists with our own bodies.  In a nutshell, the scientific method involves taking a system, changing something within the system, and observing the changes. When we actively change the diet, and pay attention to what happens, we do a little scientific experiment on ourselves that gives us the power to decide how we are going to feel each day based on the decisions we make.  When we do a food elimination, I like for you to eliminate all the potential offending foods that may be causing inflammation in your body. We give your body a few weeks–usually 4 to 6 weeks–to help the system come to a more neutral state. At this point, you note how you feel without all of those foods.

How Do I Reintroduce Foods? 

Once you have eliminated foods for an appropriate amount of time, we will  start to reintroduce foods one at a time. You will find that one of three things happens: 1. You take away a food, feel no different, then add it back, and feel no different.  2. You take a away a food, feel better, then add it back and feel obviously worse. Or 3. Somewhere in the middle–you take away a food, feel better, then you can add it back in a dose-dependent fashion and feel ok. (for example–you can tolerate eggs in baked goods but don’t feel well when you eat scrambled eggs for breakfast). When you reintroduce a food and find it bothers you, I recommend continuing to stay off of that food for at least 6 months.  For some people, a food intolerance will last for life, but for some, if the body becomes healthier and more robust overall they will be able to successfully reintroduce foods.

The knowledge you gain from eliminating and reintroducing foods helps develop what I view as the most powerful tool you have to maintain your health:  self awareness. The more aware we are, the more powerfully we can act. When we understand how our actions influence our overall state of health, we gain the ability to work as our own doctors.

Thank you for letting me be a part of your health journey!

 

Zar S1, Mincher L, Benson MJ, Kumar D. Food-specific IgG4 antibody-guided exclusion diet improves symptoms and rectal compliance in irritable bowel syndrome.Scand J Gastroenterol. 2005 Jul;40(7):800-7.

Aydinlar EI1, Dikmen PY, Tiftikci A, et al.  IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013 Mar;53(3):514-25.

Alpay K1, Ertas M, Orhan EK, et al. Diet restriction in migraine, based on IgG against foods: a clinical double-blind, randomised, cross-over trial. Cephalalgia. 2010 Jul;30(7):829-37.

Mitchell N1, Hewitt CE, Jayakody S, et al.  Randomised controlled trial of food elimination diet based on IgG antibodies for the prevention of migraine like headaches. Nutr J. 2011 Aug 11

Liu Y1, Yan H2, Shao F3,et al. Correlation between childhood eczema and specific IgG antibody level. J Biol Regul Homeost Agents. 2018 Mar-Apr;32(2):341-344.

 

The Medicinal Uses of Honey

Over the past two years, our family has embarked on an adventure into the world of beekeeping–and an adventure it has been! We have all enjoyed suiting up and walking out to the field to tend the hives. Between observing their behavior, learning how to care for bees and beehives,, collecting swarms, and processing honey we have learned and enjoyed so much about having these amazing and beneficial creatures in our backyard.

While honey has been used for thousands of years for its healing properties, there are many scientific studies that have recently established its utility for a number of issues. It is anti-inflammatory, moisturizing, antimicrobial, and promotes healing. In my mind, honey is best used to heal the skin and membranes of the mouth and nasal cavity from wounds and infections. Honey promotes wound healing by killing bacteria, reducing the size of the wound, improving the growth of healthy new cells, and decreasing scarring. It is postulated that antioxidant properties of honey improve wound healing by decreasing free radical damage.

There have been many studies that have shown the ability of honey to kill infectious bacteria, primarily because of the presence of hydrogen peroxide in the honey. When tested against mupirocin (a common topical antibacterial), honey worked equally well to kill meticillin resistant staph aureus (MRSA) that was growing in the nasal cavity. Some types of honey, such as manuka honey, also contain a chemical called methylglyoxyl, which is not as easily deactivated by enzymes in human blood. This gives these types of honey even greater antibacterial activity.

My favorite use of honey is for assisting in the healing from upper respiratory infections. It soothes the mouth and throat, decreases the cough response, and decreases any bacteria that could be aggravating the infection. Most people are familiar with the old time remedy of honey and lemon in water to soothe a sore throat and decrease a cough. Multiple studies have shown the ability of honey to decrease coughing, particularly at night. When tested against dextromethorphan (robitussin), diphenhydramine (benadryl), levidroproprazine (an antitussive more common in Europe) salbutamol (albuterol) and placebo, honey worked as well or better than all of these except dextromethorphan for decreasing cough and helping to sleep without being woken by that cough. Given the potential for side effects of all of the above medications and the efficacy of honey, it a no-brainer to try this first for treating that cough that’s keeping you up at night.

With this in mind, I use honey as the base for my cough and cold syrup that I make for my patients and my family during the cold and flu season. I make an herbal extract with a combination of herbs, including licorice root and yerba mansa to assist in healing the lining of the mouth, throat, and nose, osha to clear out mucus, wild cherry bark to decrease the compulsion to cough, and elderberry to stimulate the immune system. This mixture is combined with local honey and turned into a tasty and effective syrup that I call “Dr. Kaycie’s Slime Buster”. It is safe and effective for kids over the age of 12 months as well as adults. Feel free to let me know if you want to know more about it!

Molan P1, Rhodes T2.Honey: A Biologic Wound Dressing.Wounds. 2015 Jun;27(6):141-51.
Morroni G1, Alvarez-Suarez JM2,3, Brenciani A1 et al. Comparison of the Antimicrobial Activities of Four Honeys From Three Countries (New Zealand, Cuba, and Kenya).Front Microbiol. 2018 Jun 25;9:1378.
Willix DJ1, Molan PC, Harfoot CG. A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of manuka honey and other honey.J Appl Bacteriol. 1992 Nov;73(5):388-94.

Abd Jalil MA1, Kasmuri AR, Hadi H. Stingless Bee Honey, the Natural Wound Healer: A Review.Skin Pharmacol Physiol. 2017;30(2):66-75.
Oryan A1, Alemzadeh E2, Moshiri A3.Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis.J Tissue Viability. 2016 May;25(2):98-118.
Poovelikunnel TT1, Gethin G2, Solanki D3, et al. Randomized controlled trial of honey versus mupirocin to decolonize patients with nasal colonization of meticillin-resistant Staphylococcus aureus. J Hosp Infect. 2018 Feb;98(2):141-148.
Honey for acute cough in children. Cochrane Database Syst Rev. 2012 Mar 14;(3):
Miceli Sopo S1, Greco M2, Monaco S2 et al. Effect of multiple honey doses on non-specific acute cough in children. An open randomised study and literature review.Allergol Immunopathol (Madr). 2015 Sep-Oct;43(5):449-55.
Oduwole O1, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Evid Based Child Health. 2014 Jun;9(2):401-44.

Oduwole O1, Udoh EE, Oyo-Ita A, Meremikwu MM.:Honey for acute cough in children.Cochrane Database Syst Rev. 2018 Apr 10;4

Holistic Approaches to Inflammation and Chronic Disease

An Introduction to Chronic Inflammation

In many chronic disease states, inflammation is a common underlying factor.  If you are suffering from something that ends with “itis” (arthritis, tendinitis, pancreatitis, diverticulitis, etc), this is a medical term for “that part of your body has inflammation”. So what is inflammation?  On the large scale, we look for heat, redness, pain, and swelling; these are all key factors that tell us inflammation is taking place. Microscopically, we see that blood vessels become more permeable and extra fluid and immune cells come to the area to protect and heal the body and remove waste from the area.

What is the purpose of inflammation?  It is your body’s natural defense system: this is how your body protects and heals itself in cases of infection, allergy, and injury. When a foreign organism such as a bacteria, virus or fungus enters the body, your immune system launches a highly sophisticated attack to kill the invader and then clean up the remains of the battle afterwards.

While inflammation is a very important and appropriate action for the body to take, when it pops up in inappropriate places or continues on beyond the normal course of infection or injury it causes chronic pain and damage to that part of the body.

Chronic inflammation is the underlying cause of many very common chronic diseases.  Cardiovascular disease, arthritis, asthma, autoimmune thyroid disease, IBS and other digestive disorders, and eczema are all cases of chronic inflammation. When inflammation becomes chronic the area will be in a state of simultaneous destruction and healing, which over time can lead to scarring and loss of function.

Conventional treatment for inappropriate inflammation primarily relies on four types of drugs, all of which act by suppressing a key component of the body’s inflammatory response: Steroids such as prednisone mimic your body’s stress hormones’ ability to suppress inflammation.  Nonsteroidal antiinflammatories such as ibuprofen and acetomenophen suppress an enzyme called cyclooxygenase that creates the mediators that cause inflammation in the body.  Biologic drugs such as embrel and humira block the action of another inflammation-causing protein called Tissue Necrosis Factor. For more allergic sypmtoms, antihistamines such as Allegra suppress the release of histamine from allergic cells.  Although the effects of all of these drugs have different effects and can be quite useful to control symptoms in the short term, what they all have in common is that they suppress our body’s natural reaction to an underlying issue and can have significant unwanted side effects.  

There are a few primary concerns regarding the use of conventional medications for reducing inflammation. In the case of steroids and biologic drugs, they can suppress your immunity, leading to unwanted infection that can be difficult to treat.  NSAIDs can damage the liver, gut and kidney.  Antihistamines impact the nervous system and can cause drowsiness, hyperactivity, a decrease in secretions to the eyes, nose and mouth, and difficulty in urination. Rather than suppressing natural function, the goal with natural treatments is to divert the body’s innate function towards anti-inflammatory pathways.

Natural options for minimizing inflammation

There are three key elements to minimize inflammation holistically:  Exercise, Diet, and Supplements.  If you feel good now and want to minimize inflammation in the long-term, diet and exercise are a great place to start.  If you are already in a position where inflammation is a concern for you, botanicals and supplements may be necessary to get things under control.

Exercise:  While in the short-term exercise can trigger an acute inflammatory reaction, research has shown a long-term moderate training regimen decreases the body’s production of inflammatory cytokines.  The inflammation that is caused by working out is important for remodeling and building muscle mass.  In fact, post-workout treatments such as ibuprofen and icing the area have been shown to decrease the body’s ability to build muscle mass.  As the initial inflammation post-workout decreases, though,  It is important to keep in mind, however, that repetitive exercise that pushes the muscles past their capacity, such as long-distance running and body building, cause short-term inflammation (aka, delayed soreness after working out) that over time causes scarring damage to the muscle fibers.

Diet:  There are three basic components to reducing inflammation in the diet:  Eat more antiinflammatory foods, eat fewer pro-inflammatory foods, and avoid allergens or sensitivities.

Antiinflammatory Foods are those that support healthy digestion and improved liver function help the body rid itself of wastes that can trigger inflammation.  These include high fiber foods such as leafy greens, broccoli, and carrots, foods high in soluble fiber such as apples, flax, pears, and chia, foods high in omega-3 fats such as fish and flax, liver support foods such as beets, cucumbers, and greens, and probiotic foods such as kefir, yogurt, natural sauerkraut and pickles, miso, and kombucha.

Pro-Inflammatory Foods encourage the formation of pro-inflammatory cytokines.  While meats can be beneficial for other reasons, they are good to consume in moderation because their fat content can create more inflammation.  Refined carbohydrates in white flours and sugar can cause inflammation in the digestion; they also spike the blood sugar, which in turn can cause the formation of excess triglycerides which then causes inflammation in the blood vessels and can lead to cardiovascular disease and diabetes.  Alcohol depresses the ability of the liver to move toxins from the body which can create more inflammation and also spikes the blood sugar.

Finally, food allergens or sensitivities can compromise the integrity of the lining of the digestive tract, which allows larger particles of foods to enter the bloodstream, which in turn can cause the body to have an immune reaction to those particles.  One particularly good example of this is the association between celiac disease and autoimmune thyroid disease.  The most common food sensitivites tend to be dairy, gluten, egg, and soy, but the body can react to any food; testing or elimination diets can be useful to help sort this out.

Omega-3 fatty acids:  These fats have gotten a lot of press in the past 15 years because of their remarkable ability to decrease inflammation and improve the texture and quality of the skin and mucus membranes.  Omega-3 fats divert the biochemical pathway that normally creates inflammatory cytokines to a pathway that creates anti-inflammatory mediators.  There are several good sources of Omega-3 fats on the market today: generally, our bodies are able to use animal derived sources (such as those found in fish)  more readily than vegetarian sources (such as flax or borage seed).  While krill oil has recently become quite popular as a supplement, I do not recommend it because I have been hearing reports that krill populations are becoming threatened due to overharvesting: I prefer to leave them for the whales.

Botanicals and Supplements:  There are a number of plant medicines available that are quite useful for decreasing inflammation.  These include curcumin, derived from the turmeric plant, quercetin, derived from onions, and boswellia, or frankincense.  Supplements such as deglycyrrhizinated licorice (DGL) and L-glutamine can help restore the integrity of the digestive tract.  There are also a number of proteolytic enzyme products on the market that can be useful for decreasing scar tissue that can form during times of chronic inflammation, which will decrease pain and increase the ability of the area to heal.

 

Natural Approaches for Insomnia

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One of the most common problems my patients report is difficulty with sleep. Whether they have trouble getting to sleep, staying asleep, or waking frequently, not getting the rest our bodies need is frustrating and significantly impacts the severity of other ailments. Poor sleep or insufficient is linked to weight gain, cardiovascular disease, decreased immunity and poor healing. The reasons for insomnia are varied, so natural treatments need to address whatever it is that is out of balance. When thinking about insomnia, we have to make sure that three different systems are ready for sleep; the hormones, the nervous system, and the muscles. Having good bedtime habits such as stopping screen time one hour before bed, stretching, yoga, or meditation before bed, and a cup of herbal tea are all great first steps, but if sleep remains a problem, the primary places I look to regain balance are Hormones, Neurotransmitters, Blood sugar, Muscle tension, and pain. Here is how I approach this issue:
Hormones
In my practice, the most common reason I see for persistent insomnia is an imbalance in the hormones. There are several hormones that can be out of balance that will contribute to poor sleep. Often we will have to test to see which of these is the culprit:
Estrogen/Progesterone: Especially after childbirth and during menopause, when these reproductive hormones are not produced in balance with each other, sleep can be effected. Most commonly, this imbalance is accompanied by hot flashes and night sweats.
Thyroid: When thyroid function gets too low or too high it can impact the sleep. If thyroid levels are too high, often there are heart palpitations or agitation along with the insomnia. When thyroid is too low, people often will wake feeling insufficiently rested no matter how long they have slept.
Cortisol: This is our primary hormone that tells us we are awake. It is a stress hormone that helps the body to mobilize blood sugar for fight or flight situations (aka, so we can run from a bear). If we have too much stress over a prolonged period of time, though, the body will sometimes start making cortisol in the middle of the night–when this is the culprit people often will wake at 3-4am and won’t be able to go back to sleep.
Neurotransmitters
Neurotransmitters are amino-acid based chemicals produced by our nervous system that tell our brain and nerves how we feel–sleepy, awake, excited,happy, sad, etc. The three neurotransmitters that are most associated with deep, relaxing sleep are melatonin, serotonin, and GABA. GABA is derived from the amino acids glutamine or glutamate, and serotonin and melatonin are made from tryptophan. For people who are experiencing persistent or severe sleep difficulties, we can test to see what your levels are and if the more excitatory neurotransmitters are too high to allow your brain to calm down. Many of our best natural sleep aids are made from these neurotransmitters or contain precursors to them.

Blood Sugar
This category is directly related to the discussion on cortisol, above. For people who have difficulty keeping their blood sugar stable (either from hypoglycemia, metabolic syndrome, or diabetes), and especially for people who do not eat regularly, eat dinner very early, or eat sweets after dinner, this can impact sleep. For instance, if you eat dinner at 6pm, by 3am it has been 9 hours since you last ate. Although cortisol is primarily a stress hormone, its other function is to mobilize glucose from storage when the blood sugar gets too low. When cortisol spikes at 3am, then the brain wakes up and it becomes difficult to go back to sleep. In this case, a light protein snack right before bed such as an apple with peanut butter will greatly improve sleep.

Muscle tension and Pain
For people with chronic pain, it isn’t sleep itself that is the problem, but the pain that keeps them up. If there is chronic pain we have to get to the root of it and fix this issue. Often, however, there can be muscle tension that causes pain or headaches and leads to poor sleep. Tight muscles also may just keep the body so tense that sleep is difficult regardless of pain. The simplest options for helping the muscles relax before bed are stretching, deep breathing, hot baths and hydrating during the day (not so it keeps you up having to use the restroom). Other very effective options are taking some minerals such as Calcium or magnesium or drinking coconut water which is high in potassium before bed.

Insomnia can be a brief, transitory concern that is related to a specific event or a problem that can last many years. Persistent insomnia can lead to or exacerbate a host of other health concerns. By narrowing down the causes, we can individualize a plan to help put you back to sleep!

Homemade Sauerkraut: Improve Digestion, Prevent Cancer

There is a farm at my children’s school, and every Thursday afternoon they host a farm stand where parents and students can buy fresh veggies, goat milk products, and homemade goodies. A few weeks ago, I stopped by the stand and encountered some truly amazing produce–a head of cabbage so giant I thought I was back in Alaska. I passed on buying it, not knowing what I’d actually do with the beast, but I went home and thought about it all night, came up with a plan, and the next day headed back to the farm to see if there were more. The farmer generously took me out to the field and found me this beauty. I brought this leafy 15-pounder home and started shredding.IMG_1105

Making Sauerkraut:
It turns out making sauerkraut is a relatively simple process: it requires cabbage, salt, and a good vessel for storage. I bought a large crock for making vinegar a few years ago so I decided to use this. I would recommend using something nonreactive and not plastic, so crockery or glass are good options. According to Alton Brown, my go-to resource for all cooking projects that seem a bit more like chemistry, for every 5lbs of cabbage, use 3Tbsp pickling salt (I used kosher salt and doubled the amount). He also uses 1 Tbsp of juniper berries and 2 tsp caraway, but that is optional. After shredding and mixing the cabbage with salt, pack it firmly into your sanitized fermentation vessel of choice. Place a plate on top of the cabbage, then lay a quart-sized glass jar full of water over the plate (sanitize these too).
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After a couple days, a liquid brine should form to cover the top of the cabbage, if not, add enough water to cover the cabbage. Check it every couple of days and skim the scum off the top if necessary. The sauerkraut should be ready in 10 days to 4 weeks-just take a bit out and taste it! When it is finished, pack it into sanitized quart jars and cover with brine (the spigot at the bottom of my vinegar crock was handy for this). It should keep in the refrigerator for a few months.IMG_1177

Why Sauerkraut?

In addition to being a good source of Vitamin C, B6, and iron, there are two primary health benefits to eating sauerkraut: improved digestion and cancer prevention. The digestive benefits are twofold: there are many strains of probiotic bacteria (including lactobacillus) that work together to eat the sugars in the cabbage and produce this fermented food. Eating raw sauerkraut will help to repopulate the large intestine with beneficial bacteria, which can improve digestion, relieve inflammation, and increase the strength of the immune system overall. Green cabbage is also a good source of glutamine, which is an amino acid that is the preferred food for the lining of the digestive tract. This can also help to repair damaged cells and improve the integrity of the large intestine. One word of caution; the process of fermentation can create a trisaccharide that, when consumed by the bacteria that live in the digestive tract, can cause gas for some people. The addition of caraway and juniper (as advised by Alton Brown’s recipe) can help to dispel that gas and maximize the digestive benefit of the sauerkraut.

Indole-3-carbinol (I3C) is the primary chemical present in sauerkraut that has been associated with cancer prevention. I3C can be found in all members of the cabbage (brassica) family, but particularly high levels have been found in cabbage that has been fermented for 7-9 days. After this length of time, I3C levels continue to remain elevated but will taper off over time. I3C has been shown to reduce proliferation (growth) of several types of cancer, including colon, prostate, breast, and leukemia. I3C has been discussed particularly in reference to prevention of breast and cervical cancers because it helps to metabolize and remove estrogens from the system. These types of cancer are frequently (though not always) dependent upon estrogen as a growth promoter. However, I3C also can help to initiate natural cell death (called apoptosis) and protect the liver against cancer-causing chemicals which is why benefit has been found for non-estrogen dependent cancers as well.

Making sauerkraut is a little adventure that yields a delicious, health promoting, and cost-saving product with flavor unrivaled by the canned store-bought types. You can purchase raw sauerkraut at many health food stores, but the cost can be upwards of $20/quart. Making it at home requires only the cost of the cabbage–mine cost about $1.30/quart, plus the glory of figuring out what to do with a cabbage the size of my torso.

Enjoy and be well!

Women Need More Protein In Pregnancy

This article was originally printed in the Natural Medicine Journal–if you would like to see the references, Click here
Especially during a first pregnancy, many women have a pronounced concern about diet: how to eat, what to eat, and when to eat. As providers, we have the opportunity to help guide them towards optimal nutrition and provide reassurance that they are making sound choices. Within the context of so many “don’ts” regarding maternal nutrition–foods to avoid because of possible bacterial contamination, mercury, lead, pesticides, nitrates, blood sugar dysregulation, insufficient or too much weight gain etc–it is good to also have some advice that helps women relax and trust their intuition. This study finds that the protein needs of women throughout pregnancy is higher than previously recommended and possibly closer to what women may be craving.

IAAO is a relatively new method that has become popular for determining protein requirements in human subjects.1-4 In the past, protein requirements were assessed by the nitrogen balance method which can be difficult because it requires that all nitrogen intake and output is carefully recorded and that the subject stays in the testing facility for the duration of the testing to measure nitrogen loss from urine, feces, saliva, and wounds. This testing takes much longer to perform and requires that subjects are put in a deficiency state for longer, which makes it unsuitable for pregnant women. For this reason, the current recommendations for protein intake during pregnancy (Estimated Average Requirement (EAR) of .88 g/kg and RDA of 1.1 g/kg) have been based on nitrogen balance studies of nonpregnant adults that have been extrapolated with total body potassium studies of protein deposition during pregnancy. 5 With the development of IAAO, researchers have been able to more accurately determine protein needs during pregnancy because they can run this study on pregnant women. Additionally, this is one of the first studies to distinguish maternal needs during early and late gestation.

Understanding protein requirements during pregnancy is important because protein is the macronutrient with the most influence on birth weight. This study assumes caloric sufficiency; for well nourished non-diabetic women, increasing protein intake is the macronutrient most likely to increase birth weight.6,7 In addition to neonatal complications and increased mortality, low birth weight is also correlated with long-term health problems such as type 2 diabetes, kidney disease, cardiovascular disease, and respiratory problems. 8-11 Ensuring that pregnant women have a protein-sufficient diet is therefore crucial for the short- and long-term health of their children.

It is important to keep in mind, however, that while this study showed protein needs to be higher than current recommendations, it is still by no means extraordinarily high. The average weight of the subjects during early pregnancy was 64.4 kilos, indicating a need for 78.6 grams of protein per day, or 314 calories. Calculated resting energy expenditures (REE) averaged 1370 calories per day, so subjects were given an average of 2329 calories (1.7 REE), putting sufficient protein consumption at 13% of calories. In late pregnancy, average weight was 71.1 kg, with a need for 108.1 grams of protein or 432 calories per day. REE was 1480, so subjects were given an average of 2516 calories, with sufficient protein consumption at 15% of calories. 13-15% of calories from protein is far lower than the recommended amounts in virtually any contemporary dietary plan save for some raw, vegan and pritikin diets which are rarely recommended or undertaken during pregnancy.

Based on these new recommendations the example below provides sufficient protein sources on average for late pregnancy with far fewer calories than necessary for a day; a pregnant woman could be encouraged to include these foods within the context of whatever other foods she prefers to meet her additional caloric needs:

Breakfast: 2 eggs, 2 slices toast=21g

Snack: One ounce of cheese=7g

Lunch: 1 cup cooked lentils with steamed veggies=18g

Snack: 2 Tbsp peanut butter on 2 rye krisp crackers=12g

Dinner: 1 cup cooked chicken breast with 1 cup quinoa and steamed veggies=51g

Total: 109g protein, approximately 1300 calories

With this in mind, practitioners may find that their patients may intuitively be eating an appropriate amount of protein: a current Canadian study found pregnant women generally eating amounts of protein more consistent with the findings of this study, rather than the current DRI.12 This assumes, of course, that women have adequate caloric intake and the financial and practical means to choose what foods they eat.

One question that is relevant to how complete the information is from the study is the possible impact of the types of food consumed rather than just macronutrient content. On the day of the study, all of the calories for the day were consumed as a shake consisting of the protein supplement which was based on an egg-white composition, kool aid or tang, and a shake base powder consisting of palm, soy, coconut and sunflower oils, corn syrup, corn starch, sucrose, calcium phosphate, sodium citrate, vitamins and minerals, plus unspecified “protein-free cookies.” This does meet the requirements of the macronutrient breakdown desired for the purpose of the research study, but certainly doesn’t resemble a dietary plan that would be advocated by most providers who would be counseling a pregnant woman. While this study certainly gives us a good baseline from which to advise patients, it is certainly within the realm of possibility that a pregnant woman’s metabolic and protein needs will shift if fiber, complex carbohydrates, and phytonutrients are present in the diet.

While it can be confusing to create an optimal diet for each individual during pregnancy, the findings from this study indicate that advising for protein intake may be a little more intuitive. For women who are adequately nourished with the financial means to choose what foods they eat, as long as they feel well enough and remember to eat some protein-containing food every few hours, they will probably be able to approximately meet their protein needs each day. For women who struggle to meet this recommendation for increased protein intake, it is important to instruct them on which foods contain protein and remind them to eat these foods every few hours. This will help to optimize the health of their baby as a newborn and throughout life.

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“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”  John Quincy Adams

As an “alternative” health care provider, I have seen over the years a tendency for patients to expect miracles. I am coming out today to announce that I don’t perform miracles. My job is to educate and inspire you to work your own miracles! I’ve mentioned this before, but my favorite part of this job is watching people develop greater self-awareness, and then powerfully use that awareness to improve their health. I have noticed that people who come in with a positive outlook and strong life purpose seem to make those improvements the most successfully, so I did a little digging to see what the research shows.

There is a growing body of evidence that shows our state of mind can positively influence our physical health. Studies have found that people with a well-defined sense of life purpose are overall more proactive about their health and more frequently take the time to utilize preventative health resources. Even beyond this, people with a strong sense of purpose have a decreased risk of stroke and heart attack, spend fewer overall nights in the hospital, and have an increased lifespan. Finding and maintaining an active engagement with our inner world and the world around us improves health.

The rapidly expanding field of epigenetics explores how environmental factors influence the expression of our DNA. While we are each given a packet of chromosomes at birth, the genes that are activated throughout our life that determine our physical and behavioral traits will vary based on our experiences and physical interactions. Interestingly, we are finding that people who have an overall perspective of well-being can actually shift their genetic expression towards greater health. Not only this, but it is possible that our attitude has an even greater effect than our conscious experiences. This means we have the ability to make our own health or at least shift the course of disease just based on the way we approach life.

Creating your own health is not just about being an optimist: health creation is a practice that you can consciously work on each day. One study showed that introducing a simple practice of gratitude improved subjects’ sense of well-being, sleep, and blood pressure. Each time you choose to eat something you know will make you feel good, get up a few minutes early to get some exercise, take a deep breath and smile at someone you care about instead of thinking about how they make you crazy, or ask someone for help when you need it, you are choosing health. And making your own miracles!

Yu L1, Boyle PA2, Wilson RS2, et al. Purpose in life and cerebral infarcts in community-dwelling older people. Stroke. 2015 Apr;46(4):1071-6

Kim ES1, Strecher VJ2, Ryff CD3. Purpose in life and use of preventive health care services. Proc Natl Acad Sci U S A. 2014 Nov 18;111(46):16331-6.

Barbara L. Fredrickson, Karen M. Grewen, Kimberly A. Coffey et al. A functional genomic perspective on human well-being. PNAS August 13, 2013 vol. 110 no. 33 13684-13689

Jackowska, Marta, Brown , Jennie, Ronaldson, Amy., et al. The impact of a brief gratitude intervention on subjective well-being, biology and sleep. J Health Psychol. 2015 Mar 2.

McKnight, Patrick E.; Kashdan, Todd B. Purpose in life as a system that creates and sustains health and well-being: An integrative, testable theory. Review of General Psychology, Vol 13(3), Sep 2009, 242-251.

Kim ES, Sun JK, Park N, Kubzansky LD, Peterson C Purpose in life and reduced risk of myocardial infarction among older U.S. adults with coronary heart disease: A two-year follow-up. J Behav Med 36(2):124–133. 2013

Kim ES, Sun JK, Park N, Peterson C Purpose in life and reduced incidence of stroke in older adults: ‘The Health and Retirement Study’ J Psychosom Res 74(5):427–432. (2013)

Hill, Patrick L., Turiano, Nicholas A. Purpose in Life as a Predictor of Mortality Across Adulthood Psychol Sci. 2014 Jul;25(7):1482-6

The Incredible Dandelion: Spring Health Supporter!

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We live on the outskirts of Golden at 6200 feet, which has been right about at snow line for the past month or so. The result is that, while even the bottom of the neighborhood is decked out in tulips and lilacs, we are still (im-) patiently waiting for the profusion of blooms to hit at our house. So today when I went outside to take some photos for the newsletter, all I could find in my backyard was a big, happy, sunny patch of dandelions–which reminded me how fantastic is our friend the dandelion. Let me count the ways:

Dandelion leaves are power packed nutritionally: One serving has more than a day’s supply of Vitamins A and K, and are high in Vitamin C, Iron, and Calcium. They are also a good source of trace minerals such as Manganese, Phosphorus, Potassium and Copper. The beauty of dandelion leaves is that they are a diuretic, meaning they help move excess fluid out of the body, which can be helpful during spring cleansing. On the flip side, they also replace minerals, as opposed to other diuretics which tend to leach minerals from the body.

Dandelion roots are wonderful medicine. I frequently add dandelion root to herbal formulas where gentle support to the liver is desired. This is helpful for liver conditions but also for spring cleansing, allergy support, or chronic inflammatory issues. Roasted, ground dandelion roots have also long been used as a coffee substitute.

Dandelion flowers are also edible and medicinal. The flowers can be thrown into pancakes and muffins, boiled in a sugar solution to make a lovely yellow honey-like syrup, or fermented to make wine. Studies suggest that the flavonoids found in dandelions help to prevent oxidative damage to cells and are protective to the liver.

So, even if spring hasn’t quite turned the corner into full bloom at your house, remember to look down under your feet and celebrate the return of the Dandelion. It has so many gifts to offer! (Also remember, please to only harvest in a place you know has been free from pesticides, runoff from industrial chemicals, and marking animals. 🙂

Enjoy!