Category Archives: Winter

Natural Approaches for Insomnia

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:
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 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).
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!

Cranberry-Apple Crisp (Gluten Free, Vegan)


Apple-Cranberry Crisp (Gluten Free, Vegan)
We had some old friends over for dinner the other night to catch up and let the kids run around together.  We had this for dessert and the recipe was requested, so here it is!
Baked fruit desserts are my go-to standby for company because they are simple, easy to make ahead, relatively healthy, and great the next morning with yogurt for breakfast.  This is a gluten free, vegan winter version that utilizes what’s in season now.
(serves 6-8)
Preheat oven to 375 degrees
5 small apples, peeled and cut into chunks
2/3 cup fresh cranberries
2 Tbsp corn starch
2/3 cup maple syrup
1 cup rolled oats
1/2 cup brown rice flour
1/3 cup almond flour
1/2 tsp salt
1 tsp cinnamon
1 tsp vanilla
1/3 cup oil (I used avocado, but any mild oil or butter is fine)
In a medium bowl, mix apples, cranberries, corn starch, and 1/3 cup maple syrup. Transfer to an 8X11 baking dish.  Using the same bowl, mix oats, flours, salt, cinnamon, vanilla, oil, and the other 1/3 cup maple syrup until it forms a crumb texture.  Sprinkle over the fruit, making sure all fruit is covered. Bake 45 minutes to an hour until the fruit bubbles and the topping is brown.

Congee Takes Away the Chill of Winter

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In my first year of medical school, I had a delightful roommate who was of Vietnamese descent, born in China, and raised in her family’s restaurant in San Jose, California.  Lucky for me, she was a wealth of food knowledge and was happy to share.  From her, I learned about sticky rice steamed in banana leaf, hot pot, geoduck, how to efficiently dispatch a live crab in the kitchen sink, and the magic of congee.

During the winter, the body craves warming foods that provide optimal, easy to assimilate nutrition.  In Chinese medicine, there is a concept called “digestive fire”, which roughly equates to your body’s ability to break down food and absorb it properly.  The bigger the fire, the better you can digest.  I like the metaphor of fire because it seems to parallel how our bodies generally are able to digest:  in the summer when the weather is warm, we can break down much more complex foods and do better with raw fruits and vegetables.  In the winter, we lack that external heat source and so we must apply heat to our foods to assist our digestive fire. Congee is the ultimate digestive assistant.

So what is congee?  Well, more than a specific recipe, congee is more of a concept.  The basic rule of making congee is you take a pulse (most often rice, but millet, wheat, barley, sorghum, mung beans, or other grains or legumes can be used), add a high proportion of water, and cook it for a long time over low heat.  Congee is a traditional food all over Asia, India, and even Portugal, and has historically been viewed as a medicinal food in all of these cultures.  Depending on taste preference, regional specialty, and the specific medicinal quality desired, other foods, herbs, and spices are added.  It can be served for any meal, and depending on your preference can be served sweet or savory.  Many Indian congees are served with milk and jaggery (palm sugar) but many Asian congees contain meats, pickled vegetables, ginger, eggs or crispy fried onions. (for more information, Wikipedia gives a great description of traditional congees across the world).

In my practice, I often recommend making congee as a winter food to bolster nutrition.  However, it is an especially good food for people who are recovering from extended illness or have significant digestive problems.  For patients who seem to “get sick no matter what I eat”, congee is a great place to start.  In people who are needing the simplest, easiest nutrition possible, white rice congee is appropriate. If your digestion is rather intact, brown rice should be fine.

In his book Healing with Whole Foods Paul Pitchford talks about many foods that can be added to congee to boost its healing properties.  A few of the most useful options I’ve found are: Using chicken or mutton broth instead of water is recommended for wasting illnesses and injuries, and duck or fish broth are supposed to relieve swelling. Ginger is warming to the organs and improves digestive function.  Fennel and black pepper also assist in reducing gas and improve digestion. Brown rice is good for nursing mothers and general nutrition, while sweet rice is more specific for recovering from digestive illnesses.

Chicken and Ginger Congee
Use bone-in chicken for this recipe.  The skin, bones, and connective tissue are rich in hyaluronic acid, chondroitin, and other building blocks of a healthy digestive tract and properly functioning immune system.

1 cup rice
2-inch piece of fresh ginger root, sliced thinly
1 chicken cut into parts
1 onion or 2 shallots, thinly sliced
6 cups water
1 tsp salt
soy sauce, sesame oil, and cilantro for serving

8-10 hours before eating, place rice, ginger, chicken, onion, and water into a large soup pot on low heat or ideally a slow cooker on low. When you come back 8-10 hours later, you should have a thick porridge.  Remove chicken parts from the porridge.  Remove the skin, then remove the meat from the bones and shred.  Skim the top of the porridge if necessary.  Ladle porridge into bowls and top with shredded chicken.  Garnish with soy sauce, sesame oil, and cilantro to taste.

Inspiration to Cook Seasonally in January?

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What’s for dinner? Now that January is here, it’s getting a little less exciting figuring out what to eat.  We are firmly sandwiched between the festive excesses of December and the first exciting green things to emerge in March.  Additionally, many of us (myself included) are starting to long for a bit of “spring cleaning” after all the heavy foods of the holiday season.  However, despite our crazy see-saw we call Colorado weather, when it comes down to it, January is just a cold month.  With this in mind, true detoxification must be put off until our bodies are warmed enough from the outside world to feel good with the cooling action of cleansing foods (aka, you gotta wait a couple of months).

So, we have to find a way to feed ourselves in a way that is consistent with the season but respects our need for simpler, more wholesome foods.  If you take a look at my article from last year about the basic principles of supporting the body through food for the winter, there are three primary goals: Keep blood sugar balanced, support the endocrine system, and eat foods with bountiful stored energy.  Keeping this in mind, we can easily cut back on rich, refined foods while honoring the body’s need for nutrient density.  Here’s a few tips for jazzing things up a bit in the kitchen during the January lull:

Try Something New
This, of course, is a handy state of mind no matter what time of the year you’re cooking.  However, there are many ways to add variety by experimenting with different members of familiar families of foods.  For example, try out kabocha squash instead of butternut, mung beans instead of black beans, or a new kind of leafy green instead of spinach again.  Last week, my local grocery had a giant pile of a leafy green they called chicory.  Despite the checkers’ inability to even locate a PLU code for it, I brought it home and found some amazing italian recipes (thanks to Mario Batali) for this nutty, escarole-like green. It can also be exciting to discover a new way of preparing basic foods by exploring other culinary traditions.

Make a Kitchen Garden
There’s not many fresh fruits and veggies coming out the garden these days, but you can bring a little excitement to the table by growing something small in your kitchen window.  Herbs will do well in a pot in a window with good light, or you can use something like an aerogarden to grow vigorous greens, herbs, and even tomatoes.  My father gave me a grow-your-own oyster mushroom kit this year for my birthday, the picture above shows the unexpected and delicious meal that came of it.

Use Your Kitchen Tools
For the time-limited, cooking winter foods can be challenging because often they require extensive cooking times.  A good pressure cooker can cook beets in 10-12 minutes, a pot of dry beans in 20 minutes, or chicken soup from scratch in 25 minutes.  On the opposite end, a crock pot is a super handy way to spend just a few minutes in the morning and come home to a wonderful, rich and warming dinner.  A rice cooker is also a handy way to produce a side dish with minimal thought or effort.

Keep it Simple
Remember the basics:  vegetable, protein, starch.  In the winter it is important to focus on blood sugar supporting foods, so for starches stick to sweet potatoes, winter squash, beans, and whole grains such as quinoa, buckwheat and brown rice.  Choose veggies that are in season and look good in the store; deep green veggies such as broccoli, sea vegetables, or leafy greens are going to be high in minerals that support the endocrine system.  Make sure protein sources are high quality and responsibly raised. Generally, if you can get something from each category on the table you will be doing well to nourish yourself and your family without a lot of fuss.


Does Grapefruit Really Help with Weight Loss?

As we start to turn the corner from wintertime and head into spring, many of us start thinking about how we are going to “spring clean” any extra accumulation from the winter.  As we start sweeping out the dust bunnies under the bed, we may also start thinking about how to lose the few extra pounds we have accumulated during the cold months.  Because it is still wintertime we do still need to focus on support of our internal energy production; (for more on this, see Conserving) but this is possible to do while also starting to increase the body’s metabolism in preparation for the warmer months.

In my 12 years of seeing patients, I have encountered many diet regimens; my patients have come in zoning, flushing fat, south beaching, low fat, high fat, vegan, high protein and everything in between.  But one diet that seems to have persisted over time is the grapefruit diet: basically, eat grapefruit at the beginning of every meal, limit your calorie consumption to less than 800 per day, and the grapefruit will burn the fat right off of you.  So let’s take a moment and talk about whether this is a good regimen and whether grapefruit can play a role in weight loss.

First I’ll talk about the second half of the grapefruit diet:  Any long-term regimen that recommends less than 800 calories per day will probably aid in weight loss at the outset.  That said, after a week or two the body will reset its metabolism and go into starvation mode.  The effect of this is that you will stop being able to lose weight by restricting calories and your metabolism will still be lowered once you return to your normal caloric intake causing rapid weight gain.  Also, when you lose weight rapidly in combination with low levels of food in the bloodstream, your body can go into ketosis, which is dangerous for the health of the brain.  Also, if you are burning fat quickly you can release stored toxins into the blood very quickly; especially for those who already have other health conditions this can make you feel downright nasty.  So, I’m not an advocate for the severe caloric restriction part of the plan.

So now, let’s talk about grapefruit.  There are studies that indicate that eating grapefruit at the beginning of each meal will help you eat less and lose weight.  One study, however, compared this to drinking a glass of water or any high density low calorie substance and didn’t find much difference; the point here is that your stomach is full before you start eating the high-calorie stuff.  That said, those people who had grapefruit rather than water developed better blood cholesterol levels over time.

Another study compared people taking grapefruit either in whole, juice, or capsule form against those taking a placebo capsule.  Those eating whole grapefruit lost the most weight, but all three groups had a statistically significant weight loss greater than those who took the placebo.  This does indicate that the grapefruit itself can accelerate weight loss.  Also, those who were taking grapefruit had lower levels of insulin in their bloodstream following a meal, and showed improvement in insulin resistence (which can lead to type 2 diabetes).

One interesting study done on mice just looked at the effect of inhaling the scent of grapefruit oil.  This study found that inhalation of grapefruit oil scent helped to excite the sympathetic nerves, reduce appetite, and increase fat burning.  They then blocked their sense of smell, and inhalation of the oil without being able to sense the scent showed no effect.  This indicates that having your brain register the scent of grapefruit in itself may help with weight loss over time.

Overall, grapefruit does seem to be a useful adjunct to a weight loss plan.  It can possibly help burn fat, improve insulin and cholesterol levels, and replace unwanted extra calories by filling you up at the beginning of your meal.  So eat reasonably, and enjoy this tasty late winter delight to help boost metabolism and get ready for the warm weather to come!

Cauliflower and Cancer Prevention

I am generally not a great advocate of the “superfood” craze:  the thought that there is one magical food out there just waiting to be discovered that will cure all our ills is just plain silly.  We are multidimensional beings and the more we achieve balance on all planes: mental, emotional, and physical, including a balanced diet full of a variety of healthy (but not necessarily fancy) foods the better our health will be.

That said, there has been some interesting research done in the past few years about cauliflower and the other vegetables in the crucifer family and their potential role in cancer prevention.  These vegetables all contain a family of compounds called glucosinolates.  These are sulfur-containing compounds that when broken down in the body seem to induce cancer-preventing enzymes

for the rest of this article, click here to see it on Dr Rosen’s website

Lemon Ginger Cauliflower

Roasting has to be my favorite way to prepare cauliflower. It is so simple. Just a toss of olive oil, salt and pepper and then let it hang out in the oven. Of course, this simple preparation can be dolled up with any medley of flavors from seasoned olive oils to fresh herbs to flavorful vinegars & salts. This combination of lemon and ginger is currently my favorite way to take Roasted Cauliflower from simple to magnificent. Do you have a combination you would like to share?

A microplane will make your life so much easier for this dish, but very finely mincing the lemon peel and fresh ginger will work instead.

1 head of cauliflower

1 tablespoon coconut oil or olive oil

½ teaspoon salt

1 tablespoon ginger, peel and finely mince


Preheat the oven to 425.

Trim the cauliflower and break into bite size floret pieces. Dollop on the coconut oil and sprinkle with the salt. Place in the oven for 15 minutes.

Using a microplane, zest the ginger and lemon, toss with a bit of melted coconut or olive oil to make a little sauce that is easier to spread on the cauliflower. When the cauliflower has roasted for 15 minutes, remove and toss with the ginger & lemon zest. Toss.

Return to the oven, tossing every 5-10 minutes until the cauliflower is golden.

Seaweed and Thyroid Health

During the winter months, as I have mentioned a few times, we want to support our own internal sources of energy production.  One of our primary hormone producing centers in the body is the thyroid.  Generally speaking, the thyroid helps to regulate how “fast” the body runs.  A good way to illustrate this is to talk about what happens when the thyroid gets out of balance:  too much thyroid hormone will make the heart beat too quickly and cause weight loss from increased metabolism.  Too little thyroid hormone will cause weight gain, slowed production of skin, hair and nails (causing hair loss, weak nails, and dry skin), weight gain, and constipation from slowed digestion.

Seaweed has traditionally been used as medicine for the thyroid.  In Chinese medicine, it is seen as cooling and good for dissolving any type of swelling.  In autoimmune thyroid conditions such as Hashimoto’s or Graves disease, it has been used to decrease inflammation and swelling. In hypothyroid, the swelling of the thyroid known as “goiter” has also been treated by seaweed.  In Western medicine, this is assumed to be related to replacement of deficient Iodine.

To read the rest of this article on Dr. Rosen’s blog, click here

Love and Chocolate

I have been listening to my great grandmother Sonia lately when she talks about food.  She will turn 102 next week, lives on her own, cooks all her own meals, has all her own teeth, good eyesight and is mentally sharper than most so I think she must have something figured out.  She has some good rules to live by:  make your own food, if you do eat out only eat vegetarian or fish, and she never makes meat two nights in a row.  However, if you ask her why she has lived this long, she will reply without hesitation “it’s because I eat chocolate every day.”

Now, don’t get me wrong, this certainly isn’t a health decision she is making; we brought her a box of truffles last birthday and after asking my husband to open the bag, her eyes lit up and I think she downed six of them before we left the room.  Healthy or no, her relationship to chocolate (and mine, and I suspect a few of yours out there as well) is pure love.

So in honor of grandma Sonia’s passion and in pursuit of longevity and lifelong health, let’s talk a bit about love and chocolate.  The research is showing more and more what those of us who are devotees to chocolate have suspected all along; chocolate is good for us and makes us feel good.  It improves the two things most crucial to love; the way our minds function and the health of the heart.

There are three primary physiological responses that have been documented in humans in response to chocolate consumption:  Antioxidant activity, decrease in platelet aggregation, and blood vessel dilation.  As an antioxidant, the polyphenols in chocolate have been found to be quite active.  We hear quite a bit about the importance of antioxidants these days; stress, chemical exposure, smoke inhalation, and other toxins cause oxidative damage to our cells.  Especially in the blood vessels, this can lead to inflammation and eventually atherosclerosis (hardening of the arteries).  Antioxidants, especially those found in chocolate, can prevent this type of damage.  Chocolate is also good for the cardiovascular system because it helps to decrease platelet aggregation, which means the blood becomes less “sticky” and flows more easily through the heart and blood vessels.  Over time, this can help to prevent heart disease.

Finally, the flavanols in chocolate have been shown to assist with dilation of the blood vessels.  The innermost layer of the arteries, called the endothelium, is made up of cells that can contract or relax to allow different amounts of blood through.  Chocolate flavanols assist in relaxing those cells to allow greater blood flow.  This can have several positive affects:  following chocolate consumption, studies have shown improvement in mood due to increased blood flow to the brain.  Cognitive function has also shown improvement in those who have recently ingested chocolate for the same reason.  The relaxation of blood vessels also can cause a decrease in blood pressure that is useful for battling hypertension.  As the research has shown, chocolate helps us to feel happier, think more clearly, and keep our hearts healthy.

Happy Valentine’s Day, grandma Sonia.  Enjoy our chocolatiest holiday, and may we all live well and long by your example.