Myintegrativehealth Blog – Adrenal Fatigue – Natural Hormone Therapy – Thyroid Dysfunction – Pain Relief – Digestive Health

So often people begrudge initiating change because of perceived obstacles such as travel or holidays.  I’ve learned that it is really not that hard to stay healthy on the road!

Thriving on the go:  3 Key Steps
Ok, you’re taking care of yourself and getting healthier.  You’ve worked out some good habits and healthy routines in your daily life.  You’ve probably learned that it is easy to lose momentum and drift back to unhealthy habits.  Whether you’re going across the globe, or over the river and through the woods, don’t let travel do this to you!

Think of your health as drawing energy from 3 main sources:  your sleep, your exercise and your diet.  If you can keep these sources working for you, you’ll be OK.

Sleeping on the go.  Nothing ruins your memory of a good trip like the lingering bronchitis you picked up on the flight home.  What is the main reason this happens?  Your immunity was down from lack of sleep.  When you’re traveling, you want to take it all in and you have time zone changes to deal with.  Put these factors together and our bodies really need as much or more sleep than normal, not less.

• Start scheduling the week before traveling; shift your sleep schedule towards your new schedule as much as possible.  This works best when you are moving your sleep schedule forward.
• Avoid sleep at your destination until it is your bedtime in local time.
• Avoid alcohol and caffeine the day of travel.
• Adults can use 2-3mg of time-released melatonin at bedtime during short trips and the first few days back home.  This resets your internal clock.

Exercise on the go.  How do you workout when you can’t get to the gym?  Easiest answer is do lots of walking.  Fortunately this is easy whether you’re going to an amusement park, beach or most other parts of the world.  You can also get an good workout with simple body weight exercises.  Here is a great link to a page with 20 amazing exercises you can do anytime and anywhere.  P.S.  If you’re a climber, you can always find a place for pull ups : )

Eating on the go.  OK, so far so good, but how about food?  When traveling, think about food in terms of fuel, protein and produce.  Your fuel needs are minimal when you’re on a plane, car or boat, so don’t worry about it then.  I love using meal replacements like MediClear when traveling.  I’ll make up single servings in snack size baggies and mix them up in a water bottle.  Have 2-3 servings per day while en route.  This way you get a nutritionally complete low calorie meal and your body gets to rest and detox.  You’ll also drop a few pounds which may help you break even by the time you get home.  When you arrive, focus on soups as an easy way to get produce and protein without lots of fat or the risk food-borne illness.

If there is one thing women fear, it is breast cancer. Perhaps it is the fact that breasts are such a feminine attribute, strongly associated with attractiveness and fertility, that women associate breast cancer with a loss of sexuality and even a loss of self. Some women are afraid of the various treatment modalities such as surgery, chemotherapy and radiation. These treatments may cause pain, sickness, or physical changes such as hair loss and even breast loss. I have had many patients state they feel that the treatment is worse than the disease.

Everyone knows someone who has had it – family, friends, or coworkers. According to BreastCancer.org, 1 out of every 8 women will develop invasive breast cancer in their lifetime. And our risk of getting breast cancer increases as we age.

Many women do not go in for regular screening because they do not want to hear bad news. The idea is that “no news is good news.” But nothing could be further from the truth. Breast cancer, like most cancers, is completely treatable if caught early. Regular screening and follow up with your doctor is extremely important, but what can we do to prevent breast cancer?

Research shows that the way our bodies break down estrogen can increase our risk of breast cancer. Estrogen is metabolized in the liver and the metabolites, or byproducts of metabolism, are a key to developing breast cancer. There are six metabolites that we look at – four metabolites are considered “bad” and only two are considered “good”. And although all six metabolites may be present, it is the ratios of these metabolites to one another that are important. One of the most reviewed ratios is commonly called the 2:16 ratio. If this ratio is less than 2, meaning that you have too much of the bad estrogen (16) and not enough of the good estrogen (2), studies show that you are at an increased risk of breast cancer, as well as other estrogen driven cancers such as cervical cancer and ovarian cancer.

How can you find out how your liver is breaking down estrogen? A simple morning urine sample can be sent to the lab for evaluation to determine your estrogen metabolism ratios. Once we have that information, we can assess your risk and take steps to mitigate that risk. This test can also be used to monitor current treatment plans to reduce breast cancer risk, as well as to monitor hormone replacement therapy. It is a great test to determine a woman’s osteoporosis risk as well.

What can affect the balance of this ratio? Diet and exercise have a strong impact on the 2:16 ratio. Adding flax seeds, cruciferous vegetables, and soy products into your diet can increase this ratio. Likewise obesity and alcohol consumption can have a negative impact. Definitely kidney function and fluid consumption can affect this ratio so I recommend a basic CBC and CMP with the estrogen metabolism test. Your doctor will be able to interpret your labs, determine how you metabolize estrogen, and create a plan to shift your metabolism to a different pathway if necessary.

Mention the phrase “food allergies” and most of us imagine those poor kiddos who get near a peanut butter sandwich only to have massive swelling around the eyes and throat, followed by difficulty breathing and hives.  The constellation of these symptoms make up what’s known as an anaphylactic reaction which, unfortunately, has become more and more frequent in the general population over recent years.  In fact, some newer studies suggest that approximately 3-8% of Americans run the risk of anaphylaxis when exposed to any number of foods, although tree nuts, milk and shellfish are at the top of the anaphylactic list.

Even more, we are seeing a less severe variation of these dangerous food allergies, called “allergy sensitivities” that don’t typically cause life-threatening symptoms, but can still be quite uncomfortable nonetheless.  If you have symptoms like indigestion, gastritis, eczema, asthma, celiac disease, arthritis, and even depression, anxiety, and chronic fatigue, it could be a result of a “food sensitivity.”  Additional reports suggest that at least 60% of Americans suffer from symptoms due to adverse food reactions as a result of food sensitivities.

Food allergies/sensitivities may be a reaction to a protein, a starch, a contaminant found in the food (e.g., pesticide residues) or a food additive (e.g., colorings, preservatives, flavor enhancers, etc).  Once the body decides it’s uneasy with a food, a complex cascade of events takes place that can result in either a life-threatening situation (anaphylaxis) or simply the aforementioned unpleasant symptoms.

Driving this reaction is the immune system’s production of multiple types of antibodies.  For example, during an anaphylaxis response, IgE antibodies are produced within two hours of exposure.  These antibodies then bind to specific cells called mast cells and basophils which release their inner contents–histamine.  This is why an anti-histamine, like Benadryl or Quercetin, is often prescribed for allergies.

Yet, it’s the more delayed allergic response found in food sensitivities, one that can take up to 72-hours after exposure, that causes the aforementioned “uncomfortable” symptoms.  This response is usually driven by IgG antibodies and although it can stimulate the release of some histamine, it usually recruits many more players of the immune system, further complicating the reaction in the body.

Studies suggest that dairy, wheat and eggs are the three biggest sources of food sensitivities in people.  How is this determined?  In the past, the skin prick test was used where small amounts of foods were injected into the skin either on the back or forearm.  Now a simple blood test does away with this antiquated test.  These blood tests can measure for both IgG and IgE antibodies and help guide you and your provider in a direction for food avoidance, which is the mainstay of treatment.

So if you suffer from indigestion, asthma, eczema, etc., simply avoiding problematic foods could be your ticket to feeling well.  In addition to elimination, I recommend rotation of food families (e.g., veggies, fruits, meats, etc.) along with assisting the body with its normal digestive processes through the use of pancreatic and stomach enzymes.  Probiotics can be quite helpful as well.

Living in fear of foods because of their potential to make us sick is unnecessary when you recognize there are easy ways to identify possible sources of food allergies/sensitivities.  Combined with practical and realistic interventions you can take to calm the reaction and subsequent symptoms, you can alleviate a multitude of health conditions.

On the way in to the office this morning I dropped off my daughter at middle school and my son at elementary school.  Over the course of the drive I saw children, adolescents, teens, parents, cyclists, and workers all drinking what I call the ‘new soda’ – Gatorade.

There is a scary new disease identified as ‘Orthorexia Nervosa’.  It is a somewhat tongue-in-cheek attack on the elaborate web of food rules we find ourselves trapped in.  ‘Ortho’ refers to right or correct.  The ‘rexia’ is of course taken from anorexia, meaning suppressed appetite.  Interestingly the origin of anorexia is the same origin as the term rack, meaning to straighten.  We straighten our arms when we reach, therefore reaching became tied to appetite as in reaching for food.

Over the years I’ve heard so many versions of what to avoid.  If I avoided every food that I’ve ever been told to I would literally have nothing left except perhaps a few types of lettuce.  Oh, wait, the Chinese medical texts do recommend against raw vegetables.  OK, so cooked romaine.  That would get old fast.   We have to eat something.

Many current researchers and public health experts are realizing that telling someone not to eat something bad may be less productive than encouraging them to eat something good.  The best things to go out of our way to eat are the foods that give us the greatest benefits (number of important nutrients) for the least harm (calories).

Several authors have embraced the term ‘superfoods’ to describe certain foods that are especially high in nutrients and low in calories.  Although there is no formal list, some of the superfoods are tastier and more readily available than others.

Variety is certainly important in the diet, but with modern foods the idea of variety is misleading.  Rotating your morning Pop Tarts between cinnamon and cherry does not count as variety.  If you are talking about foods as great as the superfoods, don’t be afraid to find a few favorites and eat them everyday!

So why don’t we eat well?  The biggest concern I hear is that people don’t have time.  Between my family, practicing medicine, training and writing, believe me, I understand about time constraints.

The problem is that many have an idea of shopping daily and making every dish from scratch.  Mind you it’s a blast to spend a few hours puttering around in the kitchen, but that is not realistic for our workdays.  Bear in mind that anything you eat from wherever you get it will take some time.  If all of your meals are drive throughs, heaven forbid, you’ll still be spending at least 15 minutes per day just waiting in line.

Below are my top 20 easy to find superfoods.  Stay with me and I’ll show you how you can get most of these in a day with under 15 minutes of work, I promise!

1. Spinach
2. Broccoli
3. Blueberries
4. Carrots
5. Edamame
6. Black beans
7. Tomatoes
8. Turmeric
9. Grass-fed beef
10. Salmon
11. Mushrooms
12. Celery
13. Walnuts
14. Almonds
15. Greek yogurt
16. Avocado
17. Green tea
18. Pomegranate
19. Steel cut oats
20. Brown rice

When you wake up, make a 5 a day drink.  If you haven’t tried it yet, here’s the

videoon how to do it.    So far we’ve invested 3 minutes.

For breakfast, warm some pre-cooked steel cut oats from Sprouts or Whole Foods, just 1/4 cup if you’re watching your weight, add a dollop of non-fat plain Greek yogurt, some blueberries and a few almonds.  Now is also a good time for a cup of green or white tea.

So, 2 minutes to warm oatmeal and assemble, our tally is at 5 minutes.

Before you leave for work, pour together a nice salad.  Shop right and you’ll have zero prep work to do.

Mix into a large bowl:

• Washed spinach leaves
• 2-3 ounces smoked salmon
• Sliced mushrooms
• Prepped pomegranate seeds (you can now buy these already cleaned and separated!)
• Broccoli florets
• Black beans, canned – rinsed
• Walnuts, small handful
• 1 – 2 tbsp natural guacamole

The guacamole also works as a ‘dressing’ and flavoring for the salad.  This whole process should not take more than 2 minutes so we’re at 7 minutes.

For dinner, sauté some lean grass fed ground beef, add in Thai curry paste (Turmeric and lots of great flavor).  Stir in your favorite frozen mixed vegetable blend and serve over pre-cooked brown rice.  Have 1/4 cup of rice only if you’re watching your weight.  Allow 5 minutes for this and we’re at 12 minutes of cooking for the whole day and we ate every single superfood!  How awesome is that!

By now most of you have read or heard directly from me about my bicycle crash two weeks ago.  I’ve been overwhelmed by the deluge of positive thoughts, emails, cards and well-wishes from everyone.  For those of you who missed the story, I shattered my collarbone into six pieces two weeks ago following a crash during a Saturday century ride.  This photo is right after the crash as my ride-mates loaded my broken bike into the car before my ER visit.  Thirteen screws later, the bone is back into one “piece” and the pain is improving everyday.  With my doctor/patient roles reversed and this being my first broken bone and surgical procedure, it’s been an emotionally eye-opening educational experience for me.  The constant pain and the mental lows lead to my inability to perform my daily work and home responsibilities requiring major adjustments.  No fun.

Yet with the help of my wife, I made some powerful insights that have been invaluable to me and, I believe, to my future practice with my patients.  Maintaining good physical and mental strength through a medical challenge can be, well, challenging.  But with all my down time (I felt like I visited every website ever created) I was able to pour over the research and I think I’ve discovered three approaches that seem to apply to nearly anyone with any difficult medical situation.  If you can implement these three tenets, you should be able to overcome most challenges.  They are:  1) keep moving, 2) monitor your daily progress, and 3) design a healthy environment.

There’s a lot to consider in those three tenets and that last one may sound intimidating, but I promise, they’re all very simple.  First, keep moving.  Our bodies are designed to stay in motion.  In no other time during our history as humans on this planet have we been able to survive through our daily routines with so little physical movement.  From desk jobs to nearly limitless access to goods and services, we physically work much less than we should.  Most studies suggest as little as 30-minutes of dedicated briskly-paced walking can do the trick although upwards of 60-minutes a day is even better.  Even with my busted shoulder, I made it a point to keep moving with walks around the neighborhood to waist-deep plunges in the pool.  Make it a point to move around and your body will thank you for it.

Next, monitoring daily progress.  With half of 2011 already over, you too might see how easy it is to let the days slip by without recognizing both positive and negative changes you make to your lifestyle.  There is nothing more powerful than frequently tracking your progress throughout each day in order to take control of your lifestyle.  I constantly recommend to patients “Diet Diaries,” or writing down everything you eat and drink, along with fitness achievements.  Studies have shown time and time again that this simple approach is more effective than any other strategy at evaluating and modifying basic lifestyle behaviors. With my collarbone, I measured the angles surrounding my shoulder’s range of motion daily, along with slow but daily additions of gentle strengthening exercises.  Sprinkle on multiple cryosauna applications and my surgeon, during a recent follow-up visit, couldn’t believe my progress in two short weeks.

Third, create an environment that is conducive to better health. Surround yourself with positive influences like people who have healthy lifestyles–studies show it will motivate you to do the same.  Think of it as a healthy dose of peer pressure.  Also, build into your daily routine healthy food choices at home and work that are readily accessible. More specifically, if healthy food choices are not easily available at home, when you’re hungry, your concept of what’s healthy quickly becomes skewed.  In addition, when it comes to a healthy diet, use smaller plates (which decreases portion-sizes), serve yourself a healthy portion and then store left overs before eating.  One last strategy I discovered is to consider eating in front of a mirror, which seems weird, I know, but a great German study last year showed it dramatically decreased the amount of calories test subjects ate.  You have incredible control over the environment in which you live.  Take the time to make it conducive to better health.

Finally, after doing all that you can to implement the first three tenets, be sure to be kind to yourself.  Don’t be hard on yourself if you have a tough day and “fall off the wagon.”  Studies show that the stress hormones released as a result of this added pressure on yourself is much more harmful than simply moving back to your healthy baseline. Life isn’t about being perfect.  Do the best you can, strive for your best, but allow yourself to recover from expected and unexpected setbacks.  On the day of my crash I was in great physical shape through great strides I had made during my training.  Instantly I was forced to “slow things down” and quickly have lost my physical stamina.  But, by taking proactive and preventative steps now, including the above ideas, my recovery has been relatively quick.

A major health issue can very quickly derail you from a healthy lifestyle.  But by following the above three tenets, you can regain control of your health, your surrounding environment and treat yourself better than you ever have before.

May is National Osteoporosis Awareness and Prevention month.  The National Osteoporosis Foundation estimates that 1 out of every 2 women and 1 out of every 4 men, over the age of 50 will break a bone due to osteoporosis.  I find that figure staggering.

What are the risk factors?

Well, based on the statistics I just mentioned, being female and over the age of 50 are risk factors.  If you have a family history of osteoporosis, statistically you are more likely to break a bone due to this condition.  Obviously these are risk factors that cannot be changed; so let’s look at the ones that we can do something about:

• Low body weight/dieting – Women tend to have a lower body weight then men, as well as a history of dieting.  Unbalanced “trendy” diets lead to poor nutritional status.  Diets with severe caloric restriction may trim your waistline but at a cost to your bones.
• Inactivity – Exercise strengthens your bones.  Aerobic exercise, such as jogging or walking, and weight-bearing exercise, such as strength training, creates micro fractures in weight-bearing bones.  These micro fractures trigger your body to rebuild and strengthen bone by recalcifying the micro fractures.
• Poor nutrition status – If you are deficient in calcium, your body will not be able to respond to your body’s need to rebuild bone.  Calcium, along with co-factor vitamin D, supports recalcification.
• Excess salt – High levels of salt in the diet have been linked to excessive levels of calcium in urine.  Some researchers believe that the high salt diet in America is a major causative factor in osteoporosis.  Read labels when shop; salt is used as a flavor enhancer and a preservative in most processed foods.  Many foods that do not taste salty are actually high in sodium.
• Smoking – Smoking is bad for us for countless reasons.  Smoking interferes with the body’s utilization of calcium and estrogen in bone formation.
• Alcohol consumption – Drinking too much alcohol will interfere with the body’s absorption of calcium.  It also robs the body of vital nutrients and causes poor nutritional status.
• Consumption of Caffeinated or Carbonated drinks – Phosphoric acid and caffeine leach calcium from bones, increasing you risk of osteoporosis.  Caffeinated drinks and supplements are often used to suppress appetite during calorie restriction diets. This is another reason why women tend to be more at risk of osteoporosis.

FRAX is a great tool that calculates your risk for a potential fracture.  It takes race, age, weight and other risk factors into consideration.  Under the menu select Calculation Tool, then follow the menus to select your continent, country, and race.  For those of you who do not know your weight in kilograms or your height in centimeters, do not panic.  On the right side of the screen is a handy conversion tool for you.

My diet is healthy and I exercise every day.  Am I still at risk?

Some of the most commonly prescribed medications actually lead to bone loss.  Corticosteroids are anti-inflammatory agents that are commonly prescribed to help control chronic conditions such as asthma and arthritis.  Unfortunately, studies show that patients lose an average of 14% of bone mineral content in the first year after starting corticosteroid treatment.  Most people achieve peak bone density around age 25.  However, for patients who develop asthma at an early age, and use corticosteroids to manage their condition, they may never achieve maximum bone density.

SSRIs such as Lexapro, Prozac and Zoloft have been linked to decreased bone density.  Here is a great article from the May 2009 issue of Psychology Today explaining the misuse of these medications.  According to Dr. Lane, 80% of patients surveyed who were taking these medications showed no depressive symptoms at all.  These medications are often prescribed to women for PMS symptoms or menopause symptoms.  This may be another reason that more women than men are diagnosed with osteoporosis.

Here are some other common prescription drugs that affect bone health:

• Antibiotics such as tetratcycline, commonly used to treat acne
• Proton pump inhibitors (PPIs), including Prilosec, Nexium, Prevacid, and Aciphex used for acid reflux and gastritis
• Diuretics that are used to treat high blood pressure
• Depo-provera, or the Depo Shot, a form of birth control

When should I request a bone density test?

The US Preventative Screening Task Force (yes, the same task force that caused an uproar with their breast cancer screening recommendations) recommend bone density screenings for the following demographics:

• Women aged 65 years or older
• Younger women whose risk fracture is equal to or greater than that of a 65 year old white woman with no additional risk factors (use the FRAX tool to assess risk)
• No recommendation to screen men for osteoporosis

The National Osteoporosis Foundation recommends bone density testing of:

• Women age 65 or older
• Postmenopausal women under age 65 with one or more risk factors
• Men age 70 or older
• Men between age 50 and 70 with one or more risk factors
• Anyone older than age 50 and who have experienced a broken bone
• Postmenopausal women who discontinue hormone therapy

I utilize the NOF’s guidelines when making recommendations to my patients.  However, for patients with long-term SSRI use or corticosteroid use, I encourage them to get a DEXA scan earlier.  If you suspect that osteoporosis may be a problem for you, ask your doctor for a bone density test.  You may have to pay out of pocket for it, but the sooner you start to reverse bone loss, the better off you will be.

R ed paper hearts, heart-shaped boxes full of chocolate, one whole day dedicated to love – it must be February! But this month isn’t just about valentines and chocolate, it is also about the heart; February is heart disease awareness month.

According to the American Heart Association in 2006, 81 million Americans had some form of cardiovascular disease.  About 73 million had high blood pressure, which is a common risk factor for strokes and heart attacks.  But high blood pressure isn’t the only risk factor, others to be aware of include:

• Age
• Gender
• Personal history of cardiovascular events

Ok, so you cannot do anything about those three risk factors, but here are some that you can do something about:

• Smoking
• Diabetes
• Cholesterol (Watch Dr. Christianson’s video on cholesterol)
• Obesity
• Sedentary lifestyle
• Stress

What are the warning signs of a cardiovascular event?

Stroke:

• Numbness or weakness of face, arm or leg, especially on one side of the body
• Confusion, trouble speaking or understanding
• Trouble seeing out of one or both eyes
• Trouble walking, dizziness, loss of balance or coordination
• Severe headache with no known cause

Heart attack:

• Chest pain or discomfort, pain may radiate down left arm
• Pain that radiates to the jaw, neck, back or stomach
• Shortness of breath, with or without chest discomfort
• Cold sweat, nausea or lightheadedness

Cardiac arrest:

• Sudden loss of responsiveness
• No normal breathing (someone does not take a normal breath when you tilt their head up and check for a breath for at least 5 seconds)

It is important to note that men and women are very different.  (You probably didn’t need a doctor to tell you that!)  Women typically don’t manifest the same symptoms of a heart attack as men.  Indigestion and extreme fatigue are the most common early warning signs of a heart attack in women.

New Research

A new study published Tuesday, February 15, 2011, in the Journal of Cardiovascular Electrophysiology shows that the heart’s ability to handle premature contractions (known as heart rate turbulence) may be the strongest indicator of a potential heart attack.  The study showed that even individuals considered to have a low cardiovascular risk are 8-9 times more likely to die of cardiovascular disease if they have abnormal heart rate turbulence. Heart rate turbulence is a measure of how well someone can handle sudden or extreme stress.  At this time, testing heart rate turbulence is not a standard test used to assess cardiovascular risk.  However based on this research, it may soon be.

So what can you do to maintain a healthy heart?

• Eat healthy, nutritious whole foods.  Avoid processed foods, fried foods, and fast foods.  Give your body the fuel it needs to keep it healthy.  This will also help you maintain a healthy body weight and lower your cholesterol levels.
• Remove all sodas (diet and regular) from your diet!  Consumption of sugary sodas leads to diabetes, which is a modifiable risk factor for cardiovascular disease.  But don’t think that you can safely switch to diet sodas.  A recent study shows that people who consume diet sodas have a 48% greater risk of CVD (cardiovascular disease) than those who don’t.
• Get out and move every day! We cannot say enough about the benefits of exercise.  Exercise helps lower other risk factors on this list such as high blood pressure, high cholesterol levels, diabetes, and obesity.  It is also a great stress reliever and helps maintain a healthy body weight. Get your family, friends and neighbors involved, make active living a group event and part of your daily life.
• Maintain healthy, loving relationships with your family and friends.  These are the people who make you happy and who support you when you need them. A smile on your face is great for the heart!
• If you smoke, please stop.  Smoking leads to atherosclerosis which can cause high blood pressure.

Awareness and education is key to understanding how to reduce your risk of heart disease.  See your doctor regularly and ask for help in reducing your risk factors.  It is the best way to show your love for your family, and yourself, in February.