Merry Christmas!

Merry Christmas! We're enjoying a beautiful white Christmas here in the Pacific Northwest.

I hope you are all enjoying a peaceful holiday season with your friends and family.

See you in the New Year.

Winter Sports

It's winter and as the snow starts to fall, many of us are getting ready for winter sports. Skiing and snowboarding are very thrilling but have the potential for serious injury. Here are a few tips to keep you safe on the mountains this year.

1. Wear a helmet: Head injuries are no fun! You may be the best snowboarder in the world but there's no guarantee that the guy next to you is.

2. Warm up: Even if you are an expert skiier, take the time to ski a few green and blue runs before you head up to the double black diamonds. It's probably been at least 8 months since you last used your body in the specific way required for skiing. Give your "muscle memory" a chance to recall what you know before challenging it too much.

3. Stay hydrated: Dehydration leads to rapid muscle fatigue and greater chance of injury. Carry a water bottle with you and hydrate as you ride the lifts. It's easy to forget as you won't "feel" your sweat as you would when doing other sports. But don't let the cold and layered clothing fool you. It's easy to lose water.

4. Take snacks: Just as you are likely to lose water, you are likely to experience demands on your blood sugar. Easy to pack snacks are raisins, trail mix or dried fruits. While fresh fruits are also great, they may not hold up to the bumps and spills you are likely to take. My last skiing adventure lead to smashed bananas all over my backpack by lunchtime. Not much fun to clean up.

5. Quit before you want to: I know this isn't the advice most of us want to hear at $60 a lift ticket. But your passion for the slopes may outweigh your body's ability to handle it as it gets late in the afternoon. We all know that athletes are generally more likely to be injured late in the game as muscles fatigue and it becomes more difficult to stabilize joints. The same is true for skiers. If you are driving home with a sprained MCL (medial collateral ligament), you'll probably be thinking that that last run just wasn't worth it.

Have fun!

Gluten Intolerance- Part 3

In part 1 and 2 of this series, I wanted to convince you of two important ideas.

First, gluten intolerance is very serious even if you don't have symptoms.

Second, a lot of people in the United States are at risk.

So now what? There really are two options.

Option 1: Get tested for gluten intolerance.
There are a few ways to get tested; saliva, blood or stool.

A) Realistically, saliva testing is the least reliable among these. I don't recommend it. Saliva testing is an excellent way to test for certain hormone levels in the body, but when looking for antibodies related to gluten, it's not quite as useful.

B) Blood tests have been the standard for many years. When antibodies are detected, the gold standard has been to follow up with an intestinal biopsy to assess for destruction of the gut. If the intestinal wall shows signs of distress, you officially have "Celiac Disease." If there is no destruction, then you may not be a "true" celiac patient, but after reading part 1 and 2 of this series, I hope you understand that a lack of intestinal distress does not mean you're out of the woods.

C) Stool tests are newer on the laboratory testing scene (for gluten intolerance) but have been around for about 7 years. This is the best way to assess for gluten intolerance. Because gluten is ingested, the initial immune response occurs in the intestines. Anitbodies can be more reliably detected in the stool.

Final word on testing.
If you have a positive blood test, stay away from gluten.
If you have a negative blood tests, then it doesn't guarantee you are safe. Follow up with a stool test.
If the stool test is negative, there is a very good chance you are safe....

... but remember, gluten sensitivity can show up later in life. You may have a gene that predisposes you to this and this gene may be expressed later in your life. You may actually want to follow up with a genetic test to see if you have a gene that can predispose you.

Most labs can routinely assess for antibodies in the blood. If you choose to go with the stool test, I recommend Enterolab.


Option 2: Go on a gluten free diet
If you are having symptoms, you may try a gluten free diet even without having the test. If you feel better, then you should stay away from gluten for the rest of your life. If you are having symptoms, there is no harm in trying this method. The only problem is if you don't see changes in your symptoms. You may come to the false conclusion that you have no reaction to gluten.

Remember that immune responses to gluten can be subtle and slowly degrade different tissues in your body. Much of the current research is showing us that even things like osteoporosis may be related to gluten. You can see that if you remove gluten from your diet for two weeks, in this case, you may not actually feel any different. But you will be calming the inflammatory response that contributes toward the decrease in your bone density.

In my mind, the lab tests are a simple and easy way to remove doubt.

Gluten Intolerance- Part 2

In the previous post, we identified gluten and some of the problems it may cause. Today, we'll talk about the next steps you should take.

Get tested for gluten intolerance.
Even if you don't have symptoms... get tested.
Even if you are abundantly healthy, exercise daily and eat a perfect diet... get tested.

Why? Gluten has a way of wreaking havoc on many systems of the body. When it affects your brain, you won't actually feel anything. Then, one day, you will wake up and feel like your thoughts just don't flow as smoothly as they should. You can chalk it up to "getting older" or realize that years of assault on your brain have finally led to a few symptoms.

Before you were diagnosed with hypertension, you probably felt fine. Before your cholesterol levels came back high, you probably felt fine. 10 years before your family members were diagnosed with Alzheimer disease, they probably felt fine. But the science tells us that damage was being done to their brains long before the diagnosis. The point is; bad things happening to your body may not always feel bad. Even so... they can be very, very bad.

I truly wish that everyone who was gluten intolerant felt terrible after ingesting gluten. That way, all those people would stop any kind of insidious assault on their body long before the damage is done. Unfortunately, you may actually feel fine while your gut and body act as a battlefield.

How many people have gluten intolerance?
Honestly, it's tough to tell. Our understanding of gluten intolerance has come a long way in the past ten years. We're still a long way from understanding exactly how it causes such a variety of symptoms. Nonetheless, here are the numbers we do know.

1 in 133 people have celiac disease; a very aggressive form of gluten intolerance that leads to significant destruction of the gut.

That may seem like a pretty small number but there's more. Approximately 30-40% of the US population carry a gene that predisposes you to developing gluten intolerance! Of course it doesn't guarantee that you will actually react poorly to gluten but keep in mind; genes may express themselves later in life or under periods of physiological stress. That does mean that 30-40% of Americans have at least one major risk factor for developing gluten intolerance.

The 1 in 133 is a statistic for outright celiac disease. But given the recent evidence that gluten may be involved in many other disorders, we're likely to have more reliable numbers for gluten intolerance in the future. Some experts state that approximately 30% of the population are actually gluten intolerant. I'm not willing to hang my hat on those numbers just yet; but it is enough to make me take a serious hard look at gluten in my patient population.

Gluten Intolerance- Part 1

If you've been into a health food store recently, you probably saw a variety of gluten free products on the shelves. Even popular brands like Chex Cereals boast of gluten free products like their popular Rice Chex.

Let's answer two big questions today. What is gluten? Why is it bad?

What is gluten?
Gluten is a protein found in wheat, rye and barley products. While oats do not typically contain gluten, conventional processing methods commonly contaminate the oats with gluten. Conventional breads, pasta, crackers, waffles, pancakes, cookies & cakes contain gluten. Wheat products are ubiquitous in today's society. Many processed foods like sauces, soups, gravies, chowders, cereals, flavorings, baking products & seasonings contain gluten.

Why is it bad?
Gluten isn't necessarily bad. Some people can consume gluten and live healthy lives. But many others have a reaction to gluten that may lead to significant health issues. For whatever reason, in some people, the immune system reacts and actually starts attacking gluten. As this battle wages on, there are casualties such as the lining of your intestines. In some situations, this war actually destroys the intestines so much that food is poorly absorbed. This malabsorption may lead to weight loss and other signs of nutrient deficiency. In some individuals, that battle will turn inward as the immune system starts to attack your own tissues. This is an autoimmune component to gluten intolerance.

If you feel like you don't suffer from gut issues, don't breathe that sigh of relief just yet. Rather than thinking of gluten intolerance as a gut issue, it is more appropriate to think of it as an immune issue that may or may not affect the gut.

Once the immune system gets riled up in the gut, it can be activated throughout the body and may result in symptoms/conditions such as:

• Osteoporosis, anemia, depression, behavioral problems, skin conditions
• Type 1 diabetes, rheumatoid arthritis, thyroid conditions
• Cognitive impairment, ataxia, peripheral neuropathy, epilepsy, attention problems
  
• Infertility, recurrent miscarriage
• ... and more
  

To be clear, this is not to say that gluten is the single cause for all these symptoms. But it is likely to play a significant role in many cases.

Kids Need More Vitamin D

The American Academy of Pediatrics released a statement this week that your kids may need to double their intake of vitamin D. Vitamin D has made waves in the health care community over the past few years. In the old days, people thought that vitamin D deficiency was rare since it is made in the skin in response to sunlight. But mounting evidence over the past few years suggests that deficiency may play a significant role in: heart disease, cancers, autoimmune disorders, depression, chronic pain, type 1 diabetes, muscle & bone problems.

The AAP now recommends a dose of 400IU per day with supplementation beginning shortly after birth and continuing through adolescence. The 2003 recommendation stood at 200IU per day.

Here's some food for thought. A study published in July 2008 issue of The Journal of Endocrinology and Metabolism suggests that adolescents may actually need 2000IU per day to establish healthy serum levels of vitamin D. This is 5 times the current, updated recommendation!

The October 2008 issue of Current Diabetes Reports has a study that recommends children and adults get 1000IU of vitamin D when sunlight is not readily available. Note that this is also higher than the updated AAP recommendations.

While most regions of the United States receive sufficient sunlight to make vitamin D during the warmer months, Dr. Joan Lappe, a vitamin D researcher, states that areas north of 37 degrees latitude do not get adequate sun exposure to make vitamin D from October through March.

That means that if you live north of a line drawn straight across the U.S. from San Jose, CA, through Springfield, MO, and into Newport News, Virginia, you will not make vitamin D from fall through winter. More accurately, you could make vitamin D if you sat out in the sun a very long time, but in the time it would take to make enough vitamin D, you would get badly burned.

Your best bet:
Have your vitamin D levels measured. This should be the 25(OH)D (aka 25 hydroxyvitamin D or calcidiol). Then supplement with D3 (cholecalciferol) and recheck your levels in a few months. If it is winter time, you'll most likely need to supplement.

Neti Pots

The weather is turning and we're heading into cold and flu season. Many drugstores, pharmacies and grocery stores have already begun offering flu vaccines to the public. There are many nutritional strategies you can use to reduce the potential for getting sick. We'll talk about some of those in the coming weeks. But there is one tool that can be used safely by most people; the Neti Pot. Dr. Oz demonstrated use of the Neti Pot on Oprah's show last year. Following that episode, neti pots flew off the shelves of health stores.

Neti pots are great tools for nasal irrigation. The concept is simple. You pour warm water into one nostril and it comes out the other nostril. On its way through the nasal passageways, it clears the 'gunk' out of your nose. The first time you see it, it's weird. The first time you try it, it's even more weird. But other than looking and feeling funny, is there any merit to it? Absolutely.

You've probably heard that the best way to ward off cold and flu viruses is through regular hand-washing. Those viruses are easily passed from person to person and object to person. Those viruses often work their way into our nasal mucosa before we have a chance to wash them off. Nasal irrigation is our opportunity to wash the inside of our nose.

Start your day with nasal irrigation and you'll breathe easier as well. Neti pots are very affordable and will last for years. They are effective during allergy season as they wash away the irritants on the mucosa. But with cold viruses ramping up for the fall/winter, now's the time to get in the habit.

The Omnivore's Dilemma

If you've ever thought that you need to revamp your relationship with food; then read this book. Food has become one of those things that we don't really need to think about. Michael Pollan does a good job in forcing you to assess the origin of your food. If you had a hamburger for lunch today, have you thought about where the beef really came from and how it got to your plate? The story, told in this book, is quite disturbing. He dissects the origin of much of our "food" and starts with the story of corn. He interviews farmers who farm on an industrial scale, and those that work hard to preserve the land and therefore, improve the quality of their product.

Pollan is a great writer. He brings you into the experience of food so much that you'll never see your dinner plate the same again. I've always said that eating is one of the most intimate things you can possibly do. You are literally inviting the outside world into your body with every bite you take. Pollan expands that concept and beautifully describes eating in terms of our relationship with nature.

One of the best books I've read- highly recommended.

What's in Your Bottle?

Earlier this year, the FDA released a statement that Bisphenol A (BPA), a chemical commonly contained in plastics, was safe. This statement was not made casually, but after careful consideration of the best evidence available.

Now, the National Toxicology Program, which falls under the large umbrella of the National Institutes of Health, disagrees. Their own assessment released last week determined that there is some concern for effects on the brain, prostate and behavior of fetuses, infants and children at typical levels of exposure.

Interestingly, rather than accepting this as a cause for legitimate concern, the American Chemical Society’s weekly magazine proudly claims, “Bisphenol A Called Mostly Safe.”

From the article itself:
“The findings in NTP's draft report provide reassurance that consumers can continue to use products made from bisphenol A,” said Steven G. Hentges of the American Chemistry Council's Polycarbonate/BPA Global Group.

That must be the most sensational piece of political spin I’ve ever heard! Most rational individuals understand that health risks ought to be avoided even when they are only risks- not guarantees. Scientists agree that bisphenol A is an endocrine disruptor although the minimum amount required to be significant is unknown. Shall we wait until enough brains, prostates and behaviors are disrupted so that we have undisputed evidence that BPA is bad? Walmart, Nalgene, Toys R Us say no. All 3 are clearing their shelves of products containing BPA.

The FDA says it is safe. The National Toxicology Program says it is not safe. Let’s err on the side of safety and avoid BPA containing products.

Alabama's Fat Tax

Obese state employees may soon have to pay an additional $25 in health insurance per month. Some argue that it asks the people most likely to consume health care resources to invest in it now. Others cite discrimination and unfair policies toward the overweight.

I’m not going to comment on the delicate politics of this situation, but it does give us food for thought.

Chronic disease, (not car accidents, trauma, gunshot wounds etc.)… chronic disease which is often preventable, has the potential to bankrupt our health care system. When 1 in 4 Americans has a blood sugar disorder, what will happen to their health 20 years from now? If we don’t wake up now, then 20 years will pass and our hearts will be sick, our brains will be on fire and ours organs will fail. What can any doctor, even the world’s best doctor, do at that point? From an economic standpoint, these sick people will continue to consume healthcare resources for problems that could have largely been prevented.

Check out this article from the Canadian Diabetes Association. It states that the health care system can pay $2000-5000 per year now to properly care for a diabetic or pay $50,000 a year to care for a diabetic who has progressed to kidney failure.

This article was published in the Mississippi Business Journal in 2006. In it, Dr. Marshall Bouldin, Director of the Diabetes and Metabolism Program at the University of Mississippi Medical Center, said, “The burden of both type 2 diabetes and obesity is rapidly increasing and shows no sign of stopping. If our society does not change this, diabetes alone will bankrupt our medical system.”

A “tax on the fat” appears to be one proposed method to prevent this. But the more important message seems to be; to save our health care system, we must first save ourselves.

There are a lot of mysteries surrounding the cause of many chronic diseases. We aren’t even close to having all the answers. Genetic predispositions, single nucleotide polymorphisms, prenatal environment, environmental toxicants, phthalates, BPA’s, heavy metal load etc.à all these things may be relevant and it is easy to feel out of control.

But the one thing we can all do to significantly decrease our risk of most chronic disease: eat better, exercise more, reduce stress and carefully regulate our blood sugar. These things, in our control, usually outweigh the many things beyond our control. For government employees in Alabama, it will also save $300 per year.

Organic Foods not more nutritious

Last week, the Journal of the Science of Food and Agriculture reported that organic food is not more nutritional than conventionally raised foods. The Society of Chemical Industry, the sponsor of the journal, proudly declares on their website “No evidence to support ‘organic is best’” The researchers found that the nutritional content of carrots, kale, mature peas, apples and potatoes were comparable between organic and conventionally grown foods. This is actually good news from a certain perspective, but as in any industry, when we hear ‘breaking news’, it is important to take a step back and look at the big picture.

Many of you are aware that this news was not quite as ground-breaking as the coverage made it out to be. Picture this scenario: you step out into your backyard and pick two ripe home-grown tomatoes. The nutritional content is exactly the same. Now spray one with bleach & pesticide and leave the other alone. Which would you rather eat?

The article makes no mention of potential risk of pesticides. In fairness, the article was simply looking at nutritional content of foods. But for practical purposes to the average consumer, this study does very little to dissuade one from choosing organic when possible.

Two Faces of Insulin

Insulin is quite important for our survival. It is a good hormone that helps cells make use of the food that you eat. If you didn't make any insulin, you would suffer a lot and eventually die. It is safe to say that insulin is a good thing.

But when insulin levels go out of control, your body starts to ignore the message that insulin is trying to send. This is called insulin resistance. This is often accompanied by high levels of insulin. Since your body is ignoring insulin's message, your pancreas (the organ that makes insulin), screams louder and louder... producing more and more insulin. This leads to the bad things associated with insulin. Insulin resistance is associated with:

• Elevated bad cholesterol and triglycerides
  
• Lowered good cholesterol
• Hypertension
• Systemic inflammation
• Vascular endothelial dysfunction
• Changes in sex hormone levels in both men and women
• Women's testosterone levels can increase.
  
• Men's estrogen levels can increase while testosterone levels go down.
• Both of these scenarios promotes even more insulin resistance which then sets up a vicious cycle of destruction
• Cortisol levels go up as your body perceives insulin resistance as a "stress response"

If all that sounds like just a bunch of scientific mumbo-jumbo, let's translate that into English:

1. You'll be tired all the time
2. Blood vessels will get clogged up leading to potential:

• blindness
• impotence
  
• kidney failure
• heart attack
• stroke

3. You're more likely to get Alzheimer Disease or other forms of dementia
4. You won't be able to lose weight
5. Your sex drive will plummet
6. You'll be crabby most of the time

... and this is the short list.

The food you eat sends signals to your body. If you eat right, you send the right signals. If your idea of a healthy meal is a big plate of pasta, garlic bread, a baked potato, apple juice and a cookie, then I guarantee you are sending the wrong kinds of signals.

The Root of Many Evils...

The single most important thing you can do for your health is to regulate blood sugar. Sleep is good, hydration is good, meditation is good, laughter is good, yoga is good, swimming is good, vitamin consumption is generally good.

All these things are wonderful and should be an integral part of your lifestyle. But the single most important thing you can do for your health; regulate your blood sugar.

It’s almost like asking what the most important thing is in a house. Is it the plumbing, electrical wiring, roof, furnace, doors? Of course they’re all incredibly important. If any of them goes awry, your home life will be very uncomfortable for a while. But none of those are any good unless your foundation is strong. Have you seen those million dollar homes slide off the hills when it rains in California? I think those homeowners would tell you that when the foundation failed, none of the other stuff mattered.

Your body’s foundation for everything is your blood sugar. It may be a stretch to say that all diseases have some foundation in blood sugar irregularities. But it’s not a stretch to say that many people with health issues do have problems that arise from blood sugar problems.

There are many things that factor into good health from a functional medicine perspective. The gastrointestinal system plays a huge role in overall health. The thyroid glands, adrenal glands, good nutrient status, oxidative stress, gut infections, systemic inflammation etc. There are many avenues to pursue when you just feel “off” and unhealthy. We’ll discuss many of those in this blog. But if blood sugar levels repeatedly spike and crash, then none of those other things matter.

Some people are quick to dismiss the blood sugar issue saying, “no one in my family is a diabetic. I’m fine.” Diabetes is one possible end result when blood sugar levels get completely out of control. But what about the approximately 280 million Americans who have not been diagnosed with diabetes? How do you know if you have problems with blood sugar?

If have sweet cravings, get irritated or light-headed when you eat lunch a little too late…

If you get easily fatigued in the afternoon or really sleepy after lunch…

If you really need coffee to get you going in the morning or depend on the afternoon latte…

… you probably have problems with blood sugar.

You see, blood sugar is the stimulus that tells your pancreas to release insulin. When blood sugar goes out of control, insulin goes out of control. It is released excessively and over time, your body stops paying attention to what insulin is trying to say. This is ‘insulin resistance.’ In the next blog, we’ll talk about the 2 faces of insulin. The good and the bad.

Welcome to the functional medicine & clinical nutrition blog

Hello everyone. Welcome to the blog! I hope it becomes a place where you can get up to date information that is useful and practical. The world of clinical nutrition is swimming with new information daily. Many people are left with the question, "So what? What am I supposed to do with that information? Does that influence my life in any way?"

Health care is changing rapidly. Most physicians admit that we've been sucked into a failing model of health care. There seems to be a drug for every symptom. Those of us that work with nutrition aren't removed from blame either. For years, we've followed the same model but instead of drugs, here's a vitamin or supplement for every symptom.

Got headaches? Take magnesium.
Sleepless nights? Take 5 HTP.
Got a cold? Take vitamin C.

The old model of health care and nutrition is being replaced by the functional medicine model. It's about understanding the web-like interactions of different systems of your body. Then identifying those areas that are involved and trying to make corrections.

We need to stop asking questions like, "What causes headaches?" And starting asking the right question, "What's causing your headache?"

We are all similar in a lot of ways. We've all got the same parts; a brain, liver, heart, lungs, intestines etc. But we are also very unique. More than ever, the concept of biochemical individuality is becoming relevant to health care. That is the essence of functional medicine. Your headache (or fatigue, chronic pain, poor digestion, insomnia, lousy memory, sexual dysfunction, gas etc.) is likely to have a different cause than your best friend's, sibling's, aunt's or uncle's. Functional medicine is about getting to the bottom of your problem.

In this blog, you'll get some answers in plain English. But more importantly, I hope you come away with the right questions to ask your doctor so you can work together as a team.

Happy reading.