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Monday, September 9, 2013

Just Eat a Healthy Diet - Part 2

In Part 1, we discussed things that can sabotage us from making dietary changes.  In this post, I wanted to show some tools that can be used to determine what a person's needs are.  The body is remarkable in that it can survive on a wide variety of diets - I have seen people live for years on only fast food and latte's.  However, what we are concerned about here is what is the best diet for a person.  This question is difficult to answer as each person is an individual and there is not one diet that is right for everyone.  In future posts, we will talk some more about this personalizing of diets, but today I wanted to focus on some useful web based tools to see what we need in our diet. Read this article at this url

The first website is put out by the US Department of Agriculture and is called an Interactive Dietary Reference Index (DRI) guide.  The website can be found by clicking .  It is designed for health professionals, but there is nothing that would be too hard for a non-professional to do.  You enter your height, weight, gender, and activity level and then click what you would like to calculate.  I recommend clicking everything and then submit.  It will give a guideline of how many proteins, fats, carbs, vitamins, minerals, and water a person needs daily for optimal health.  It also gives a safe upper limit on intake to prevent any problems.  It is not a perfect system but it can be a useful guide on things.

For example, I put my data in and saw some interesting findings:

MacronutrientRecommended Intake per day
Carbohydrate314 - 454 grams 1
  Total Fiber38 grams
Protein65 grams
Fat62 - 109 grams 2
   Saturated fatty acidsAs low as possible while consuming a nutritionally adequate diet.
   Trans fatty acidsAs low as possible while consuming a nutritionally adequate diet.
   α-Linolenic Acid1.6 grams 3
   Linoleic Acid17 grams 3
   Dietary CholesterolAs low as possible while consuming a nutritionally adequate diet.
Total Water*3.7 Liters (about 16 cups)

I find it interesting that is recommended 38 g of fiber per day.  The standard recommendation (RDA) is 25 g per day, but research has shown that getting 35 g of more per day is beneficial for weight management and disease prevention.  The Standard American Diet (S.A.D. - an appropriate acronym) provides an average of about 15 g of fiber per day.  This is one of the reasons that we have an epidemic of digestive diseases in our culture.  Also interesting is that it recommends 16 cups of total water per day.  The asterisk is that this includes water in our food - mostly in fruits and vegetables which is hard to calculate.  However, eating a plant based, non-processed diet is going to provide much more water than an animal protein/processed grain diet that most Americans eat.

Moving on to Vitamins and Minerals:
 
VitaminRecommended Intake per dayTolerable UL Intake per day
900 mcg3,000 mcg4
90 mg2,000 mg
15 mcg100 mcg
15 mg1,000 mg5
120 mcgND
1.2 mgND
1.3 mgND
16 mg35 mg6
1.3 mg100 mg
400 mcg1,000 mcg7
2.4 mcgND
5 mgND
30 mcgND
Choline550 mg3,500 mg
CarotenoidsNAND8
Click individual vitamin for fact sheet.
Click on numbered footnote for more information.
Minerals 
(Elements)
Each reference value refers to average daily nutrient intake; day-to-day nutrient intakes may vary.
MineralRecommended Intake per dayTolerable UL Intake per day
Essential
1,000 mg2,500 mg
2.3 g3.6 g
35 mcgND
900 mcg10,000 mcg
4 mg10 mg
150 mcg1,100 mcg
8 mg45 mg
420 mg350 mg 9
Manganese2.3 mg11 mg
Molybdenum45 mcg2,000 mcg
700 mg4,000 mg
4.7 gND
55 mcg400 mcg
1.5 g2.3 g
11 mg40 mg
Non-Essential
ArsenicNAND 10
BoronNA20 mg
NickelNA1 mg
SiliconNAND 11
SulfateNAND
VanadiumNA1.8 mg 12

It is interesting to see these numbers and then do some calculations about how you are doing.  2 things that stand out to me is Magnesium and Selenium.  The Standard American Diet is notoriously low in both of these key nutrients.  A person would need to work to ensure they are eating food containing these foods or to supplement with an outside source.

So how do you know how much of these you are getting in your diet.  There are other online tools that can tell you how much you are getting.  I like  which allows you to enter a food and see what it contains.  It also lets you search for what food are highest and lowest in certain nutrients.  

For example, I searched the for what foods are the highest in fiber, selenium, and magnesium together and the results showed Brazil nuts, rice bran, wheat bran, seaweeds, and mushrooms.  So I could use this tool to determine what foods I could eat to increase certain nutrients.

If you become a member (this is free) you can also enter in everything you eat in a day and it will track how you did as far as nutrients, vitamins, and minerals.  This can give you an idea if you are getting enough from your diet alone, or if you need to make some changes or supplement with outside nutrients.

There are many more online tools and smartphone Apps nowadays that will do these difficult calculations for you to determine what you need and if your diet is providing it.  I would encourage you to take the time to do a little investigation on how healthy your diet is and what could be changed.  You could also bring a diet recall guide in to an appointment with a nutritionist or your naturopathic physician and discuss it with them.  I prefer to see at least 3-4 days including both work and non-work days to really get a feel for someone's diet and what we can do about it.

In future posts, we will discuss other tips for improving diet.

Thursday, February 7, 2013

Just Eat a Healthy Diet - Part 1

I have heard doctors say this to patients, "Just eat a healthy diet and you should be fine."  Other times, i have heard - "You just need to make healthier choices."  At the time, I thought this was a stupid thing to say to someone for several reasons.  First of all, there is much disagreement on what constitutes a healthy diet.  Next, the chances are that the patient has no idea what this means or often the case, thinks they are eating a pretty health diet, when in reality it is often quite poor.  And lastly, making dietary changes is notoriously difficult.

Let's look at that last issue first.  People often start out with the best of intentions to try to eat "healthier."  Usually this comes around New Years as a resolution or sometimes after a health scare.  And yet despite, starting strong, we often fall back into the same rut that we were in before.  I believe that there are a few reasons for this:
  1. Food triggers dopamine pathways in the brain.  Dopamine is the a neurotransmitter in the brain that is associated with pleasurable feelings.  Cocaine and many other drugs will boost dopamine.  Food will also boost dopamine.  The three largest boosts of dopamine come from sugar, fat, and salt.  If you think about your food cravings, they usually contain some combination of 2 or 3 of these.  In a sense we are addicted to our foods and especially those rich foods that give us comfort.  Making changes in our diet to healthier choices will often lead to mood shifts and generally just not feeling good.  This could be compared to an addict going through withdrawal.
  2. Food has a social value as well as just nutritional value.  Almost any family or friend gathering involves sharing a meal together.  Many of our best memories are associated with eating with others. When we start to make changes, we often feel like we are being sabotaged by our family, friends, BBQs, potlucks, holidays, business meetings, etc.
  3. Food has complex reward vs punishment motivations.  Think back to as a kid - if you were good you would get ice cream or pizza party, but if you were bad you would go to bed without dessert.  This sets up a scenario when many of us feel like we are depriving ourselves without proper pleasure foods or we do little food rewards throughout the day.
  4. Marketing.  The first thing you notice when you are on a diet is all the food advertisements around.  TV commercials with melting cheese oozing, billboards with hamburgers, magazines with some yummy treat.  The goal of advertisement is to make you feel like your life is lacking without something and that your life will be better with their product.  Advertisers are quite skilled at getting you to want their product.
  5. Food processing industry tricks.  The food industry has a financial motivation in getting you hooked on their product.  The reason for certain ingredients like increased sugars (often hidden under multiple names - like dextrose, galactose, invert sugar, etc), MSG (again often hidden under names like autolyzed yeast, or hydrolyzed protein), salt, caffeine, and artificial sweeteners is to make us more addicted to a food and want to buy and eat more and more of it.
  6. Habits. Often we have come to associate certain foods with certain activities.  Whether it is chips and dip while watching a game or a cookie or baked good with your cup of coffee.  Breaking these habits can be difficult.
  7. Government subsidies.  I have heard that 80% of government food subsidies go to corn and soy in this country.  Much of this is used to make junk foods using high fructose corn syrup and cheap soybean or corn oil.  Much of this also goes for animal feed to keep the price of dairy and meat down.  It does not make sense that it should be cheaper to buy processed junk food rather than real food.  In most parts of the country, you can buy a hamburger or hot dog for less than the price of a piece of fruit or a salad.  Dollar and value menus at fast food restaurants reflect government subsidies - if meat, cheese, and bread were at their true market value, you could not find a hamburger for a dollar.
  8.  Many people, especially in inner-city urban environments, do not have access to fresh real foods - fruits, vegetables, whole grains.  Often people are forced to buy from the stores in their area which have mostly processed (boxed, canned, or pre-packaged) foods with less nutritional value than real foods
So telling someone to just eat a healthy diet, or just make healthier choices is not a great piece of advice.  As you can see, we have many things setting us up for failure.  As we continue this series, we will look at ways to improve our choices and make the type of changes that are lasting and hopefully life-long.

Check back for future discussions about what we can do to overcome the cards that are stacked against us.

Monday, February 4, 2013

You Have to Reduce Your Stress - Part 4.

Part 1 - here.

Part 2 - here.

Part 3 - here.

In this 4th and final part, I wanted to discuss some nutrients and herbs that have traditionally or recently found to be helpful for the body of someone who is under stress.  Much of this research has been done in Russia and has shown to help improve athlete's performances, student's test scores, and soldier's ability to do their jobs under stressful conditions.

Naturopathic medicine specializes in treating each patient as an individual.  In this light, a therapy that might be good for one person may not work well for everyone.  Specific recommendations are best when directed to the needs of a particular person. I would encourage you to discuss any new supplements, dietary changes, and/or exercise programs with your physician - either naturopathic or otherwise.  That being said, the following is a list of many of the interventions that we use to help people to cope with stress and function better in a stressful world.

I often will suggest starting with basic nutrients that most people are deficient in.  I would like to think that we could get all of our nutrients from our diet, but the unfortunate reality is that most of us do not.  I often will suggest beginning with a whole food based multi-vitamin.  I will discuss this in a later post, but whole food vitamins get their nutrients from actual foods - not synthetic isolates put in a pill.  Second, extra B-vitamins in the form of a B-complex are often needed when the body is under stress as the body is burning through its supply quicker.  Next, Fish oils can be helpful with mood stabilization as well as decreasing inflammation that results from being in Stage 2 and 3 of the maladaptation syndrome as discussed in Part 2.  Lastly, Calcium and Magnesium tend to be deficient in most people and can help with sleep (I usually recommend taking in the evening) and muscle health.

After a person's nutritional basics are met - and often many symptoms of disease will clear up with this one simple intervention - we then think about using targeted nutrients to help support the adrenal glands.  I mentioned a B-complex and this can help, especially B-5 (pantothenic acid).  Glandular adrenal tissue from animals - usually cow's - has been used traditionally to help support the adrenal system and we have seen this help with some patients.  Lastly, there is a class of herbs called adaptogens that have been researched to help the body function better under stress.  A couple of the common ones we use in office include Siberian ginseng (Latin name is Eleutherococcus spp), Ashwaganda, Rhodiola, Licorice, and Holy basil.  These can be used in capsule form, tea, or tincture.  I would consult a physician for dosage or read the recommended dose label at the health food store.

[As a humorous aside, I once recommended that a patient take licorice for a health condition.  They came back and asked if Red Vines would be okay.  When I refer to licorice, I mean the actual licorice plant (Latin name Glycerrhiza spp).  Again, we have to choose our words carefully as a physician so that we get our message across.]

Other helpful things for building adrenal reserve and helping the body deal with stress include getting regular bodywork like massage, chiropractic, craniosacral, or acupuncture.  Many people report feeling recharged after spending time in nature like hiking or camping and I have to personally agree with this.  Also, just taking time to focus on activities that nurture you is important.

To summarize, all of us are going to be under stress at some times (or even all times).  How we respond to this stress is going to be based on our past experiences, our expectations, and our resources.  If we have the resources and the ability to reframe a stress as a positive challenge to overcome rather than an overwhelming life event, we are going to help our body out.  Persistent negative stresses (distresses) will cause a long list of health problems that often lead to severe illness.  I encourage each person to look at your stress level and make some changes to help overcome.




Wednesday, January 23, 2013

Smart Things Doctor's Say - Are You Safe in the Home?

An article on CNN health I saw this week discussed that the U.S. Preventative Services Task Force (USPSTF) recently updated their recommendations that all doctors should ask female patients about the whether domestic violence was an issue in their homes.  Here is a link to the article:



The article states that 1/3 of women and 1/4 of men experience some level of domestic violence in their lives.  This is obviously way to many people living in fear in this country and often feeling trapped.

I am grateful for this change in recommendation.  This was something I learned in naturopathic medical school that should always be asked of new patients.  I was taught that in most of these cases, they don't have anyone to tell and a doctor appointment may be the only place for them to reach out for help.

In general, I have mostly approved of the USPSTF recommendations which have sought to put guidelines in place for things like mammograms, pap smears, prostate cancer screenings, and others.  Their recommendations have made headlines frequently in the past years, but the recommendations have been based on sound research.

I try to make it a point to ask all my female new patients if there is any violence or substance abuse in the home.  I have gotten some strange looks and mostly resounding clear "Oh no, never" responses, but on occasion I have had patients disclose that they are afraid in their home currently or in the past.  I have passed on resources to these patients about options for them.  It is not an easy thing to disclose and I am grateful that they were willing to entrust me with this information.  I have had people tell me that I am the first person they have told these things to.

I therefore, strongly agree with this recommendation and hope that other doctors will follow suit.  Because, if we do not ask, we may miss the opportunity to help someone who truly needs assistance and has no where else to turn.

New Vaccinations are Perfectly Safe

A disturbing report came out in the last couple days about over 800 cases in Europe of Narcolepsy developing after people had the H1N1 vaccine in the 2009 swine flu scare.  Originally reported by Reuters and picked up by numerous new agencies, this story is more concerning because most of the cases appear to be in children.  Many of the stories are quite tragic with severe debilitating symptoms that will most like linger for the rest of their lives.

Here is a link to one of the stories:  

The culprit appears to be Pandemrix H1N1 swine H1N1 swine flu vaccine produced by the British drugmaker GlaxoSmithKline.  This vaccine was not used in the United States, where we used a different variant.

At the time of the initial swine flu scare in 2009, I repeatedly told people to be cautious of getting the vaccine as it was rushed into production and we did not have a long safety profile on the vaccine yet.  I reminded people of the last time a swine flu vaccine was rushed to market in 1976, where a spike of a rare neurological disease that is potentially fatal called Guillain-Barre syndrome occurred.

I am not 100% pro or 100% anti-vaccine.  I can argue both sides of the coin in my head and go back and forth.  I think there are compelling arguments on both sides.  I always support my patients in whatever decision that they choose as far as vaccination and give my patients as much information as possible so that they can make an educated decision on their own.  It is a hard issue - if you do not vaccinate and your child or self gets an illness that could have been prevented, or if you do vaccinate and some type of reaction happens, you are going to second guess yourself.

But I will not say that vaccines are perfectly safe.  The vast majority of people who get a vaccine have no problems, but I did once have to attend a funeral of a 4 month old son of a friend of mine who died 48 hours after his vaccinations.  That was one of the hardest things I have done in my life and I wish that scenario on no one.

My biggest concern is with these vaccines that are rushed to market with a health scare.  The H1N1 flu started out looking pretty scary and vaccines were quickly made to try to fend off the danger.  Much of the usual testing in these situations is neglected as the race to prevent an epidemic is on. The pandemic, we now know in hindsight, never was as bad as initially thought and now with stories like this, it remains to be seen whether the vaccine may have caused more problems than the flu itself.  I will continue to to recommend caution with new vaccines, especially when they are rushed to market.

Thursday, January 17, 2013

You Have to Reduce Your Stress - Part 3

Part 1 - here.

Part 2 - here.

In parts 1 and 2 we discussed the effects that stress had on the body and how a stress can be good or bad depending on how we are framing it.  In this third part, we will look at what we can actually do to help the body function better through stress - not just trying to avoid stresses which is usually an impossibility.

If you recall, we said that there are 3 things that determine if a stress is going to be a positive eustress or a negative distress.  They are

  1. Our past experience
  2. Our expectations.
  3. Our resources.
We will look at each of these areas.

Our Past Experiences

This is the hardest of the 3 to influence as it is already in the past.  However, sometimes there is some things we can do about this.  Counseling and self-analysis can help us re-frame some of our past experiences and help us come to a better understanding about how we acted in the past.  If you have a pattern of reacting poorly in to stresses in the past, I would encourage you to look into some type of counseling to learn how to change how we act in the future.

Our Expectations

This is something we can make some changes in.  I often excourage people to take an inventory of what our stresses are and think about how we view them.  Counseling (especially cognitive and/or behavioral therapy) can again help here to develop solutions on how we are viewing our stresses.  Another thing that can help here is by focusing on spiritual practices which can help us connect to concepts that are bigger than ourselves. Lastly, finding ways to focus on helping others can help take us out of our self-centered focus on our stresses.  Helping others is a good way to see that we are not as bad off as we thing as well.

Our Resources

This third and final determinate of how we handle stress is the one that gets missed the most and is the one area that we can intervene the most.  If we build up our resources, we are much more able to handle the inevitable stresses when they arise.

Improving our resources begins with basics of health living.  I always recommend that patients try to eat regular healthy meals with adequate protein, whole foods, fruits, and vegetables in order to provide sufficient nutrition for their body to function optimally.  Next, it is important to get enough quality sleep.  Doing this naturally is preferred, but if this is not possible there are herbs, nutrients, and as a last resort medications to assist in this process.  Regular exercise is hugely important as well for helping cope with stressors.  I tell people to shoot for a minimum of 20 minutes, 3x per week with a goal of working toward 60 minutes on most days.  Adequate hydration with clean water and tea is another important part of building our resources.  

Further, finding a connection with a community of like-minded individuals helps us feel valued and prevents loneliness which is a huge additional stress on an individual.  Also, engaging in activities that are recharging and relaxing is important in this extremely busy world.  Finding time to check out for a stretch is hugely rejuvinating.  My wife and I take a 24 break from work and business matters every week and I believe that this has helped us keep our sanity and preserved our marriage (working and living together is a challenge we early acknowledged could make or break us).  Taking regular time off with vacations or even just stay-cations is important as well.

Additional self care things that can be helpful include bodywork like massage, acupuncture, or craniosacral therapy. Spending time in nature is also something that many people find renewing and energizing.
By doing these things, we can help build a strong foundation of healthy living choices and become more able to cope with the inevitable stresses that will arise.

Stay tuned for part 4 which will discuss specific nutrients and herbs that have been shown to be helpful to assist the body function through stress.

Tuesday, January 15, 2013

Your Stupid Things Doctor's Say Stories: You Just Need Prozac to Cure that Rash.

An e-mailer wrote in to tell a story about what they heard from a doctor in the past.

Several years ago, I was suffering from what appeared to be eczema. During that
time I was working for a Fortune 500 company.  I tried everything. I went to a
dermatologist, who said, "Well, I moved from Palo Alto because of patients like
you!  You are so stressed out from your jobs.  What you need is Prozac!  That
will cure your eczema!"  Right, did I believe that one? No.


I have never thought of treating eczema with Prozac before, although I do have to give the doctor some credit for at least acknowledging a mind-body connection.  Our emotions do play into our physical symptoms, but to then say that Prozac is going to cure eczema seems to be a stretch to me.  I have heard numerous patients over the years be told by a doctor that their problems are all in their head, but usually that is because they can not find any tests or physical findings that are abnormal.  With eczema, it is pretty clear by just looking at the skin that there is something going on.

I like to spend time with patients and discuss possible emotional connections to their illness.  In this case, however, the tone of the doctor comes across as very condescending.  This is something that we in medicine have to be cautious to avoid.  I have heard this from patient after patient discussing their experiences with other doctors.  I imagine, unfortunately, that I have probably had patients feel this way about me.  In medicine with all our knowledge and testing abilities, we often forget that we are working with a real person, who often is scared and concerned about what is wrong with their body.

I recall a patient that came to me years ago with a chief complaint of toenail fungus.  During the course of taking a history, I quickly realized that this person had numerous other health conditions that were much more urgent than toenail fungus.  I quickly brushed off the patient's reason for coming in, focusing instead on the more serious problems.  At the end of the visit, the person seemed down-hearted and I asked if there was anything else.  They were upset because we never addressed the toenail fungus, their main reason for coming in.  We must do our best to focus on what is mattering to the patient and not just what we think needs to be the focus.

The e-mailer goes on to say that she found relief from her eczema using UV light treatments in a tanning bed or just spending time in the sun.  I have seen this be helpful.  I also will look at dietand look for possible food allergies.  Fish oil in higher doses often can be helpful.  I try to avoid steroid creams as much as possible as I don't think they really solve the problem, but rather just suppress a symptom.

Thank you to the person e-mailing in with this story.  If you have heard something stupid said in a health care setting, leave a comment or send an e-mail to drjeremiah@stevensnd.com.