Tapioca what?

My new favorite healthy grain-free, low starch, to-die-for tapioca pudding impostor. Breakfast, after school snack, or dessert, this one's a kid and mom alike pleaser.

In the last few weeks there has been a major shift in the dietary habits of my household. This is due in large to my father's MS and the recommendation of a ketogenic diet trial from his physician. As I cook for everyone in the household, and am also trying to increase my brain health I have been adopting a largely similar diet high in healthy fats (even more than before!) and super low in carbs (even lower than before) and avoidance of grains. So there's the background to this ridiculously easy, absolutely delicious, and healthful recipe's invention.

On cold evenings I am one who thinks there is nothing better than a cup of tea or other such bowl of warmth to start the evening's wind-down. As a kid I loved tapioca (think snack-pack) although as an adult I learned how to make it the "real" way with tapioca and whole milk. Tonight I was craving such a treat so I invented this little beauty which absolutely hit the spot. Variations are highly encouraged as you could go a million different directions. I give the amounts for a single serving (about 6 oz) so just increase as needed for additional hungry mouths.

Ingredients:
- 1/2 cup Whole fat coconut milk, non sweetened, with no carageenan. (For me, this means cans at this point as my grocery store doesn't carry it otherwise to these specs)
- 1/2 Tbs Coconut sugar (or sweetener of your choice- maple syrup or honey would be yummy too)
- 2 Tbs chia seeds
- 1 Tbs ground flax seed
- 1 Tbs butter (grass fed organic is my fav)
- 1/2 tsp cinnamon
- 1 tsp vanilla
- 1 Tbs crushed/chopped nuts of your preference

Directions:
Stir the coconut milk, sugar, chia seeds, flax seeds, butter and cinnamon together in a microwave safe bowl/mug. Heat on high for 1 min. Remove from microwave and stir in nuts and vanilla. Allow to cool or serve warm. The longer it sits, the more liquid will be absorbed, and the softer the seeds will become. Expect a little crunch if you eat it hot.

This can also be made on the stove by heating the first 6 ingredients together on the stove top with a heavy bottom pan, stirring frequently, until it thickens and then allowing to cool before adding the nuts and vanilla.

Yum! Enjoy in good health :)

Here's the specs:

Recipe Nutrition Calculator

Recipe name

Number of servings

Serves  people

Ingredients	Calories	Carbs	Fat	Protein	Sodium	Sugar
Taste of Thai - Coconut Milk (Non-Lite), 0.5 cup	180	3	17	2	38	3
Madhava - Coconut Sugar, Organic, 0.5 tsp.	8	2	0	0	0	2
Seeds - Chia seeds, dried, 1 oz	139	12	9	4	5	0
Bob's Red Mill - Ground Flax Seed Meal (1 Tbsp, 6.5g), 1 Tbsp (13 g)	30	2	2	2	0	0
Organic Valley - Grass Fed Butter, 1 TBSP	110	0	12	0	40	0
Cinnamon - Cinnamon, 1/2 Tsp	4	1	0	0	0	0
Pecans - Chopped, 1 oz	199	4	21	3	0	1
Add Ingredient

Total:	670	24	61	11	83	6
Per Serving:	670	24	61	11	83	6

The Gut and Brain Connection

Have you ever “felt butterflies in your stomach” or had a “gut feeling?” We use these phrases, and others relating to our gut frequently in our life but have you ever wondered why? It turns out that our gut is really a sort of a second brain. In the lining of your gut there are many nerve plexi (a fancy word for clusters of nerve cells), adding up to over 100 million neurons, which is more than in the spinal cord and all the nerves running outward from it. These clusters function as little mini-brains, formally known as the enteric nervous system. The mini-brains pump out many of the same molecules as the big brain. As much as 95% of the serotonin in your body is made by your gut! This alone gives good reason why when your gut is feeling crummy your emotions are often strongly affected too and vice versa. Even the thought of food can trigger your gut to start churning out all sorts of digestive juices. It has often been noted that people with digestive problems also had psychological problems, but this does NOT mean that it is all in your head! However, treating the mind through counseling, stress reduction techniques, or other healing methods has been shown in studies to significantly improve digestive function.

Naturopaths, when in doubt with a case, have traditionally fallen on two chronic causes of disease- the liver and the gut. “Treat the liver, treat the gut, they will get better!” This holds true especially for mental/emotional problems. Studies have shown that the largest nerve running between the brain and the gut consists of 90% information flowing from gut to brain. Obviously, what your gut feels can influence how your brain feels! This has also shown to be true with anti-depressant treatment as a common side effect of SSRIs, which increase serotonin, can cause irritable bowel syndrome. Autism has also been associated with altered serotonin levels, and autistic individuals often have gut complaints. There is currently great interest into understanding this ever extending field, and new research supports the hypothesis that the trillions of bacteria in our gut directly “communicate” with our mini-brains which in turn strongly affect our big brains.  It just makes sense that the organ responsible for absorbing all of our nutrition also strongly affects every other aspect of our being, especially emotions and brain function. Does this mean that intestinal cramping is akin to a gut migraine? One day science may agree! Until then, we must respect our guts and treat them with care as it will likely make you feel better emotionally too!

References

No author listed, based upon a Harvard Medical School Special Health Report, http://www.health.harvard.edu/healthbeat/the-gut-brain-connection

Gerson, MD. Current Opionions in Endocrine, Diabetes, and Obesity. 5-hydroxytrptamine (serotonin) in the gastrointestinal tract. Feb, 2013. 20(1): 14-21.

Hadhazy, Adam. Scientific American Website. Feb. 12, 2010 http://www.scientificamerican.com/article/gut-second-brain/

Elderberry Season

Tonight I canned up my first (and possibly last, depending on how busy the coming weeks are) jars of Elderberry syrup for the season. It's a simple process and basically involves boiling the berries in water a few hours or longer depending on your patience, straining, then boiling them down with your sweet preservative of choice- I used organic cane sugar and maple syrup. Last year I threw in a few cloves too before straining for added flavor and soothing ability. Of course there are a million recipes online as well as a few comercially available syrups if you're not game to make your own or don't have Elder trees near where you live. A word to the wise: don't eat raw elderberries- in high doses they can be toxic, but cooking removes this risk. I do not perform this yearly ritual simply so I can have delicious syrup on my pancakes- there are other berries for that. Elderberry, also known as Sambucus (Sam byook cuss) canadensis (or nigra if you're in Europe) is a mama's best friend in the coming month's of cold and flu season and making Fall syrup is a tradition in many parts of the world.
     Elderberry is native to Europe but was an early transplant to the New World. It is a small tree which can grow to 30 feet and has clusters of off-white and incredibly fragrant flowers in the late spring which develop into tiny dark blue/black berries in the late summer. It likes areas with dense vegetation, but likes to be on the edge of clearings. Once you know what it looks like, it's easy to spot. I commonly find it along roads in the Portland area and backwoods of Oregon. Historically it has been used for swelling, inflammation, pain relief, to increase urine, and as an agent to generate sweating as well as break up mucus and aid in its expulsion. It is Elderberry's strong immune enhancing properties are most useful during cold and flu season and these same properties have been the focus of many studies in the last decade. It is mainly the berries (although the flowers contain some immune enhancing properties as well) which are most commonly used medicinally. They contain molecules called flavonoids which are found in many fruits and which possess strong antioxidant and immune stimulating properties.
       Okay, enough of the science jabber. We all know how fun it is to have a sick toddler, or much worse- a sick husband, who refuses to take anything that tastes "icky." Wouldn't it be nice to be able to offer a soothing syrup, stirred into some warm tea, that also had strong bug fighting abilities? This, my friend is why I make Elderberry syrup annually. I heard a while back that the Native Americans called the Willamette Valley "the valley of winter sickness." I haven't taken the time to validate it, but it seems like a fitting title, historical or not. In this damp climate it's no wonder that winter brings with it a whole host of nasty bugs which love to dive into the respiratory mucosa and thrive, making us sick and miserable. One of the worst bugs that we all love to hate is influenza, aka THE FLU. What can you do when you get the flu? Usual prescription that we have all been given is bedrest, fluids, bland diet, yada yada yada the virus will take it's course and you just have to wait it out. Or if it's severe enough you might get one of the anti-flu pharma drugs which don't have super impressive track records although they are definitely better than nothing in bad situations. Some of the most discussed (at least in my little bubble here) studies with Elderberry are dealing with these very nasties- Influenza B, H1N1, avian flu, etc. and the good news is that most of the studies support the traditional use of Elderberry extract in treating influenza, Not only does the literature show that those given elderberry end up with a stronger immune response against the virus (it amps up your body's guns) it also binds to the viral particles themselves and can prevent them from infecting new cells (remember biology and the whole virus invading the cell, then bursting out droves of new viruses to go infect even more cells).
     This is good stuff! Many of the studies also showed a significant decrease in the time it took to recover. In one Influenza B outbreak in Panama the majority of patients given Elderberry showed significant improvement in their symptoms in 2 days versus the 6 days it took for those in the control group to reach the same level. There was also a reported decreased need of rescue inhalers among participants given Elderberry. Combine the action on the molecular level with Elderberry's other properties of helping to break up mucus and getting it out and you have one mean cold and flu fighting machine. Not only has Elderberry shown promise with influenza, but other research suggests that it might be helpful in treating giardia, bacterial sinusitis, herpes, and gingivitis. Who knew this little innocent looking berry could pack such a powerful punch?
      Elderberry has also traditionally been used to make wine and it's on my bucket list to do this someday, but for now I am happy making my syrup. Come the first sniffle this fall you bet my cup of tea with have a spoonful or two stirred in. I have also heard rumor that you can batter and deep fry the flower clusters. I'm not sure how I feel about that idea...... anyone ever try it?

Naturopathic physician... you're going to school to be a what???

It dawned on me last night in the shower (a place where great epiphanies always seem to hit me) that I hadn't done a blog on exactly what a naturopathic physician is. I realize that here in Portland, and even Oregon for that matter I am sort-of in a natural health bubble where most people you meet on the street have seen a naturopathic physician and at least have a general idea of how we practice medicine. However, when I leave the bubble it's definitely more of a puzzled look on people's faces when I say I am a med school student studying naturopathy. So if any of you are less than familiar, here's a blog for you!

First off, how did I get here? I think we need to take a journey back to when I was in highschool, although in reality many of my inclinations probably started much earlier, but for the sake of the story let's not go too far back. My freshman year was a rough one (who's isn't?). I had grown up in the company of some very nice friends, albeit of relatively conservative backgrounds. In Utah this isn't uncommon, although I like to say Moab was and is a liberal hot spot in an otherwise very conservative state. I was an early bloomer and definitely started exploring and experimenting with various things before many of my peers. My parents tended to be more open to allowing me the freedom to learn lessons for myself, a thing which I am in retrospect very grateful for (since I am one of those hard headed people who need to be thunked hard before the lesson gets through). This culminated with a mediator led meeting between my friends and I one afternoon early in my freshman year where they voiced their concerns that I was "throwing my life away" by not sticking straight on the moral pathway that I had previously tried to adhere to. I was questioning religion, authority, law, sexuality, etc... and they took this as a very bad sign. The meeting ended with my former friends essentially "disowning" me. As hard as this was at the time, in the long run it was incredibly liberating. I started hanging with a new crowd, the "alternative" kids. Many of them had been homeschooled before starting high school and many lived in homes where parents practiced sustainable living and did not conform to the "normal" standard of living. I was in heaven. I started taking Tai Chi lessons with some of them (from a wonderful man who I later discovered was an ND, although I didn't understand what this was at the time). I started seeing a traditional healer who first introduced me to herbal medicine and taught me much about body work as I was having significant growing pains and problems with my hips and lower back. I found a fabulous herbal book in the used book store, a book I still reference at least weekly to this day, and I started cooking up my own herbal concoctions every time I, or anyone I knew, got sick. They worked too!

Fast forward to my senior year. After spending my junior year in Australia (such a fabulous country that I will someday get back to visit!) I came home more independent and stubborn than ever. I quit soccer after having a heated run-in with the new coach and I decided that my senior year classes would consist of Youth Garden and Spanish, as I had been such an overachiever previously that I had no more required classes to graduate. I also decided in the winter of my senior year that I did not want to go to college. Bless my parents for being so calm when I made this announcement and for allowing me the freedom to make this decision. Even though I graduated as Valedictorian I was determined that college was not my path, at least not right away. I strongly contemplated attending an herbal school in New York that I had heard about, but didn't quite know what steps I needed to take to get there. I got a job working at a local cafe that served smoothies, fresh made juices, and yummy wraps. However, after about six months I had the epiphany (can't remember if it was in the shower or not) that I did not want to work minimum wage jobs forever and that I was feeling mentally stagnant. I decided to apply for college. I heard great things about a little town in Oregon called Ashland from one of the alternative families I was friends with who moved from Moab to Ashland. In fact, I think a total of about ten people I knew from Moab ended up moving to Ashland within a couple year period. I did a little research and found Southern Oregon University and applied. I also applied to several other larger schools in Oregon and got much higher scholarship offers, but decided in the end to attend SOU. It was a smaller school (approx 5000 student body when I started) and was in a smaller town (Ashland has about 20,000 which was still a big step up from Moab's 8,000) and it had a nice faculty to student ratio of about 17:1. I did not want to be a number and wanted to actually know my professors. It ended up being a perfect fit. The beauty of taking that year off had given me the time to figure out what I wanted to do and I knew it had to involve plants. I initially started at SOU with the intention of studying biology and getting an additional certificate in botany. I also played bassoon and after some intense recruitment (and offer of additional scholarships) decided to do a second major in music.

Some time in my second or third year at SOU I became infatuated with the idea of going to med school. Several of my friends were in the pre-healthcare society and so I joined too. I decided to change my emphasis to biomedical science and took extra chemistry and med school prep courses. I bought an MCAT study guide and diligently began working my way through it towards the end of my fourth year. Due to my double major I ended up going a fifth year and during this year I also got a job working in research as a Clinical Research Coordinator. They are the ones who actually work one-on-one with patients doing trials for pharmaceutical companies. I worked on numerous trials studying medications for asthma, COPD, allergy, and helped with a few diabetes studies as well. It was absolutely fabulous experience and several coordinators would work there for a few years and then go off to medical school. I learned how to do ECGs, spirometry, blood draws, IVs, and a whole host of other procedures. I also got great experience working directly with patients and developed several lasting friendships. I continued to work there the year after I graduated (during which I also go married and pregnant). When we decided to do a home birth I started seeing a wonderful midwife who also had a naturopathic physician working out of her office. At this point I was still considering conventional med school, although I was having a really hard time staying focused on my MCAT studying and kept putting off taking the test. I considered applying to PA school, but after a particularly gnarly week I realized that I really did NOT want to work under a doctor, but rather work for myself. That week (in the shower) I had the epiphany that I needed to return to my roots in herbal medicine. I did a quick google search for herbal medicine schools and found, much to my surprise and delight, that Portland had the oldest naturopathic school in the country. It turned out that the naturopathic physician at my midwife's office had graduated from NCNM (National College of Natural Medicine) and had also gone through the program having two kiddos. She convinced me that it was a totally doable program with kids as NCNM is very family friendly. I now think she was slightly crazy for actually having her babes while going through the program (we are waiting until I finish to have a second), but the school really is incredibly family friendly and supportive of moms and dads.

At this point I applied to NCNM but still really had no idea what all naturopathic medicine entailed. I just knew that I would get a chance to study the herbs that I loved and that it would allow me the freedom to be a doctor in my own right. NCNM gives the option of completing the program as a 4, 5, or even 6 year degree. They also have a Chinese medicine program which many students study alone, or in combination with the ND (naturopathic doctor) program. The year I started they had also just began accepting students for a research degree (masters in integrated medical research) which I initially was part of, but later dropped as it was too much piled on top of the ND degree program, which I was determined (and still am) to complete in four years. At this point I am the only mama I know of in my class who is still on the four year track. It's brutal, but I can't stand living in this rainy, foggy, soggy, wet.... you get the idea... for more that I absolutely have to. My desert roots are getting swamped and I can't wait to move back to a dryer climate!

Okay, back to naturopathic medicine. Not only do naturopathic physicians learn all about herbs (botanical medicine as we call it), but also learn all the same basics about health and disease that any primary care doctor learns. At this point naturopathic physicians are licensed in 17 states, with legislation pending in several more. Naturopathic physicians are usually general practice physicians, but some focus in on certain patient populations ranging from cardiology to pediatrics. At this point there is only one recognized and board approved "specialty" and that is in oncology and requires a two year residency after completion of the program, although a cardiology specialty is also in the works here in Oregon. Basically, the first year of the ND program is mostly basic science courses to get us all onto the same foundation. Luckily for me, most of these were classes I had taken before as an undergrad such as anatomy and physiology, biochemistry, microbiology, immunology, etc. I was very grateful for my background as it made that first year so much easier. The classes were definitely different, and included much more of a clinical (read: disease/patient) approach. Also in the first year was a Naturopathic Philosophy course in which I finally learned the history behind naturopathic medicine and what the founding philosophies are.

Naturopathic medicine, in it's modern incarnation, really started in the mid 1800's, although it's roots were based in traditional medicine reaching back for millennia. It was initially a combined approach between Nature cure and homeopathy (nature cure+ homeopathy= naturopathy!). Nature cure was a system of medicine developed in Europe based on following the inherent laws of nature. Some of these were things we take for granted now: eating a good and wholesome diet, getting regular exercise, getting fresh air, and understanding and trusting the body's ability to heal itself when confronted with disease or various stressors. Homeopathy is a whole 'nother topic (future blog?) but was founded in the 1700's and is based on giving tiny doses of medicine to correct imbalances in the body. These two systems, being very complementary to each other, merged into naturopathy in the US after being brought over from Europe and became very popular towards the end of the 19th century. In fact in the early 1900's there were over 200 naturopathic colleges in the United States! There were also many strictly homeopathic schools, chiropractic schools, osteopathic schools, as well as a newer type of medical school called allopathic.... these are the MDs we are all familiar with today. Each of these schools of medicine had different approaches to healing but were all considered valid at the time and physicians from each school were endowed with similar privileges to diagnose and prescribe. However, in the 1920's with the formation of the AMA (American Medical Association) this was all about to change. The MDs were becoming ever more popular and believed that their form of medicine was really "the" way. The AMA hired a guy named Flexner (http://en.wikipedia.org/wiki/Flexner_Report) who produced a report (with the Carnegie foundation's help) which essentially discredited medical schools who did not follow the allopathic tenants of practicing medicine. This led to the closure of most of the naturopathic schools, who at this time did not have the science to back the medicine (which we now have much of!). Many of the chiropractic schools survived, but only by giving up their right to diagnose and prescribe, and essentially losing their general medicine aspect and focusing just on what we are all familiar with today as chiropractic adjustments. The osteopaths conformed to enough of the allopathic tenants that they squeaked through and eventually won back their right to diagnose and prescribe. The naturopaths refused to give up their rights to diagnose and prescribe and were essentially persecuted to the point where in the 1940's a "good" naturopath had usually spent some time in jail for practice of their medicine. Sadly the last naturopathic school in the US closed in 1955. However in 1956 NCNM was founded in Portland. The first few years were rough and graduating classes were in the single digits, however thanks to the hard work of the remaining old school naturopaths it slowly grew and continues to regain popularity. There are now 8 accredited naturopathic schools in the US and Canada. Most are on the West Coast as this has become a haven for natural medicine and alternative lifestyles. Naturopaths are licensed to practice medicine now in 17 states, with varying scope of practice (meaning what they are legally allowed to do) depending on the state. Unfortunately, because they are not licensed country wide there are still many people who claim to be "naturopaths" in unlicensed states who have not graduated from an accredited four year program and many of them give the profession a bad name by failing to follow the accepted tenants of naturopathy. There is still a "war" between allopaths and naturopaths on many levels, but it's slowly shifting as more natural medicine is becoming mainstream and patients are wanting to treat disease with fewer toxic pharmaceuticals. Here in Oregon there are many examples of what we call "integrated" medicine where MDs and NDs are working hand in hand. In Portland there is more and more collaboration between the major allopathic medical school (Oregon Health and Science University), NCNM, the chiropractic school (Western States Chiropractic), and the Chinese medicine school (Oregon College of Oriental Medicine). A big part of this "war" is based largely on mis-information and misunderstanding between the professions and hopefully as time moves forward and communication pathways are opened the AMA will appreciate the value that naturopaths can bring to medicine.

Naturopathic physicians study not only herbal medicine, but also learn body work and adjustment techniques (similar to chiropractic), physiotherapy, orthopedics, hydrotherapy, along with conventional pharmacology. NDs are able (in most licensed states) to prescribe the same drugs that primary care physicians are allowed to, although we are taught to use these pharmaceuticals as a last resort and only for extreme cases. Most patients come to NDs expecting to get something other than drugs, and in many cases natural remedies are just as effective (if not more so) and far less toxic than the conventionally prescribed pharmaceutical for a given condition. This especially comes in handy as more diseases are becoming resistant to antibiotics. MDs don't have the training in herbs and natural remedies and are often at a loss when the antibiotics fail, but NDs have a plethora of other treatments that we can offer to patients to help conditions from pneumonia, tuberculosis, sinus infections, to cancer, diabetes, and heart disease. Just look at our country. As we have continued to follow the advice of MDs from the early 1900's on has our overall health improved? Why continue with a system that largely fails when it comes to treating chronic disease? I strongly believe that there is a time and place for allopathic intervention. If I get in a car accident and have a severe injury you better believe I will be heading straight to the closest allopathic hospital. However, allopaths have a far less impressive track record when it comes to treating things like diabetes and heart disease. For far too long their approach has simply been to manage the symptoms of these chronic disesases rather than find and treat the underlying cause of disease. Most conventional medical schools offer very little in the way of nutrition training, so how can we expect a MD to know how to counsel a patient on their diet and lifestyle? NDs receive a ton of this very kind of training and can offer patients very concrete ways to manage, and often reverse the course of chronic diseases based largely in behavior changes and gentle natural treatment approaches.

This brings me to the founding tenants of naturopathic medicine:

First do no harm. This means that with EVERY patient and EVERY treatment a naturopath will give incredible thought and consideration to the possible risks, side effects, and any other possible harm that may come to a patient as a result. We look at the statistics of how effective a treatment really is before prescribing it. Since most naturopathic visits are about an hour long (how long was your last appointment with an allopath?) we actually have the TIME to consider all these factors before recommending a treatment.

Trust the healing power of nature. The human species has survived and thrived for millennia relying on no more medicine than what we could find in nature. The human body is AMAZING! Given the right nutrients and environment it can do remarkable things in regards to healing itself and correcting disease. Naturopaths are taught to measure a person's vitality and to base treatment approaches on supporting the body's inherent ability to heal itself. This also allows us to understand that often symptoms are the body's way of alerting us to disease and that they are often beneficial (take a runny nose which is flushing the bacteria/virus out of your sinuses). If you take away the body's ability to cleanse itself you often force the disease to go deeper and manifest in more severe ways.

Treat the whole person. Why do we spend at least an hour with every patient? Naturopaths are taught to get the whole story. To really get a thorough picture of a patient's history, their family history, and a complete picture of what is happening in their health. Not only will a naturopath treat the current complaint, but will try and improve the body's whole health and vitality. We are taught to treat the person, not the disease. If two patients come in with the same disease they will very seldom receive exactly the same treatments. Every person is different and their body responds differently to disease and treatment. Naturopathic physicians recognize and honor this.

Doctor as teacher. Another reason appointments are so long! Conventional medicine has held power over their patients for far too long. So many people expect to go to a doctor and receive a prescription for their current ailment and that's it. Naturopaths are taught to counsel patients as to why they may have developed a particular disease. We try to empower patients to make educated steps towards improving their own health.

Identify and treat the cause. I mentioned this above but the heart of naturopathic care is in getting to the root of the problem, not just treating and masking the symptoms. The more I learn about natural medicine the more I am convinced that there are very few diseases (exception for some genetic in nature) in which an underlying cause cannot be established and, if you can correct the underlying problem, you can stop and even reverse the disease. This applies even to things like autoimmune disease which allopathic medicine is at a complete loss in treating. Seriously, I am witness in my own family to the ability to reverse disease course, even in long standing and severe autoimmune disease. 

Prevention. It is far far easier to prevent disease than to cure it. Easy enough said, but like I mentioned above, most allopaths have very little training in nutrition and behavioral approaches which can often divert disease course before it has even begun. In our modern society as healthcare costs for chronic disease soar this is becoming ever more important. It goes back to teaching patients what they can do to avoid developing diseases like cancer, diabetes, and heart disease. Truly these are avoidable diseases!

Ahhh... okay I feel as if I have written a novel and shared enough for one day. I am thankful every single day that I have found this medicine and am lucky enough to study it. I love what I learn and cannot wait to have my own practice where I can help to heal and put into effect all the above tenants. I hope you learned a little something too and the next time you hear the word "naturopath" you wont be confused. Here's to health!

Gluten free- why the craze?

By now I'm sure everyone has heard of gluten. Most people either know someone who is gluten free or maybe have even tried it themselves. It's estimated that Americans will spend over $7 billion on GF labeled foods this year, so there must be something to this little protein. Let's take a deeper look.

Gluten is a protein that is found in wheat, barley, and rye. It's a unique protein that allows the flours in these grains to get stretchy. Have you ever kneaded dough? Without gluten you could not bend and stretch it and the dough would just fall apart. It also helps to trap the gas from yeast gobbling up the starch in the flour to puff up the dough and allow it to rise. So what? This all sounds great right? Where's the problem and why do so many people avoid gluten like the plague?

Well, the problem does not lie in the gluten so much as it does in the body's reaction to it. Gluten, among many other things, can be a pretty severe allergen, meaning that it can trigger an allergic reaction in people who are sensitive to it. Along with soy and dairy it is in the top ranking food allergens. The most serious reaction results in celiac disease. With celiac the body's reaction to gluten is so severe that it causes serious damage and destruction in the intestines. This damage then compromises the gut's ability to absorb nutrition from food in general, and untreated celiac folks often wind up very malnourished and with severe vitamin deficiencies even though they are eating a completely balanced diet. If the damage is not too far along eliminating gluten from the diet can often completely reverse the damage, but unchecked celiac can lead to many very unhappy consequences. Approximately 1.8 million Americans are currently diagnosed with celiac disease, with another estimated 1.4 million undiagnosed. There are additionally an estimated 1.6 million Americans who buy gluten free foods without having received any kind of gluten related diagnosis, but do it for their own reasons or comfort.

 Many other diseases besides celiac may have a gluten related component. Autoimmune and inflammatory diseases can often be triggered or exacerbated by food allergies, and gluten is no exception. Gluten "sensitivity" is the label given to people who have a secondary condition which seems to benefit from eliminating gluten. Often this is attributed to antibodies that the body makes against gluten in the gut which then travel to other parts of the body and can react against other tissues. In my own case I have been diagnosed with autoimmune thyroiditis (Hashimoto's) which basically means my body creates antibodies against my thyroid gland and is slowly destroying it. Antibodies against gluten have been identified as being cross reactive against thyroid too, basically amplifying the destruction that is already happening. When I stay off gluten my thyroid levels are much more balanced and it has probably allowed me to stay on lower doses of thyroid medication then what I would need if I was still eating gluten like I used to (I am a self-admitted pastry nut). My dad was told by his neurologist in 1974 when he was first diagnosed with MS that he should avoid gluten (based on research at the Mayo Clinic about gluten and autoimmune disease even back then). He tried and failed as at that point there was no such thing as gluten free labeling and it was almost impossible to avoid. When he tried again last year (after testing very positive for a real gluten allergy) it was a million times easier and he has been successful this time! Many people also find that eliminating gluten leads to weight loss, whether it be from a eliminating an underlying inflammatory reaction or simply cutting down on refined carbs, it's hard to know, but this is another reason people often seek out gluten free foods.

So why the rise in gluten intolerance? I recently was discussing this with my doctor. She said that many doctors are completely puzzled and astounded by the number of patients they are seeing who, after eliminating gluten, report feeling remarkably better from any number of ailments. In fact, it's often joked about in naturopathic circles that the first thing any naturopath will do is tell you to cut gluten out of your diet. Of course, this isn't true as naturopaths take every case on an individual basis, but it is true that the rates of gluten sensitivity are rising. Like I mentioned above, even conventional gastroenterologists will tell you that they are seeing far more celiac patients than they were twenty years ago. So why are more and more people reacting to something that we, as a species, have been consuming for literally thousands of years?

My hubby loves those shows like "How it's Made" and recently put one on that was all about wheat. At first, it seemed like torture developed by pro-wheat propaganda (for those of us who don't tolerate wheat well), but the more we watched the more I was fascinated by the information it contained. It gave a long history of agricultural use of wheat and then went into great detail about how many things in our modern world are made using this amazing grain (did you know that it is a common component of fire-resistant furniture?). It also gave a run-down of the top six varieties of wheat that are grown in modern agriculture. Here is where the light bulb popped on in my head and I had to stop and rewind it several times. There are six major varieties of wheat grown in large scale agriculture. The top two varieties of wheat grown in the United States have purposefully been bred over the last fifty years to have high gluten contents to allow them the largest range of uses! The same fabulous agricultural breeding that brought us gorgeous strawberries with no taste (maybe a future blog there) and tomatoes that have fish genes to survive cold also have designed a wheat that is incredibly good looking, hardy, and produces plump grains, but is also much higher in gluten content than other varieties of wheat. Not only has the gluten content gone up, but wheat and wheat based gluten are found in an amazing array of foods that you would not ever suspect to contain them until you start reading labels! Since allergies are often related to high levels of exposure it makes perfect sense that this abundance of gluten in our modern American diet is directly related to the increasing rates of gluten intolerance. I did a little searching after finishing the show and, of course, I was not the first one to think of this link. In fact it is one of the current hypothesis behind the rising rates of celiac disease. Darn, well so much for my fabulous medical discovery, but it was nice validation and gave me some good food for thought (no pun intended!).

If you suspect that you may have a gluten intolerance I highly recommend talking with your naturopath about it (it seems hit or miss on conventional docs being highly knowledgeable about it at this point although gastroenterologists see enough of it they should be). It isn't easy to avoid gluten, but the options are a million times better now than they were twenty, or even ten years ago and if it helps what ails you it is incredible motivation to stay away from those pesky grains. There is always more to learn, but I hope this provides you with a better understanding of why gluten free is all the current rage. Happy eating!

Here is an article I found that talks about a lot of the research in regards to rising rates of celiac (where I got my stats) and the breeding of higher gluten wheat: http://www.cbsnews.com/8301-504763_162-57483789-10391704/gluten-free-diet-fad-are-celiac-disease-rates-actually-rising/

Iron- good for more than just pumping!

 Did you know that iron deficiency is the biggest cause of anemia worldwide? Anemia, for those unfamiliar, is when your blood isn't able to carry enough oxygen to your body, either due to a lack of red blood cells or lack of iron. How does iron figure in? Let's take a little journey inside your red blood cells to find out.

Google a picture of a red blood cell. What you'll see is a bi-concave disc (meaning it's a frisbee with a dimple on either side) that is, as the name implies, red. While you might think the shape is just for kicks, it actually serves a very important function. It's hard to imagine but your tiniest blood vessels are only wide enough for a single red blood cell (let's call them RBCs) to fit through, and it's often a very tight fit! What being bi-concave means is that your RBC is able to bend and flex around tight corners and through tiny blood vessel tubes. There are some folks who have certain blood diseases where their RBCs aren't this fabulous shape, they are spheres (hereditary spherocytosis) or shaped like crescent moons (sickle cell anemia), and those folks can have all sorts of problems, just from the shape! With spherocytosis the cells are very fragile and prone to burst open when put under pressure. In sickle cell anemia the funky shape means that the RBCs tend to get stuck and pile up in those narrowest of blood vessels. So be thankful if you are in that lucky majority who have normal shaped RBCs.

Now let's go inside the RBC. Really, in comparison to most of your cells, there's not a whole lot. There's no nucleus, which is the middle "yolk" of the cell that has all that important stuff like DNA. RBC are one a few types of cells in your body that don't have a nucleus, mainly because when they die, new cells get made from scratch rather than divide and have children cells, so they don't need DNA. What RBCs are packed full of is a molecule called hemoglobin. Hemoglobin is this fancy little protein that is made of two pairs of identical globs of protein (picture four snowballs in a square). In the center of each of these globs is a molecule that kind of resembles a trampoline, called heme, and in the middle of the trampoline is one single molecule of iron suspended. Since there are four snowballs in each hemoglobin that means that there are four iron molecules too, which doesn't seem like much, until you consider that every single RBC has an average of 280 million molecules of hemoglobin! That means there are four times that amount (I'll let you do that calculation) of iron in every RBC! Then, when you consider that the average adult has 20-30 trillion red blood cells, that gets to be a lot of iron!

So why iron? Iron has this nifty ability to bind easily to certain types of molecules, which includes oxygen (think about that old piece of rusty metal- that's iron binding oxygen too!). When a red blood cell gets into the blood vessels in your lungs it comes in contact with oxygen and the oxygen sticks to the iron molecule like a magnet. Then when that same RBC gets out to your foot which needs oxygen the iron kicks the oxygen off, then returns to the lungs to do it all over again. Unfortunately, other things can also bind to the iron. Things like carbon monoxide which binds even tighter than oxygen. Hence why carbon monoxide is so deadly toxic to you. It binds to your iron and doesn't let go easily, thus depriving your tissues of the oxygen they need to function. You will also get symptoms of this lack of oxygen if you don't have enough iron to carry the oxygen, this is called iron deficiency anemia. You can get anemia from a lot of different reasons, but this is by far the most common cause. It is most common in children and elderly folks, who are less likely to eat iron rich foods like meat. In many developing countries iron deficiency anemia is very common, especially in urban areas where poor families have little access to affordable meat. In India the rate among children is currently estimated to be around 80%. Some of the consequences are stunted growth, poor immune function, and general weakness and fatigue, among others.

There are also many interfering factors which can contribute to iron deficiency. For example calcium interferes with your body's ability to absorb iron. One recent study suggested that the ideal amount of milk for children to consume was no more than two cups a day. Any more than that could put them at risk of becoming iron deficient due to the amount of calcium in the milk. Another major interfering factor are molecules called phytates. These are found in grains and can also prevent your body from absorbing iron from the meal. An easy way to remedy this is to soak the grains overnight before using them, as this breaks down the phytates. For example, my little man loves oatmeal in the morning so I set out the bowel of oats in water with a little yogurt and let it sit overnight before cooking in the morning. This breaks down the phytates as well as starts a slow fermentation (from the yogurt) which makes the grains much easier to digest. Most traditional societies who eat grain would often do some sort of fermentation before consuming them, inherently recognizing that this made the nutrition in the grains much more accessible. Lead poisoning can also mimic iron deficiency anemia, but research suggests that it's due to the lead getting in to your bones and messing up the production of red blood cells as well as the lead interfering with iron being attached to the hemoglobin. Lead has largely been removed from modern homes, but in older homes it can still be found in paint and pipes. I know in Portland you can request a free lead water test if you live in an older home and have a child under 6 or a pregnant woman living in the home. If you are concerned about your water or paint it doesn't hurt to look into testing as even tiny amounts of lead can have pretty significant effects.

Then there's the issue of vegetarian supplied iron vs. iron from meat. You have probably heard that spinach and other dark leafy greens are just teeming with iron along with all sorts of other good vitamins. Well, it's true, but unfortunately your body has a much harder time absorbing iron from non-meat sources (this is considered "non-heme" iron vs "heme" iron that comes from meat). The iron must go through a series of reactions in your gut before it can be absorbed through the intestines whereas iron that is coming from meat is already in the proper form to be able to be sucked right up in your gut. There are a few things you can do to increase the amount of iron you absorb from food. The main thing is vitamin C. Having a big glass of orange juice or including other vitamin C rich foods with the meal can really help your body absorb more iron. Oh, and in case you're wondering, cooking in cast iron pans has also been shown to be a small source of iron for those who are just slightly deficient as trace amounts of the iron get into the food as it cooks.

So, how much iron do you need? Well this answer is different for everyone (of course- in naturopathic medicine we always approach every person as an individual), but there are some general guidelines that can help. When in doubt, it never hurts to get your iron levels checked by a medical professional, especially if you are experiencing any of the signs of anemia. Your body is actually incredibly efficient at recycling iron. When your RBCs gets broken down very little of the iron is actually lost. This means that for healthy men and non-menstruating/non-prego/non-lactating women the daily iron requirement is much lower compared to menstruating women or anyone suffering from blood loss. Children have their own requirements as they are (obviously) growing and increasing their blood supply daily. The National Institute of Health has put together several tables of daily requirements as well as recommendations on good sources of food iron: http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ I hope you feel much more informed about iron, but truly this just scratches the surface. The link above has a lot more information and resources if you want to learn even more!

Why Vitamin D is so good for me!

For the better half of the last century we have been told that the sun is our enemy. It gives us skin cancer and that the smartest thing we could do was slather on thick layers of sunscreen, wear a hat, and avoid sunburn. Unfortunately, as often happens in our society, the pendulum now seems to have swung too far. Research definitely tells us that sunburn is a bad bad thing. Even just one severe sunburn in childhood can raise your risks of developing skin cancer as an adult by a significant amount. But in our "go big or go home" rush to avoid the sun we have inadvertently caused most of us to become vitamin D deficient.

You have probably heard that we get vitamin D from the sun. Actually, it's a little more complicated than that. Vitamin D starts as a molecule called 7-dehydrocholesterol (yes, it's based on that same cholesterol you hear all the hype about). When 7-dehydrocholesterol gets into the blood vessels just under your skin, and you happen to be out in the sun, the UV rays trigger a reaction to produce cholecalciferol (coal-aay-cal-sif-fur-awl). This reaction takes about 10 minutes to really get underway and a whole day's worth of vitamin D can be produced in about 15-20 minutes of moderate sun exposure (this rate varies based on skin type- faster for lighter skin, longer for darker), but after too long in the sun your body does a very smart thing. Vitamin D in high doses can be toxic so your body naturally starts limiting the reaction. This means that more than 20 minutes is no longer beneficial in raising your vitamin levels and can actually start destroying more than is being made. When you get tan you make this reaction take longer by absorbing more of the light in higher layers of your skin with the pigment melanin. So tanning (among other things) is your body's natural way of protecting you from too much vitamin D if you are someone who spends a lot of time in the sun. For most of us in the US it would be easy to get our daily allotment of Vitamin D from the sun during the summer, but in the winter things get a little more tricky. Not only are the days super short, but if you live above about the 30th parallel (which includes most of the US except Southern Florida and Hawaii) the sun doesn't even get high enough in the sky during the winter to penetrate the atmosphere with enough strength to trigger the reaction in the skin. So even if you live in a sunny area and get out there naked in the freezing cold you sadly won't be producing enough Vitamin D to qualify for a day's allotment.

So back to our story of how your body actually makes Vitamin D. After the sun hits your skin and makes cholecalciferol it then travels to your liver where another reaction happens which changes it ever so slightly into a molecule called (boringly) 25-hydroxycholecalciferol. This then goes to the kidney where it undergoes yet another change to become 1,25-dihydroxycholecalciferol. Woohoo! We made it to the active form of the vitamin! This form only lasts approximately 2-4 hours in circulation before it begins to break down and you have to start the process all over. As you can imagine, with this kind of complicated path there are a whole host of things that can go wrong! So besides not getting enough sun, people can be low on vitamin D if they are missing any of the pieces of this puzzle.

The primary function that has been conventionally assigned to vitamin D is in bone formation. You need proper amounts of Vitamin D in order to even absorb, let alone use calcium and all the other fabulous bone building minerals. Vitamin D actually turns on a gene which makes protein in your gut that binds to calcium to allow your body to absorb it. Vitamin D has also been shown to protect against cavities (for some of the same great reasons why it's so good for your bones). In fact, in one study looking at over 3000 children from 1920-1980 researchers found a 50% reduction in cavities in the kids with adequate Vitamin D.

For thousands of years people in colder latitudes have eaten traditional foods that supply Vitamin D during the cold winter months. Vitamin D is a fat soluble vitamin which means.... surprise... that you find it in fats! Cod liver oil, lard, whale fat, dairy, meat (not lean and  often organ in nature) all these yummy (?) favorites are great traditional sources of Vitamin D. If you've read my fats blog then you'll know how fabulous fat soluble vitamins are, and Vitamin D is no exception! Among other things it acts as an anti-oxidant (yes, just like blueberries) and helps to protect your tissues from those nasty free radicals. It is also considered a  "prohormone" which then gets converted into... you guessed it.. a hormone! Researchers have found vitamin D receptors on virtually all of the body's cells. You wouldn't expect to see that many receptors if it wasn't a pretty important thing! You don't have to look far to see what happens when your body lacks Vitamin D. The disease rickets, where your bones fail to form normally, is the manifestation of a severe Vitamin D deficiency, but Vitamin D deficiency has been associated with a host of other diseases like multiple sclerosis (MS), diabetes type I (the autoimmune version), and the biggie: cancer. Not surprisingly, 84% of patients who go to the Cancer Treatment Centers of America are deficient in Vitamin D.

Like I said above, we know that severe sunburn can increase your risk of skin cancer. In fact, sun exposure in general increases your risk of skin cancer simply because those same UV rays that convert the vitamin D also can hit things like your DNA and trigger mutations which then lead to cancer. However, medicine is now starting to find out how much protection the sun gives us from cancer via..... Vitamin D! Among the cancers that Vitamin D has been shown to protect against: breast, prostate, ovarian, colon... the list goes on.... and these are not minor cancers! These are the biggies that require intense treatment and often come back again and again. Skin cancer, on the other hand is easily treated by removal (duh, skin is a lot easier to reach than your ovary) and is much more sensitive to conventional cancer treatments (you can see it, therefore radiation can too). Plus you can easily observer skin cancer and therefore it is much more frequently found in routine screenings or by the person themselves and is caught at earlier stages (which means it's easier to treat). These differences in cancer types and treatability are significant and have everything to do with figuring out the cost-benefit ratio for sun exposure. One recent study concluded that the protection that Vitamin D gave against some of those nasty internal cancers listed above far outweighed the related increased risk of skin cancer from moderate sun exposure (not counting those nasty burns)! Let me say that again because I know it took me re-reading it a few times before it sunk in. With moderate sun exposure, your risks of all sorts of nasty internal cancers goes way down and your risk of skin cancer only rises slightly. Wow! Ahhhh... this is making me crave a little sunshine... too bad it's midnight in Portland!

So how does Vitamin D do all this cancer magic? Does anyone know? Yes! There have been multiple studies looking at the so called "mechanism of action" of this fabulous vitamin and it largely has to do with it's hormonal function (remember I told you it was a hormone). Not only does it turn on the genes that cancer turns off (mainly those that stop the cell from self-destructing when it realizes things have gone awry), it also turns on anti-cancer genes (specifically one called p53). Vitamin D also helps to keep your whole cell cycle functioning properly. This is the grow-->divide-->grow-->divide....die cycle of your cells. If this malfunctions and things start to grow, and grow, and GROW you get tumors, so keeping the cycle turning properly is very important. Vitamin D also has that great little quality of being an antioxidant like I mentioned above and helps to knock out nasty free-radicals in fatty tissues. Despite your thoughts about your belly fat not mattering if the free radicals invade, you do actually have some very important fatty tissue like the insulation around your nerves (called a myelin sheath), oh... and this little old thing called your brain! If free radicals get out of control (you mean get radical?) they can cause widespread destruction of your DNA which... you guessed it, leads to cancer! So keeping them in check is definitely a good idea.

Oh yeah! Vitamin D also helps to regulate the production of a protein in your body called cathelicidin. This protein is part of your body's innate immune system which is the first part of your immune system to get activated any time you have an infection. It helps to "nip it in the bud" as they say. Having adequate Vitamin D helps ensure that your body is ready and armed to fight the bugs, be they bacteria or be they viral.

So, in summary: Vitamin D is made beginning with a reaction triggered by the sun. It is naturally found in fat (and is commonly supplemented into dairy and other foods) and meat to some degree. It has some very important functions in your body (remember the receptor is found on virtually every cell in your body!) and protects you against all sorts of nasty cancers, autoimmune diseases, helps support your bones and teeth, and helps your immune system be ready to fight. You cannot get adequate vitamin D in the winter months in the US (unless you live in Florida or Hawaii- call me I need a sunny vacation!) and supplementation is generally recommended (always good to get your values checked to see how much is needed). The current recommended daily allowance was raised in 2010 to 600 IU for pretty much everyone (special rates for those under 1 and over 70). Since it's winter up here in Oregon and trying to snow I will be including my vitamin D in my regimen today and every day until the sun comes back in the spring.... ahhh.... daydreams of sun.... and Vitamin D!

One last note! I forgot to talk about D2 vs D3. Vitamin D2 is a molecule called ergocholecalciferol which your body can then convert into cholecalciferol, but only does so at about 33% efficiency, so it's considered 1/3 as bioactive as D3 which is straight cholecalciferol ready to go to your liver. D2 is often the form that will be naturally occurring in dairy products as it is made when hay is left to dry in the sun, then the cows eat the hay, and magic! Vitamin D enhanced dairy! The downside, other than the poor bioavailability is that it is much easier to build up toxic levels of supplemented vitamin D2, hence why you rarely see it marketed as a supplement any more.

Here are a couple references from which I pulled some of this information:

The Huffington Post (huffingtonpost.com) - Vitamin D Might Protect Against Tooth Decay: Study -By Annie Hauser - (Friday, December 07, 2012) -

The Wall Street Journal (wsj.com) - Multiple Sclerosis Linked to Vitamin D Levels, Study Says -By Jennifer Corbett Dooren - (Monday, November 19, 2012)

Vit. D and Diabetes type I

http://well.blogs.nytimes.com/2012/11/26/low-vitamin-d-level-tied-to-type-1-diabetes/?partner=rss&emc=rss

Vitamin D and Cancer

http://www.pnas.org/content/109/46/18827.full?sid=92caf2e8-8f44-4550-be05-447b52d9dd09

I also included information I learned last summer in my Integrative Oncology Research Course and the basic biochem came right out of my biochem lecture on Vitamins from last year.