Why I call the blog “docere”

Docere, the origin of the word Doctor, means to teach or show in Latin. It is one of the six principles of naturopathic medicine. I strongly believe that everyone should play an active role in their own health care. Often people come to me with a diagnosis that they don’t understand. Or a prescription they are taking simply because they were told they had to. Or worse they come in after having been told they have a chronic life-long condition for which there is no cure.

I strive to use language that everyone understands to explain anatomy, physiology and biochemistry. I hope to empower each person to understand their own bodies so they can make decisions about what they put into them. Visits are a little longer so we have time for this education. Another way I educate is through this blog. If you have a question you would like me to address here, contact me.

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Do I need to take supplements?

Usually research looks at vitamin and mineral supplementation, but in my practice I use herbal supplements as well. While research is mixed1 about the value of general vitamin supplements, I find that if used appropriately they can be helpful.

First, what are supplements?

  • In short, things that you aren’t getting enough of through diet, so you need to take  in addition, or supplementally.
  • Vitamins. These are organic compounds that your body needs but can’t make itself. Most vitamins are food based, with a few exceptions like Vitamin D.
  • Minerals. These are elements from the earth, like calcium and iron. Plants get minerals from the soil.
  • Herbs. There are hundreds of herbs with medicinal qualities. Sometimes I recommend herbal teas or tinctures (water or alcoholic extracts of the plant) and sometimes I prefer a capsular product.

herbs extracting

Supplements can come in a variety of forms. Herbs can be used while cooking, made into a tea, or extracted into alcohol or water. Vitamins, minerals and herbs can also be found in capsules, softgels, tablets, liquids, powders, chewables, gummies, etc. Tablets are cheap and concentrated, but may be difficult to swallow, and there are some concerns about their ability to breakdown. Capsules are easier to swallow and can be opened to mix the ingredients into foods. They are more expensive though and have a shorter shelf-life. Capsules are often made of gelatin which is not suitable for vegans and some vegetarians, though there are veggie-cap alternatives. Softgels are one piece capsules that usually contain a liquid. They are easier to swallow and with a longer shelf-life, but more expensive. Powders and liquids are cheap and offer flexible dosing, but often taste bad. Gummies are a popular alternative for children’s vitamins, and some adults, but I think they should be avoided as they can increase risk for cavities.

rainbow food med

How do I know if I need to use supplements?2

  • In general, a well-balanced diet (a rainbow of foods!) with sun exposure or Vitamin D fortified foods is sufficient for most people. But it doesn’t hurt to take a multivitamin with 1-1.5x the Recommended Dietary Allowance. Higher doses of certain nutrients may be unsafe, and should only be done with medical supervision.
  • We also know that our soil is becoming depleted, and even organically grown fruits, vegetables and grains do not contain the same levels of nutrients that they did decades ago.
  • There are certain vitamin deficiency syndromes that can result from inadequate intake of specific vitamins. Scurvy for example from no Vitamin C. In the developed world these deficiencies are more likely to be seen in certain folks: elderly, alcoholics, vegans, etc. But we still don’t fully know how nutrients levels can relate to chronic disease and disease prevention.
  • There are many different reference tables that try to pinpoint just how much nutrient intake we need to be healthy and to prevent disease. We have Recommended Dietary Allowance (RDA), Adequate Intake (AI), Estimated Average Requirement (EAR), and Tolerable Upper Level (UL). Usually we use the RDA which is the “the average daily intake that is sufficient to meet the dietary requirement of nearly all healthy people.”
  • There are blood tests to measure blood levels of nutrients. But these tests may or may not be helpful, as we don’t really know the what the best “normal” value is. People with “low” levels of vitamins may be very healthy, and people with “high” levels may have chronic disease and therefore require more of certain vitamins.
  • Some people have certain gene polymorphisms which mean they are unable to metabolize certain nutrients. These folks might benefit from specific vitamin supplementation.
  • Some people have poor digestion, meaning they aren’t absorbing the nutrients that they are eating. These folks won’t benefit from supplements until they get their digestion optimized.

Which nutrients do conventional medical doctors recommend?

Conventional medical doctors are quite conservative about vitamin and mineral supplementation. They wait until the research is very clear about who needs it, how much is needed, what if they get too much, what if they don’t get it at all, etc. Right now, conventional medical doctors (per standards of care found at UpToDate) are making the following vitamin recommendations:

  • Folic acid for women who are (or are about to become) pregnant. This prevents neural tube defects which could occur in early pregnancy. Folic acid has been associated with increased growth of some cancers, so I don’t recommend this for people who aren’t about to become pregnant.
  • Vitamin D, especially for elderly who are at risk for osteoporosis and falls.
  • Multivitamin, probably won’t help, but unlikely to cause harm.
  • They recommend against Vitamins A, B12, E and C for disease prevention.

Capsules

For individualized dietary and supplement recommendations, make an appointment.

Read more: (to be updated as they are posted – check back!)

 


capsule photo credit: selva via photopin cc
tincture photo credit: henna lion via photopin cc
rainbow food photo credit: rageforst via photopin cc
1http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309636/
2UpToDate, accessed 5/14/13

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Optimize your Emunctories!

Obtaining and maintaining optimal health involves taking in good quality nutrients (such as oxygen, water, and food) and properly eliminating waste products. Waste products are anything that do not nourish the body and can range from carbon dioxide to toxic substances. The emunctories are organs that help to eliminate. The primary emunctories are the liver, bowels, kidneys, lungs, skin and lymph. There are simple lifestyle choices that optimize the function of these organs and thus increase your body’s ability to eliminate what it does not need.

 

liver

Liver: “Milk thistle is an herb which supports the body’s ability to detoxify and remove pollutants. A group of active constituents in milk thistle, collectively called silymarin has been shown to assist the liver and other organs in detoxification by acting as an antioxidant. Milk thistle increases the synthesis of glutathione (an enzyme necessary for detoxification), protects the liver from damage and increases the rate of liver tissue regeneration when damage has already occurred.” - Dr Sharon Tilgner, April 2011, Dreaming a Beautiful World

Liver Recommendations

  • Take 1 teaspoon to 1 tablespoon freshly ground milk thistle seed per day with water.
  • Eat 2-5 daily servings of liver cleansing foods, like beets, artichoke, flax meal, onions, garlic, leeks, shallots, mustard greens, beet greens, collard, kale, chard, sprouts, romaine lettuce, sea vegetables, daikon radish, turnips, figs, apples, bananas.
  • Castor oil packs right over the liver will stimulate the removal of waste and decrease inflammation throughout the digestive system.

 

lungs-cartoon

Lungs: The best way to help your lungs remove waste products is through deep breathing. Most people breathe shallowly from the top part of the lungs. The result is that not all of the carbon dioxide that carries waste products is exhaled. To eliminate more effectively, inhale until the bottom of the lungs are filled and exhale for twice the time of inhalation. It is also a great way to reduce stress and encourage relaxation.


Lung Recommendation

  • Throughout the day stop and take 3 conscious deep breaths. Try alternate nostril breathing to enhance focus and relaxation. Consider doing this hourly with an hourly chime reminder.

 

Skin: The skin is the largest organ of elimination.

Skin Recommendation

  • Perspire more: regular exercise, sitting in a sauna, or a nightly hot bath with Epson salts.

 

lymph-german

Lymph: The lymph filters the blood.

Lymph Recommendation

  • Dry skin brushing: start with extremities, small circular motions, brush towards the heart. Brush skin daily before bathing.

 

 

 

 

Intestine - cartoon

Bowels: The digestive system eliminates waste products through the stool. Regular daily bowel movements move waste through the digestive system before they enter other organs of the body.

Bowel Recommendations

  • Encourage regular bowel movements with fiber, fluid and movement. Eat at least 5 servings of fresh organic vegetables and fruits, drink enough water, and move.
  • Repopulate good gut bacteria with probiotic supplementation.

 

Urinary_system

Kidneys: The kidneys are the other major filtering system of the body. The kidneys filter every ounce of your blood multiple times a day. Keeping your kidneys healthy is important for a high quality of life. The kidneys eliminate wastes through the production of urine.

Kidney Recommendation

  • Drink half your body weight in ounces every day. Drink filtered water. Sip throughout the day, don’t let yourself get thirsty. This is the most effective and inexpensive way to keep the kidneys healthy.

Read more:

 

Image Credits:
Liver By Mikael Häggström (File:Human Hepar.jpg) [Public domain], via Wikimedia Commons
Lungs By Mikael Häggström [Public domain], via Wikimedia Commons
Intestines By Mikael Häggström [Public domain], via Wikimedia Commons
Lymph By Heike Brand-Grantham (Active Elements) Copyright-Inhaber ist die Deutsche Gesellschaft für Angiologie – Gesellschaft für Gefäßmedizin e.V. [CC-BY-SA-3.0-de], via Wikimedia Commons
Kidney By Mikael Häggström [Public domain], via Wikimedia Commons

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Treatment of Autoimmune Hypothyroid Disease

Conventional Medical Treatment of Hashimoto’s Hypothyroid

Synthroid

The conventional medical treatment1 of Hashimoto’s thyroiditis, or autoimmune thyroid syndrome, is to give replacement thyroid hormone. The most commonly used medication is synthetic T4. The most common medications are Synthroid, Levoxyl, and levothyroxine. The most common side effects of synthetic T3 are irregular heart rate, weight change, being nervous or shaky, difficulty sleeping, excess sweating or being bothered by heat, headache, loose stools. You’ll notice these symptoms are similar to the symptoms for hyperthyroid. These medications interacts with a lot of other medications, so be complete and honest with your doctor about what you are taking.

People with Hashimoto’s thyroiditis are at increased risk of developing other autoimmune diseases, fatty liver, heart disease and thyroid cancer. In addition, high TSH is a risk factor for melanoma (a skin cancer) and dementia.

Naturopathic Approach to Hashimoto’s Hypothyroid

medium_4882247395

 Read more:

 

1UpToDate, access 4/25/13
Synthroid photo credit: lobstar28 via photopin cc
Bunches and Bits photo credit: Bunches and Bits {Karina} via photopin cc

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How do I know if I have autoimmune thyroid disease?

I have some thyroid symptoms, what now?

Because there are so many signs and symptoms of thyroid disease, and because many of those signs and symptoms overlap with other conditions, conventional medical doctors rely primarily on labwork to diagnose thyroid disorders. Let’s go back to the analogy of the thyroid as employee and the pituitary as manager. The pituitary/manager makes TSH, or thyroid stimulating hormone. This hormone travels from the pituitary to the thyroid and tells the thyroid to make more thyroid hormones. Usually medical doctors start by measuring TSH.

The next thing they might measure are the actual thyroid hormones, T3 and T4. These hormones travel through the body so they can tell other tissues to do something. In order to travel, they hop on a bus to carry them through the blood to where they are going. This bus is actually a protein. But when it’s on the bus it can’t do its job; and most of it is on a bus! Conventional medical doctors often measure total T3 and total T4, or ALL of the hormone both on the bus and off the bus. But I prefer looking at the hormone that is actually available to do its job, free T3 and free T4.

Bus

In addition to measuring the hormones coming from the manager/pituitary (TSH) and the thyroid hormones themselves (free T3 and free T4), some medical doctors will measure thyroid antibodies, or immune system soldiers. In no case is it normal to have thyroid antibodies. Sometimes we will have antibodies present before there are measurable changes in the TSH or T3 or T4.

white_blood_cell_amigurumi_by_diygeekess-d5hi1qj

By conventional medical standards, if you have thyroid symptoms but “normal” labwork then you do not have thyroid disease.

Problem #1:

  • The currently defined normal range of TSH is 0.4 to 4.2 mIU/L (or even up to 5.0). Most normal lab ranges are just averages of all the samples that the lab sees. But there are so many people with diagnosed and un-diagnosed thyroid disease, that these “normal” values have been skewed. There was a study1 that measured TSH values in healthy adults. For these adults, TSH values ranged from 0.36 to 1.91 mIU/L. Therefore I would consider a TSH of 2.5 to be (slightly) elevated.

Problem #2:

  • You could have autoimmune hypothyroid disease, Hashimoto’s thyroiditis, without having measurable levels of thyroid antibodies.

Problem #3:

  • Signs and symptoms of Hashimoto’s thyroiditis can be present before the lab values change, including an enlarged thyroid gland.

As you can see, the diagnosis of autoimmune thyroid conditions, Hashimoto’s thyroiditis in particular, is complicated and controversial. The first step is making sure you don’t have another condition that is causing the suspicious signs and symptoms.

 

Read More:

1Referenced by Alan Christianson, ND. Erden g, Oanzden A, Tezcan G, et al. Biological Variation and Reference Change Values of TSH, Free T3, and Free T4 Levels in Serum of Healthy Turkish Individuals. Turk J Med Sci 2008; 38 (2): 153-158.
Bus photo credit: Thomas Hawk via photopin cc
WBC photo credit: DeviantArt

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I think I might have a problem with my thyroid

Signs and Symptoms of Thyroid Disease

Since thyroid hormone is involved in so many different parts of the body, if there is a problem with your thyroid you could have a lot of different symptoms. In fact, there are dozens and dozens of possible symptoms. But the most common ones are:

thyroid symptoms

Hypothyroid1:

  • Feeling tired/weak
  • Slower heart rate
  • Dry skin, brittle nails
  • Puffy face
  • Loss of eyebrows
  • Hoarseness, difficulty swallowing
  • Extra sensitivity to cold
  • Constipation
  • Memory problems
  • Irritability, mood swings
  • Weight gain

Hyperthyroid2:

  • Weight loss
  • Extra sensitivity to heat
  • Softening of the nails
  • Tremor
  • Itching or hives
  • Hair loss
  • Heart palpitations, or increased heart rate
  • More frequent bowel movements
  • Anxiety
  • Difficulty breathing, shortness of breath

 

Thyroid Disorders

Autoimmune thyroid disease is the most common. Other thyroid disorders include: thyroiditis (inflammation of the thyroid, most common in pregnancy), thyroid cancer, and thyroid nodules or goiters.

What can cause autoimmune thyroid disease?

Not just one thing causes autoimmune disorders. In this case it’s a collection of genes, toxins and infections, plus some other things we don’t know about.

  • Genes: if you have a family history of thyroid disease you are a lot more likely to have thyroid disease yourself.
  • Toxins: iodine, fluoride, mercury, perchlorate, and cadmium all play a role in the development of thyroid disease.
  • Infections: often having an infection somehow triggers an autoimmune response that can then directly target the thyroid.
  • Low vitamin D levels can also be a risk for autoimmune thyroid disease.

Autoimmune thyroid disease can cause too much thyroid hormone (hyperthyroid)or not enough thyroid hormone (hypothyroid). Hypothyroid is more common, conservative estimates are that one out of four women will have it at some point. Autoimmune disease overall is more common in women, they are 8 times more likely to have autoimmune thyroid disease. Autoimmune hypothyroid is called Hashimoto’s thyroiditis (-itis meaning inflammation of the thyroid). In this scenario there are antibodies, or immune system soldiers, attacking the cells that make thyroid hormone so that less hormone is made. Autoimmune hyperthyroid is called Graves’ disease. In Graves’ those antibodies, or soldiers, are attacking receptors on the thyroid cells so the cells are making too much hormone.

Read More:

 

1UpToDate, accessed 4/25/13
2UpToDate, accessed 4/25/13
I can’t find the photo credit, please email me if you know where it came from.

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Thyroid Gland, and its Chemical Messengers

Thyroid Anatomy

Thyroid_anatomy_PI
Your thyroid gland is located in your neck. A gland is an organ that secretes things. The thyroid secretes hormones, so it is an endocrine gland. It is one of the largest endocrine organs in your body. The thyroid gland is about as big as a deck of cards, is shaped like a butterfly or bow-tie, and is found just below where the Adam’s apple is (if male) or would be (if female).

Thyroid Control and Function

The thyroid gland, like all hormone or endocrine glands, is regulated through a complex system involving different parts of the brain, specifically the hypothalamus and the pituitary. We can imagine1 that the hypothalamus is the CEO giving orders to the pituitary which is like a manager encouraging the thyroid employee to produce hormones. In this analogy, everyone is inherently lazy: if the CEO isn’t on the manager or the manager isn’t talking to the employee then we won’t have enough hormone. While sometimes we can have thyroid problems as a result of the hypothalamus or pituitary, most of the time it is a problem with the thyroid itself.

Thyroid Chemical Messengers

Hormones work as chemical messengers carrying messages from one place in the body to another. In fact, thyroid hormones have effects on almost every part of the body. The thyroid produces four hormones, abbreviated as: T1, T2, T3 and T4. The number refers to how many iodine molecules are attached to the hormone molecule. The thyroid also makes the hormone calcitonin which helps to control how much calcium is found in the blood.

T3 is the active hormone, or messenger. T1 and T2 are building blocks that add together to make T3 or T4. T3 is very active, meaning it would start doing things as soon as it left the thyroid and never get where it was going, so we turn it into T4 so it can travel throughout the body. When it gets to its end location it turns back into T3.

Thyroid hormones helps cells form energy, helps to burn carbohydrates and fat, helps to regulate body temperature, plays a role in hair, skin and nail growth, repairs brain cells, interacts with other hormone or endocrine organs like ovaries and adrenals, and plays a role in intestinal and immune function. Thyroid hormones play a crucial role in brain development of infants, which is why we check the thyroid function of all newborns.

Read more:

 

1Thanks to Alan Christianson, ND for this analogy.
Thyroid image via UpToDate.

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Apple Cider Vinegar Digestive Aid

Is your digestion a little sluggish? Maybe you have gas and bloating after you eat. Or a bit of heart burn after meals. Consider this yummy digestive stimulant. My friend and colleague, Rose Paisley, shared this recipe with me.

 Vinegar Bowl

In a Mason jar combine:

  • 1 cup unfiltered apple cider vinegar
  • ½ cup filtered water
  • 1 tsp of powdered ginger or 2 tsp of finely grated fresh ginger
  • 1 tsp of honey

Shake and drink ¼ – ½ tsp (a small swig) before each meal. Store in refrigerator and make a fresh batch every week or two. Have a swig of this stimulant, or plain apple cider vinegar, or lemon water, before every meal.

If you have any inflammation in the throat or stomach, this might cause some uncomfortable burning on the way down. If this is the case for you, then don’t use vinegar until the inflammation has resolved.

 

photo credit: Veganbaking.net via photopin cc

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Serving Sizes

I ask almost every person who comes to see me if they are eating five servings of fruits and vegetables and 90% of people are not. I encourage them to eat a serving with every meal and snack during the day. That way those servings don’t sneak up on you, creating the need for a dinner of nothing but vegetables!

But people often ask, “how big is a serving?” Check out this handy guide to servings sizes!

Serving Sizes

 

Portion size estimator. (via UpToDate)

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“The Basics”

Sometimes we all need a little reminder about the simple things we can do to prevent illness and illuminate health. Here are what I like to call “The Basics.” I have to remind myself to do them every day!

Sleep: Get enough sleep! Most adults need between 7-9 hours per night. Remember that if you don’t get enough sleep one night you need to “catch up” that sleep in the next few nights. Also practice good “sleep hygiene” – don’t have a TV or computer in the bedroom, sleep in a dark room, remove all your EMF emitting devices from your nightstand. Go to sleep before midnight! Nap to tolerance.

Water: Drink half your body weight in ounces every day. Sip throughout the day, don’t let yourself get thirsty.

Breathing: Conscious deep breaths return the body to a parasympathetic state (rest and digest). By taking deep breaths, we tell the body to turn off the cortisol stress response, we improve the function of our lungs, we keep our arteries from getting clogged. And if we use the breathing time mindfully, it resets our brains as well. I recommend either deep belly breaths or left nostril breathing at least three times a day.

Exercise & Movement: The benefits of exercise cannot be overstated. Balance between weight bearing and aerobic. Find a schedule that works for you. Current recommendations are exercise at a moderate activity level for 30 minutes 5 times a week, or strenuous activity level for 20 minutes 3 days a week.

Nature

Nature & Fun: Spend enough time outside to aquire Vitamin D without getting burned. Breathe clean fresh air. Do something fun every day! Laugh more: laughing boosts your immune system, stimulates your endorphins which reduce pain, and protects the heart. Hug your friends, family and pets.

Hydrotherapy: End your hot shower with a brief cold spray to push the blood inward. Hot relaxes muscles and cold relieves pain.

Be Kind: There is growing evidence that people who perform acts of kindness throughout the day experience less social anxiety.

Eat Fruits and Vegetables: Aim for at least 5 servings per day, and ideally eat 7-10! A serving of raw leafy greens is one cup, for other vegetables (and cooked greens) it’s half a cup. A fruit serving is also half a cup, and most of the time a single piece of fruit (one apple, one banana) is one serving. Consider snacking on fruit (with a protein), making smoothies (fun for the kids too), eating a big salad for breakfast, etc.

Fresh Vegetables

Nature photo credit: OneEighteen via photopin cc

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