Naturopathic Medicine

SIBO Part 1: What is it and what do we actually need to treat?

*Note: This article concerns a specific condition, but the themes discussed apply to many conditions. Read on if you feel inspired!

There are many names for the nonspecific digestive symptoms that could mean that you have S.I.B.O. (aka Small Intestine Bacterial Overgrowth). A few of them include irritable bowel syndrome, gas, bloating, heartburn, nausea, tummy troubles, constipation, diarrhea and so on. It turns out that about 60% of people who would get the diagnosis of irritable bowel syndrome if they talked to a conventional medical doctor actually have this syndrome called SIBO. It’s a condition where the bacteria that normally live happily in your colon (aka the large intestine aka further down the digestive pipes) begin to grow in large numbers in the small intestine. The pattern of symptoms that may mean you have this condition consists of digestive disturbances such as those listed above, usually worsened by eating foods rich in fiber like apples, raw vegetables, ground flaxseed, whole grain foods etc. You also might have noticed a seemingly random improvement in your digestive symptoms when you took antibiotics for some unrelated reason. For many, these symptoms come on after a bout of food poisoning, though for some it’s hard to pinpoint when they started, or they have been going on for so long that you can’t remember the origin story.

The trouble that I see with this label of SIBO is that it simply describes your current predicament, but not how it came to be, or how to unravel the root causes so you can actually heal. No two people experience SIBO the same, because their bodies are reacting individually to a unique set of stressors. This is a problem that applies to any disease, and explains why a given treatment for a given disease only works for some percentage of those people with the disease.

The concept of a disease is an interesting thing. I know this sounds like the beginning of a long philosophical musing, but stay with me for a moment. In conventional medicine certain symptoms are often lumped together, given a name, and considered to be a specific disease. For example: if you are coughing and sneezing and have a runny nose and low energy, that “disease” is called a cold. If you have a burning sensation in your chest after eating certain foods, that’s called acid reflux or gastro-esophageal reflux disease in medical terminology.

The thing is, this is a reductionist way of looking at things. People develop similar symptom patterns that could be lumped into disease categories for different reasons, and if you just lump them all under the same disease title and give them all the same treatment, you’re missing the why of it, and therefore missing the opportunity to treat the root cause so the person can heal and eventually stop needing treatment.

So instead, what if we looked at each person as an individual and approached symptoms in a different way. If someone comes to me with burning in their upper chest after eating certain foods, I think “This person’s body is responding in the best way it knows how to a stress or a combination of stresses in their environment. Why is that? What are the stresses at work here? (And I’m not just talking about emotional stress, though that plays a role.) What can we do to shift this pattern? I find this approach to be much more successful in helping my patients to feel better.

So what about SIBO?

Now, we could do testing, identify SIBO, leave it at that and treat each person with SIBO the same... But that would not be very successful because SIBO is actually a result of deeper imbalances that vary from person to person. These imbalances may be in the digestive tract, endocrine system, musculoskeletal system, nervous system, immune system or mental/emotional system (or likely a combination!). If we don’t figure out where these imbalances lie and address them, then the so-called disease will just keep coming back over and over again.

Stay tuned next month for a discussion of the types of underlying imbalances at work in SIBO.

If you are ready to receive some individualized support with your health concerns, please be in touch. 

Wishing you vibrant health, 

Dr. Jennea

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Stolen Minerals: The Story of Anti-Nutrients

I’m a big fan of healthy eating. I believe it is some of the best medicine available, and without it, no other treatments will work very well.

I love to keep it simple when I talk to people about how to eat well, and I love Michael Pollan’s recommendation to “Eat food, not too much, mostly plants.” : ) For people who are just starting out on the journey of learning how to care for their body with a wholesome diet, this advice is overly simplistic, but it covers some important points.

So, my goal with bringing up the concept of anti-nutrients is not to make you feel like you’re doing it all wrong, or to make your life more complicated. It’s an important topic, especially for folks with mineral deficiencies, and there are some fairly simple things you can do to help your body extract more minerals out of that healthy food you are so lovingly feeding yourself and your family.  

First of all, what are anti-nutrients?

Anti-nutrients are compounds found in plant foods that prevent animals from extracting nutrition from them. These compounds likely evolved as a defensive system developed by plants (who can’t fight or run away) to help prevent them from being eaten in the first place, or to help their seeds survive intact as they pass through animals’ digestive systems.

There are a number of anti-nutrients including oxalic acid, tannins, enzyme inhibitors and phytic acid. This article will focus on phytic acid for simplicity’s sake, and because it’s a particularly big issue in the American diet.

Definitions and language:

This is a technical distinction, but phytic acid, once it’s bound to minerals is called phytate. To avoid confusion, I’ll be using the term phytic acid throughout this article. Phytase is an enzyme that is prepackaged in seeds, nuts and grains that, once activated, breaks down phytic acid. Grains and nuts are both technically a type of seed, so I’ll mostly be using the word seed as a general term for all three of these foods.

Phytic acid and why it’s a problem

Phytic acid is found in large quantities in nuts, seeds and grains, especially in the bran or outer hull. It’s a snowflake-shaped molecule with an important job. It is a storage molecule that holds onto phosphorus in the middle of the snowflake and keeps it stable until the seed sprouts and needs the phosphorus to grow into a new plant. It holds onto that phosphorus so tightly, that when seeds are eaten by animals, they remain intact, and the phosphorus inaccessible all the way through the digestive tract.

Here is the issue. Unless dealt with appropriately, phytic acid not only doesn’t let us extract phosphorus from our food (which we need for cell growth and repair, and bone health), but the arms of the 'snowflake' actually bind to other minerals such as iron, zinc, magnesium and calcium, and make them much more difficult to absorb, thus taking a healthy diet and depleting it of minerals.

To be clear, phytic acid doesn’t target your ability to absorb protein, fat or fiber (the macronutrients) or vitamins from your food, just the minerals. However, phytic acid also inhibits the activity of our digestive enzymes, so on top of making our food less nutritious, it makes our digestion less efficient.

To give you an idea of the scale of the issue, in a meal free of phytic acid, you will absorb approximately 20% more zinc (1) and 60% more magnesium from your food. (2)

It's actually a bit ironic, because we’ve been told for years that whole grains are healthier than white bread/grains. But unless those whole grains are prepared properly, there’s not much nutritional difference between white bread and whole wheat bread because the phytic acid makes the minerals in whole grains much less accessible.

Who needs to worry about this?

This is a particularly big deal for people struggling with issues of calcium metabolism such as osteopenia, osteoporosis and frequent cavities (Though there is actutally a lot more going on with these conditions than calcium deficiency). But we all need magnesium for nervous system and heart health, and small amounts of trace minerals including iron, cobalt, chromium, copper, iodine, manganese, selenium, zinc and molybdenum for countless other daily tasks our bodies must perform for us to thrive. Deficiencies in any of these minerals can cause all sorts of symptoms.

I won’t get into all the problems that can be caused by deficiencies in each of these minerals, but as an example, deficient magnesium can result in headaches, muscle cramps, high blood pressure, and irregular heart beats.

I think you get the point that paying attention to phytic acid is important.

As an interesting note, there is some research linking dietary phytic acid to decreased risk of colon cancer. This may be because it can actually bind to or chelate excess iron and harmful metals and remove them from the body, in essences aiding in detoxification. It may also act as an antioxidant.

So this tells us that perhaps we don’t need to panic that we all get some phytic acid in our diet, we just need to be conscious of its presence and make sure we’re not getting too much. 

So, what can you do about it?

Solutions fall into two categories:

1.     Preparing food in a way that breaks down phytic acid.

2.     Optimizing digestion and food choices to help prevent mineral depletion.

How much is too much phytic acid?

It is neither practical, nor likely necessary to remove all phytic acid from your diet. So let’s get practical. According to Ramiel Nagel in his article “Living With Phytic Acid”, the average phytic acid intake in the U.S. and the U.K. rages from 631 to 746 mg per day; the average in Finland is 370 mg; the average in Italy is 219 mg; and in Sweden it is 180 mg per day. (11)

In the context of a balanced diet taking into account my other suggestions listed below for optimizing mineral absorption, most people should do ok with 400-600 mg of phytic acid daily. For anyone who struggles with bone loss, tooth decay or other mineral deficiencies, I would recommend a total of 150-400mg per day as a healthy guideline. (11)

This means preparing your foods to decrease phytic acid content, and sticking to 2-3 servings of phytic acid containing foods per day. For example, a small handful of nuts, two slices of true sourdough bread, and one serving of properly prepared oatmeal.

Problems arise when whole grains, nuts or beans are eaten with every meal and make up the main sources of calories. Regular consumption of granola or commercial cereals for breakfast is also problematic.

Check out this table for an idea of phytic acid content of various foods without special preparation.

Reference (5)

 

Preparation Techniques

Our ancestors figured out through trial and error how to deal with phytic acid through food preparation. Some helpful techniques that decrease phytic acid are soaking, sprouting and fermenting grains, nuts and seeds. Fermenting is the most affective and soaking the least affective, with sprouting somewhere in between. Basically the goal is to recreate the conditions under which the plant would naturally sprout (warmth, acidity and moisture), because under these conditions, the seed produces an enzyme called phytase, which breaks down the phytate, releasing the phosphorus within.

Soaking

Soaking can begin the process of waking up the phytase enzyme and other enzymes stored in the seed to break down the phytic acid as well as complex sugars that might cause gas. It still leaves lots of phytic acid intact, however.

Sprouting

Sprouting not only activates the phytase enzyme which begins to break down phytic acid, but the process of germination also produces vitamin C and increases the B vitamin content and carotene content. Complex sugars (which would otherwise cause intestinal gas) begin to be broken down, and naturally occurring enzymes found in the seed, bean or grain are activated which work synergistically with our own digestive enzymes to improve our digestion.

Fermentation

Fermenting nuts, seeds and grains has the most dramatic effect on increasing their nutritional value and decreasing phytic acid content. The proliferation of lactobacilli bacteria in fermented foods significantly increases digestibility and increases vitamin levels. These probiotic bacteria produce copious enzymes that improve our digestion as well as substances that encourage growth of healthy bacteria, and discourage growth of unhealthy bacteria in the digestive tract.

Preparing foods for maximal removal of phytic acid can be a bit of a rabbit hole. Scroll to the bottom of this article for some basic preparation techniques for common foods, but if you want to investigate further, the Weston A. Price foundation and the cookbook Nourishing Traditions by Sally Fallon are good places to start. Look here for a more in depth exploration of this topic.

Optimizing digestion and food choices

1. Optimize stomach acid

Apple cider before meals – Drink 1 tsp of apple cider vinegar in a little water before meals to help optimize your stomach acid. Stomach acid is vital for absorbing minerals.

2. Have one paleo meal per day

For example, have a breakfast of eggs or sausage and a plate of vegetables. No toast, no grains at all, and no nuts, seeds or legumes. Alternatively, you could have meat and veggies for dinner. I don’t believe that most people need to follow a strict paleo diet, but one meal per day gives your body an anti-nutrient free meal, allowing for better mineral absorption.

3. Take your vitamin D or get enough sun

Sufficient vitamin D is associated with stronger bones regardless of diet. Obviously a healthy diet is crucial too : ) Aim for 2000 IU of vitamin D daily, bumping your dose up to 4,000 IU daily during the winter.

4. Get enough absorbable calcium

Getting good forms of calcium in your food helps prevent bone loss from phytic acid. This might explain why cultures that traditionally eat bread, often eat it with cheese. The calcium in the dairy helps offset the calcium losses from the bread.

Great sources of calcium include raw cheeses and milk, yogurt, bone broth, and dark leafy greens. If you need to take a supplement, consider a food based calcium like this one or this one.

5. Eat vitamin C -rich foods with your grains, nuts and seeds

Vitamin C helps keep the iron in your food absorbable, so it doesn’t get stolen by phytic acid.

Good sources of vitamin C include bell peppers, dark leafy greens, strawberries and citrus. Vitamin C gets rapidly destroyed when cooked, so this is a good reason to eat some of your veggies raw.

6. Eat foods rich in vitamin A and beta carotene

These compounds can also help keep iron soluble and prevent phytic acid from binding to it. (8)

Foods rich in vitamin A include organ meats, grass fed butter, cod liver oil, milk and eggs. Foods rich in beta carotene are orange and green vegetables such as carrots, sweet potatoes, squash, kale, collards, broccoli and chard. 

7. Eat plenty of probiotic rich foods, and make sure your digestion is healthy.

The extent to which phytic acid inhibits mineral absorption varies somewhat from person to person, with some people severely affected, and others seemingly immune. This likely has to do with each person's specific gut flora, as certain probiotic bacteria can break down phytic acid. Making probiotic rich foods like sauerkraut, kimchi, yogurt, kombucha and other fermented foods a regular part of your diet can help cultivate a healthy gut. 

8. Ask for help

If you’re struggling with compromised bone health or frequent cavities and need further support, schedule a complimentary 15-minute consultation to discover how I can help.

 

Specific Food Prep Tips for removing phytic acid

Brown Rice

Soak brown rice in filtered water for 24 hours at room temperature without changing the water. Reserve 10% of the soaking liquid (should keep for a long time in the fridge). Discard the rest of the soaking liquid; cook the rice in fresh water.

The next time you make brown rice, use the same procedure as above, but add the soaking liquid you reserved from the last batch to the rest of the soaking water.

Repeat the cycle. The process will gradually improve until 96% or more of the phytic acid is degraded at 24 hours. (

Quinoa

Process                                                                                   Phytate Reduction

Cook for 25 minutes at 212 degrees F                                           15-20 %

Soak for 12-14 ours at 68 degrees F, then cook                              60-77%

Sprouted quinoa is available as well. 

Oats and Corn

Some grains such as oats and corn are high in phytic acid, but naturally low in phytase, the enzyme that breaks down phytic acid under the right conditions. So even when soaked or sprouted, their phytic acid levels do not reduce much.

One option is to add a tablespoon or two of freshly ground rye flour (keep whole rye kernels around and grind some in a coffee grinder as needed) to your oats or cornmeal, then soak overnight (12 hrs) in an acidic medium. Soak your grain in 2 cups of warm water plus 2 TBSP of whey, lemon juice, yogurt or vinegar, and 2 TBSP of rye flour. Once processed this way, your oatmeal will only take about 5 minutes to cook the next day.

Breads

  • Sourdough starter is significantly more effective than packaged yeast at reducing phytate content.
  • Heat-treating flours destroys the phytase enzyme that breaks down phytic acid during fermentation. Therefore look for breads made with stone ground flour.
  • Phytic acid content decreases about 60% after 2 hours of leavening, and 80-85% after 48 hours of leavening. So make your own bread with non-heat treated flour, or look for a bakery near you who follows these guidelines.
  • Sprouted bread such as Ezekiel brand is widely available as well.

Beans

Soak for 24 hours, changing the water at least twice, then cook over low heat. This removes about 50% of the phytate. Sprouting would likely be even better. 

Some types of beans are available pre-sprouted, or you can sprout your own.

Lentils

Consider buying sprouted lentils or sprouting your own. This removes about 50% of the phytic acid.

Nuts and seeds

  • Nuts and seeds contain significantly more phytic acid than grains.
  • It’s unknown how much phytic acid is removed by various preparation techniques.
  • Roasting probably removes a significant percentage of phytic acid (since it does so in grains and soy nuts), but this hasn’t been studied.
  • Consuming large amounts of raw nuts, nut butters or nut flours like almond flour is likely problematic for long-term health due to mineral depletion.
  • Consider buying sprouted and dehydrated nuts like these.
  • Sprouted nut butters are also available and likely a better choice.
  • Don’t go overboard eating a ton of nuts. Keep it to occasional snacks, and don’t eat them with every meal, or handfuls at a time.

Coconut

While coconut does contain phytates, they actually have an extremely low mineral binding capacity, and therefore you don’t need to worry about soaking or otherwise processing your coconut.

Tofu

Limit tofu consumption, and purchase organic, sprouted tofu. 

*Note that if you soak your phytic acid-containing foods, you don’t need to throw out the soaking water, because the phytic acid has simply been broken down by the phatase enzyme. It is no longer present.

Resources:

Thrive market offers discounts on wholesome non-perishable food items like sprouted lentils, brown rice, pumpkin seeds, etc.

Nourishing Traditions by Sally Fallon

The Weston A. Price Foundation, and this blog post in particular.

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Citations

  1. Barbro, N., Sandström, B., & ÅKE, C. (1985, January). Reduction of the phytate content of bran by leavening in bread and its effect on zinc absorption in man. British Journal of Nutrition, 53(1), 47-53. http://dx.doi.org.nunm.idm.oclc.org/10.1079/BJN19850009
  2.  Bohn, T., Davidsson, L., Walczyk, T., & Hurrell, R. F. (2004). Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorption in humans. The American Journal of Clinical Nutrition, 79, 418-423.
  3.  Ellis, R., Kelsay, J. L., Reynolds, R. D., Morris, E. R., Moser, P. B., & Frazier, C. W. (1987, August). Phytate:zinc and phytate X calcium:zinc millimolar ratios in self-selected diets of Americans, Asian Indians, and Nepalese. Journal of the American Dietetic Association, 87(8), 1043-1047. Retrieved October 20, 2016.
  4.  Fallon, S., Enig, M. G., Murray, K., & Dearth, M. (2001). Nourishing traditions: The cookbook that challenges politically correct nutrition and the diet dictocrats. Brandywine, MD: NewTrends Pub.
  5. Figures collected from various sources. Inhibitory effect of nuts on iron absoprtion. American Journal of Clinical Nutrition 1988 47:270-4; J Anal At Spectrum. 2004 19,1330 –1334; Journal of Agriculture and Food Chemistry 1994, 42:2204-2209.
  6. Guyenet, Stephan. http://wholehealthsource.blogspot.com/2009/04/new-way-to-soak-brown-rice.html.
  7.  Kresser, C. (2011, September 23). Another reason you shouldn’t go nuts on nuts. Retrieved October 20, 2016, from https://chriskresser.com/another-reason-you-shouldnt-go-nuts-on-nuts/
  8. Layrisse, M., Garcia-Casal, M. N., Solano, L., Baron, M. A., Arguello, F., Llovera, D., . . . Tropper, E. (2000, September). New property of vitamin A and beta-carotene on human iron absorption: Effect on phytate and polyphenols as inhibitors of iron absorption. Archivos Latinoamericanos De Nutricion, 50(3), 243-248. Retrieved October 20, 2016. 
  9.  Liang, J., Han, B., Nout, M. R., & Hamer, R. J. (2008, October 15). Effects of soaking, germination and fermentation on phytic acid, total and in vitro soluble zinc in brown rice. Food Chemistry, 110(4), 821-828. doi:10.1016/j.foodchem.2008.02.064
  10. Mensah, P., & Tomkins, A. (2003). Household-level Technologies to Improve the Availability and Preparation of Adequate and Safe Complementary Foods. Food and Nutrition Bulletin, 24(1), 104-125. doi:10.1177/156482650302400106
  11. Nagel, R. (2010, March 26). Living With Phytic Acid. Retrieved October 20, 2016, from http://www.westonaprice.org/health-topics/living-with-phytic-acid/
  12. Zhou, J. R., & Erdman, J. W. (1995). Phytic acid in health and disease. Critical Reviews in Food Science and Nutrition, 35(6), 495-508. doi:10.1080/10408399509527712

 

7 Tips for Natural Relief from Heartburn

Heartburn or acid reflux is a condition where the acid made in the stomach backs up into the esophagus causing some seriously unpleasant sensations like: 

  • A burning sensation in the chest or throat
  • A gnawing sensation in the solar plexus area
  • Nausea
  • An acidic taste in the mouth
  • Cough and/or hoarseness

It is still often assumed that heartburn is the result of the stomach producing too much stomach acid, and therefore medications like Tums or Prilosec are prescribed to neutralize the acid or prevent the stomach from manufacturing it. In fact, it’s usually too little stomach acid that causes or contributes to heartburn, so these medicines actually worsen the problem in the long term (Though they can certainly provide short term relief).

Check out my blog post Why I hate Prilosec, Tums and Zantac for a more detailed discussion of the root causes of acid reflux and the health problems that can result from long term use of acid blocking medications.

Luckily, it is totally possible to be permanently heartburn free by discovering the root causes and using some simple natural therapies.

1. Avoid common heartburn triggers:

Note: These foods are not the CAUSE of heartburn. If they were, anyone who ate these foods would have heartburn, and that is not the case. They are a trigger for people who are already susceptible to this condition, so avoiding them can offer some relief while we work on the true root causes.

  • Spicy foods like salsa and hot sauce
  • Coffee, chocolate and caffeine
  • Greasy foods
  • Cigarettes
  • Alcohol
  • Mint  (Peppermint relaxes the sphincter at the bottom of the esophagus, making reflux more likely)
  • Acidic foods like tomatoes and citrus
  • Carbonated drinks
  • Refined carbohydrates like cookies, pastries, bread and pasta

2. Pay attention to how you eat

Your body can’t make enough stomach acid to properly digest your food and prevent heartburn if you’re stressed or rushed while eating. Slow down and give your body a chance to do its job.

  • Take 10 deep belly breaths before meals to help your body get ready for digestion.
  • Sit down while eating and take your time. Chew each bite fully.
  • Avoid eating within 3 hours of bedtime

3. Identify food allergies/sensitivities

For some folks, certain foods other than those listed above will exacerbate their acid reflux. This is a sign that you may be allergic or sensitive to that food. Identifying and avoiding foods that you are allergic/sensitive to can go a long way toward stopping heartburn. The best way to do this is through an elimination diet. Check out my blog post on allergies (Allergies: Getting to the guts of the problem) for information on how to do an elimination diet. Just scroll down in the blog post until you get to the Remove phase of the Four R Program

4. Check in on your hormones

Elevated progesterone can relax the lower esophageal sphincter or "LES". This sphincter is a band of muscle that lies at the bottom of the esophagus and should stay closed at all times except when you swallow, preventing reflux.

Progesterone levels are high during pregnancy, and this is one of the reasons that pregnant women are more prone to heartburn (The other reason is the growing baby squashing your stomach up against your diaphragm).

Non-pregnant women can develop hormone imbalance with low estrogen and high progesterone which can contribute to heartburn. Consider getting your hormone levels checked and working with your doctor to balance them out if necessary. 

5. Make use of some soothing herbs

There are a number of herbs that have a "slippery" quality when they get wet. These can be used to coat the esophagus and stomach lining as you swallow them and help sooth and heal inflamed tissue. Pick one or two of the following and take them between meals or as needed during bouts of acid reflux.

Marshmallow tea - Steep 1 TBSP of the root in 8 oz of water for 30 minutes, and drink 1 cup as needed. You can make larger amounts and refrigerate for up to 3 days so you'll have it on hand when you need it. (Safe in pregnancy)

Aloe vera juice - Drink 1 oz as needed. 

Deglycyrrhizinated licorice (DGL) - Chew 1-2 tablets (~500-1,000 mg) as needed for heartburn. Note: This type of licorice will not raise blood pressure

Slippery elm lozenges - Chew or suck on 2-4 lozenges as needed. (Safe in pregnancy)

6. Gentle abdominal massage

One often-overlooked factor that can cause or worsen heartburn is called hiatal hernia syndrome. This is a condition where the top of the stomach presses up against the bottom of the diaphragm. Hiatal hernia syndrome is less severe than a true hiatal hernia in which part of the stomach actually sticks up through the diaphragm into the chest cavity, but it causes problems none-the-less. 

A gentle abdominal massage technique that takes about 15 minutes can help correct this syndrome and offer immediate and often dramatic relief if this is part of the root cause of your acid reflux. Seek out a naturopathic doctor or functional medicine doctor trained in visceral manipulation or applied kinesiology for this treatment. 

7. Increase your stomach acid with foods or herbs

Sour and bitter tasting things stimulate the body to get ready for digestion. One of the ways they work is by signaling your stomach to make acid. Choose one of the following and use it 15 minutes before meals and large snacks. 

I saved this recommendation for last because for people who have been struggling with heartburn for a long time, especially those taking an acid blocking medication, going off the medicine and increasing stomach acid can sometime cause increased symptoms. First addressing the 6 recommendations above can go a long way toward making it easy and painless to wean off your medication and restore normal stomach acid levels. 

Bitters - 15 drops directly on the tongue or in a little water. Here are a couple kinds I like. 

Lemon juice - Squeeze 1/4 lemon into a glass and dilute with a little water. It should still make your mouth pucker. 

Apple cider vinegar - 1/2 to 1 oz mixed with a little water. Choose an organic one like these made by Bragg or Spectrum

Bitter greens - chew on a bit of dandelion green (make sure you get it from somewhere that isn't sprayed with pesticides), endive or other bitter greens. You can even get fancy by starting your meal with a small salad of bitter greens with an apple cider vinegar or lemon based dressing.

 

If you have been struggling with heartburn for some time now, taking these steps to address the root causes and get over it for good is such a wonderful thing to do for your long term health. Please let me know if I can offer you any support. 

Warmly, 

Dr. Jennea

 

Check out my earlier blog post Why I hate Prilosec, Tums and Zantac

 

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How We Eat

I spent a recent weekend at a retreat where naturopathic doctors assembled to discuss the philosophy of the medicine we practice. One of the overarching themes of the weekend could be summed up as “Physician heal thyself”, or the necessity of healing and caring for yourself first so that you can better serve those who come to you seeking healing. As a side note, this concept applies to everyone who cares for or serves others in some way: teachers, parents, restaurant servers, etc. This can be as simple as making time each day to eat healthy food, exercise, sleep and spend time with loved ones. Or it can be as complex as delving into your flaws and biases and doing your best to become aware of them and address them so they don’t negatively influence your ability to help others. If you don't take time for self-care, it's so easy to get burned out. This is such an important conversation to have in the field of health care.

While at this retreat, I noticed a pattern that I have noticed many times before. I slept in a tent for two nights and woke refreshed. I ate the delicious food that was provided for us while sitting outside in a beautiful place. Meals were enjoyed with warm and kind people over inspiring discussions. I felt such gratitude at each meal for the food and the sense of community. Between the meals and the discussions and lectures, I walked in the forest. And this is what I noticed. My digestion improved dramatically for those two days.

Then I went back to the city and my normal schedule, and while I was still eating healthy food, I found myself eating more snacks during moments of boredom while doing things like filling out paperwork. I ate two out of three meals alone most days since I work from home when not seeing patients and my partner leaves early for work. I was indoors most of the time, and though I try to avoid this, I would sometimes check email or read while eating. And instantly my digestion became somewhat disturbed again. Nothing serious, but food didn’t sit quite right. I felt a little bloated after meals.

This is such a common pattern that I have observed countless times in my patients and myself. In many ways, how we eat is as important as what we eat. When we eat hurriedly, or while distracted, inside, alone; when we don’t chew thoroughly; when we don’t stop to appreciate our food. When these things are true, we don’t fully digest the food we eat. This means that we extract less nutrition from it, and our friendly gut bacteria get ahold whatever is left and ferment it causing gas and bloating. 

It’s not always possible to eat with friends or family, or eat outside. When that is the case, I encourage you to pause before you start eating, take 10 belly breaths and spend a moment seeing if you can feel some authentic gratitude for the food you are about to eat. This actually helps flip the switch in your nervous system to “rest and digest” mode, which allows you to more completely digest the food you eat. But more foundationally, I encourage you to consider the way you structure your life, and whether it allows you to regularly eat meals with friends and family or eat outside. Where could you potentially simplify your life and make more space for these types of essential acts? And what do you notice about your digestion when you are distracted and hurried during meals versus when you are relaxed, grateful and surrounded by loved ones?

Wishing you health,

Dr. Jennea

 

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A Naturopathic Doctor’s Thoughts on Sugar (And a Delicious Granola Recipe)

Sugar is delicious, but don’t kid yourself, it’s incredibly addictive. We’re evolutionarily programmed to think so. Sugar isn’t intrinsically good or bad, but human beings’ genetically mandated love of the stuff combined with the fact that it is incredibly cheap and ubiquitous spells trouble.

On a personal note, I discovered some time last year via a dietary evaluation and elimination diet that I react very poorly to cane sugar (aka table sugar, made out of sugar cane). I actually get an earache within moments of eating something with cane sugar in it, and if I keep eating more, I catch a cold. It’s like clockwork. Following this discovery my subsequent adventures in removing cane sugar from my diet have been enlightening.

Here are some of the things that I have learned:

  • Suffering is quite motivating. Knowing that if I cheat, I’ll feel terrible makes it much easier to stay away.
  • My sweet tooth has become much more manageable since giving up cane sugar. I still enjoy occasional treats sweetened with maple syrup, honey, coconut sugar, agave, etc., but I don’t feel controlled by those sugar cravings the way I used to.
  • For the most part I don’t really miss it (seriously).
  • I do sometimes feel awkward saying no to sugary sweets when spending time with friends and family. Not because I want to eat the offered treat (My body actually doesn’t want it), but because it’s just hard on a social level to say no sometimes.
  • There are many completely delicious desert options that don’t contain cane sugar.
  • Without trying to count calories or lose weight (Though I certainly pay attention to eating a healthy, whole food diet), my weight naturally rests at about 5 lbs less than it did when I was eating cane sugar.

How does sugar affect your body?

Well I'm glad you asked!

For the purposes of this next section, when I say sugar, I mean added sweeteners of any kind, because any sweetener causes the same host of problems when eaten in excess. A few of the names you might find on labels include cane sugar, evaporated cane juice, maple syrup, honey, rice syrup, agave, coconut sugar, corn syrup, dextrose, evaporated cane juice, fruit juice concentrate, high fructose corn syrup etc. Sugar naturally found in whole fruit, vegetables or milk doesn’t count. Calorie free sweeteners also don't count, though I beg you to steer clear of NutraSweet (aspartame), Splenda (sucralose) and saccharine (Sweet N' Low). They are toxic. Stevia is generally fine in small amounts, and xylitol is well tolerated by some while others get some digestive upset from it as it is not absorbed. Be aware though, that even non-calorie sweeteners contribute to an addiction to excessively sweet foods. 

I talk to all of my patients about limiting sugar. It may not be necessary for everyone to avoid cane sugar entirely like I do, but most people could benefit from eating less of it.

Here’s why:

Table sugar is made up of half glucose and half fructose. All the other sweeteners I listed above contain some ratio of these two sugars. Glucose and fructose are processed very differently by the body. Glucose is mainly what the body needs to function (though you don’t have to eat sweet things to get enough of it because your body gets plenty from complex carbs found in whole grains, legumes and vegetables, and can even make its own out of fat and protein). Fructose, while fine in moderate amounts found in fruit is very taxing to the liver in high amounts. I encourage you to watch Sugar: The bitter truth for more on how your body processes glucose and fructose.

The body’s goal is to maintain the level of glucose in the blood at a very specific level because that is what the brain needs to be happy. When blood glucose drops too low, you feel terrible. Foggy thinking, irritability, nausea, and fatigue: these are all common feelings when your blood sugar drops too low and your brain is expressing its displeasure. On the other hand, the brain doesn’t protest when blood sugar is too high. If it did, we likely wouldn’t have such high rates of diabetes in this country because people would receive consistent negative feedback from their bodies when they overindulged.

The pancreas produces two hormones that are responsible for keeping your blood sugar in the perfect middle range:

  • When blood sugar levels are too high, Insulin tells your cells to remove sugar from the blood and store it as glycogen in the liver, and as fat all over the body, but especially around the midsection.
  • When blood sugar levels are too low, Glucagon tells your cells to add sugar to the blood.

But what if blood sugar levels are bumped up over and over again throughout the day because you regularly eat sugary meals or snacks, and this continues for days, months or years on end? Over time your cells stop listening when insulin tells them to remove sugar from the blood. Like a child who no longer listens to her mom nagging her to clean her room, cells all over the body quit listening to insulin telling them to clean up the sugar. When this happens, sugar levels remain high, eventually leading to type 2 diabetes. High sugar levels in the blood begin to gum up the blood vessels as well other cells in the body. This leads to heart disease and speeds up the aging process. If you’re interesting in slowing or reversing the aging process, listen up. The first and best way is to keep your blood sugar levels in the normal range. All of that excess sugar floating around directly causes wrinkles and sagging skin.

So what are some basic guidelines to aim for around eating sugar?

I generally have people focus on sticking to the American Heart Association’s recommendations, which say that:

Women should aim to consume no more than 6 teaspoons (24 grams) of added sugar per day

Men should aim to consume no more than 9 teaspoons (36 grams) of added sugar per day

Children up to age 8 should consume no more than 3-4 teaspoons (12-16 grams) per day

Children age 8 to 18 should consume no more than 5-6 teaspoons (20-24 grams) per day

An important conversion to keep in mind is that there are 4 grams of table sugar in 1 teaspoon. Most nutrition labels list sugar in grams, so this helps with label reading.

The US Food and Drug Administration recommends that people not exceed 10% of their daily calories from added sugar. That works out to about 50 grams of sugar per day or 12.5 teaspoons of table sugar. That’s over double the American Heart Association’s recommendations for women and much too high in my opinion.

My Favorite Granola

I recently made my own granola, modifying a recipe from Food 25 to reduce the sweetener and only use maple syrup. I ended up with a completely delicious crunchy, mildly sweet and ever so slightly salty granola that I absolutely love. I love that this recipe contains a ton of nuts and seeds lending it a relatively high protein content. Pumpkin and sunflower seeds are some of my favorite super foods as they’re packed with minerals. This granola is also high in healthy fats from the coconut flakes, nuts, seeds, and olive oil. I enjoy it with some whole fat yogurt and fresh berries to increase the antioxidant punch. I’ve listed the nutrition facts below the recipe.

An important thing to note is that even though it has relatively low sugar, I still consider this granola a treat and don’t eat it every day. My goal is to make the majority of my diet veggies, fruits, legumes, whole grains and occasional meat. In order to eat enough veggies each day, it takes eating vegetables with most meals, and having granola for a meal usually means I don’t eat vegetables. So I reserve it for special occasions or times when I’m in a bit of a hurry.

Here’s the recipe

Ingredients:

3 cups gluten free rolled oats

1 cup hulled raw pumpkin seeds

1 cup hulled raw sunflower seeds

1 cup unsweetened coconut chips

1 cup raw pecans, left whole or coarsely chopped

½ cup pure maple syrup

½ cup extra-virgin olive oil

1 scant teaspoon coarse salt

Directions:

  1. Heat oven to 300 degrees F.
  2. Place oats, pumpkin seeds, sunflower seeds, coconut, pecans, syrup, olive oil, and 1 scant teaspoon salt in a large bowl and mix until well combined. Spread granola mixture in an even layer on a rimmed baking sheet. Transfer to oven and bake, stirring every 10 to 15 minutes, until granola is toasted, about 45 minutes
  3. Remove granola from oven and season with more salt to taste. Let cool completely before serving or storing in an airtight container for up to 1 month.

Serving size: ½ cup

Makes about 14 servings

Per serving (approximate):

Total fat: 29g

Omega-3 fats: 257mg

Potassium: 369mg

Total carbohydrate: 33g

Dietary fiber: 6.5g

Added sugar: 5g

Protein: 11g

Vitamin A: 47IU

Calcium: 42mg

Iron: 4mg

Magnesium: 151mg

Selenium: 7mcg

Zinc: 3.6mg

Looking at these stats, I’m impressed with the protein content. One of my main problems with having granola or oatmeal for breakfast (besides that it usually means skipping vegetables) is that it has fairly low protein content unless you’re adding protein rich toppings. 11 grams of protein is great! The fiber content and omega 3 fats are good too. I’m very impressed with the amount of potassium, iron, magnesium and zinc in this granola. It is loaded with minerals! Though it is true that minerals are less well absorbed with eaten with grains. The added sugar of 5 grams per serving is nice and low, and it still tastes amazing, especially with added berries or other fresh fruit. The fat content of 29g is pretty high, but as I am always trying to convince my patients, added sugar is the main culprit for weight gain, not fat. The fats in this recipe are all very healthy, and a higher fat content means you don’t crave added sugar as much. You’ll likely feel more satisfied by this granola than a lower fat variety, meaning you won’t be craving additional snack foods after eating it.

What questions do you have about eating healthy?

Crunchily,

Dr. Jennea

 

p.s. Ready to start getting down to the nitty gritty root causes of your health concerns? Schedule a free 15 minute consult to chat about your story and how I can help. 

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What is with all the Anti-ND press lately?

There have been a number of opinion pieces in popular blogs and online news sources lately that speak poorly of naturopathic medicine. In case you’ve seen one of them and wondered what to make of it, I thought I’d weigh in.

These articles pretty much all say something along the lines of: “NDs aren’t real doctors”,  “NDs practice woo woo pseudoscience”, and “NDs are hurting people.” While I’ve pretty much stopped reading these types of articles because they all use the same tired, opinion-based, fact-light formula, what I see is really going on here is this:

NDs are gaining traction as a serious force in healthcare. We are licensed to practice medicine in 18 states and counting. We practice safer and more effective medicine for most chronic diseases and it scares the hell out of some in the conventional world who are witnessing the beginning of the end of the conventional way of practicing medicine: i.e. a corrupt, prescription mill bought by pharmaceutical companies whose best offering is managing symptoms, not preventing or healing diseases. A recent study out of Johns Hopkins University medical school reported that, after heart disease and cancer, medical error is the third leading cause of death in this country. People want better, safer healthcare. NDs are taught to understand the limits of our medicine and when to refer, but when treating non-life threatening chronic diseases, what we do is incredibly safe. The cost of our malpractice insurance (much, much less than MDs) reflects this.

To be clear, there are plenty of MDs and DOs who know how much the medical system in this country needs an upgrade, and are changing with the times, or have been quietly practicing similarly to NDs for years. Those are not the people writing these articles.

There is more and more high quality evidence supporting the efficacy of what NDs do, and the body of research will continue to grow. And the biggest reason of all that our numbers are growing and more states are licensing NDs is this: Our patients are so happy to have access to safe, effective, cause-resolution healthcare.

So…

In conclusion, haters will hate, and the best evidence that a movement is taking off is increased fussing from those entrenched in the old way of thinking.

 

Yours in health,

Dr. Jennea Wood, ND