Gluten Free Living

How to Eat Gluten Free

 Gluten Free is the new Vegetarian – almost every grocery store now has gluten free breads and products in their freezer sections, and crackers and baking mixes in the  aisles. Websites abound on not only celiac disease resources (a disease caused by severe gluten allergy) but on gluten free recipes, resources, and restaurants in almost any geographical area.

So, what is all the hype? Why go gluten free, and why are so many people changing their diets? The bottom line is that gluten sensitivity begins with the immune system of the digestive tract becoming hypersensitive to gluten proteins. The body creates antibodies to the sequence of amino acids, which enter the bloodstream and travel throughout the body. Whenever these antibodies see that same sequence (which is repeated as a small part of many tissues of the body exposed to blood i.e. thyroid, joints, brain, lungs, skin) they attack that tissue as if it was gluten. This creates “auto” or “self” antibodies, which are then produced in greater and greater numbers and cause disease.

Therefore, gluten has been linked to autoimmune diseases such as lupus, rheumatoid arthritis, Hashimotos thyroid disease and multiple sclerosis. These are end stage conditions that develop years after smaller warning signals such as headaches, digestive disturbance, asthma, allergies, psoriasis, alopecia, insomnia and various “undiagnosible” ailments. Sometimes eliminating the offending foods or doing testing to assess your body’s immune response is the only way to assess if food is an underlying factor in your ill health.

Gluten is a protein that is found in the following Grains:

  • Wheat
  • Rye
  • Barley
  • Kamut
  • Spelt
  • Oats is technically gluten free but very often contaminated in manufacturing.

Therefore, people with a gluten sensitivity or allergy cannot eat any of these grains, or products that contain them such as soy sauce, gravy, doritos or other gluten based products. Oats are technically not a gluten containing grain, but should be avoided unless it states “gluten free” on the package.

Non Gluten Grains which can be eaten by people with gluten allergies include:

  • amaranth: highly nutritious, tiny seeds available whole or as a
  • rice: including brown and white rice, Arborio, basmati and rice flour
  • corn: including cornmeal, cornstarch and corn flour
  • millet: small seeds, eaten whole or combined with other gluten-free flours
  • quinoa: small seeds that can be eaten whole, as a hot cereal or ground into flour
  • buckwheat: used whole, cracked or ground into flour
  • oats: gluten free oats and oat bran
  • tapioca: made from cassava root, often combine with gluten-free flours
  • teff: very small black grain, contains symbiotic yeast
  • arrowroot: a starch used as a thickener, superior to cornstarch, blends well with gluten-free flours

Potatoes, sweet potatoes, squash, and other starchy vegetables can also generally be enjoyed by those who are gluten free.

For the most thorough information on gluten allergy, see http://www.thedr.com./store.html and order Unlocking The Mysteries of Wheat and Gluten Intolerance for yourself. Dr. Tom DC offers eloquent and thorough evidence based information on why it is worth at least trying gluten free living for one month and then reassess.

Many people have a wheat sensitivity or allergy, but can tolerate other gluten grains like spelt and kamut. Some people with a wheat, but not gluten sensitivity will later develop a gluten sensitivity. Corn, potato, dairy and/or soy sensitivities are also common in addition to gluten. For this reason, it is best to start your food eliminations by eliminating all of the above products, and slowly reintroducing each gluten grain as well as corn, potatoes, and soy separately to judge your individual reactions.

AVOID FOR GLUTEN -FREE SHOPPING:

  • look for labels that say – wheat (or whole wheat) flour, wheat germ, bran, farina, graham flour, semolina, gluten, modified food starch, wheat starch, vegetable starch, vegetable gum
  • Pastas – spaghetti, vermicelli, macaroni…..
  • Soups – commercially canned
  • Desserts – most contain wheat – so read carefully
  • Cereals and breads – as with desserts – read labels carefully
  • It’s probably best to go to health food store in order to find alternatives. Most breads, bagels, wraps, pizza doughs, etc are kept in the freezer sections
  • For persons allergic to wheat, but not to gluten, you can use flour substitutes such as spelt or kamut (these are the most similar to wheat); rye, oats and barley can also be eaten.

TIPS FOR A GLUTEN-FREE DIET:

  • focus on protein, vegetables, fruits, and healthy fats like avocado 
  • Lots of delicious gluten free options abound: Tray various  pasta, breads, crackers, etc until you find what your taste buds prefer.
  • Avoid any food that contains wheat, barley, rye, oats – as well as spelt and kamut. Also, remember that gluten can be found in most processed foods, including soups, sauces, gravies, and of course in breads, cereals, and desserts.
  • 40% of people allergic to gluten are also allergic to soy and/or corn – which are often found in “gluten-free” breads, etc.
  • READ LABELS on everything the first few months to find hidden sources of gluten.

Eating Out and Travelling:

Most cream based soups and chowders are made with a gluten base. Boone’s in Portland has a gluten free chowder, bisque, crab cakes etc if you are craving those.

It is pretty easy being gluten free in restaurants once you get the hang of it. Focus on protein and vegetables, fancy salads and avoid gravies, pasta, gnocchi and sandwiches. If you are craving a burger, ordering it without the bun is pretty standard in today’s low carb world. Steak and arugula salad is always a good choice.

Sadly, fried treats are out the window like calamari, fried clams, fish and chips… once it gets battered it is almost always a wheat base. French fries are also often battered. Best to ask ahead of time instead of getting a delicious plate of inedible fries. Frontier restaurant in Brunswick has delicious GF fish and chips, and rice flour calamari.  Not cheap but delicious!

Fish options and mussels or raw oysters rarely have gluten unless they are fried or pan fried. Eating fish at home with rice and salad is a great nutritious option too.

Some places have gluten free sandwich bread but most places don’t. In a pinch on the road, subway will make a “chopped salad” which is basically a sub in lettuce/salad. Planning your food and having fruit, yogurts, nuts & seeds or trail mix, protein bars, and even leftovers or sandwiches on GF bread you make yourself before you leave become important while travelling.

What else? Gluten free breads and crackers abound.  I personally like Millet breads the best – available in Whole Foods GF freezer section. Rice breads tend to be very dense and gummy, but are the most common across the board. Mary’s Gone Crackers are the best GF crackers, followed by Nut Thins and Glutino brand. Glutino also makes a great pretzel. Rice cakes can have a bad reputation but are a quick tasty snack and great vehicle for dips, cheese, avocado and almond butter.

Sweets: Lots of gluten free cookies and treats are available! Any ice cream or candy without “cookie dough” or brownies or cones is usually GF. Many coffee places have at least one GF option. Flourless chocolate torte, chocolate mousse, crème brule or pannacotta are restaurant dessert options that are usually safe.

 

Tips for Gluten-Free Baking

FLOUR

GOOD TO KNOW

Equivalent to 1 Cup of Wheat Flour
 

Amaranth Flour

 

-best combined with other flours that  have more cohesion (arrowroot, tapioca, bean)

-add to baked goods, pancakes/waffle recipes

 

1 cup

 

Arrowroot Starch

 

-add 1tbsp to an equal parts of cold water before adding to dishes as a thickener

-combines well with gluten-free flours to give them cohesion

 

1/2 cup

 

Bean Flour

 can be gassy. Often used in Paleo cooking.  

3/4 cup

 

Buckwheat Flour

 

-makes a dark, heavy bread

-use with rice flour

 

7/8 cup (1 cup minus 2 tbsp)

 

Chestnut Flour

 

-used to sweeten baked goods

-adds lightness and creaminess

-use alone or mix w/ other flours

 

Chickpea Flour

 

-too dense and rich to use on its own

 

7/8 cup (1 cup minus 2 tbsp)

 

Cornmeal

 

-makes a light bread

-mix with equal parts of cold water before adding as a thickener

-best combined with small amounts of other flours

-stone ground is more nutritious

 

1 cup

 

Cornstarch

 

thickener

 

3/4 cup

1 cup corn flour

 

Millet Flour

 

-always combine with other flours

 

1 cup

 

     Potato Flour/Starch

 

-best combined with other flours

thickener

 

5/8 cup flour

3/4 cup starch

 

Quinoa Flour

 

-best combined w/ other flours. May have a beany taste.

 

Rice Flour

 can be grainy, does not rise.  

7/8 cup

(1 cup minus 2 tbsp)

 

Soy Flour

    -makes bread or baked goods more moist and smooth

-best if add small amounts to other flours

-u       -use only 20% soy flour in recipe, decrease temperature by 25 degrees

 

 

3/4 cup

 

Tapioca Starch

 

-thins if reheated

-combines well with gluten flours to give them cohesion, thickener

 

1 cup

 

Teff Flour

 

-do not add to yeast breads because it has its own symbiotic yeast

 

Flour Combinations: equivalent to 1 cup of white or whole wheat flour

1 cup soy flour + 1/4 cup potato starch

1/2 cup soy flour + 1/2 cup potato starch

5/8 cup rice flour + 1/3 cup potato flour

1/2 cup corn starch + 1/2 cup rice/potato flour

1/2 cup arrowroot + 1/2 cup potato flour

For 2 cups of flour good for baking cookies:

1 cup of brown rice flour + ½ cup of tapioca rice flour + ½ cup white rice flour + 1 tsp of xanthan gum.

Namaste company also makes a “Perfect Flour” gluten free mix of flours that you can buy and use with any recipe. Makes cookies really easy!! They also have a great pancake mix if you love pancakes.

Tips for substituting wheat flour:

  • do not be concerned if batter appear thinner than wheat batters, this is common
  • add 1/2 tsp baking powder per cup of substitute flour; add just before cooking because it loses its potency when mixed with liquid and allowed to sit
  • refrigerating dough 1/2 hour helps improve texture
  • do not bake anything thicker than 4 inches
  • when baking, lower the temperature a little
  • baking time is usually longer, especially if egg or milk is eliminated from the recipe
  • experiment with your options – buy small quantities from a bulk food store and make half recipes first

For thickening, the following quantities equal 1tbsp of wheat flour:

*Arrowroot 1 tbsp = 2 tbsp wheat flour

*Corn starch 1 tbsp

*Potato flour/starch 1/2 tbsp

*Rice flour 1/2 tbsp

*Tapioca flour 1/2 tbsp – my favorite

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Fertility is the New Holy Grail

Resolve to know more about the underling factors affecting conception and alternative family possibilities. * This article was originally written for the February 2015 Digital Issue of Essential Living Maine*

I had two stepmothers who were infertile for various reasons, and have an adopted baby brother. Several of my close friends and family member have used IVF to conceive, and I have my eggs cryopreserved. A few of my good friends have fostered and adopted, and others have intentionally chosen childfree lives. As lesbian and gay marriage has normalized, and divorce rates have climbed, more and more alternative families are being created using sperm banks, surrogates, egg donors, known sperm donors and more. The quest for fertility is all around us, and has been for the past 30 years in ever-increasing numbers.

The Internet has an enormous amount of information available on this topic, as the World Wide Web offers an enormous cross cultural support network for women trying to conceive (#TTC.) Infertility is usually a silent disease without any visible disability associated; however, it draws deeply on the mind/body and soul in underground ways that cannot be explained to those who do not have to undergo its trails and tribulations. Thus, the web is a great way to connect, share information, and do research while maintaining public anonymity.

220px-Sangreal-1Integrative Medicine is key to enhancing fertility. Integrative Medicine combines the best of modern medicine (reproductive technology) with time-honored complementary and alternative medicines (botanical therapies, clinical nutrition, homeopathy, acupuncture, and stress management support.) The quest to get pregnant (and stay pregnant!) has been a calling of doctors and midwives since the beginning of time and across all cultures.

After ten years of fertility specialization, here are my Top Ten Integrative Medicine Fertility Fundamentals to know about when mapping your journey:

  1. First, while on oral contraceptive pills, rings, or IUD’s and for at least 6 months coming off them, it is important to supplement with a good quality multivitamin that contains at least 10-20mg of all of the B vitamins, magnesium, vitamin C, and 800mg folic acid. These are depleted by synthetic estrogens, and a deficiency can cause long term fertility issues down the road.
  1. If you have a family hx of miscarriage, have had a miscarriage yourself, or have any anemia or high homocysteine on lab work, you may want to test for a genetic defect called MTHFR that leads to a folic acid absorption issue. http://www.apothecarybydesign.com/blog/archives/332
  1. DHEA is a fat-soluble antioxidant and hormone precursor produced by the adrenal glands. DHEA is also a key player in egg health, showing improved embryo quality and higher live birth rates than controls. Studies have used 75 mg of DHEA daily. 1 DHEA supplementation also evidenced higher rates of spontaneous pregnancies in long-term poor responders to IVF in another study using 25 mg three times per day. 2 DHEA supplementation slows the aging process by preventing lipid oxidation while improving energy and metabolism.
  1. CoQ10 is imperative to egg health. Egg division from 46 to 23 chromosomes requires effective mitochondrial function. 3. It has been suggested that mitochondrial DNA defects that effect metabolic capacity may be a cause of failure in egg maturation, fertilization, or early embryonic development. 4. Aged eggs have decreased mitochondrial energy which can result in deficient energy to divide properly resulting in Downs’s syndrome and other genetic anomalies. All women over 30 who are still considering pregnancy should be on 100mg of ubiquinol daily to maintain efficient mitochondrial activity.
  1. Test your hormones early, and keep testing every few years for an objective measurement of fertility reserves. Follicle Stimulating Hormone (FSH) levels must be tested on day 3 of the menstrual cycle with Anti Mullerian Levels (AMH) levels before beginning fertility protocols. FSH reflects the relationship between the ovaries and pituitary and higher levels indicate perimenopause and poor ovarian function. Therefore, levels of FSH under 10 are best. AMH is also called the “egg timer” as it gives an accurate level of the follicular reserves of the ovaries. AMH levels do not fluctuate throughout a cycle and can be tested at any time. Serum AMH levels decline throughout ones reproductive life cycle, and are undetectable after menopause; therefore, higher levels are more desirable.
  1. Don’t wait too long to consider IVF. If you have been #TTC for more than 9 months and have not become pregnant with regular, timed inseminations, IUI’s or intercourse, make appointments with a fertility clinic and an Integrative fertility specialist. Having a Plan B will decrease stress, and it takes time to consider the financial and medical burdens associated with reproductive technology. However, it is worth it to have that baby in your arms! If IVF is needed, committing to the process earlier in your fertility journey can increase your chances for that #BFP (Big Fat Positive) on your first attempt.
  1. Don’t forget the men! At least 30% of infertility is male factor. Too often one half of the couple is doing everything possible (yoga, clean eating, no caffeine, no alcohol, meditation, support group, acupuncture, etc) while the other half is the root cause of the issue. Getting a sperm analysis is one of the first steps in a fertility evaluation, and can bypass months of angst from non-conception.
  1. Sperm need fertility enhancing supplements too! Omega 3 fats, 15 mg zinc, and stress busting herbs like Maca or Ashwaganda will improve sperm health, tonify libido and boost fertility.
  1. Have your thyroid hormones including TSH, Free T3 and Free T4 and your progesterone levels tested. Low thyroid function leads to low progesterone, which leads to frequent miscarriage in a classic vicious cycle. Some Endocrinologists and Family Docs may have conservative opinions on these levels and may use outdated reference ranges or be unwilling to test for Free T3. Consulting an Integrative Medicine Doc, Naturopathic Doctor or anti-aging Hormone Doctor may give you more information about optimizing your hormone levels rather than operating at a subclinical deficiency.
  1. Consider alternatives to the traditional nuclear family. There are many beautiful babies who want safe, stable, loving homes and need fostering and adoption. I know three amazing families of beautiful fostered babies! There are also women able and willing to carry babies to create families that are not their own. While a biological birth is what we are taught to dream for, this is not the answer for some. Infertility is tragic and real for people who have always assumed they would be able to birth when they are ready. Allow your self to grieve as a couple, but do not close the door on other options even if they seem inconceivable at first.

On another note, childfree living also has many blessings. Our culture is slowly shifting away from the definition of having a (nuclear) family as the ultimate success. Childfree living allows for a more relaxed and abundant lifestyle with more freedom, ability to travel, and heightened romance for a couple. We are an overpopulated planet, and I know from my life, having an auntie that is invested and involved in my life is incredibly valuable. Here are many ways to be a part of a family, and each version needs to be recognized as equally valuable and important!

I could keep typing another ten set of treatments supports, and probably another ten after that,  I am so passionate about fertility! However, as I said earlier the Internet is a rich resource. Some other articles I have written on the topic include:

I wish each of you success on your Holy Grail of Fertility. May your journey connect you to your own Divine nature as you experience one of the great, uncontrollable mysteries of life: Conception!

References

  1. Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500Accessed September 13 2013
  1. Leonidas mamas, Eudoxia Mamas. Dehydroepiandrosterone supplementation in assisted reproduction: rationale and results. Current Opinion in Obstetrics and Gynecology 2009, 21:306-308.
  1. David Meldrum, MD. Aging gonads, glands, and gametes: immutable or partially reversible changes? Fertility and Sterility 2013; 99:1-4.
  1. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5.

To book an appointment:

http://www.agemanagementcenter.com/contact-amc/  or call 207-774-1356

Clinical Practice:

www.agemanagementcenter.com

www.facebook.com/AgeManagementCenter

For more information about Infertility see:

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DETOX 2015: Start the New Year With A Clean Metabolic Slate

tabula rasa – the latin term for “erased slate” referring to the emptiness of a slate sheet that was previously written on by chalk.

 To start the New Year with a fresh clean slate we need to erase the old clutter from our internal metabolic “chalk board”, which means DETOXIFICATION.

Why detoxify? Intermediate metabolites build up like desk clutter from all of the work that our liver has to do to break down hormones, pesticides, pollution, cholesterol, medications, bacteria, viruses, alcohol, caffeine, and everything else that we inhale or ingest. Symptoms of this “clutter” include allergies, skin disorders, constipation or diarrhea, heartburn, irritability, fuzzy thinking, headaches, low energy, fatigue and many more low grade but uncomfortable signs of poor health.

I do not believe in crazy diets, water  fasting, purges, enemas, or other “heroic” efforts. An effective detoxification process can be simple, inexpensive, easy to accomplish and leave you feeling fresh, renewed and in many cases with less weight! The focus is on fresh, whole foods, clean water, daily smoothies and supplements to improve liver detoxification.

I will be offering an all-inclusive program for one week in January – The tentative dates are January 10-17, 2015. One week is enough time to begin the detoxification process in the liver, but not so much time as to interrupt our busy lives. This program will be a group event, with individual introductory sessions to troubleshoot potential obstacles during the detoxification process.  This program will consist of:

  • A 30 minute detox interview and consultation to assess your personal needs. (The interview can be bypassed for Dr. Wright’s current patients.)
  • A 60 minute group meeting to introduce the program, review the basics of detoxification, and get you ready to start!
  • One week of detoxification with daily email support and a Facebook group for recipe sharing, troubleshooting and cheerleading.
  • A 30 minute group program review at the end to assess the effects, with suggestions on supplements and lifestyle options to maintain the beneficial effects of the detox.

Some people may choose to repeat the detox cycle for 1-3 more weeks in order to really delve into metabolic restoration; however this is an independent option.

Call Age Management Center today at 207-774-1356 IMG_1420or email Dr. Wright at thewrightnd@gmail.com and find out how our New Years Metabolic Detox program can help improve focus, increase energy, decrease allergies and enhance metabolic balance.

Cost: $250 inclusive, prepaid new patients or those needing individualized 30 minute support session.

Cost breakdown: 30 minute consultation: $75, Core Restore Detox Kit $100, 60 minute initial group consultation $50, 30 minute review session $25. Administration, daily emails during the detox program, Facebook group monitoring and detox troubleshooting included.

Current patient & friend/family rate: $175. (Does not include the 30 minute individual consultation.)

Some patients may choose additional Integrative Medicine consultations for more personalized care; individuals who choose to become patients of Dr. Wright’s during or after the program will have $75 taken off her initial consultation fee.

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Vanquishing Fat Improves Weight Loss

12428062215_8a3fa42d45_zI dreampt I was lying on a comfortable table in a private office, with a machine sending warm Infra-Red rays into my abdomen, melting away my belly fat. I was dozing, and imagining the fat cells bursting and my body’s lymphatic system scooping them up and leaving me with a trimmer waistline as I  thought about my life for 45 minutes…. Oh Wait! That wasn’t a Dream! That is the Vanquish machine!

It must be the 21st century because medicine has finally found a way to literally melt off fat in targeted areas like the belly, hips and thighs. This revolutionary selective radiofrequency technology is non-invasive, safe and effective. Heat penetrates deeply into the body targeting adipose tissue (fat cells) while protecting other neighboring organs and skin layers with cooling air flow.

The Vanquish experience is relaxing, pain free and requires no medication or recovery time. It requires lying still for about 45 minutes. Best results are obtained when repeated twice per week for at least 3 weeks (six sessions). Clinical results are visible within 3-4 weeks after your last session – do not expect immediate results! Physiologically, your fat cells are melted and slowly die, spilling their contents into local tissue to be cleaned up by the lymphatic, immune and circulatory systems. This process takes a few weeks, which is why results are not immediate.

A little science on fat cell physiology. It is now recognized that a fat cell is not just a glob of fat. Adipose tissue is a metabolically active, highly functioning part of the endocrine (hormone) system.

When your energy in (food & alcohol) is greater than your energy out (activity, intellectual work and exercise) insulin directs the body to store fat. The capacity to store fat is seemingly endless,  as individual cells can grow quite large while chemically signalling neighboring undifferentiated cells to turn into new fat cells. Energy deficit (energy out greater than energy in) stimulates the adipose tissue to release free fatty acids and become smaller fat cells, or the cells can die through apoptosis.

Centrally located adipose tissue is used as a storage area for many fat soluble hormones and chemicals like estrogen, pesticides and THC. When fat cells spill their contents, these are also spilled. Adipose tissue also independently synthesizes chemicals like adipsin that activate the inflammatory cascade. (This is why heavier people can have more inflammatory disorders than thin people.) As the Vanquish machine melts away the fat cells, stimulating apoptosis (cell death) your body will have to clean up these excess chemicals and inflammatory mediators as well as the free fatty acids released. Fortunately, a healthy body is designed to effectively remove cellular debris like this through the lymphatic and circulatory systems.

Drinking extra water is essential during this process. We also recommend using herbal teas like the Traditional Medicinal Daily Detox Tea, nettle tea and organic green tea for free radical/antioxidant protection. Taking a good quality multivitamin provides minerals and B vitamins to support liver detoxification while daily exercise will also stimulate fat burning metabolism and support free fat elimination. Nutritionally, a meal plan focused on weight reduction principles will enhance the slimming effects of Vanquish. I suggest small amounts of whole fiber rich grains a few times a week, daily leafy greens and raw vegetables, low sugar fruits like apples and blueberries, lowered carbohydrate intake, no processed foods, and grass-fed meats, vegetarian proteins and fish.

Some individuals with compromised health or congested lympathic or liver systems may benefit from additional Integrative Medicine alongside Vanquish treatment plans to optimize results. Integrative Medicine combines the best of botanical medicine, clinical nutrition and evidence-based nutraceuticals with modern diagnostic, laboratory and pharmaceutical expertise. This style of medicine is patient-centered; no two patients will get exactly the same protocol with our highly individualized care. Targeted therapies could include reducing systemic inflammation, improving detoxification pathways, clearing lymphatic channels, or tailoring nutrition to promote fat elimination.

Dr. Wright will be offered a group metabolic detoxification program at Cosmetic Enhancement Center in January 2015 and again in March 2015. This 7 day detoxification program is the perfect complement to a Vanquish Fat treatment plan. Ask Dr. Wright or Dr. Atkins for more information about the Vanquish Fat treatment plan, Integrative Medicine, or our upcoming Metabolic Detoxification program.

References:

Integrative physiology of human adipose tissue. K N Frayn, F Karpe, B A Fielding I A Macdonald and S W CoppackInternational Journal of Obesity (2003) 27, 875–888.

Adipsin and an endogenous pathway of complement from adipose cells. Choy LN1, Rosen BS, Spiegelman BM.J Biol Chem. 1992 Jun 25;267(18):12736-41. http://www.jbc.org/content/267/18/12736.long  Accessed 24/10/2014

Adipose cell apoptosis: death in the energy depot. A Sorisky,  R Magun and AM Gagnon. Department of Medicine and Biochemistry, Microbiology and International Journal of Obesity (2000) 24, Suppl 4, S3±S7 http://www.nature.com/ijo/journal/v24/n4s/pdf/0801491a.pdf  Accessed 10/22/2014

 

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5 Steps for Fertility Preservation Over 35

1Rope_Cross. CoQ10 preserves the quality of the eggs mitochondria  – essential for replication and good “egg energy” aka ATP for cell division. 100-400 mg daily prevention, 400 mg twice daily during a stimulation cycle.  ( The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5. )

2. DHEA is a lipid antioxidant and youth-reviving hormone precursor. I suggest 10 mg daily for prevention,  25 mg daily 6 weeks before stimulation cycle. Up to 75mg daily is evidenced to improve egg and embryo quality and enhance spontaneous conception. (Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500 Accessed September 13 2013)

3. This is your individualized medicine step – what do you need to tonify your specific reproductive patterns and enhance the chances of conception?

4. Fertility Massage is key for addressing muscular and ligament stress lodged deep in the pelvis that could mechanically impair the ability to maintain pregnancy. Concomitant castor oil packs clear debris from the ovaries and fallopian tubes, flushing lymphatic channels for a more balanced local immune response. The self massage/ hands on aspect maintains a connection between the cerebral, medicalized experience of ART and the physical sensations of the lower belly while reducing emotional stress. http://natural-fertility-info.com/fertility-massage.

5. Optimize your nutritional status with: extra leafy greens on a regular basis; superfoods especially in smoothies;daily  fresh vegetables; and choosing clean meat and dairy whenever possible. Reduce or eliminate sugar during high intensity hormone treatments including birth control pills.

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Advanced Maternal Age

IMG_0560I did not think I would be single and 41. I was pretty sure at 25, 27, 33, even 35 that kids were unconditionally on the horizon. I was not concerned that I would have kids later – after all I didn’t even graduate from medical school until I was 27. Then, I broke up with my long term love at 35. A quick trip to the fertility clinic at that time told me I was still good to go, and gave me info on my options.

I have been a lesbian for most of my adult life,  so assisted reproduction was  a necessary part of the planning. I  had considerable time to collect information on the legalities of sperm donors vs sperm bank options, and to become familiar with the insemination options that both gay and straight couples use in the quest for pregnancy. As a fertility specialist, I have supported many people through natural conception, IUI, and IVF. Now, well, lets say it could happen accidentally as I have switched teams. But, at my “advanced maternal age” natural conception is quite unlikely. So, after a second trip to the fertility clinic to confirm my continued fertile-ability, I am 3 days away from cryopreserving my eggs.

What this means, is I am doing the first half of an IVF cycle, and then instead of fertilizing  and transferring them, the eggs are put on ice for a later date. I am choosing to suspend the eggs instead of pre-made embryos, because  as referenced above, I am not in a relationship ready for babies. Its a logical choice for a single woman who is reaching the end of the #fertile years. It is also exciting to foil time, and have the possibility of a young family in the next few years. The miracles of modern medicine :)

Fortunately,  I decided around 33 to become an expert in #enhancingfertility and Assisted Reproductive Technology (ART) as an Integrative Medicine doctor. I studied  TCM/ acupuncture and fertility support from 2005-2011, and switched my focus to botanicals, endocrine function and anti-aging medicines in 2012. Read my published article about Integrative Medical support for the follicular phase of #IVF here.

I have quietly been preparing for this date in case I did not end up with a kid on my hip during my rather tumultuous 30’s. I will gracefully accept a child-free lifestyle if that is what is meant to be, as it has a freedom I value and I have wonderful children in my life. I may also choose to foster and adopt locally in Maine. The point of this cryopreservation is not only to end up with a child,  it is to preserve my choice to work towards conceiving within the next few years.

IMG_0672For those in the know, I am on day 8 of a stimulation cycle. I took 450 IU of Gonal-F for the first 6 days, and have ramped down to 300 for the next 2 days. I started 0.25 mg Cetrotide yesterday and will be continuing that for the next few days. Then, the trigger shot and retrieval Tues or Wed. My response is good and side effects minimal, which I am very grateful for. It really does pay to prepare for an event like this even years ahead. (PS. I had 21 eggs collected! 12 mature and 8 immature)

Here are my Top 5 steps for Fertility Preservation in Women over 35

1. CoQ10 preserves the quality of the eggs mitochondria  – essential for replication and good “egg energy” aka ATP for cell division. 100-400 mg daily prevention, 400 mg twice daily during a stimulation cycle.  ( The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertility and Sterility 2010; 93:272-5. )

2. DHEA is a lipid antioxidant and youth-reviving hormone precursor. I suggest 10 mg daily for prevention,  25 mg daily 6 weeks before stimulation cycle. Up to 75mg daily is evidenced to improve egg and embryo quality and enhance spontaneous conception. (Addition of Dehydroepiandrosterone (DHEA) for poor-responder patients before and during IVF treatment improves the pregnancy rate: a randomized prospective study. Hum Reprod.  2010; 25(10): 2496-500 Accessed September 13 2013)

3. This is your individualized medicine step – what do you need to tonify your specific reproductive patterns and enhance the chances of conception?

4. Fertility Massage is key for addressing muscular and ligament stress lodged deep in the pelvis that could mechanically impair the ability to maintain pregnancy. Concomitant castor oil packs clear debris from the ovaries and fallopian tubes, flushing lymphatic channels for a more balanced local immune response. The self massage/ hands on aspect maintains a connection between the cerebral, medicalized experience of ART and the physical sensations of the lower belly while reducing emotional stress. http://natural-fertility-info.com/fertility-massage.

5. Optimize your nutritional status with: extra leafy greens on a regular basis; superfoods especially in smoothies;daily  fresh vegetables; and choosing clean meat and dairy whenever possible. Reduce or eliminate sugar during high intensity hormone treatments including birth control pills.

It is the grit of everyday living that builds the pearl of one’s career. In the process of enhancing my own fertility, I have learned as much from the patients I have treated and supported as they learned from me. This primal biological drive has helped me to become a much better doctor in this field as I experience the nuances of treatment myself. I look forward to continuing to support all patients seeking conception, especially those of us above 35 that have lived full complicated lives and have had to balance the biological desire to have children with the real-life tensions of sex, gender, career, finance, and relationship.

 

 

 

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Nutrition, Herbal Medicine, Homeopathy

Naturopathic medicine is not a single kind of healing, but is an array of healing practices. I think of Naturopathic Medicine as a wheel, and what we do as the different spokes that make up the whole. These “spokes” are called modalities, and include acupuncture, counseling, herbal medicine, functional medicine, homeopathy, massage, minor surgery, nutrition and in some states/provinces, prescription medications and/or IV therapies. Naturopathic Medicine is diverse – each doctor chooses what areas to focus on.  Many N.D.’s choose one specific modality, like acupuncture, functional medicine, or homeopathy. Others, like myself, are eclectic and utilize many of the modalities, depending on the individual case.

Acupuncture, counseling and massage are not as applicable for self care; however, nutrition, herbal medicine, and homeopathy are very important ways that people can take care of themselves. There is only so much help that Dr. Google can offer. If general information basics are not resolving the issue, or you have complex health concerns with multiple medications involved, having a licensed ND assist you in recovery is going to be the most effective and safest utilization of natural medicines.

NUTRITION is the philosophy of using food as medicine. Nutrition can be used therapeutically to treat specific conditions – such as eating beets and dandelion leaves for liver cleansing, or cabbage juice for ulcers. The foods that we eat in 2013 are very different from what our grandparents were eating. The soils are stripped of minerals (or toxic like on Munjoy Hill, ) many foods are genetically modified, and the preparation and processing of foods radically alters nutritional values. Supplementation is generally included with nutrition as it is often necessary, given today’s food choices, to supplement some nutrients that are no longer found in food.

HERBAL MEDICINE is an excellent way to treat the whole family. In theory, it is similar to using pharmaceuticals – specific components within each herb cause specific actions in the mind, body and spirit. Herbs can have a powerful action or a gentle action. Generally, the best herbs for self care are simple, common and safe for everyone in the family. If there are any specific contraindications such as interactions with medication, I would be sure to mention those.  The general dose for herbal medicine for an adult is 1 teaspoon of tincture (alcohol extract) in a small amount of water, 3 times a day. Teas are drank hot 2-3 times a day or as needed. Children’s dosage can be determined as follows:

Patients weight in lb divided by 150 = percent of dose

ie) 70 lb child / 150 = 0.46 so child gets slightly less that ½ adult dose.

If is 1 tsp 3 x a day for adult, give ½ tsp 3 times a day to child.

Herbs are generally best taken on an empty stomach, to maximize absorption.

HOMEOPATHY is a very complex system of medicine that gently supports the body’s ability to heal itself through the use of “remedies” and the philosophy that “like treats (or cures) like.”  The specific remedy chosen is one, which, if given to a healthy person, would elicit the very symptoms of an illness. Therefore, the remedy is known to cure that illness. Homeopathic treatment can be a profound journey of self-discovery as old wounds are healed and our true potential is illuminated. Explaining the mechanism of homeopathic medicine is difficult as it operates on the quantum level rather than the commonly understood Newtonian mechanism of action.  Symptoms are seen as effective reflections of compensation on the  mental, physical, and emotional levels. For example, when a warning light comes on in your car,  we investigate what was wrong with the engine, not just disconnect the light! Seen as warning lights, symptoms are the body’s way of showing the outside world that something is wrong or not working properly. The constellation of symptoms points the Homeopathic Doctor to understand the bigger picture overall, and which remedy is indicated to effectively treat the underlying condition. A Naturopath practicing Homeopathy gives a homeopathic remedy to stimulate the body’s defense systems to complete the healing process. This is the concept of the vital force: the body is always trying to move towards health.  This medicine is an extremely safe and effective method of eliminating disease.

 

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Beauty Medicine: VariLite

I had a VariLite laser treatment this week at the Cosmetic Enhancement Center of New England to treat my facial veins. And as I lay twiddling my toes and breathing thru the mild burn, I mused on how long I have had the purple and red lines and from whence they came…. Nose veins and rosacea run in my family, as does fair skin that burns easily. I started getting my redness as soon as I hit the ski slopes with my Dad, and continued to insidiously develop them throughout my twenties. As my eyes watered and Dr. Ollila erased my venous congestion, I thought about how Chinese Medicine correlates the areas being treated with the stomach and large intestine, and my own struggles with digestion. And I promised myself that because I have the good fortune to be able to eliminate these physical signs of my own genetic faults and dietary excess, I will do what I can to prevent this same congestion, stagnation and dis-ease from developing again.

8949_7Traditional Chinese Medicine maps the body with meridians or channels that carry the energy of each organ along the arms and legs. Many of the meridians also run on the face. Areas of physical imbalance in specific areas reflect deeper organ health issues. In my case, the large intestine area at the side of the nose was an obvious place of congestion, reflecting a chronic issue of constipation that was finally resolved in my thirties when I identified and removed food allergies.

The stomach area near my mouth also had faint signs of congestion and stagnation. This area is less of an obvious problem for me – I have a so called “iron stomach.” On the other hand, I do worry. And the stomach is one of our primary organs that is effected by stress, anxiety and rumination. From a mind-body perspective, it makes sense that my stomach area would show signs of strain after years of academia, life’s lessons,  and all the personal stresses that happen. Removing the veins will not remove the underlying strain I put on myself, but I can (and will)  do more to improve my stress management and coping skills to prevent them from resurfacing.

Beauty medicine is a valuable component of modern medicine. With healthy living, exercise and great nutrition, many people’s biological age is younger than their chronological age.  Cosmetic treatments allow us to defy our years and erase the physical evidence of our earlier mistakes. However, it is important to delve deeper and work beyond the superficial level. I am grateful for the opportunity to diminish the signs of aging and look as young as I feel inside. I am also more aware now that I am older (and wiser) to include nutrition strategies like daily fiber ( raw vegetables, ground flax seeds) and probiotics to maintain long term large intestine health.  (For some people,  deeper digestive issues will need to be resolve before a simple maintenance regime is enough.) Stress insists on wreaking its havoc on my face, so I can find better ways to metabolize stress or wear the consequences!  And, of course I will also be aware of the critical damage that sun, wind and cold can have on the sensitive visage – only mad dogs and Englishmen go out in the noon day sun!

If you are interested in beauty medicine, contact The Cosmetic Enhancement Center of New England at http://www.cecofne.com/.

To find out more about how Integrative Medicine can complement your treatments for long term effects and internal wellness  call 207-774-1356 to book an appointment today.

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Dr. Wrights website: www.thewrightdoctor.com

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#TTC – Safe Treatments for Fertility & First Trimester Anxiety

The work of becoming/being pregnant marks a time in a woman’s life when the game changes. Alcohol is no longer an option for stress management. Most herbs and even common teas are viewed with suspicion, and many medications are frowned on. Many of our crutches for managing the stresses of daily life are taken away, and the stress of in/fertility is added. However, there are natural treatments available for this time period to reduce stress, ease anxiety, and support a healthy first trimester.

Flower Essences are very safe for all expecting and #TTC moms, and are especially useful for women using multiple fertility and metabolic medications as they have no interactions or side effects! Flower remedies are literally essences of the particular flower in a brandy solution. Bach flower essences are the most commercially available. FES (Flower Essence Society,) Alaskan Essences, Perelandra and more are other well respected flower essence brands. Bach has 38 different flower remedies available; however the following are especially pertinent for fertility and first trimester. Dosage is 3-5 drops in water 2-4 times daily or as needed. The very small amount of alcohol in these medications will not cause any fetal problems as it is so minute a dose.

Aspen: For apprehension and vague fears

Gorse: Brightens perspective and increases optimism.

Holly: For envy or jealousy of others

Larch: Gets one out of the success/failure paradigm and increases self-confidence

Wild Rose: Restores interest and joy when feeling apathetic or resigned.

White Chestnut: Restores a peaceful mind when caught in repetitive thoughts

Botanical Medicine: Some herbs are appropriate for this time period, however most herbs are best set aside until the pregnancy is well established or beyond breastfeeding. One herb that is a #TTC and first trimester best friend is viburnum prunifolium otherwise known as black haw. This is different from viburnum opulus aka cramp bark – do not mix the two! Black haw quiets an “irritable” uterus, and prevents miscarriage. It is very safe and quite effective. I recommend 1/4 to 1/2 tsp daily for the first trimester as needed. For questions and concerns, refer to your local Naturopathic Doctor who can take your full history and prescribe according to your individual health care needs. Oatstraw or avena sativa is also a wonderful tonic that is nourishing to the body and calming to the mind. This herb is best taken as a tea. It is gluten free, hydrating with rich minerals (therefore great for morning sickness) and soothing to frazzled nerves. Valerian is perfect for nighttime anxiety. It is safe in pregnancy, breastfeeding, and for pediatrics. This is Mother Nature’s truly sedative herb. Used in doses of 5-30 drops before bed, this can help quiet the mind and improve the duration and quality of sleep. I like it as an alcohol free (glycerite) tincture as the taste is slightly sweeter than the alcohol based formula. Capsules are also an option although I prefer the smaller dosing options of the liquid form. (Valerian is very well researched, please contact me for a formal monograph if desired.)

imagesFinally, lavender essential oil has a time honored place in the treatment of anxiety.  For those whom lavender has a calming effect you can use lavender products liberally that have the real essential oil in them – avoid synthetic fragrance analogues. There are now lavender essential oil capsules that are quite effective for treating occasional or situational anxiety. These act quickly and safely to diminish feelings of panic, irritability and stress. Typically essential oils should not be used internally during pregnancy, so these lavender caps are best used only until the day of ovulation. There is a lavender glycerite tincture also available which can be used sparingly while pregnant in doses of 1-2 drops for anxiety and panic as needed. There is some (internet) controversy surrounding the use of lavender in pregnancy; however, it is not listed in any of the classic literature as a herb to avoid in first trimester.  My opinion is that if this botanical medicine is the one thing that works to soothe your fears, use it in moderation. If it increases your anxiety due to the multitudes of internet opinions, avoid it! Here is a link to a well researched blog post on the safety of lavender essential oil in pregnancy: http://roberttisserand.com/2011/07/lavender-oil-and-pregnancy/

Acupuncture and Registered Massage Therapy are also fabulous safe care therapies for anxiety and stress while #TTC. Acupuncture has a proven track record of efficacy when it comes to enhancing not only assisted reproduction but also all conception. Studies have shown that weekly acupuncture greatly reduces the rate of miscarriage during first trimester, especially for women with a previous miscarriage. This is in part due to its ability to support the expectant mom through the first 12 weeks. The therapeutic touch offered by massage therapy also has the ability to soothe anxiety, ease depression, and support the physical changes of pregnancy. The resulting relaxation offers an anxious expecting mom a few moments to quiet the mind, which can have great positive effects overall. It is important to see an acupuncturist or massage therapist trained in pregnancy massage as there are specific techniques and positions used for this treatment.

All in all, this is such a time of mystery, of waiting, and of trust that it can be overwhelming to have to “go with the flow.” Every couple experiences some level of anxiety, and some have a very hard time as #BFN’s happen again and again.  Flower essences, black haw, oatstraw and lavender glycerite are natural remedies that any couple can use to support their own mental and emotional wellness on the road to becoming a family. There are many more herbs, vitamins, and therapies available for #TTC and expectant moms that are based on the individualized medicine offered by a licensed Naturopathic Doctor.

Links and Resources:

http://www.gowonderworks.com/flower_essences

http://www.bachflower.com

http://www.fesflowers.com

http://www.biomedcentral.com/1472-6882/12/20

http://www.fertilityfactor.com/infertility_acupuncture.html

http://americanpregnancy.org/pregnancyhealth/prenatalmassage.html

 

 

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#TTC Obsession – Confessions

Getting pregnant is scary and exciting. The process of wanting to conceive and then waiting to find out…. not priceless. I am intimately aware of this as a Naturopathic Doctor with a focus on In/Fertility. I have also been privately preparing for this moment of my late 30’s when I am ready to conceive.  I have treated and supported many women through this process already. And here I am, alone with my OPK stick in the bathroom, discerning the workings of a secret universe. CONCEPTION.

I am amused at my complete immersion in the consuming nature of trying to predict my own ovulation. I cannot believe how often I think of the subject. I am constantly turning the information over in my mind. I read fertility forums online to gather information; I delve into friends’ personal experiences. Medicine looks so different when one is the patient! Suddenly there are a thousand things I do not know… Ovulation Predictor Kits are only the beginning.

And, in the obsession of pregnancy, it becomes everywhere. Books and television remind me that women have been torturing themselves about the ability to get pregnant forever! First, it was conceiving a boy, and whether or not the First Son would be born.  With rampant infertility, the collective obsession has turned to the BFP and away from gender preference.

We want to be able to control this event with every ounce of heart and mind. We are so used to be able to create what we need, if we only put enough effort into the act! It is maddening to have to develop techniques like trust and patience to achieve our highest goal…. and yet that is what it comes down to in the end. Do we hold the ultimate responsibility of whether or not life occurs in our very body?  It is appears to be the hugest responsibility, and yet it is one we cannot. create. on. our. own.  As my friend said yesterday, “We are accomplished and often privileged women! Powerful creations, and yet…” we cannot read what should be the simplest signs of all from our flesh. Are we ovulating today? Are we pregnant? It’s a huge pressure.

For same sex couples and single folks, there is the additional stress of genetic material to procure. The art of conception (often) looks very different for lesbian and gay couples. Not only will the inseminations need to be precisely timed, but the acquisition of said tools of conception must also be arranged. The cost of becoming pregnant begins with the very first try, an additional ingredient in the pressure-cooker of preparation. (In a call-out to women with biologically male partners, I do understand that when women hit the fertility clinics, we are all in the same machine.  The sex or gender of our partner becomes much less relevant although issues of accessibility to and cost of genetic material remains an additional stress.) It’s a wonder any of us become pregnant at all! But we do, in every increasing numbers.

The minute details, test results, and potential scenarios become an endless gerbil wheel of anxiety. It is important to step back from your own fertility and restore some normalcy to your daily routine. I was wound up over the timing of what was only a pre-cycle. Imagine how physically stressed out I could be for the real thing! One of my friends advised me after her first birth – make it fun. Try to relax around it. And she laughed knowing how hard that would be. I suggest distracting yourself as much as possible from thinking the same old anxious thoughts.  HOW? Listen to music that makes you sing. Watch a movie that engages you. Make time for friends or family who you like talking to and who are interesting. Write in a journal so you can get the thoughts out of your head and onto paper. The less time that is spent obsessing about the timing or prediction of said events will be in your best interest overall!

There is no conclusion to the story. The (new brand of) OPK kits wait for next cycle in my bathroom cupboard. I am going to pray for myself, light candles of hope, and continue to make the daily small offerings I do towards pregnancy – high quality prenatal vitamins, DHA essential fats, green tea, and other things appropriate for my personal care. My sweetheart and I also have a plan B, and C in place to rely on. When I get in the hamster mind of prediction anxiety again, please remind me of this post. Stress inhibits Ovulation!

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