Foods to Enhance Detoxifcation

tortellini-soup6+srgb.What you eat and how well you take care of yourself will affect how well your liver works. Therefore it’s important that you choose foods that will help maintain and support your liver. Good nutrition can also help to rebuild some damaged liver cells and help the liver form new cells.

The liver has two detoxification pathways called Phase One and Phase Two. To work, each of these phases requires specific vitamins and minerals. These in turn need other nutrients called phytochemicals and amino acids to help them. The liver has a big job to do and as you will see, it requires a team effort.

Phase One changes a toxic chemical to one that is less harmful, and free radicals are formed. Free radicals are unstable particles that react within the body and damage cells. If too many free radicals are made, they can hurt liver cells. In order to get rid of or reduce free radicals, our bodies need foods high in antioxidants and phytochemicals. Antioxidants are beta carotene, vitamins C and E, and selenium; phytochemicals are found in fruits, vegetables and whole grains. One of the most important antioxidants is an amino acid called glutathione that cannot be taken as an oral supplement. Glutathione is made by the body and is also found in some foods. B vitamins including folate are also very important in the Phase One process.

In Phase Two the liver adds a substance to the now less harmful chemical to make it water soluble. It can then be moved out of the body in urine or feces. During Phase Two, sources of sulphur compounds are needed. Some of the foods with a lot of sulphur compounds are (you know the kind, they smell when you cook them) cabbage, brussel sprouts, and broccoli.

Following is a list of foods that have the nutrients needed to help Phase One and Phase Two work as well as they can.

Foods to Help Phase One Detoxification (choose 2 per meal)

Beets contain antioxidants such as beta-carotene, other carotenoids and healing flavonoids. They also contain folic acid which is necessary for Phase One detoxification. Enjoy these as fresh vegetable juice, grated raw on salads, boiled or roasted.

Broccoli contains B vitamins and vitamin C both of which help Phase One detoxification; it also is a source of folic acid. Use raw as a snack with dips, lightly steamed or stir fried.

Brown Rice provides B vitamins and the antioxidant selenium.

Carrots contain beta-carotene and other carotenoids that help to protect the liver. Enjoy as freshly juiced (with beets!) grated raw on salads, steamed, roasted, or in soups and stews.

Eggs supply B vitamins.

Garlic has selenium and glutathione, both of which act as antioxidants.

Spinach provides folate and other B vitamins.

Tomatoes have vitamins C and E which are both needed for Phase One detoxification. They are also a good source of the antioxidant lycopene.

Wheatgerm contains selenium and vitamin E and is an excellent source of phytochemicals.

Melons and peppers are good sources of vitamin C.

Tomatillos, papaya, plantains, carambola and guava are good sources of the antioxidants beta-carotene and vitamin C.

 

Foods to Help Phase Two Detoxification (choose 2 per meal)

Broccoli contains natural sulfur compounds needed to enhance Phase Two detoxification.

Cabbage like broccoli, contains natural sulfur compounds.

Eggs contain methionine, a sulfur-containing compound needed for detoxification.

Brazil Nuts contain selenium, an antioxidant needed for detoxification.

Garlic has high levels of methionine which is needed for detoxification; also contains glutathione, a powerful antioxidant.

Onions have sulfur compounds which are important in both detoxification pathways; also a source of glutathione.

Asparagus and Watermelon are rich, natural sources of glutathione.

Papaya and Avocado help the body to produce glutathione.

Mushrooms are high in glutamic acid which is needed to produce glutathione and aids in detoxification pathways.

 

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Counter-Response to the Multivitamin Controversy

This post was originally written for Apothecary By Design in December 2013 http://www.apothecarybydesign.com/blog/

Stop Wasting Money on Vitamin and Mineral Supplements! 5 medical doctors cried out in an editorial piece first released in the Annals of Internal Medicine, and then circulated through all major newspapers and social media outlets early this week.  The articles released in the New York Times, Wall Street Journal, LA Times, and countless other newspapers pointed out that multivitamins have failed to show benefit in several large scale studies; however, the evidence reviewed was not as clear as we were led to believe. As with every evidence based study, it is important to look at the information behind the research, the studies cited, and the actual information the studies gathered.

The quality of multivitamins IS a true concern for consumers. The studies supporting multivitamins have been mixed, and we acknowledge this. If you are going to take a multivitamin it is not an effective use of money to buy a low quality product (like the one illustrated below) that is not well absorbed and/or is coated in toxic chemicals and fillers. A very good diet may reduce or eliminate the need for a daily dose of essential nutrients. Some multivitamins may be a waste of money, not because studies illustrate a lack of benefit, but because of the abysmal quality of the product itself. Choosing an appropriate multivitamin is another question – one that Apothecary by Design’s wellness specialists welcome.

The following studies were used to support the evidence that multivitamins are not worth taking:

fmgt4Yi09-XGE8j8WdSI0z2key4wGe5glRyJ-QC8wH2_S3x8dxi0mHnxUERU0zmV047v=s1001.     Multivitamins and cognitive decline in men 65 or older

For example, in the first study on cognition, the multivitamin assessed was a well-known  common multivitamin that provides low level nutrients in the cheapest, least bioavailable forms. These poor quality minerals generally include  oxides and sulphates. For example, magnesium sulfate is epsom salt, like you would use in a bath. Magnesium citrate is a better quality, more absorbable mineral. (See label) Check out the “other ingredients” as well – 3 artificial colors including the noxious FD&C Red #40.

Regardless of the supplement quality, cognition issues are not primarily related to vitamin/ mineral deficiencies, but are a long term response to heavy metal toxicity, poor cerebral perfusion (not enough blood to the brain), omega 3 deficiency, hormone deficiency, environmental contamination, stress and elevated cortisol levels, head trauma, prescription medication side effects and many more individual variants.

For example, how many of the physicians studied were also taking statin drugs? These ubiquitous prescription medications are known to have memory impairment, loss of memory and amnesia as potential side effects.

When presenting strong statements like multivitamins are a waste of money, it is responsible to use evidence that considers a straighter line between cause and effect.

2.     Multivitamins failed to reduce cardiovascular events in men and women with previous myocardial infarction

The second study cited as proof that multivitamins are a waste of money was a 2012 study evaluating the effects of chelation therapy on men and women over 65 with history of a heart attack.

This study had significant setbacks.  Chief among them were the high drop-out rates due to the strenuous protocol of 30 weekly chemical chelation infusions followed by 10 maintenance infusions two to eight weeks apart.

It is difficult to assess the effect of a multivitamin on long term health with such invasive chemical and vitamin therapies being administered at the same time, and it certainly clouds what is presented as a black and white result.

Antioxidants, nutritional counseling and botanical therapies are also first line treatments in the Integrative health world to repair myocardial function. Once again, the true nature of the study being cited is obscured by the dramatic headlines.

2.     Multivitamins did not prevent the development of chronic disease or death.

If only a simple, cheap, low dose, poor quality multivitamins could save the world from chronic disease….

Quality matters in the food we eat, the medications we take and the supplements we buy. Chronic disease is a complex, multifactorial health concern whose cure cannot be reduced to oversimplified statements like these.

Finally – the original article states “….beta carotene, vitamin E and possible high dose vitamin A supplements increase mortality.” What they leave out, is that high dose beta-carotene increases risk of … lung cancer in smokers (only.) And alpha-tocopherol vitamin E increases the risk of heart disease …but full spectrum vitamin E with both tocopherols and tocotrienols reduce the risk.  Limiting the information sensationalizes the story, obscures the evidence and limits its relevance.

The great thing about this editorial is that it exposes the poor quality multivitamins out there for what they can be: a sense of false security. No one can eat fast food regularly, take a poor quality low dose multivitamin, not practice any preventative measures, and not develop chronic disease eventually. That much IS true.

A multivitamin needs to be able to be absorbed, with high quality minerals and therapeutic dosages of vitamins at the very least to offer prevention and protection. These remain a worthwhile investment for people wanting to maximize their nutritional value. Furthermore, high quality children’s multivitamins remain a good nutritional adjunct for picky eaters and kids with behavioral or health issues. Multivitamins are not a substitute for a healthy lifestyle with good quality food choices, exercise, and stress reduction.

http://www.mayoclinic.org/medicalprofs/trial-to-assess-chelation-therapy-cvuv10n4.html

http://www.ncbi.nlm.nih.gov/pubmed/10359235

http://www.medscape.org/viewarticle/501471

http://www.nleducation.co.uk/resources/reviews/the-next-generation-vitamin-e-how-tocotrienols-benefit-the-heart-brain-and-liver/

Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. Annals of Internal Medicine. Eliseo Guallar, MD, DrPH; Saverio Stranges, MD, PhD; Cynthia Mulrow, MD, MSc, Senior Deputy Editor; Lawrence J. Appel, MD, MPH; and Edgar R. Miller III, MD, Phd p. 850

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Navigating the Holidays with a Special Diet

This blog post was originally written for Apothecary By Design – a premium quality specialty, retail and compounding pharmacy in Portland, Maine. http://www.apothecarybydesign.com/blog/

I remember when I was a kid going to my Aunt’s house for Thanksgiving, my mom would always show up with a box of special food for us with brown rice, special breads and other jars of rattling, unappealing looking things. I always felt slightly embarrassed, wishing we could just blend in with everyone else. Now, I am that person. I always travel with special bread, usually my brown rice pasta in case of dinner emergency, and other ingredients and snacks that I know I can eat.

Food allergies are on the rise world-wide. It is estimated that 15 million Americans have food allergies, and this potentially deadly condition affects 1 in 13 children. Another study found that 3 out of 4 children had a food reaction. Symptoms can range from an itchy mouth or runny nose, to asthma attacks, skin eruptions, behavioral changes, anaphylaxis and more.  The Center for Disease Control released a study in 2013 stating that food allergies increased 50% between 1997 and 2011. With these kinds of numbers being evidenced in clinical studies, it is likely that many of our readers will be figuring out how to manage this holiday’s season with at least one family member on a restricted diet. For more information on food allergies, please see the following links:

http://newsinhealth.nih.gov/issue/aug2012/capsule1

http://www.foodallergy.org/facts-and-stats

So, what is your plan for managing these holidays that are full of delicious foods that don’t work for you? The first step is to strategize. Complete restriction is unlikely for most of the population, and can lead to binge eating behaviors as a reflexive backlash. This is the “no-strategy” strategy that usually fails. Instead, make some educated choices, and make a plan. Some people can get away with small amounts of some allergenic foods, and can’t get away with others. So, making choices to suffer a little on some fronts so you can stay strong on others may be a safe plan. If you need to stay on a strictly narrow regime for health reasons, it will be more important than ever to plan ahead and bring tasty alternatives to the traditional choices so you have a meal you can enjoy as well.

For example: You really suffer when you eat gluten, but you can get away with eating dairy occasionally.

Thanksgiving Plan: Bring gluten free crackers for the crackers/cheese hour. Bring Imagine brand gluten free turkey gravy (not incredible but good enough.) Bake a gluten-free apple crisp. Plan on skipping the stuffing, but eating the mashed potatoes and dessert with ice cream.

Some families are willing to substitute key ingredients to make some elements of the meal safe for the whole family. For example, mashed potatoes could be made with Earth Balance margarine and an alternative (unsweetened) milk option to be dairy free. Again, a gluten free gravy could be used in addition to the traditional recipe, and a small amount of oven baked stuffing could be set aside for the vegetarians.

If you or a family member has an anaphylactic response to a particular food, it is best to inform all guests ahead of time. Make sure you have an epi pen available as well if you or your child has this kind of severe allergic reaction. There are some supplements that can help balance the overindulgence for mild to moderate food reactions . Gluten-ease was mentioned in our last newsletter as a simple occasional digestive support. This product contains high potency enzymes that ensure complete digestion of gluten, gliadin and casein proteins, reducing allergenic effect and potentially reducing symptom onset. This product is not recommended for celiac disease or people with severe gluten or dairy reactions.

Other products that help quiet an inflammatory food response are quercetin, bromelain, and nettles. These products can often be found combined together in products like D-Hist and D-Hist Jr by Ortho Molecular, and are best taken for 2-3 weeks before the food is introduced to minimize systemic inflammation.  Quercetin is not safe in pregnancy, but nettle tea is a safe, simple remedy that everyone can use. Carminative teas like peppermint, fennel, and ginger can also help ease digestion for everyone after a large meal.

 

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Naturopathic Trans Health 101

** This is a handout from PTHC June 2013 – Please email me at thewrightnd@gmail.com with your experiences using natural medicines in transition! **

Naturopathic Medicine is: licensed in the state of Maine and many other states and Canadian provinces. We provide primary care using medical and alternative medicine. Naturopathic philosophy is based on the premise your body knows how to heal itself, and medicines from nature can help you overcome obstacles to health.

Naturopathic Doctors tools are: Botanical Medicine, Homeopathy, Nutrition, Lifestyle Counseling, Stress Management. Some ND’s also provide hands-on treatments (Chiropractic, Massage, CranioSacral Therapy,) Prescription medication (thyroid and female hormones, antibiotics, some Lyme medications, topical products),  Acupuncture, Traditional Chinese Medicine and IV Therapies.

FOUNDATIONAL NATUROPATHIC SUPPORT – FOR ALL GENDERS

  • Green tea 1-2 cups daily– anti-cancer, antioxidant, immune system support
  • Adrenal support – adrenals are a major source of hormone production when the gonads are taken out of the picture as is evidenced in menopause and andropause. B5, vit C, Siberian ginseng, Ashwaganda, Rhodiola, Licorice.
  • Probiotics – the digestive tract is the seat of our vitality and overall health.
  • Cruciferous vegetables, fresh ground flax seeds, green tea, sprouts all enhance excess (endogenous and environmental) estrogen elimination – important for every body!

GENERAL TRANSMALE SUPPORT

–       Support adrenals with herbs known to increase testosterone production.

–       Testosterone metabolizes into Dihydrotestosterone (DHT) – a biologically active metabolite of testosterone 30x more potent because of its increased affinity for T receptors. DHT is known to promote hair loss. This conversion can be modulated with SAW PALMETTO – stops the conversion of T –> DHT. PLus ZINC 10-30mg daily.

–       Nettle Tea – decreases bound T/ increases free (active) T, lymphatic support.

–       Reservage Keratin Booster  – prevention of baldness.

GENERAL TRANSWOMAN SUPPORT

–       Breast health! Reduce methylxanthine chemicals found in coffee, black tea, caffeine, and chocolate. At least monthly breast massage for lymphatic health using herbal oils.

–       Aerobic exercise.

–       Freshly ground flax seeds help the body eliminate excess estrogen – add to smoothies or yogurt with fresh fruit and maple syrup. Cancer prevention.

–       What is a phytoestrogen? Plant compounds that bind to estrogen receptors throughout the body.  Soy Isoflavones, Alfalfa (Medicago Sativa), Burdock (Arctium Lappa), Dong Quai (Angelica Sinensis), Evening Primrose, Pau D’arco (Tabebuia Avellanedae), Red Clover (Trifolium Pretense), Saw Palmetto (Serenoa Repens.)

–       Organic non-GMO soy 1-3 times week if tolerated.

–       HRT Companion by Vitanica** Great prevention product for long term use.

–       Reduce systemic inflammation for optimal long-term health – estrogen is protective for heart and bone health, but it can also be inflammatory. How to reduce inflammation? (CRP, homocysteine measures on bloodwork.)

SEXUAL TONIC HERB REVIEW– from The Male Herbal by James Green

Ashwaganda – WITHANIA SOMNIFERA Withanaloid chemicals resemble steroids biochemically. They are classified as an adaptogens to enhance libido and restore fertility and sexual potency.

PANAX QUINQUEFOLIUM – American ginseng.  PANAX GINSENG – Asian Ginseng. All ginsengs provide ginsenoside compounds that effect hormonal balance. Their overall chemistry supports strong sexual function through tonifying activity. They can also increase nitrous oxide levels, improving blood flow where needed. Panax ginseng is classically only used for men as it is too Yang for women’s health unless specifically prescribed.

Horny Goat Weed – EPIDEMIUM SAGITTATUM, EPIDEMIUM GRANDIFLORUM Exhibits moderate androgen-like effect.  Contains flavonoid ICARIIN which is a cGMP-specific PDE-5 inhibitor (like Cialis, Viagra and Levitra)

Muira Puama  – PTCHOPETALUM OLACOIDES Increases circulation, nervous system tonic, improves sexual weakness and diminished sexual desire in all genders.

Maca – LEPIDIUM MEYENII, L. PERUVIANUM ** Nutritive tonic for all genders. Simulates ovarian and erectile functions. **  – Could restore fertility for FTM’s who decide to want to conceive after testosterone use.

Gokshura  – TRIBULUS TERRESTRIS ** Prostate and urinary system tonic. Contains saponin, a steroidal plant chemical to improve libido with impotence. Improves sexual desire, fantasy life and sexual self-confidence. May prolong duration of intercourse before ejaculation. Increases endogenous LH levels. May stimulate endogenous testosterone production in men and women.  ** May also stimulate ovarian or testicular action in ways that are not desired. Use with caution.

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Resolving an Arthritis Flare – for My Dad

Chronic inflammation can cycle into snowballs of pain that catch us off guard. For those with a familial tendency towards rheumatism, arthritis can become quite severe. Joint inflammation usually takes the autoimmune form of rheumatoid arthritis or the inflammatory/ immune joint presentation of osteoarthritis.

It takes time and patience and a good amount of work to manage an acute pain flare. We want a recipe for success to include a small pill and minimal work. Unfortunately, this is rarely the case. To follow is a recipe for treatment of an acute, immediate or aggressive flare up of arthritis/tendon inflammation or bursitis that may be causing moderate to extreme pain and inhibiting mobility.

1.You will need to rest as much as possible for 7-10 days. Plan to stay home and lay low whenever possible. Stand up every 2-3 hours (except while sleeping) for 10-20 minutes of stretching and gentle exercises. Walking in nature, Pilates, physiotherapy, gentle yoga, or  Wii Fit balance exercises good choices to support rehabilitation.

Plan your life accordingly. You may need to work from home if possible, and reschedule activities. This is necessary to address the pain. It is likely your pain and inflammatory levels will be up to 50% resolved by the tenth day of treatment.

2. Take a daily bath if you have access, soaking the affected joints for up to 45 minutes. Use Epsom magnesium bath salts with 10-15 drops of lavender essential oil or a bath salt of your choice. Follow with 20 minutes of icing the affected joint. If you don’t have a bath, use a hot shower and/or hot towels or a heating pad and ice after a shower. 

This plan will not cure your arthritis. This does not replace the need for surgery if you have a fracture or true tear like a labrum or rotator cuff. Do not discontinue scheduled plans prescribed by your physicians and specialists.

3. Start an Anti-Inflammatory Diet. This is best continued until joint replacement is successful; however, it is crucial during the initial rest window. Studies have proven that nutrition is directly linked with inflammation. By eliminating foods known to increase systemic inflammation, you can reduce your own inflammatory load. This allows your body to begin healing. You can google one, find a local holistic nutritionist for guidance, or a local ND. The anti-inflammatory diet eliminates gluten, beef, tomatoes, potatoes, eggplant, peppers, peanuts, soy, oranges, and often dairy. What else can you eat? So many things! Fish, apples, pears, chicken, rice, legumes, nuts, seeds, quinoa, pork, lamb, oats, berries, greens, beets, carrots… the list is endless!

4. The Medicine. Zyflamend- 3 capsules morning and nighttimes daily. This is a modern formulation of 6-10 botanicals to treat inflammation, joint pain and rheumatism using herbal medicine. New Chapter has combined these into an effective and well researched formula called “Zyflamend.” http://www.newchapter.com/zyflamend The PM version also contains a small amount of relaxing herbs which are helpful for supporting a restful attitude during your healing. You may continue this for up to one year’s duration before a break is needed.  This product is safe to take with most narcotic and non-narcotic pain medication including Vicodin, Oxycodone, Ibuprofen, Tylenol 3 and Ibuprofen. However, do not drive while taking the nighttime formulation. 

5. Nordic Naturals Omega Joint Plus – 3 capsules daily with  food. This is a premium joint care formula containing 1500mg of glucosamine sulphate as well as anti-inflammatory levels of EPA and DHA. The product is expensive at ~$50/bottle for one month supply however, it is worth it. Switch to this product during your first month of resolution treatment for best results, and hold your other fish oil or glucosamine supplements. http://www.nordicnaturals.com/en/Products/Product_Details/514/?ProdID=1548

During your 7-10 day acute healing time, you can take your other supplements as well, or take a supplement vacation and focus on the above products only to streamline your protocol.

This is the skeleton treatment plan. This is a great place to start If you do not get the results you are looking for or have trouble adhering to the program, consider seeing a ND in your area. In addition to the above protocol, continue to take your medications for heart, kidney, lung or other medical health conditions. Specific neutraceuticals to address sleep, anxiety, digestion, or other issues may also be prescribed in a consultation. Classical homeopathy is also extremely useful in complex cases. It is safe with complicated pharmaceutical treatments and provides lasting results.

Your pain is a sign that something is wrong, Respecting the pain by changing your every day lifestyle can provide insight into the pathology. Physiotherapy, Osteopathic medicine, Acupuncturem Chiropractic, Craniosacral therapy and other physical medicine treatments are essential to rebalancing pain as well. Z

Side Note; If you drink More than 2 drinks a night, NSAIDS like ibuprofen, celecoxib, Alleve, and other antiinflammatories are not safe for more than 7 days of use for pain. If you have heart failure, either preserved or reduced ejection fraction these medications can damage your heart and kidneys. Seek appropriate treatment from your primary care doctor or orthopedist and disclose your daily alcohol intake as this could lead to life threatening stomach or esophageal bleeding. If you have marooon or black poop, or vomit what looks like coffee grounds, go to your ER immediately,

Pain is a message, Increasing pain means something is worsening. Listen to your pain by doing the above lifestyle changes. If you do not find improvement, follow the resource branches of care with primary care, orthopaedics, rheumatology, psychiatry and physical medicine to get to the root of the cause. Your bones will thank you for it,

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Spring Wellness Shopping List

Spring! Winter skin comes out from under the covers, and the winter blues start to melt away…. Here are a few simple things you can do to feel and look your best!

Shopping List

£ Nettle Tea

£ Dry Skin Brush

£ Weleda Cellulite Birch Oil (or other good quality body oil.)

£ Flax Seeds

£ Sheep Yogurt

Instructions:

The key to Spring Wellness is getting the lymphatics moving and improving detoxification systems. The lymphatic channels run just underneath the skin, and are the highways of the immune system. Rough and bumpy skin is often from congested lymphatics – toxins literally surface to the skin when they cannot be eliminated properly. Nettle tea is an excellent and very safe lymphatic tonic that can used by everyone – for children, in pregnancy and breastfeeding, with multiple medications, and beyond!

Dry skin brushing is a physical medicine that sloughs off dry skin and stimulates lymphatic channel movement. It creats a youthful vibrant skin surface and helps to eliminate toxins released by the Nettle tea! Dry skin brush before every bath or shower. How? Using a specially designed brush, start at your feet and gently sweep upwards in big circles. Repeat from the wrists to the shoulders and across the chest.

Continuing topical care, nourish your skin with a rich organic oil when you are just out of the bath or shower. This improves dehydration and provides your cell membranes with the rich lipids it needs for optimal elasticity. Don’t towel off your extremities, instead just dry your trunk, face and hair. Generously apply your body oil, massaging your muscles and rubbing it in. Then, take a minute and lie back down wrapped in your towel to let the oils sink in. If you don’t have the time to rest, just wait a few extra moments before you get dressed (to let the oils sink in.) Weleda Birch Cellulite Oil is my favorite for Spring as it stimulates the dermal layers under the skin to continue detoxifying, and has no synthetic perfumes or chemicals that add to your body’s toxic burden.

Internally, adding 2 tbsp of ground flax seeds daily will have great health benefits. First, they are good source of fiber – this  will gently help your bowels to eliminate more effectively, without any laxative effect. Flax seeds also contain lignans, which support estrogen detoxification, which can help men and women taking any hormonal therapies. If you aren’t taking any hormones, lignans still help your body find its best state of hormone balance. And finally, flax seeds are a tasty source of vegetarian omega 3 oils.

I like taking my flax seeds in organic sheep yogurt, with fresh or frozen fruit and maple syrup. This makes a great snack! Its also an easy and yummy breakfast. The reason for using sheep rather than cow yogurt is threefold. First, Variety is the Spice of Life. Most of us eat a fair amount of cow dairy, so diversifying the food spectrum is good for the digestive health. Secondly, our body is made to absorb the small protein molecules in sheep and goat (and human) milks, not the large protein molecules from a cow. This is why many people with dairy intolerance can still have goat (and sheep) products.  Third, sheep yogurt is creamy and tasty! It doesn’t have the “farmy” flavor that many goat products have, so it is more like organic cow dairy in taste and texture. Yum.

Simple changes for simple wellness. Its not the drastic cleanses and restrictions that really make a difference to health in the long run. It’s the simple daily choices that add up to big results. Gently sweeping out the old and inviting in the new and fresh cells by stimulating lymphatics and nourishing the skin will have you feeling radiant.  For any questions or concerns about your personal health and health care, please contact me at http://thewrightdoctor.com/contact-information/

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Essential Fatty Acids and Mental Health by Tori Hudson, N.D.

~ This article was published in the Emerson Ecologics Womens Health Email update December 2011.

When it comes to the biological basis for mental health disorders, the presumption is an abnormality of neurotransmitters- whether it be excess, deficiency, or abnormal interactions with receptors or transporters. While the focus of current pharmacological therapy is the neurotransmitter and its proteins, the impressive role of lipids, particularly long-chain polyunsaturated fatty acids (LC-PUFAs), cannot be overstated. The weight of the brain is roughly 80% lipid, the richest source of fatty acids in the body and 15-30% of those lipids are essential fatty acids (EFAs) and LC-PUFAs. Nerve cell function, membrane fluidity, neuron membrane dynamics and the subsequent receptor, transporter and neurotransmitter function are profoundly affected by the lipids that we take in from our diet and supplementation. Considerable research including randomised controlled trials now demonstrate the role and efficacy of EFAs in numerous psychiatric disorders.

Depression

According to the American Journal of Psychiatry, depression is one of the 10 most frequent indications for the use of complementary and alternative medicine.1 While many nutraceuticals and botanicals have published evidence to their benefits, omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) are among the more commonly used.2

Epidemiologic studies in several countries suggest that decreased omega-3 fatty acid consumption correlates with increasing rates of depression. One researcher who studied the relationship of fish consumption and the incidence of depression correlated the annual incidence of major depression per 100 people in nine countries with the consumption of fish.3 He found a high incidence of depression in countries with low fish consumption. For example, New Zealanders have an annual fish consumption of about 40 pounds and they had an annual incidence rate of depression of 5.8%. Japan on the other hand, with a fish consumption of almost 150 pounds per year, had the lowest incidence of major depression, at .12%. His group also demonstrated that prevalence rates for bipolar affective disorder rise when the annual fish intake falls below 75 lbs of fish per person annually. In Taiwan for example, there is a 0.04% rate and their fish intake is 81.6 lb per person per year as compared to Germany, the rate is 6.5% at 27.6 lb of fish per person annually. In a survey of 3,204 Finnish adults, infrequent fish consumption was associated with depression in women and although not statistically significant, a trend was seen in men.4 Fish intake also appears to have an influence on suicide with a reduced risk of death from suicide in individuals with daily fish consumption.5

In a study of 20 patients with moderate to severe depression, the relationship between depression and levels and ratios of omega-3 and omega-6 fatty acids in plasma and erythrocyte phospholipids was studied.6 Using two commonly accepted scales and methods of evaluation depression, researchers found a significant correlation between the ratio of phospholipids arachidonic acid to EPA and the severity of depression. The greater the omega-6 to omega-3 ration, the greater the severity of the depression.

In 2010, researchers found that patients with major depressive disorders, exhibited significantly lower erythrocyte DHA composition compared to healthy controls and those with bipolar disorder appeared to have an even lower DHA level.7

Other investigations have confirmed that a high concentration of blood plasma of docosahexanoic acid (DHA), an essential fatty acid found in fish, has been linked to increased serotonin turnover with lower rates of depression and even suicide. Switching to a cholesterol-lowering diet may also result in reductions in measures of depression,8 although not all studies demonstrate this. It appears as though there is a consistent positive association between depression and coronary heart disease and heart attacks.9 They may in fact carry a common cause, that of elevated cholesterol. Since there is such a strong correlation between depression and coronary artery disease, and a predictive correlation between elevated cholesterol and heart disease, elevated serum cholesterol should also predict increased depression.

Depression, secondary to alcoholism, is quite common and occurs in up to 59% of alcoholics. Alcoholism is certainly a complicated illness with social, psychological, hereditary, physiological and physical factors to consider. We know that alcohol is a pro-oxidant that leads to increased lipid peroxidation and a consequence of increased lipid peroxidation may be a decrease in the concentrations of the more highly unsaturated species of fats. Several studies have demonstrated that chronic alcohol abuse depletes long-chain n-3 polyunsaturated fatty acids from neuronal membranes.10 It is hypothesized that the subsequent effect on the membranes may promote the development of depression.

Higher intakes of fish, EPA or DHA did not have a protective role against suicide in more severe situations and has not been associated with a lower risk for suicide in Japan, but women in Japan with very low intakes of fish, did have an increased risk of suicidal death.11

A search of the literature examining the therapeutic efficacy of essential fatty acids for depression was published in 2006.12 One double-blind placebo controlled RCT examined the use of omega-3 fatty acids in 30 men and women.13 The intervention group received 9.6 gm of omega-3 fatty acids from fish oil in addition to their standard pharmacological treatment for 4 months. A Kaplan-Meier survival analysis found that the fish oil group had a significantly longer period of remission than the placebo group and performed better than the placebo group in other outcome measures. Three case control studies of adults with major depression and non-depressed healthy adults all showed a definite difference in omega-3 polyunsaturated fatty acids (PUFAs) between depressed and non-depressed adults.14, 15, 16 A review article suggests that DHA is beneficial for depression as well as several other conditions.17 Another review article discussed the effects of dietary intake patterns on fatty acid balance and potential effect on mood.18

Other intervention studies have been done since the initial literature review that concluded in 2001. The only intervention trial up until that point was the Stoll study on bipolar disorder. Since then, RCT trials have been done that assessed the role of omega-3 PUFAs in the treatment of major depression. 2/g of DHA or placebo in 36 depressed patients found no significant difference between the DHA and the placebo, although there was a better overall response rate in the DHA group.19 In another of 28 patients with major depression, 9.6 g/day showed significant improvement compared to the placebo group.20 In a study of EPA, 1gm/day demonstrated significant improvement in two different depression scales compared to placebo and no further improvement was seen in higher doses of EPA than 1gm/day.21 A combination of EPA or placebo and conventional pharmaceutical antidepressant treatment in unipolar depression demonstrated that those in the EPA group had significantly better effects by the third week. In an eight weeks, single-blind placebo trial, peri or postmenopausal women with depressive disorders and hot flashes were given 6 gm/day of EPA and DHA. The response rate was 70% and a decrease of 50% or more on the Montgomery-Asberg Depression Rating Scale (MADRS).22

Several probable mechanisms may explain the link between EFAs and depression. EFAs can modify 5-HT receptors, serotonin and dopamine metabolism, lower monoamine oxidase B, modulate cytokine production and enhance signal transduction. The composition of cell membranes, neurotransmission and prostaglandin metabolism are all affected by the amounts of EFAs and while clinical trials are few, there is substantial laboratory and observational evidence of the correlation between low essential fatty acid levels and depression.

Bipolar disorder

It is generally thought that bipolar disorder involves an overactivity in the signal pathways of neurons. Omega-3 fatty acids are known to dampen this overactivitiy and a previous hypothesis was confirmed in a landmark study at Harvard Medical School. The double-blind placebo controlled study of men and women with bipolar disorder were given either seven fish oil capsules twice a day or a placebo of olive oil capsules.23 Each capsule contained 440 mg of EPA and 240 mg of DHA. More than twice as many individuals in the fish oil group completed four months of the study without a major episode of mania or depression than those in the placebo group. In addition, nine individuals in the placebo group had worsening depression during the study compared to none in the fish oil group. The average decline in depression rating was almost 50% in the fish oil group compared to an increase of 25% in the control group.

Schizophrenia

Research is limited but intriguing regarding the hypothesis and evidence that symptoms of schizophrenia may result from altered neuronal membrane structure and metabolism. Several studies have shown that individuals with schizophrenia often have low levels of particular EFAs necessary for normal nerve cell membrane metabolism.24 Although the evidence is small, one initial open label study indicating efficacy which led to two small double-blind pilot studies is encouraging. In the pilot study, EPA showed a statistical superiority over DHA and placebo on the total Positive and Negative Syndrome Scale (PANSS).25 In the first small study, 45 schizophrenic patients who were stable on antipsychotic medications but still symptomatic were treated with either PEA, DHA or placebo for three months.26 The EPA group’s PANSS was significantly superior to both DHA and placebo, and EPA was significantly superior to DHA for positive symptoms using the analysis of variance (ANOVA). In the second placebo-controlled study, only EPA was used, although antipsychotic medications were permitted if necessary.26 By the end of the study, 8 of the 14 patients on EPA were taking medications and all had improved PANSS scores, while all 12 on placebo were taking antipsychotic drugs.

It is surprising that EPA was the most therapeutic in the first study, given that DHA is a major constituent of neuronal membrane phospholipids. The positive results of these pilot studies and the observed abnormal PUFA and phospholipids metabolism in individuals with schizophrenia is supportive of the potential for the role of EFAs in prevention and management.

 Summary

 I look forward to more research on prevention and intervention with omega-3 fatty acids in mental health disorders. While three conditions were discussed in this article, there are other promising areas of research in the areas of aggressive behavior, personality disorders and attention deficit disorder. Psychiatric disorders, behavioral problems and neurodegenerative disorders are some of our society’s most prevalent and serious challenges. Dietary changes in decreasing saturated fats and increasing seeds and fish along with supplementation, particularly fish oil, hold great promise for improving our brain function and the diseases affected by health EFA metabolism and the brain.

Lastly, in the search for high quality fish oils, I recommend looking for products that perform and supply third party testing on peroxides, total oxidation, PCBs, heavy metals and dioxins.

Sources

1 Kessler R, Soukup J, Davis R, et al. The use of complementary and alternative therapies to treat anxiety and depression in the United States. Am J Psychiatry 2001;158:289-294.

2 Smit E, Muskiet F, Boersma E. The possible role of essential fatty acids in the pathophysiology of malnutrition: a review. Prostaglandins Leukot. Essent. Fat. Acids 2004;71(4):241-250.

3 Hibbeln J. Fish consumption and major depression. Lancet 1998;351, April 18: 1213

4 Tanskanen A, Hibbeln J, Hintikka J, et al. Fish consumption and depression and suicidality in a general population. Archives of General Psychiatry 2001;58:512-513.

5 Hirayama T. Lifes Style and Mortality. A Large Census-Based Cohort Study in Japan. Basel: Karger 1990

6 Adams P, Lawson S, Sanigorski A, Sinclair A. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids 1996;31:157-161.

7 McNamara R, Jandacek R, Rider T, et al. Selective deficits in erythrocyte docosahexaenoic acid composition in adult patients with bipolar disorder and major depressive disorder. J Affective Disorders 2010;126:303-311.

8 Weidner G, Connor S, Hollis J, Connor W. Improvements in hostility and depression in relation to dietary change and cholesterol lowering. Ann Intern Med 1992;117:820-823.

9 Booth-Kewley, Friedman. Psychological predictors of heart disease: a quantitative review. Psychol Bull 1987; 101(3):343-62.

10 Salem N, Ward G. The effects of ethanol on polyunsaturated fatty acid composition. In: Alling C, Diamond I, Leslie S, Sun G, Wood W, eds. Alcohol, cell membranes, and signal transduction in brain. New York: Plenum Press, 1993:33-46.

11 Poudel-Tandukar K, Nanri A, Iwasaki M, et al. Long chain n-3 fatty acids intake, fish consumption and suicide in a cohort of Japanese men and women- The Japan Public Health Center-based prospective study. J Affective Disorders 2011;129:282-288.

12 Williams A, Katz D, Ali A, et al. Do essential fatty acids have a role in the treatment of depression. J Affective Disorders 2006;93:117-123.

13 Stoll A, Severus W, Freeman M, et al. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry 1999;56:407-412.

14 Maes M, Christophe A, Delanghe J, et al. Lowered omega3 polyunsaturated fatty acids in serum phospholipids and cholesteryl esters of depressed patients. Psychiatry Res 1999;85:275-291.

15 Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated faty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disorders 1998;48(2-3):149-1555.

16 Peete M, Murphy B, Shay J, Horrobin D. Depletion of omega-3 fatty acid levels in red blood cell membranes of depressive patients. Bio. Psychiatry 1998;43(5):315-319.

17 Horrocks L, Yeo Y. Health benefits of docosahexaenoic acid (DHA). Pharmacol Res 1999;22(5-6):474-480.

18 Bruinsma K, Taren D. Dieting, essential fatty acid intake, and depression. Nutr Rev 2000;58(4):98-108.

19 Marangell L, Martinez J, Zboyan H, et al. A double-blind, placebo-controlled study of the omega-3 fatty acid docosahexaenoic acid in the treatment of major depression. Am J Psychiatry 2003;160 (5):996-998.

20 Su K, Huang S, Chiu C, Shen W. Omega-3 fatty acids in major depressive disorder-a preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2003;13:267-271.

21 Peet M, Horrobin D. A dose-ranging study of the effects of ethyl-eicosapentaenoate in patients with ongoing depression despite apparently adequate treatment with standard drugs. Arch Gen Psychiatry 2002;59 (10):913-319.

22 Freeman M, Hibbeln J, Silver M, et al. Omega-3 fatty acids for major depressive disorder associated with the menopausal transition: preliminary open trial. Menopause 2011 18(3):279-284.

23 Stoll A, Severus E, Freeman M, et al. Omega-3 fatty acids in bipolar disorder; a preliminary double-blind, placebo-controlled trial. Arch Gen Psychiatry 1999;56:407-412.

24 Joy C, Mumby-Croft R, J L. Polyunsaturated fatty acid (fish or evening primrose oil) for schizophrenia. Cochrane Database Syst Rev 2000;2:CD001257

25 Peet M, Laugharne J, Mellor J. Double-blind trial of fatty acid supplementation in the treatment of schizophrenia. International Congress on Schizophrenia Research, Colorado Springs, CO, April.

26 Peet M, Brind J, Ramchand < et al. Two double-blind placebo-controlled pilot studies of eicosapentaenoic acid in the treatment of schizophrenia. Schizophrenia Research 2001;49:243-251.

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Treatment Protocol: Weaning Off Coffee

Treatment strategy adapted in part from Naturopathic Doctors News and Review article Managing Caffeine Withdrawal in the Patient Undergoing Detoxification (V. 7 Issue 12 p. 8-9) by Dr. Peirson ND and from Dr. Braverman’s Dopamine Deficiency Protocol. For more information on caffeine addiction see: http://thewrightdoctor.com/2011/12/26/coffee-addiction/

Daily Supplements and Lifestyle Changes:

  • 200-400 mg Magnesium Citrate – I like Trace Minerals Research liquid mineral formulas. It allows for a personal tailoring of dosage. Too much magnesium can have a laxative effect (which can be helpful if constipation is a side effect of caffeine withdrawal.) Take daily in juice.
  • 100mg B Complex  – I like Orti B by Seroyal, Thorne B5 Complex or Cortico B5B6 by Metagenics. 1 daily with food.
  • Buy several organic green teas, decaf coffee beans, a black tea and a decaf black tea. Start to mix the caffeinated and decaffeinated beans in your morning brews, and order “half-caf” when out.  Eventually leave the coffee behind and just have decaf or green teas.
  • Adrenal Assist by Vitanica – Vitamins, herbs and minerals for restoration of adrenal glands. Cross-check any medications with the herbs for possible interactions before starting this. 3 capsules daily, best in the morning for 3 – 6 months.
  • Coffee 6ch homeopathic remedy. 2 pellets as needed for headache associated with caffeine withdrawal.
  • High paced lifestyles need to be balanced with relaxation and restoration. Stress busting exercises such as deep breathing exercises, non-work related reading, chess, and non-aerobic exercises such as weight lifting are recommended 3 times per week.
  • Eliminating the kick of caffeine will result in cravings for sugar. Instead of sweets, turn to high protein foods rich in phenylalanine and tyrosine to restore dopamine levels depleted by chronic caffeine use. Round out high protein meals with plenty of fruits and vegetables. Phenylalanine is an essential amino acid found in the brain and blood that is converted to tyrosine and then to dopamine. Food sources of dopamine include:
Foods Amount Phenylalanine Tyrosine
Wild game 6-8 oz 2.6g 1.5g
Cottage cheese 1 cup 1.7g 1.7g
Chicken 6-8 oz 1.6 g 0.40
Duck 6-8 oz 1.6g 0.60
Turkey 6-8 oz 1.6g 0.70
Walnuts 6-8 oz 1.4 g 0
Wheat germ 1 cup 1.35g 1.00
Ricotta 1 cup 1.35g 1.50
Granola 1 cup 0.65 0.40
Rolled Oats 1 cup 0.50 0.35
Plain nonfat yogurt 1 cup 0.40 0.40
Whole milk 1 cup 0.40 0.40
Egg 1 0.35 0.25
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On The Other Side of a Cold

6 days later, I’m finally feeling human. Colds can be so rotten! I felt so awful on Tuesday and Wednesday – headache, runny nose, achy, tired, sinus pain, sneezing. UGH. Everyone gets colds, and after this round I want to share some ways to get through them easier, and how to help them not turn into the 6 week sickness, or bronchitis, or worse….

I grew up in a Yoga Ashram where getting sick was considered “cleansing” and an opportunity to throw off toxins and heal the body. I still think of sickness in this framework to some degree, and as such embrace having a cold in the following ways (once I am willing to accept I am, in fact, sick, which is another story.)

I like to view mini-sicknesses like colds, flues, and other bugs as opportunities for a mini-detox. As soon as I realize I am sick, all cow dairy, sugar, alcohol, corn, beef and gluten are eliminated. I also try to wean off caffeine by only having 1/2 cups of black tea as needed for caffeine headaches. This automatically gives my immune system a huge boost to fight off the offenders (see my food sensitivity blog post.) It also allows my liver, intestines and kidneys to do a little detox of their own, cleaning up old metabolites while other systems fight off the cold. This helps me heal faster, and makes me feel even better once the cold is done! I also often lose a couple of pounds while being sick.

What does this leave to eat? Lots of fruit, rice, steamed veggies, rice cakes and 100% fruit jam, gluten free toast, butter (even tho its cow I allow this), nut butters, eggs, organic chicken, goat milk kefir or yogurt if craved. I just made a butternut squash, ginger, chicken broth soup with kale, apples and lemon this sickness. I also found a coconut milk, agave sweetened vanilla ice cream when I was craving something cold for my throat. And lots and lots and lots of herbal tea. With raw honey, and lemon.

Botanical Medicine is *very* important for treating colds. Most colds start out as viruses and then develop into bacterial infections after the immune system has been worn down. Unlike drugs, herbs can be antiviral AND anti-bacterial at the same time. As soon as I start feeling sick, out comes the elderberry syrup that lives in my medicine cabinet. 2 tsp 2-3 times a day, AND once a day for my girlfriend so she doesnt get sick. Start taking lots of vitamins – everything you have. Take your C’s, B’s, multivitamin…. your immune system is weak and needs support. Olive leaf is a great anti-microbial to take at any stage of sickness. The trick with herbs is to take alot, early.  As in, 2 caps three times a day for the first week, rather than 1 cap a day for 3-6 weeks of sickness. Traditional Medicinals has some great teas with a good mix of acute care herbs. I drank Cold Care PM night and day, with lots of honey as well as lemon ginger tea and echinacea tea.

A side note on echinacea – this herb is anti strep as well as antibacterial and antiviral and antifungal. Its actually a great herb for colds and flues *when taken right away.* Echinacea seems to work better for some people than others as well. If you are going to use this botanical, start taking it as soon as you feel sick in high doses. Once you have been sick more than 5 days, it is no longer as effective *unless* you are fighting a strep infection.

If you can, go see an acupuncturist immediately. Acupuncture can do great things for helping a cold to not settle into your lungs, and move it through you faster. I’m certain it also helped this cold not become a sinus infection and just stay at the superficial level. I see Hadley Clarke of www.zenkaiacupuncture.com although http://www.jadeintegratedhealth.com also helped me when I had a serious case of bronchitis last year.Chinese herbs are also very effective when prescribed by an acupuncturist, however they are not meant for self-prescribing.

Finally, REST. Sometimes I think I get sick when my mind or body really needs down time. Call in sick, and lie in front of the TV, or in your bed all day. Pad around in track pants and socks and drink tea and moan on the couch. Facebook, nap, eat soup, but don’t do anything productive. The body *really* needs time to heal, and repair, and fight the good fight, and cant do that if you are also trying to teach or lead or answer phones or tend bar or save the world do all the other active things we all do in a day.


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Keeping the Pace – Part One

Part One – Making Choices

 Keeping pace with life’s To Do list, career, academics, and family… its tough. Its hard on the body, its hard on the mind, and it can be hard on the waistline too. It’s worth it – for evolution, advancement, and a life well lived – but how can one minimize the toll of stress?

Adapting effectively to stress requires both a short term and long-term commitment to nourishing and sustaining hormonal response. The body responds to chronic stress by first an alarm phase, then sustained effort, then exhaustion. Making appropriate nutritional choices and choosing herbal adaptogens that match the endocrine condition relieve strain and sustain long-term health.

First and Foremost – What can you actually do when you are exhausted, and hungry, and cant stop? One answer: eat something green. A fresh arugula salad would be perfect; however a greens drink is very convenient. Spirulina and other microalgae are the red blood cell equivalents of the plant kingdom. They provide an instant nutrient-rich boost of antioxidants, alkalinizing and balancing your starved system and tiding over the hunger until you can take a break. Mix greens with juice for blood sugar support, or choose green protein-enhanced shakes or bars if needed. Odwalla has a yummy green pre-made green Superfood smoothie. There are several products available in one-serving envelopes that travel well. If you are on *any* medications, including Hypertension, Birth Control, Antidepressant and Anti-Anxiety medications, please choose a formula that ONLY has the microalgae, and/or wheat grasses, without herbal components.  The energy-supporting herbs used in many “energy greens” can have multiple medication interactions.

Protein is also an integral component of a high stress diet. The immune and hormonal systems require adequate protein for sustained cellular responses. This protein must be high quality: fast food meats or veggie burgers do not “count!” Good quality protein will create a smooth and better-sustained blood sugar response decreasing headaches, crabbiness, and dizziness while improving energy and balance. Include one serving of protein in most significant meals, and look for protein snacks on busy days.

Sugar, crackers, pastries, fruit or raw vegetables alone will burn quickly and leave you depleted. Lunchtime protein can include tahini on a cooked whole grain or steamed vegetables, avocado, hard-boiled eggs, nut butters and nut butter sauces, quinoa salads, and cheese in addition to fish or meat. Prepare ahead! Protein and fiber rich snacks like applesauce and cottage cheese, hard-boiled egg, toasted nuts and seeds with raisins, celery and nut butter can be pre-made and stored in little “to go” containers. It’s best to avoid consistent intake of processed proteins including whey and soy protein isolates as bars or shakes, but occasional use is well tolerated.

Therefore, the immediate moment, when you hit a wall look to greens and to protein for a boost. This will keep you from turning to sugar or fat to maintain your energy, keeping your waistline trim and nourishing your body rather than taxing it further.

If you cant get away from the piece of chocolate that seems like its the only thing that will save your day in that moment, choose a small piece of good quality chocolate! Research shows that small amounts of high quality chocolate actually have beneficial effects on our health. It is an antioxidant, and releases GABA neurotransmitter that is one of the “off” buttons in our brain. Commercial “industrial” chocolate, mochas, lattes, cookies, and other quick fixes have low nutritional value and provide high fat calories that lead to abdominal weight gain and create sugar addictions. Cacao Nibs are Nature’s superfood candy, and are a must for any true chocolate addict. Rich in magnesium, these replenish lost minerals lost through caffeine. Add Cacao Nibs to your trail mix with home-toasted walnuts, pumpkin seeds and organic raisins.

Long-term adrenal restoration in the form of individualized and endocrine-specific supplementation is also integral. Adrenal fatigue is a buzz term in today’s medicine, and will be the topic of Keeping the Pace  – Part Two!

Cocoa and chocolate in human health and disease. Katz DL, Doughty K, Ali A, Antioxidants & Redox Signaling [Antioxid Redox Signal], ISSN: 1557-7716, 2011 Nov 15; Vol. 15 (10), pp. 2779-811; PMID: 21470061; http://web.ebscohost.com.ezproxy.ccnm.edu/ehos/viewarticle?data=dGJyMPPp44rp2%2fdV0%2bnjisfk5Ie46bNNsa6zTrOk63nn5Kx95uXxjL6nrkewrq1KrqevOK%2bwsVC4qbE4zsOkjPDX7Ivf2fKB7eTnfLujsUm2p7NMsaakhN%2fk5VXj5KR84LPrhuac8nnls79mpNfsVbCntE6zqbdIpNztiuvX8lXk6%2bqE8tv2jAAA&hid=17

The impact of chocolate on cardiovascular health. Fernández-Murga L, Tarín JJ, García-Perez MA, Cano A, Maturitas [Maturitas], ISSN: 1873-4111, 2011 Aug; Vol. 69 (4), pp. 312-21; PMID: 21665390

 

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