Nerd Out: Fibromyalgia Syndrome

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the nervous system. I chose Fibromyalgia as it affects someone close to me and I wanted to find out the various therapeutic modalities and treatment options available.

If you’d like to nerd out with me, continue reading:

Fibromyalgia syndrome (FMS) is characterized by widespread, generalized pain of at least a 3-month duration, affecting an estimated 6-12 million Americans, 80% of whom are women (Kohlstadt, 2012, p. 637; Pizzorno & Murray, 2013, p. 1374; Rakel, 2018, p. 475). Patients with FMS typically experience pain at certain anatomical points on the body, along with extreme fatigue, joint stiffness, headaches, sleep disturbances, irritable bowel, cognitive dysfunction, anxiety, depression, and exercise intolerance, among other symptoms (Pizzorno & Murray, 2013, p. 1375). Although not considered an autoimmune disorder, FMS can coexist and imitate such conditions as Lyme disease, hypothyroidism, and hepatitis C (Rakel, 2018, p. 475). Once considered a result of serotonin deficiency, FMS is now thought to be a disorder of the central nervous system (CNS), specifically neuronal dysregulation (Gota, 2018; Kohlstadt, 2012, p. 637) and a dampening of hypothalamus–pituitary–adrenal reactivity (Gota, 2018). 

There is a strong psychosomatic component to FMS. Symptoms seem to begin with a precipitating stress occurrence or trigger, such as an accident, illness, emotional stress, or trauma (Galvez-Sánchez, Duschek, & Reyes Del Paso, 2019; Rakel, 2018, p. 475). Patients may present with a sensitive personality temperament, inappropriate cortisol response to stress, heightened pain perception (hyperalgesia), and/or a concurrent mood disorder such as anxiety or depression (Bellato et al., 2012; Gota, 2018; Rakel, 2018, p. 475).  

The etiology of FMS isn’t fully understood, though there may be genetic, hormonal, psychiatric, external stressor, neurotransmitter, immune system, and other contributing dysfunctions (Bellato et al., 2012). Obesity, reduced physical activity, hypothyroidism, adrenal dysfunction, irritable bowel syndrome, post-traumatic stress disorder (PTSD), and nonrestorative sleep all are recognized as possible underlying causes (Coppens et al., 2017; Kohlstadt, 2012, p. 642).

Diagnosis of FM can be challenging, as each patient presents with a unique combination of symptoms (Bellato et al., 2012). A thorough patient history including sleep quality, physical activity level, bowel habits, pain perception, fatigue level, menstruation, and cognitive function are key (Pizzorno & Murray, 2013). The ACR Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity, the Pain Distribution Body Form, the FibroQuest Symptoms Survey, and/or the Fibromyalgia Impact Questionnaire may be used to measure the patient’s pain, symptoms, and functional status (Pizzorno & Murray, 2013, p. 1381). 

A physical examination finding abnormal tenderness at 11or more of 18 specific anatomic tender points indicates FMS (Pizzorno & Murray, 2013, p. 1375). The Widespread Pain Index and Symptom Severity Scale also help define the patient’s pain experience (Gota, 2018). A mental health screening, including Zung’s Self-Rating Depression Scale, may provide insight to depression, anxiety, trauma, and PTSD and provide opportunities for referral to mental health specialists (Coppens et al., 2017; Pizzorno & Murray, 2013, p. 1381). 

Laboratory tests include a complete blood count, erythrocyte sedimentation rate, cyclic citrullinated peptide test, rheumatoid factor, antinuclear antibody, Celiac serology, and vitamin D levels, to rule out infection, autoimmune disorders, etc. (Fibromyalgia, 2020). In addition, a thyroid function test and thyroid antibodies test may be ordered to rule out concurrent hypothyroidism (Pizzorno & Murray, 2013, p. 1377). Adrenocorticotropic Hormone test (ACTH), salivary cortisol, Dehydroepiandrosterone Sulfate (DHEA-S), 24-hour urine cortisol, and urinary organic acids (OAT) testing help uncover other possible metabolic, toxic, and infectious contributors to FMS (Kohlstadt, 2012, p. 642). Finally, a colonoscopy and/or stool culture may be ordered to rule out other sources of gastrointestinal discomfort (Kohlstadt, 2012, p. 642).  

Pain relievers, antidepressants, muscle relaxants, and anti-seizure drugs are prescribed most often for FMS. Over the counter non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve), are preferred to allay the discomforts associated with FMS (Fibromyalgia, 2020). Acetaminophen (Tylenol) is another widely-used option (Fibromyalgia, 2020). In addition, the analgesic, tramadol, is approved by the FDA specifically to treat pain in FMS (Bellato et al., 2012). Opioids are not recommended due to their significant side effects and dependence (Bellato et al. 2012; Fibromyalgia, 2020). In addition, they have not proven effective in long-term relief, possibly worsening the pain experience over time (Fibromyalgia, 2020). 

Serotonin-norepinephrine reuptake inhibitors (SARIs) such as duloxetine (Cymbalta), milnacipran (Savella), and trazodone (Desyrel), as well as the tricyclic antidepressant/sedative (TCA) amitriptyline (Elavil), are commonly prescribed to help with anxiety and depression associated with FMS (Bilodeau, 2020; Fibromyalgia, 2020; Gota, 2018). Other medications such as the muscle relaxant cyclobenzaprine (Flexeril), the anticonvulsant pregabalin (Lyrica), gabapentin (Neurontin), and/or melatonin are also often prescribed to help with sleep (Bilodeau, 2020; Gota, 2018). Referral to support groups, counseling, and/or therapy may also be part of a traditional FMS treatment plan (National Fibromyalgia Association, 2020).

An integrative approach to FMS includes a focus on nutrition, movement, detoxification, mental health support, and sleep hygiene, minimizing long-term pharmaceutical use (Myers, 2020).  Digestive issues including food intolerances, candida albicans overgrowth, small intestinal bacterial overgrowth (SIBO), leaky gut, irritable bowel syndrome (IBS), and gut dysbiosis are all addressed in a functional treatment plan (Kresser 2019; Myers, 2020). Healing the gut and restoring a healthy gut microbiome is the foundation for healing FMS (Kresser, 2019). 

Removing inflammatory foods, ingredients, and medications such as gluten, sugar, industrial seed oils, dairy, MSG, aspartame, coffee, and when possible, antibiotics, and replacing them with an antiinflammatory diet rich in leafy greens (kale, salad greens, chard, arugula, etc.), cruciferous vegetables (broccoli, cauliflower, Brussels sprouts, etc.), omega-3 fats (salmon, sardines, anchovies, etc.), fermented foods (unsweetened, full-fat yogurt, sauerkraut, kombucha, etc.), fermented fibers (sweet potato, yams, etc.), and bone broth (Kresser, 2019; Rakel, 2018, p. 483) heals the gut and begins restoration of the microbiome. Integration of adaptogenic herbs into the diet such as turmeric, ashwagandha, schisandra, rhodiola, and ginseng aid in balancing the immune system and help to decrease inflammation (Myers, 2020). Finally, nutritional support of the thyroid may be encouraged with consumption of sea vegetables and dulse (Higdon & Drake, 2012, p. 153).

FMS patients often present with deficiencies in magnesium and vitamin D (Myers, 2020). A balance of calcium, magnesium, vitamin D, and vitamin K is crucial to support optimal uptake of all four nutrients (Mercola, 2018). Food sources of magnesium are oats, spinach, beans, nuts, seeds, blackstrap molasses, banana, and avocado (Higdon & Drake, 2012, p. 175; Mercola, 2018). Vitamin D sources are salmon, sardines, and mackerel (Higdon & Drake, 2012, p. 91).  Balanced supplementation is an option when quality food sources aren’t available or tolerated (Higdon & Drake, 2012, p. 175; Mercola, 2018). 

B12 deficiency is also common in FMS patients, and may be the result of age, poor digestion and/or absorption of nutrients, poor diet, or mutation of the MTHFR gene (Kohlstadt, 2012, p. 652; Myers, 2020). Genetic testing may be prescribed by an integrative practitioner. If a mutation is found, supplementation with methylfolate in addition to dietary means (salmon, beef, eggs, chicken, turkey, and nutritional yeast) helps optimize B12 levels (Higdon & Drake, 2012, p. 67-68; Procyk, 2018, p. 101). Healing the gut as mentioned earlier is key to B12 digestions and absorption (Myers, 2020).

Other supplements for FMS may include a high-quality multivitamin, iron, coenzyme Q10, acetyl-L-carnitine, D-ribose, S-adenosylmethionine, boswellia, N-acetyl choline, milk thistle, alpha lipoic acid, and/or St. John’s wort (Kohlsdadt, 2012, p. 652; Myers, 2020; Rakel, 2018, p. 479).

In addition to the laboratory tests mentioned above, functional medicine practitioners may also order an intestinal barrier function test to evaluate the mucosal lining of the intestines, and/or a comprehensive stool assessment to check for parasites and bacterial infections (Grisanti, 2015). Heavy metals testing with a pre- and post- DMPS urine challenge reveals heavy metal burden and indicates any need for chelation therapy (Myers, 2020). Celiac serology confirms sensitivity or allergy to gluten (Fibromyalgia, 2020).

Finally, positive lifestyle habits are encouraged in the integrative treatment of FMS. Exercise has been shown to ease the pain of FMS patients (Bellato et al., 2020; Mercola, 2010). Starting with just a few minutes a day working up to at least 30, a combination of weight-bearing, aerobic, and strength training activities bring the best benefit (Pizzorno & Murray, 2013, p. 1382; Rakel, 2018, p. 483). Sleep hygiene is addressed, optimizing the sleep environment, quality, and duration (Chetlin & Landis, 2020). Stress, anxiety, and/or depression are managed through psychotherapy, cognitive behavioral therapy, emotional freedom technique tapping (EFT), meditation, journaling, art, etc. (Michalsen et al., 2013; Rakel, 2018, p. 482). Lastly, various forms of fasting have been shown to help with inflammation and pain management (Michalsen et al., 2013).







References

Bilodeau, K. (2020, September 15). Getting the best treatment for your fibromyalgia. Retrieved November 16, 2020, from https://www.health.harvard.edu/blog/getting-the-best-treatment-for-your-fibromyalgia-2020091020905

Bellato, E., Marini, E., Castoldi, F., Barbasetti, N., Mattei, L., Bonasia, D., & Blonna, D. (2012). Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Retrieved November 03, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3503476/

Chetlin, S. M., & Landis, C. (Eds.). (2020, September 28). Fibromyalgia & Sleep. Retrieved November 19, 2020, from https://www.sleepfoundation.org/articles/fibromyalgia-and-sleep

Coppens, E., Van Wambeke, P., Morlion, B., Weltens, N., Giao Ly, H., Tack, J., . . . Van Oudenhove, L. (2017, May 24). Prevalence and impact of childhood adversities and post‐traumatic stress disorder in women with fibromyalgia and chronic widespread pain. Retrieved November 09, 2020, from https://onlinelibrary.wiley.com/doi/full/10.1002/ejp.1059

Fibromyalgia. (2020, October 07). Retrieved November 09, 2020, from https://www.mayoclinic.org/diseases-conditions/fibromyalgia/diagnosis-treatment/drc-20354785

Galvez-Sánchez, C., Duschek, S., & Reyes Del Paso, G. (2019, February 13). Psychological impact of fibromyalgia: Current perspectives. Retrieved November 03, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386210/

Grisanti, R. (2015, January 31). Fibromyalgia Who Told You There Wasn't A Cure? Retrieved November 18, 2020, from https://www.functionalmedicineuniversity.com/public/986.cfm

Gota, C. (2018, May 01). What you can do for your fibromyalgia patient. Retrieved November 03, 2020, from https://www.ccjm.org/content/85/5/367

Higdon, J., & Drake, V. J. (2012). An evidence-based approach to vitamins and minerals health benefits and intake recommendations (2nd ed.). Stuttgart, Germany: Thieme.

Kohlstadt, I. (2012). Advancing medicine with food and nutrients. Boca Raton, FL: CRC Press, Taylor & Francis Group.

Kresser, C. (2019, June 18). Is Fibromyalgia Caused By SIBO and Leaky Gut? Retrieved November 16, 2020, from https://chriskresser.com/is-fibromyalgia-caused-by-sibo-and-leaky-gut/

Mercola, J. (2010, January 19). Foods to Avoid by Patients Dealing with Chronic Pain. Retrieved November 18, 2020, from https://articles.mercola.com/sites/articles/archive/2010/01/19/foods-that-chronic-pain-sufferers-need-to-avoid.aspx

Mercola, J. (2018, March 21). Magnesium: An Invisible Deficiency That Could Be Harming Your Health. Retrieved November 16, 2020, from https://www.prohealth.com/library/magnesium-an-invisible-deficiency-that-could-be-harming-your-health-34192

Michalsen, A., Li, C., Kaiser, K., Lüdtke, R., Meier, L., Stange, R., & Kessler, C. (2013, January 23). In-Patient Treatment of Fibromyalgia: A Controlled Nonrandomized Comparison of Conventional Medicine versus Integrative Medicine including Fasting Therapy. Retrieved November 18, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3566607/

Myers, A. (2020, September 15). Fibromyalgia - A Functional Medicine Approach. Retrieved November 03, 2020, from https://www.amymyersmd.com/article/fibromyalgia-functional-medicine/

National Fibromyalgia Association. (2020, November 10). Retrieved November 16, 2020, from https://fmaware.net/

Pizzorno, J. E., & Murray, M. T. (2013). Textbook of natural medicine. St. Louis, MO: Elsevier.

Procyk, A. (2018). Nutritional treatments to improve mental health disorders: Non-pharmaceutical intervention for depression, anxiety, bipolar & ADHD. Eau Claire, WI: Pesi Publishing & Media.

Rakel, D. (2018). Integrative Medicine. Philadelphia, PA: Elsevier Health Science.

Nerd Out: Deep Vein Thrombisis

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the cardiovascular system. I chose Deep Vein Thrombosis, a common and potentially lethal syndrome that can happen to anyone, no matter your health or fitness status. If you’d like to nerd out with me, continue reading:

Deep Vein Thrombosis (DVT), also known as thromboembolism, post-thrombotic syndrome, venous thromboembolic disease, or postphlebitic syndrome (Delgado & Holland, 2018; Tovey & Wyatt, 2003) is defined as a clot formation deep inside a vein. A serious condition representing the third most common cardiovascular disease, DVT is commonly underdiagnosed though preventable (Sista, Vedantham, Kaufman, & Madoff, 2015; What is Venous Thromboembolism, 2020). Most often affecting the lower extremities, including lower leg, thigh, or pelvis, it can also manifest in the arms (What is Venous Thromboembolism, 2020). Complications arising from DVT can be life-threatening, as the clot may break free and travel to the lungs, causing a blockage known as a pulmonary embolism (PE) (What is Venous Thromboembolism, 2020). The risk of DVT recurrence is approximately 7% despite anticoagulant therapies, and may lead to a persistent, chronic condition known as post-thrombotic syndrome (PST), due to the valves of the affected vein remaining scarred, inflamed, weakened, and dysfunctional (Behravesh, Hoang, Nanda, Wallace, Sheth, Deipolyi, Memic, Naidu, & Oklu, 2017; Sista, et al., 2015; Tovey & Wyatt, 2003).

Risk factors for DVT are varied and fall under the umbrella of the following conditions: injury to a vein, as in fractures, muscle injuries, or major surgery; slowed blood flow, as in confinement to bed, immobilization, excessive sitting, and paralysis; increased estrogen due to hormone replacement, especially estrogen, hormonal birth control, pregnancy, and immediate postpartum; certain chronic illnesses, such as cancer, cardiovascular disease, and inflammatory bowel disease; and other factors including advancing age, previous DVT or PE, family history of DVT or PE, obesity, and inherited clotting disorders (Galson, 2008; What is Venous Thromboembolism, 2020). 

Signs and symptoms of DVT include swelling, pain, tenderness, stiffness, and redness of an affected extremity, although half of those with DVT have no symptoms at all (What is Venous Thromboembolism, 2020). More specifically, unilateral swelling on the foot, ankle, or leg; cramping in leg or calf; severe, unexplained pain in the foot or calf; warmth of skin compared to surrounding areas; and changes such as paleness, redness, or bluish coloration of skin all point to DVT of the lower extremity (Delgado & Holland, 2019). Upper extremity symptoms include neck pain, shoulder pain, swelling in the arm or hand, weakness, blue coloration of arm or hand, and pain radiating from the arm to forearm (Delgado & Holland, 2019).

It is important to know the symptomatology of PE in addition to DVT, as it can occur before a diagnosis of DVT is made (Delgado & Holland, 2019). Labored breathing, rapid or irregular heart beat, coughing up blood, hypotension, and lightheadedness are all symptoms of pulmonary embolism (What is Venous Thromboembolism, 2020). 

In low-risk patients, the Pulmonary Embolism Rule-out Criteria (PERC) can be used to rule out PE and determine need for further testing (Behravesh et al., 2017; Kline, 2020). Further screening is indicated when a patient presents a PERC score of 1 or higher (Kline, 2020), in which case the next step is a D-dimer assay, a blood test which can rule out venous thromboembolism (VTE) in 30-50% of patients (Behravesh et al., 2017; Delgado & Holland, 2019; Strandberg, 2017). A positive D-dimer assay leads to computed tomography angiogram, or CT angiography, imaging which can show narrow or blocked blood vessels, or a VQ scan, to examine airflow (ventilation) and blood flow (perfusion) in the lungs (Behravesh et al., 2017; Jong, 2018). Moderate-risk patients skip the PERC and go straight to the D-dimer, while high-risk patients are promptly assessed with imaging, such as a QT scan (Behravesh et al., 2017). At any point in the diagnostic process a clinician may also order plethysmography, which records changes in size of the limb, or Doppler or duplex ultrasonography, which use high frequency sound waves to detect clots (Behravesh et al., 2017; Cheung & Firstenberg, 2020; Tortora & Derrickson, 2015, p. 387).

A positive diagnosis of DVT indicates anticoagulation therapy, most likely intravenous heparin or low molecular weight heparin (LMWH), or fondaparinux, a factor Xa inhibitor, both for acute cases (Behravesh et al., 2017; Galson, 2008; Tovey & Wyatt, 2003). Compression socks or stockings are also encouraged to relieve pain and swelling (What is Venous Thromboembolism, 2020). In the case of PE, immediate administration of intravenous thrombolytics, such as bivalirudin, argatroban, dabigatran, or antithrombin III, is necessary (Delgado & Holland, 2019; Omudhome, 2019; What is Venous Thromboembolism, 2020). Many patients are given warfarin, a vitamin K antagonist, in tablet form for long-term therapy (Behravesh et al., 2017).

Other treatments include inferior vena cava filters to prevent clots from entering lungs; thrombectomy surgery to remove large clots; catheter-directed thrombolysis (CDT) to dissolve clots; percutaneous mechanical thrombectomy (PMT) to macerate and aspirate clots; pharmacomechanical catheter-directed thrombolysis (PCDT) to simultaneously macerate and infuse a lytic drug; and stent placement to encourage and maintain vascular integrity (Behravesh et al., 2017; Delgado & Holland, 2019; Sista et al, 2015).

Lifestyle modifications are encouraged, such as increasing movement through exercise and frequent breaks from sitting, wearing elastic compression stockings to provide support and to increase circulation, stretches and foot exercises to improve blood flow, and wearing loose-fitting clothing to encourage venous flow (Delgado & Holland, 2019; What is Venous Thromboembolism, 2020). Smoking cessation, a detailed family health history to determine genetic predispositions, weight loss, adjustment or cessation of hormone-replacements, and use of non-hormonal birth control may also be encouraged in an allopathic setting (Galson, 2008). Follow-up appointments are necessary to check progress and to ensure integrity of vein post-diagnosis. 

Integrative and holistic approaches to healing DVT support the above-mentioned therapies but it is important to note they do not replace them. Moving away from the standard American diet (SAD), increasing movement through regular exercise, a focus on sleep, hydration, and chronic stress reduction, in addition to allopathic measures encourage optimal blood circulation and overall cardiovascular health.

An anti-inflammatory and antioxidant-rich diet supports a healthy cardiovascular and immune system. Cold-water fish, such as salmon, mackerel, sardines, and low-mercury tuna, are rich in Omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and are potent anti-inflammatory foods (Weil, 2020). Red, yellow, orange, and deeply-colored fruits and vegetables, such as cherries, blueberries, raspberries, blackberries, pumpkins, sweet potatoes, etc., are rich in flavonoids, carotenoids, and polyphenols, with both antioxidant and anti-inflammatory properties (Pandey & Rizvi, 2009; Weil, 2020). Red wine, black and green tea, legumes, mushrooms, onions, garlic, dark chocolate and herbs and spices such as turmeric, curry powder, chili peppers, ginger, basil, cinnamon, rosemary, and thyme all offer antioxidant benefits  (Pandey & Rizvi, 2009; Weil, 2020). Dark, leafy salad greens, cruciferous vegetables such as broccoli and Brussels sprouts, avocado, and bananas are all high in vitamin K, potassium, and magnesium, which support optimal blood flow (Levy, 2019). These foods may enhance blood thinners and anticoagulants, so regular follow-up checks are important to monitor medication dosages (Levy, 2019). 

Moving away from trans fats and industrial seed oils towards healthier oils such as olive oil, walnut oil, coconut oil, avocado oil, decreasing sugar and over-processed foods, and limiting alcohol and caffeine all round out a diet supportive of cardiovascular health (Levy, 2019; Weil, 2020).

Supplementation of diet might be necessary, depending on dietary tastes, preferences, and access to whole foods. Vitamins A, C, E, beta carotene, selenium, copper, zinc, magnesium, coenzyme Q10 (Ubiquinone), alpha-lipoic acid (ALA), n-acetylcysteine (NAC), glutathione, quercetin, pine bark extract (PBE), grape seed extract (GSE), silymarin, resveratrol, and ginkgo biloba are among the most recommended antioxidant supplements (Pizzorno & Murray, 2013, p. 894-902). 

A program to increase movement is imperative for prevention of DVT and its recurrence. Setting a timer when sitting for long periods serves as a reminder to get up, stretch, and walk around to stimulate blood circulation in the legs (Levy, 2019). Incorporating walking into a daily routine is recommended, with shorter, more frequent walks a priority over longer walks (Delgado & Holland, 2018). Movements that focus on the legs, such as cycling, running, squats, lunges, etc., are also beneficial for blood flow (Levy, 2019). 

Both quality and quantity of sleep affect adiposity, in that it is more difficult to lose body fat when sleep deprived (Nedeltcheva, Kilkus, Imperial, Schoeller, & Penev, 2010). Fat cells store hormones, including estrogen and testosterone, and thus a weight-loss program ultimately decreases the body’s exposure to hormones that might trigger a DVT (Chodosh, 2018).

Hydration is important to maintain optimal blood viscosity and venous integrity (Simmons, 2011). Current recommendations are to drink twenty-five to fifty percent of one’s weight in ounces of water each day (Axe, 2020), or to drink according to thirst (LaFee, 2014). Sipping water throughout the day and replacing non-nutritive drinks with water will enhance hydration as well. 

Finally, chronic oxidative stress is known to negatively affect cardiovascular health. By taking measures to reduce lifestyle stressors it may be possible to lessen this sympathetic response and help prevent DVT and its recurrence (Dong, Cheng, Yang, Sun, Zhu, Zhu, & Zhang, 2015). Meditation, deep breathing, yoga, journaling, and Tai-Chi, are examples of proven relaxation methods that help calm the nervous system and thus discourage the cascade of negative effects related to chronic stress. Combined with an anti-inflammatory diet, regular exercise, deep, restful sleep, and hydration, these holistic practices fully support the allopathic approaches to manage and prevent DVT and its recurrence (Dong et al., 2015; Galson, 2015; Levy, 2019). 




References

Axe, J. (2020, February 13). How to Stay Hydrated in 4 Steps. Retrieved May 6, 2020, from https://draxe.com/nutrition/how-to-stay-hydrated/

Behravesh, S., Hoang, P., Nanda, A., Wallace, A., Sheth, R. A., Deipolyi, A. R., … Oklu, R. (2017, January 5). Pathogenesis of Thromboembolism and Endovascular Management. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244017/

Cheung, M. E. (2020, January 20). Duplex Ultrasound. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK459266/

Chodosh, S. (2018, January 11). When you lose weight, your fat cells don't just let go of fat. Retrieved May 5, 2020, from https://www.popsci.com/when-you-lose-weight-your-fat-cells-release-more-than-just-fat/

Delgado, A., & Holland, K. (2019, November 13). Deep Vein Thrombosis (DVT): Symptoms, Treatments, and Prevention. Retrieved May 2, 2020, from https://www.healthline.com/health/deep-venous-thrombosis

Dong, T., Cheng, Y.-W., Yang, F., Sun, P.-W., Zhu, C.-J., Zhu, L., & Zhang, G.-X. (2015, October 20). Chronic Stress Facilitates the Development of Deep Venous Thrombosis. Retrieved May 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630420/

Galson, S. K. (2008). Prevention of deep vein thrombosis and pulmonary embolism. Retrieved May 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2430635/

Jong, I. (2018, August 24). VQ Scan. Retrieved May 3, 2020, from https://www.insideradiology.com.au/vq-scan/

Kline, J. (2020). PERC Rule for Pulmonary Embolism. Retrieved May 2, 2020, from https://www.mdcalc.com/perc-rule-pulmonary-embolism

LaFee, S. (2014, April 21). 10 Colors That Suggest Urine Trouble. Retrieved May 6, 2020, from https://health.ucsd.edu/news/features/Pages/2014-04-21-colors-that-suggest-urine-trouble.aspx

Levy, J. (2019, February 18). What You Need to Know About Deep Vein Thrombosis. Retrieved May 3, 2020, from https://draxe.com/health/deep-vein-thrombosis/

Nedeltcheva, A. V., Kilkus, J. M., Imperial, J., Schoeller, D. A., & Penev, P. D. (2010, October 5). Insufficient sleep undermines dietary efforts to reduce adiposity. Retrieved May 5, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951287/

Omudhome Ogbru, P. D. (2019, November 25). Anticoagulant Drug List: Blood Thinner Side Effects & Types. Retrieved May 2, 2020, from https://www.medicinenet.com/anticoagulants_drug_class_of_blood_thinners/article.htm#what_are_anticoagulants

Pandey, K. B., & Rizvi, S. I. (2009). Plant polyphenols as dietary antioxidants in human health and disease. Retrieved May 3, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835915/

Pizzorno, J. E., & Murray, M. T. (2013). Textbook of Natural Medicine. Churchill Livingstone.

Simmons, S. (2011, August). Deep vein thrombosis : Nursing2020. Retrieved May 6, 2020, from https://journals.lww.com/nursing/Fulltext/2011/08000/Deep_vein_thrombosis.12.aspx

Sista, A. K., Vedantham, S., Kaufman, J. A., & Madoff, D. C. (2015, July). Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4787709/

Strandberg, K. (2017, June). The clinical use of a D-dimer assay. Retrieved from https://acutecaretesting.org/en/articles/the-clinical-use-of-a-d-dimer-assay

Tortora, G. J., & Derrickson, B. (2015). Introduction to the human body: the essentials of anatomy and physiology. Hoboken, NJ: John Wiley & Sons.

Tovey, C., & Wyatt, S. (2003, May 31). Diagnosis, investigation, and management of deep vein thrombosis. Retrieved May 2, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126050/

Weil, A. (2020, April 28). Anti-Inflammatory Food Pyramid: Anti-Inflammatory Diet: Andrew Weil, M.D. Retrieved May 3, 2020, from https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/dr-weils-anti-inflammatory-food-pyramid/

What is Venous Thromboembolism? (2020, February 7). Retrieved April 30, 2020, from https://www.cdc.gov/ncbddd/dvt/facts.html

Nerd Out: Plantar Fasciitis

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the musculo-skeletal system. I chose Plantar Fasciitis, as many of the active people I know experience it. If you’d like to nerd out with me, continue reading:

Plantar Fasciitis is a chronic foot condition, described by some experts as inflammation of the fascia or connective tissue supporting the arch of the foot (Wheeler, 2019), and by others as chronic degeneration and irritation at the insertion of the fascia to the calcaneus, or heel bone (Young, 2019). Affecting an estimated 2 million people a year in the United States (Searing, 2019) the cost of treatment of plantar fasciitis is estimated at between $192 and $376 million dollars annually (Young, 2019).  Pain ranges from mild to extreme, intermittent to constant, and may affect one or both feet. Risk factors include obesity, age, overuse of feet via running, jumping, or standing for long periods of time, tight calf muscles, menopause, flat feet or high arches, and wearing unsupportive footwear (Ingraham, 2019; Wheeler, 2019). Symptoms include sharp, stabbing, burning pain in the heel or arch of the foot, or both. Pain is often most intense with the first steps in the morning, with symptoms sometimes subsiding with increased blood flow to the calves, heel, arch, and fascia as the day progresses. However, it is common for symptoms to be severe, lasting months or even years, affecting work, recreation, and activity level for its sufferers. 

Etiology is multifactorial but overuse is most often to blame (Young, 2019). Because of its high incidence in runners and other athletes such as football, basketball, and baseball players, it is supposed that repeated microtraumas through jumping and running contribute to plantar fasciitis (Young, 2019). Heel spurs may encourage or magnify symptoms, and are thought to be a result of plantar fasciitis rather than the cause (Wheeler, 2019; Young, 2019). Plantar fasciitis often presents in conjunction with an uptake in activity or training: increased miles, increased duration, or the addition of higher-intensity drills are examples (Young 2019). This condition is not limited to athletes, however, as overweight may be a contributing factor (Young, 2019). Standing for long periods of time, wearing footwear with insufficient arch support, age, and gender play a role as well (Young, 2019). Women experience plantar fasciitis twice as often as men, with peak incidence occurring between the ages of 40-60 (Young, 2019), coincidentally during the time of perimenopause and menopause (Wheeler, 2019). Any hormonal connection is yet to be explained.

Structural risk factors include a low arch (pes planus) or high arch (pes cavus), as each is associated with increased stress on the connective fascia (Young, 2019). Other sources of fascia stress include leg-length discrepancy, overpronation, excessive lateral tibial torsion, and excessive femoral anteversion (Young, 2019). Tight muscles, specifically the hamstrings, gastrocnemius, and soleus, as well as tight Achilles tendon may play a role as well (Young, 2019).

Plantar fasciitis is diagnosed by ultrasound, MRI, or x-ray (Wheeler, 2019), by ruling out other causes of pain, such as heel bruising, fractures, achilles tendonitis, infection, arthritis, and other foot syndromes (Ingraham, 2019; Wheeler, 2019). 

Once a diagnosis is made, Allopathic approaches indicate rest, ice, stretching, massage, and non-steroidal anti-inflammatories (NSAIDs) for relief of symptoms (Wheeler, 2019). Despite these options, this chronic inflammatory condition may last many months. At the 12-month mark, 80% of cases will experience relief, with 5% of cases progressing to more invasive options (Young, 2019). Treatment for persistent or severe cases includes physical therapy, extracorporeal shock-wave therapy, shoe inserts or orthotics, corticosteroid injections to the affected area, and/or surgery for plantar fascia release (Buchbinder, 2004; Wheeler, 2019; Young, 2019). Because each case is unique,combinations of treatments are recommended for optimal healing (Buchbinder, 2004).

Integrative approaches to treatment of plantar fasciitis utilize the above-mentioned allopathic treatments in addition to other holistic measures. An integrative practitioner will take into consideration stress levels of patients as well as quality of sleep, hormone levels, and nutritional status. Complementary treatment practices include chiropractic, massage and body work, dry needling, acupuncture, cupping, etc., with the intention of decreasing inflammation and restoring blood flow (Al-Boloushi, Gómez-Trullén, Bellosta-López, López-Royo, Fernández, & Herrero, 2019).

Assessments utilized may include meal-tracking with subsequent data on nutrient excesses and deficiencies. A detailed health history including sleep tracking and stress-level questionnaires provide important background information related to inflammation and lifestyle patterns that may contribute to chronic pain. Lab tests, including insulin and glucose levels assess inflammatory markers, while a gut microbiome test or comprehensive stool analysis can assess gut integrity (Rakel, 2018, p.869). 

An anti-inflammatory diet may be recommended. Eating foods high in healthy fats including omega-3s (found in cold water fish, such as salmon, mackerel, anchovies, and herring), oleic acid (found in olive oil), a variety of nuts, and coconut oil, lead to the formulation of less-inflammatory or antiinflammatory prostaglandins and leukotrienes (Rakel, 2018, p.870-872). Organic vegetables and fruits provide protective phytochemicals (Rakel, 2018, p.873). Avoiding gluten may reduce inflammatory markers, while decreasing intake of  over-processed, packaged foods and focusing on whole-food, nutrient-dense sources of low-glycemic carbohydrates favor an optimal gut microbiome composition and balanced insulin response (Rakel, 2018, p. 872-873). Cultured or fermented vegetables such as kimchee or sauerkraut also optimize gut microflora while sea vegetables such as kombu, arame, dulse, wakame, and nori provide essential micronutrients and trace nutrients (Lipski, 2012, p.148). Finally, bone broth is touted for its collagen-enhancing properties (Kresser, 2019), while certain spices (turmeric, ginger, rosemary, oregano and cayenne), garlic, green tea, wild mushrooms, organic red wine, and cacao or dark chocolate all provide improvements in inflammatory markers (Rakel, 2018, p.874; The Anti-Inflammatory Diet & Food Pyramid: Andrew Weil, M.D., 2019; Turmeric, 2018). 

Integrative approaches may also call for supplementation. Common anti-inflammatory supplements include glucosamine chondroitin, s-adenosyl methionine (SAMe), EPA/DHA fish oils, Hawaiian astaxanthin, vitamins C and D, medium chain triglyceride oil (MCT oil), Co-enzyme Q-10 (CoQ10), N-acetyl-cysteine (NAC), methylsulfonylmethane (MSM), and trace mineral drops (Bode & Dong, 1970; Kohlstadt, 2012, p.684-689; Wilson, 2018). 

Lifestyle changes are encouraged in holistic practice to decrease stress and support healing. Positive sleep hygiene promotes deep, restful sleep, allowing the body to heal and restore (Seaward, 2014, p.13). Meditative practices, including breathwork and moving meditations like yoga and tai chi, provide opportunity to release emotional and physical stress (Krohn & Taylor, 2000, p.342-344). Hyperbaric oxygen therapy helps oxygenate tissue to promote healing (Krohn & Taylor, 2000, p. 348-349). Cold therapy, including cryotherapy, increases microcirculation and synthesis of collagen, while heat therapy, including epsom salts soaks, steam rooms, and saunas provide pain relief and help to improve circulation (Krohn & Taylor, 2000, p. 262-265). Magnets are thought to encourage healing (Krohn & Taylor, 2000, p. 437-438). Finally, body work, touch therapy, and energy work such as chiropractic adjustments, Swedish massage, shiatsu, Rolfing, sports massage, Thai massage, reflexology, acupuncture, therapeutic touch, Reiki, and qi gong provide relaxation and reduction in chronic pain  (Al-Boloushi et al, 2019; Krohn & Taylor, 2000, p. 258-261).

Both allopathic and integrative experts agree that plantar fasciitis is persistent and often challenging to treat. With multiple options and different approaches, the consensus is that a combination of treatments bring the most favorable results (Fink, 2012).

References

Al-Boloushi, Z., Gómez-Trullén, E. M., Bellosta-López, P., López-Royo, M. P., Fernández, D., & Herrero, P. (2019). Comparing two dry needling interventions for plantar heel pain: A protocol for a randomized controlled trial. Journal of Orthopaedic Surgery and Research, 14 doi:http://dx.doi.org/10.1186/s13018-019-1066-4

Anti-Inflammatory Food Pyramid:Andrew Weil, M.D.(2020, January 16). Retrieved January 18, 2020, from https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/dr-weils-anti-inflammatory-food-pyramid/

Bode, A. M., & Dong, Z. (1970, January 1). The Amazing and Mighty Ginger. Retrieved January 25, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK92775/

Buchbinder, Rachelle, MB,B.S., F.R.A.C.P. (2004). Plantar fasciitis. The New England Journal of Medicine, 350(21), 2159-66. Retrieved from https://search.proquest.com/docview/223938185?accountid=193085

Daniels, C. J., & Morrell, A. P. (2012, March 11). Chiropractic management of pediatric plantar fasciitis: a case report. Retrieved February 7, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315855/#bb0070

Fink, B. R., M.D. (2012). Management of plantar fasciitis evolving. The Journal of Musculoskeletal Medicine, 29(1), 16-20. Retrieved from https://search.proquest.com/docview/922379503?accountid=193085

Ingraham, P. (2019, November 1). What Works for Plantar Fasciitis? What Doesn't? Why? Retrieved February 5, 2020, from https://www.painscience.com/tutorials/plantar-fasciitis.php

Kresser, C. (2019, September 24). Bone Broth Benefits: Everything You Need to Know. Retrieved February 7, 2020, from https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/

Kohlstadt, I. (2012). Advancing medicine with food and nutrients. Boca Raton: CRC Press, Taylor & Francis Group.

Krohn, J., & Taylor, F. A. (2000). Natural detoxification. Point Roberts, WA: Hartley & Marks Publishers.

Levy, J. (2019, September 3). Is This Fatty Oil Actually Good for You? Retrieved January 25, 2020, from https://draxe.com/nutrition/mct-oil/

Lipski, E. (2012). Digestive wellness: strengthen the immune system and prevent disease through healthy digestion. New York: McGraw-Hill.

Rakel, D. (2018). Integrative medicine (4th ed.). Philadelphia, PA: Elsevier.

Searing, L. (2019, November 25). The Big Number: 2 million Americans get treated for heel pain caused by plantar fasciitis. Retrieved February 5, 2020, from https://www.washingtonpost.com/health/the-big-number-2-million-americans-get-treated-for-heel-pain-caused-by-plantar-fasciitis/2019/11/22/0dfe89e8-0c7a-11ea-97ac-a7ccc8dd1ebc_story.html

Seaward, B. L. (2014). Essentials of managing stress. Burlington, MA: Jones & Bartlett Learning.

The Anti-Inflammatory Diet & Food Pyramid: Andrew Weil, M.D. (2019, August 9). Retrieved January 18, 2020, from https://www.drweil.com/diet-nutrition/anti-inflammatory-diet-pyramid/what-is-dr-weils-anti-inflammatory-food-pyramid/

Turmeric. (2018, November 27). Retrieved January 25, 2020, from https://nccih.nih.gov/health/turmeric/ataglance.htm

Wheeler, T. (2019, October 7). Plantar Fasciitis: Symptoms, Causes, Diagnosis, Treatment. Retrieved February 5, 2020, from https://www.webmd.com/fitness-exercise/understanding-plantar-fasciitis-basics

Wilson, D. R. (2018, September 18). 7 Health Claims About Astaxanthin. Retrieved January 25, 2020, from https://www.healthline.com/health/health-claims-astaxanthin


Young, C. C. (2019, November 12). Plantar Fasciitis. Retrieved February 5, 2020, from https://emedicine.medscape.com/article/86143-overview#showall

Nerd Out: Hypothyroidism

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a disorder of the endocrine system. I chose Hypothyroidism, as it ranks up there as one of the most prevalent chronic disorders people experience. If you’d like to nerd out with me, continue reading:

Hypothyroidism is defined as a deficiency of thyroid hormone (Pizzorno & Murray, 2013, p.1473), and is due to one of three factors: insufficient hormone synthesis, a lack of stimulation by the pituitary gland, and/or impaired conversion of thyroxine (T4) to triiodothyronine (T3) (Pizzorno & Murray, 2013, p. 1473; Rakel, 2018, p. 347). Many factors contribute to hypothyroidism, including nutrient deficiencies, environmental toxins and endocrine disruption, estrogen dominance, infections, food intolerances and food allergies, poor liver function, and chronic stress (Kohlstadt, 2012, p. 391, 398; Myers, 2019; Rakel, 2018, p. 348-350).

In primary hypothyroidism, iodine deficiency is the most common cause due to lack of dietary iodine intake in certain regions of the world, with autoimmune destruction of the thyroid gland (Hashimoto’s Disease) most common in iodine-sufficient regions (Rakel, 2018, p. 347). Other factors contributing to primary hypothyroidism include surgery to thyroid, radioactive iodine administration, certain medications, overconsumption of goitrogens, and external beam radiation (Rakel, 2018, p. 347). Low thyroid hormone levels and high thyroid-stimulating hormone (TSH) levels from the pituitary gland indicate defective thyroid hormone synthesis (Pizzorno & Murray, 2013, p. 1473). 

Secondary hypothyroidism, on the other hand, is indicated by decreased levels of both TSH and thyroid hormones (Pizzorno & Murray, 2013, p.1473). This occurs most commonly due to pituitary tumors, pituitary surgery, or disease of the pituitary gland (Rakel, 2018, p. 347). Finally, tertiary hypothyroidism is defined by a deficit of thyroid hormone-releasing hormone (THRH) from the hypothalamus (Pizzorno & Murray, 2013, p. 1473), and may be due to infection, congenital defect, or infiltrative processes of the brain (Rakel, 2018, p. 347). Subclinical hypothyroidism is indicated by elevated TSH but normal levels of T4, and may be asymptomatic, but may lead to primary hypothyroidism over time (Rakel, 2018, p. 347). 

Hypothyroidism, regardless of its etiology, affects women more than men, and whites and Mexican-Americans more than African-Americans (Kohlstadt, 2012, p. 391; Pizzorno & Murray, 2013, p. 1473). It is estimated that the rate of hypothyroidism is somewhere near 25% of the adult population, with incidences significantly higher among the elderly (Pizzorno & Murray, 2013, p. 1473).

Symptoms of hypothyroidism can mimic other diseases making it challenging to identify and diagnose (Kohlstadt, 2012, p. 392). Mild fatigue or depression may go on for years and precede any clinical serum abnormalities, therefore a careful analysis of both symptoms and lab test results are crucial to diagnosis (Kohlstadt, 2012, p. 393; Pizzorno & Murray, 2013, p. 1474). Chronic fatigue, depression, malaise, difficulty concentrating, forgetfulness, weight gain, sensitivity to cold (especially in the hands and feet), edema, decreased libido, menstrual abnormalities, infertility, dry skin, hair loss, thinning eyebrows, thin, brittle nails, muscle weakness, joint stiffness, gastroesophageal reflux disease (GERD), shortness of breath, constipation, delayed tendon reflex, loss of hearing, and atherosclerosis are all possible presentations in hypothyroidism (Kohlstadt, 2012, p. 393; Pizzorno & Murray, 2013, p. 1474; Rakel, 2018, p. 348).  

Allopathic approaches to treatment of hypothyroidism rely primarily on serum lab testing of TSH and sometimes T4 (Mayo Clinic, 2018). Traditionally the accepted as normal range for TSH is quite broad, measuring 0.35-5.50 mIU/mL, with some conventional practitioners using levels greater than 10 mIU/mL as a basis for recommending treatment (National Academy of Hypothyroidism, 2012; Pizzorno & Murray, 2013, p. 1476). Additional labs such as cholesterol and triglyceride measures as well as clinical presentation of the patient may also be taken into account. If lab results indicate low TSH, a pharmaceutical is prescribed, most often the synthetic T4 thyroxin (levothyroxine sodium), with the most common brand names of Levoxyl (levothyroxine) and Synthroid (Lee & Hopkins, n.d.; National Academy of Hypothyroidism, 2017). It is interesting to note that thyroid hormone-replacement drugs are ranked the third most common prescribed in the United States (National Academy of Hypothyroidism, 2017). Rarely are nutrition, lifestyle, gut integrity, and stress addressed in allopathic care of hypothyroidism, with the focus almost solely on pharmaceutical intervention (National Academy of Hypothyroidism, 2012). Typically, once stabilized within normal range, TSH levels are monitored yearly and dosages adjusted as needed (Mayo Clinic, 2018). 

Integrative approaches to healing hypothyroidism are more holistic in approach, taking into account not only lab tests of thyroid hormones but also nutrition, stress levels, lifestyle choices, sex hormone levels and blood sugar regulation. A comprehensive evaluation, including labs, medical history, symptomatology, and lifestyle choices recognize that hypothyroidism is a multi-faceted disorder with often more than one overt cause (Kohlstadt, 2018, p.392). 

Comprehensive thyroid labs test not only for TSH, but for T4, free T4, T3, free T3, and reverse T3 (rT3) (Pizzorno & Murray, 2013, p. 1474; Rakel, 2018, p. 348). Cholesterol, triglyceride, cortisol, homocysteine, and C-reactive protein (CRP) levels may also be tested, and if elevated, indicate possible hypothyroidism (Pizzorno & Murray, 2013, p. 1474). Low iron and B12 are also indicators of thyroid insufficiency (Pizzorno & Murray, 2013, p. 1474). Supplementation is recommended based on lab results, with brand name Armour Thyroid most commonly prescribed in functional medicine. Combination via dessicated pig or cow thyroid (also called USP thyroid) provides both T3 and T4 support in approximately the ratio made by the human thyroid (Lee & Hopkins, n.d.; National Academy of Hypothyroidism, 2017) as opposed to only TSH replacement. In addition to labs and to further support a hypothyroid diagnosis, a Basal Body Temperature test may be done to measure for lowered body temperature, while the Iodine patch test demonstrates iodine uptake and therefore the body’s need for iodine (Weatherby & Ferguson, 2005, p. 17-23). 

Environmental toxins play a role in thyroid health. Heavy metals compete for thyroid hormone, iodine, and selenium uptake in the thyroid, so testing for mercury, lead, and cadmium by way of urine provocation test would be indicated (Kresser, 2019; Pizzzorno & Murray, 2013, p. 194-195). The halides, including fluoride, bromide, and chloride bind with iodine receptors in the thyroid gland (Fluoride, Bromide, Chloride, and Thyroid Health, 2018). A 24-hour urine iodine test may be ordered to check for possible iodine deficiency and levels of halides (Fluoride, Bromide, Chloride, and Thyroid Health, 2018; Kohlstadt, 2012, p.396). Measures to decrease exposure to these chemicals are encouraged.

Gut dysbiosis and increased intestinal permeability both interfere with iodine, selenium, and other mineral absorption (Kohlstadt, 2012, p. 394). A Comprehensive Digestive Stool Analysis for dysbiosis, Organix test to measure protein digestion, and a lactulose-mannitol test to measure intestinal permeability may all be utilized (Rakel, 2018, p. 580). Selenium- , zinc-, and iodine-rich foods and/or supplementation may be recommended to ensure proper uptake (Kresser, 2019).

Lifestyle, and particularly stress plays an enormous role in thyroid health, as excess cortisol inhibits thyroid hormone metabolism (Kohlstadt, 2012, p. 401; National Academy of Hypothyroidism, 2017). An adrenal stress profile using salivary collection will provide clues to cortisol levels (Kohlstadt, 2012, p. 401). Meditation, low-intensity exercise, breathwork, and body work may all be recommended to support thyroid health, even if cortisol levels are within normal range (Rakel, 2018, p. 358-359). Blood glucose levels may be checked and measures taken to balance insulin levels and reduce inflammation through diet and exercise (Wentz, 2019).  Encouraging proper sleep hygiene and maintaining a healthy body weight are regarded as positive practice as well (Rakel, 2018, p. 590). 

Estrogen dominance and/or progesterone deficiency also play a big role in hypothyroidism. An imbalance of these female sex hormones not only produce symptoms mimicking hypothyroidism, but increase serum thyroid binding globulin (TBG), rendering thyroid hormones inactive (Myers, 2019). A 6- or 24-hour saliva or urine collection to measure estrogen levels may be ordered to determine a course of action.  Balancing estrogen-dominance calls for a multi-faceted approach, including decreasing stress and inflammation, minimizing exposure to xenoestrogens and hormone disruptors, reducing exposure to heavy metals, and eating organic and minimally-processed whole foods (Myers, 2019; National Academy of Hypothyroidism, 2017).  

Nutrient-rich foods are encouraged to support optimal thyroid health, regardless of lab results. Iodine-rich foods such as sea vegetables, ocean fish, and unrefined sea salt support iodine levels (Fluoride, Bromide, Chloride, and Thyroid Health, 2018; Kohlstadt, 2012, p. 394). Cooking raw goitrogens (cruciferous or Brassica vegetables, including cabbage, turnips, Brussels sprouts, broccoli, cauliflower, bok choy, etc.) before consuming or avoiding altogether is recommended (Kohlstadt, 2012, p. 394-395), as goitrogens compete for iodine uptake and block incorporation into the thyroglobulin molecule (Kohlstadt, 2012, p. 394-395. Minimizing the effect of thyroid peroxidase enzyme-inhibiting (TPO-inhibiting) soy isoflavones by consuming fermented soy is encouraged (Kohlstadt, 2012, p. 395). Increasing intake of zinc-rich foods (seafood, oysters, red meats, and organ meats), heme iron (chicken liver, oysters, beef liver, beef, turkey, and chicken), selenium (Brazil nuts, grass-fed meat, eggs, ans seafood), and copper (organ meats, eggs, yeast, beans, nuts, and seeds) are also extremely supportive to the thyroid (Kohlstadt, 2012, p. 393-398). Finally, daily exposure to sunshine or vitamin D supplementation, and vitamin A, C, E, copper, the B vitamins, and trace mineral supplementation may also be indicated to optimize thyroid hormone production and uptake (Pizzorno & Murray, 2013, p. 1479). 

Regardless of etiology, hypothyroidism can be managed through lab testing and hormone supplementation. A holistic approach provides additional support with nutritional supplementation, a nutrient-dense diet, exercise, and lifestyle modifications. 




   

References

Fluoride, Bromide, Chloride and Thyroid Health. (2018, January 2). Retrieved November 26, 2019, from https://www.naturalendocrinesolutions.com/articles/fluoride-bromide-chloride-and-thyroid-health/.

Kohlstadt, I. (2012). Advancing Medicine with Food and Nutrients, Second Edition. Hoboken: Taylor and Francis.

Kresser, C. (2019, October 10). How Environmental Toxins Harm the Thyroid. Retrieved November 25, 2019, from https://kresserinstitute.com/environmental-toxins-harm-thyroid/.

Lee, J. R., & Hopkins, V. (n.d.). What Your Dr May Not Tell You About Your Thyroid. Retrieved November 24, 2019, from https://www.virginiahopkinstestkits.com/thyroidarticle.html.

Myers, A. (2019, November 14). 9 Causes of Estrogen Dominance and What to Do About It. Retrieved November 24, 2019, from https://www.amymyersmd.com/2019/03/9-causes-estrogen-dominance/.

Mayo Clinic. (2018, December 4). Hypothyroidism (underactive thyroid). Retrieved November 24, 2019, from https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289.

National Academy of Hypothyroidism. (2012, January 27). Why Doesn't My Endocrinologist Know All of This? Retrieved November 24, 2019, from https://www.nahypothyroidism.org/why-doesnt-my-doctor-know-all-of-this/.

National Academy of Hypothyroidism. (2017, September 13). Estrogen Dominance and Hypothyroidism: National Academy of Hypo. Retrieved November 24, 2019, from https://www.nahypothyroidism.org/estrogen-dominance-and-hypothyroidism-is-it-hypothyroidism-or-hormone-imbalance/.

Pizzorno, J. E. (2013). Textbook of natural medicine. St. Louis, MO: Elsevier/Saunders.

Rakel, D. (2018). Integrative medicine. Philadelphia, PA: Elsevier.

Weatherby, D., & Ferguson, S. (2005). The complete practitioners guide to take-home testing: tools for gathering more valuable patient data. Ashland, OR.: Emperors Group.

Wentz, I. (2019, March 14). Why Balancing Blood Sugar is Vital for Hashimotos Help. Retrieved November 26, 2019, from https://thyroidpharmacist.com/articles/blood-sugar-imbalances-and-hashimotos/

Nerd Out: Irritable Bowel Syndrome

My latest assignment for my Master’s in Holistic Nutrition was to write a paper about a gastrointestinal disorder. I chose Irritable Bowel Syndrome, as it ranks up there as one of the most prevalent chronic disorders people experience. If you’d like to nerd out with me, continue reading:

Irritable Bowel Syndrome, or IBS, is defined as chronic inflammation of the large intestine and presents itself through a cluster of symptoms, including abdominal pain, spasms, bloating, gas, and abnormal bowel movements (Lipski, 2012, p.286). Because there is a spectrum within the symptoms (mild to severe), and because the symptoms fluctuate over time, it is often challenging to differentiate between IBS and normal variations of the gastrointestinal tract (Rakel, 2018, p.423). Stress has proven to play an integral part in the flare-up of IBS, providing a psychosocial perspective to treatment (Rakel, 2018, p.423), although some experts prefer to categorize it as a disorder of the gut-brain axis rather than as a psychiatric disorder (Kohlstadt, 2012, 261). A diagnosis is made due to its chronic nature (at least 6 months’ duration) (Kohlstadt, 2012, p.261), by excluding pathology, and including some or all of the symptoms of abdominal pain/discomfort, bloating, and diarrhea/constipation (Rakel, 2018, p.423).

Specifically, the Rome III Criteria for Irritable Bowel Syndrome defines IBS as at symptoms lasting at least three months, with onset at least six months previously of recurrent abdominal pain or discomfort associated with two or more of the following: Improvement with defecation; Onset associated with a change in frequency of stool; And/or onset associated with a change in form (appearance) of stool (Kohlstadt, 2012, p.262). This, with the absence of weight loss, anemia, and rectal bleeding, support the diagnosis of IBS (Kohlstadt, 2012, p.261).

Also prevalent amidst the cluster of symptoms may be nausea, anorexia, hypersecretion of colonic mucus, restless leg syndrome, migraine headaches, chronic fatigue, irritable bladder, and dyspareunia (Pizzorno & Murray, 2013, p.1557). IBS is often seen in patients with a history of sexual abuse and/or sexual dysfunction, fibromyalgia, urinary frequency and urgency, poor sleep, menstrual difficulties, lower back pain, and insomnia (Pizzorno & Murray, 2013, p.1557).

IBS is cited as the most common GI disorder seen in general practice, representing 30%-50% of all referrals to gastroenterologists (Pizzorno & Murray, 2013, p.1557). Women are diagnosed twice as often as men, which might be due to men under-reporting symptoms (Pizzorno & Murray, 2013, p.1557), and is more prevalent in Caucasian persons than others. Early studies demonstrate that IBS patients tend to have an enhanced stress responsiveness that presents higher morning cortisol levels and an inability to turn off the stress response, both which have been shown to increase intestinal permeability and inflammation (Rakel, 2018, p.429).  

There are three subgroups of IBS under which patients are categorized: constipation predominant (IBS-C), diarrhea predominant (IBS-D), or mixed (IBS-M) (Kohlstadt, 2012, p.261).  Risk factors may be environmental, genetic, or both (Kohlstadt, 2012, p.262). Several conditions, including food allergies, infections, poor diet, and metabolic disorders mimic the symptoms of IBS and must be ruled out in order to make the diagnosis.

The etiology of IBS is unclear, although it frequently occurs in concert with Small Intestinal Bacterial Overgrowth (SIBO) and Leaky Gut Syndrome (Lipski, 2012, p.287). IBS can also be caused by stressors to the gut as mentioned above, leading to an over-active inflammatory response in the mucosal tissue of the large intestine (Lipski, 2012, p.288). Parasites and candida overgrowth may also play a role in IBS, and women may experience increased symptoms around their menstrual periods (Lipski, 2012, p.288). Chronic stress, dysregulated immune response, dysbiosis, overconsumption of alcoholic beverages, certain medications such as NSAIDs and birth control pills, and even lectins have been implicated in the chronic inflammation characteristic of IBS (Lipski, 2012, p. 46-47) (Rakel, 2018, p.423).

Allopathic approaches to IBS focus on three main therapies: increasing fiber in diet, probiotics, and antibiotic therapy (Rifaxamin), especially if SIBO is indicated (Lipski, 2012, p.287) (Rakel, 2018, p.430). Another pharmaceutical, oral Cromolyn (brand name Gastrocrom), is used to control the release of GI-irritating substances from mast cells in the GI tract (https://www.mayoclinic.org/drugs-supplements/cromolyn-oral-route/description/drg-20063181).  And with the mind-body connection to IBS, tricyclic antidepressants and selective serotonin reuptake inhibitors are an option for patients with IBS-D (Rakel, 2018, p.430).

For IBS-C, a diet high in fiber (25-30 grams per day, preferably insoluble fiber such as in oats and psyllium), and low in fat help with stool bulking and intestinal motility (Kohlstadt, 2012, p.272).  Pharmaceuticals such as 5-hydroxytryptophan (5-HTP), Lubiprostone, Tegaserod, and Renzapride may be indicated soften the stool and relax the gut. (Kohlstadt, 2012, p.265) (Pizzorno & Murray, 2013, p.1560).

Anticholinergic agents are used to reduce abdominal cramping and smooth muscle spasms (Kohlstadt, 2012, p.266). Peppermint oil is gaining traction in the allopathic medical community as another option for relaxation of the smooth muscle in the GI tract as well as for mediation of other symptoms (Kohlstadt, 2012, p.266) (Pizzorno & Murray, 2013, p.1560).

Broad-spectrum probiotics are recommended to repopulate the intestinal microbiome with optimal rather than pathogenic gut microflora, decrease fermentation, and stimulate proper immune function (Rakel, 2018, p.427) (Pizzorno & Murray, 2013, p.1559).

Antibiotic therapy, specifically Rifaxamin, has been found to significantly improve IBS symptoms, especially in IBS-D patients and those with comorbid SIBO (Rakel, 2018, p.430).

All types of IBS may benefit from Cognitive Behavioral Therapy and/or hypnotherapy to help with accompanying anxiety and depression (Kohlstadt, 2012, p.271).

The above-mentioned approaches are based on an extensive medical history, including frequency of abdominal pains, gas, bloating, constipation, and/or diarrhea. Lab tests may include a comprehensive stool analysis, complete blood count, erythrocyte sedimentation rate, free thyroid T3 hormone levels, and antiendomysial antibody testing for celiac disease (Pizzorno & Murray, 2013, p.1557).  The enzyme-linked immunosorbent assay (ELISA) allergen challenge test or the ELISA IgE/IgG4 test are sometimes used to detect food allergies (Pizzorno & Murray, 2013, p.1558).

IBS-D type symptoms may indicate a panendoscopy with duodena, colonic, and terminal ileal biopsies to rule out celiac disease, inflammatory bowel disease, and colitis (Pizzorno & Murray, 2013, p.1557). Additional stool testing for eosinophilic cationic proteins may be indicated if food allergy is suspected (Pizzorno & Murray, 2013, p.1557). Finally, screening for occult fecal blood, flexible sigmoidoscopy/colonoscopy are also options to rule out other causes (Pizzorno & Murray, 2013, p.1557).

Integrative approaches take a broader approach to diagnosis and treatment. Assessments such as a health history questionnaire are combined with a comprehensive discussion and/or physical assessment, and include all of the inclusions and exclusions as a diagnostic tool as listed previously. Family medical history is noted, as there may be a genetic link (Rakel, 2018, p.423). A food journal and dietary history is collected to detect possible food sensitivities, intolerances, and allergies (Lipski, 2012, p.288-289), as well as helps determine detrimental dietary choices and eating patterns.

Breath tests, including the SIBO breath test (or the Hydrogen-Methane test), the Lactose-Intolerance/Lactose Malabsorption test, the Fructose Intolerance/Fructose Malabsorption test, and/or the Sucrose Intolerance/Sucrose Malabsorption test are utilized to detect gut sensitivities to sugars, and are especially indicated if leaky gut or SIBO are suspected (What is Irritable Bowel Syndrome, 2019, https://www.commdx.com/)  (Lipski, 2012, p.289) (Kohlstadt, 2012, p.272). Organic acid testing is also a possibility, providing an evaluation of intestinal yeast and bacteria (Lipski, 2012, p.289), and an HCl challenge test can detect decreased gastric acid production (Rakel, 2018, p.430).

Permeability, or leaky gut issues can also be assessed using a lactulose-mannitol urine test or with positive IgG food antibody testing (Rakel, 2018, p.423).

A comprehensive digestive stool analysis including parasitology is recommended, as candida overgrowth and parasites are often overlooked causes of IBS (Lipski, 2012, p.288).

An elimination diet and subsequent food challenge helps identify triggering foods (Rakel, 2018, p.426). Introducing therapeutic dietary systems (FODMaPs/fermentable carbohydrates avoidance, GAPS, Paleo, low-sugar, dairy-free, gluten-free, lectin-free, caffeine-free, alcohol-free, etc.), based on individual needs often provides symptomatic relief (Pizzorno & Murray, 2013, p.1558, 1559) (Lipski, 2012, p.289) (Rakel, 2018, p.426) (Kohlstadt, 2012, p.269). It is important to note that artificial sweeteners such as sorbitol, maltitol, or xylitol may worsen bloating and diarrhea in IBS patients so should be avoided (Kohlstadt, 2012, p.270-271).

Increasing fiber with psyllium seeds, flaxseed, or hemp seed is recommended, as well as adding a broad-spectrum probiotic that includes lactobacilli and bifidobacteria (Lipski, 2012, p.290). Eliminating dairy foods, sugar, fruit, honey, and maple syrup may ease symptoms (Lipski, 2012, p.289, 290). Prebiotic-rich foods (bananas, artichokes, garlic, onions, etc.) as well as probiotic foods (sauerkraut, kimchee, and kvass, etc.) stimulate and feed healthy GI flora (Rakel, 2018, p.428) (Axe, 2018, https://draxe.com/leaky-gut-diet-treatment/).

Other dietary supplements include pancreatic enzymes, ginger, aloe, Chinese herbs such as Padma Lax and STW-5, glutamine, EPA/DHA fish oil, peppermint oil, chamomile, rosemary, Melissa (balm), valerian, betaine hydrochloride, and calcium-magnesium citrate (Rakel, 2018, p.428- 430) (Lipski, 2012, p.290-291).

Bone broth soothes the gut and provides the nutrients collagen, glycine, proline, and glutamine, as well as easily absorbable minerals and natural anti-inflammatories like chondroitin sulfate and glucosamine (Kresser, 2019, https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/).

Decreasing the chemical load by eating organic produce, and pastured eggs and meat, allows for optimal healing of the gut. Other nutrient-rich foods include healthy fats like coconut oil, avocado, and the omega-3 fats in fatty fish. Sprouted seeds, fermented vegetables, and adequate hydration round out the list (Axe, 2018, https://draxe.com/leaky-gut-diet-treatment/)

Finally, lifestyle modifications that include more self-care to decrease stress, anxiety, and depression have been shown to decrease IBS symptoms. Mind-body therapies include stress management, relaxation therapy, meditation, hypnosis, journaling, biofeedback, art therapy, acupuncture, and gentle exercise such as yoga, and walking (Rakel, 2018, p.429). Often more effective than medical therapy (Rakel, 2018, p.429), stress reduction strategies tap into the mind-body and gut-brain connection that affects both sickness and wellness. An entire paper could be written on this topic as well, but suffice it to say, a holistic approach to Irritable Bowel Syndrome, including diet, supplementation, exercise, and stress reduction, offers promise to provide not just physical but emotional relief as well.   

References

Axe, J. (2018, July 30). Leaky Gut Diet and Treatment Plan, Including Top Gut Foods. Retrieved May 30, 2019, from https://draxe.com/leaky-gut-diet-treatment/

Cromolyn (Oral Route) Description and Brand Names. (2019, February 01). Retrieved May 30, 2019, from https://www.mayoclinic.org/drugs-supplements/cromolyn-oral-route/description/drg-20063181

Kohlstadt, I. (Ed.). (2012). Advancing medicine with food and nutrients. Boca Raton: CRC Press.

Kresser, C. (2019, May 28). Bone Broth Benefits: Everything You Need to Know. Retrieved May 30, 2019, from https://chriskresser.com/the-bountiful-benefits-of-bone-broth-a-comprehensive-guide/

Lipski, E. (2012). Digestive wellness: Strengthen the immune system and prevent disease through healthy digestion. New York, NY: McGraw-Hill.

Pizzorno, J., & Murray, M. T. (2013). Textbook of natural medicine. St. Louis, MO: Elsevier.

Rakel, D. (2018). Integrative medicine. Philadelphia, PA: Elsevier.

What is Irritable Bowel Syndrome? (2019). Retrieved May 31, 2019, from https://www.commdx.com/

My Optimal Health/Weight Loss Workshop Explained (Phase 2)

**This is an explanation to my professor of the second module (or phase 2) of my weight-loss, optimal health online program. I’m currently working on my Master’s of Holistic Nutrition from Hawthorn University.**

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Once a client is fully entrenched in Phase 1 of my Fittbodies Optimal Health Plan, I introduce the Phase 2: Boost Immunity formula. In this phase we build on the Phase 1: Alkalize steps with immune-supporting habits, paying closer attention to fasting, sleep, cravings for sweets, and holistic health.

I begin by encouraging clients to eat their meals within a small, condensed window of time, also known as Time Restricted Eating (TRE) (Longo & Panda, 2016). Scaling back the timing of their first and last meals gradually, by 30 minutes a week, allows the client to ease into a longer fasting window without feeling deprived. For example, if a client’s regular breakfast time is 7am and dinner time is 7pm, I would have them begin Phase 2 by taking 30 minutes off each side of their fasting window. They would therefore eat breakfast at 7:30am (at the earliest) and eat dinner at 6:30pm (most days). Of course there needs to be flexibility to accommodate work schedules and social engagements, but the aim is to achieve a longer fasting window 80% of the time. As the client builds confidence in fasting, we will lengthen the fasting window by another 30 minutes for a week. It may not be feasible to scale back dinner as much as it is to put off breakfast, so once a client finds an optimal dinner time for their schedule, preferably 2-3 hours before bedtime to allow for complete digestion, we hold that dinner time and begin scaling back the first meal only. Not only does this way of eating better coincide with circadian rhythms (Longo & Panda, 2016), but it allows the cells to undergo positive metabolic changes (Longo & Mattson, 2014). Ideally, we work up to a 16 hour fast with an 8 hour eating window over the course of weeks to months.

Physical activity is maintained during Phase II, with the challenge of exercising while in a fasted state. Stressing the body occasionally this way encourages hormesis and builds the body’s ability to adapt to stress (Mercola, 2013, https://fitness.mercola.com/sites/fitness/archive/2013/09/13/eating-before-exercise.aspx).

Phase II also encourages clients to eliminate refined sugar and artificial sweeteners and instead use honey, maple syrup, coconut sugar, and stevia leaf for sweeteners. We continue to work on reading labels with emphasis on avoiding products with added sweeteners. If a client has a favorite treat that holds a lot of emotional value for them, we’ll work together to find a healthier version that they can eat without compromising their newfound health. An example of this is my healthy “raw cookie dough” recipe, which is comprised of almond butter, MCT oil, plant protein powder, and bittersweet chocolate chips. I personally eat this, mixed in a small cup, instead of eating the white flour, sugar-laden traditional version, without feeling deprived.

Alcohol is also limited in Phase II, as alcohol metabolizes in the body as sugar. We scale back to consuming only on the weekends, and one-to-two drinks only (Cloe, https://www.livestrong.com/article/435315-the-effect-of-alcohol-on-insulin-resistance/).

Phase II begins the elimination of grains, including wheat, corn, oats, rye, buckwheat, etc. to see if it makes a difference in the client’s energy levels, mood, and sleep. Processed foods, such as crackers, pasta, breads, cereals, cakes, and cookies are avoided. Limited intake of home-prepared quinoa and black rice is acceptable as they provide fiber while creating less of an insulin response in the body (Goldman, 2018, https://www.healthline.com/health/why-is-quinoa-good-for-diabetes), and (Price, 2019, https://draxe.com/black-rice-nutrition-forbidden-rice-benefits/).

I teach about our toxic exposure to potentially dangerous chemicals in Phase II, and encourage the client to purge their make-up, body-care, and personal-care products and cleaners and to purchase cleaner alternatives. Obsesegens, hormone-disruptors, and chemicals hidden in our daily routines wreak havoc on our bodies, resulting in hormone imbalances, weight gain, and other disease states. A great resource for finding “clean” alternatives is the Environmental Working Group’s Skin Deep database (https://www.ewg.org/skindeep/).

I encourage clients to begin the practice of daily oil pulling as a way to detox as well during Phase II. Oil pulling is an ancient Ayurvedic practice in which a person swishes coconut, olive, or sesame oil for up to 20 minutes a day. It is purported to whiten teeth, reduce inflammation, boost immunity, and kill bad breath, among other things (Axe, 2018, https://draxe.com/oil-pulling-coconut-oil/). Clients start with 3 minutes a day of swishing, working up to 5, 7, then 10 minutes minimum, with coconut oil.

Finally, we work on both quality and quantity of sleep in Phase II. Rest is underrated, in my opinion, and so we work on emotional as well as physical aspects of sleep hygiene. This includes darkening the room for sleep by unplugging clock radios, night lights, or anything else that glows at night; plugging in cellular phones as far away from the bed as possible; using room-darkening window coverings; wearing blue light blocking eyewear at night; and avoiding digital devices for at least an hour before bedtime (Stevenson, 2013, https://themodelhealthshow.com/sleep-problems-tips/.) Moving up bedtime 30 minutes earlier each week is a goal, until a minimum of 7 ½ hours of sleep a night, on average, is reached. Use of a Fitbit or other sleep-tracking device is a great motivator, as sometimes we over-estimate the sleep we get.

There is a lot to this Phase II, and clients are allowed to take it as slowly or as quickly as they need or want. At the fastest, the above steps are implemented over the course of a week and maintained over a month or two before moving on. Those who choose (or need to) take it slower can incorporate one new step every week or two, progressing over the course of 2-3 months.

Individuals may experience some setbacks during this phase, including symptoms of detoxification such as irritability, nausea, fatigue, muscle aches, headaches, etc. Sugar cravings may ramp up before dissipating, and some may struggle with limited alcohol and grain intake. Longer sleep may take time, as will the transition to shorter eating windows, eating the garlic, and exercising in a fasted state. It’s very possible clients will get impatient if results don’t occur quickly enough, or if they regress at any point, so I’ll need to provide lots of support and reminders that this is a lifestyle change that will enable their weight to drop off and stay off over time.

Check-ins, weekly (or more often as needed), videos, and Facebook group support are key to success in Phase II. The initial “glow” of success with Phase I will diminish, and it is possible clients may feel more deprived of the foods and habits they love most during Phase II. Progress in this phase may slow down, or even seemingly stop, so I will need to provide reading materials, hand-holding, and testimonials from other clients to help them stay motivated through these changes.

 

References

Axe, J. (2018, June 02). Coconut Oil Pulling Is the New Flossing (It Stops Tooth Decay, Prevents Cavities, Kills Bad Breath & More!). Retrieved March 16, 2019, from https://draxe.com/oil-pulling-coconut-oil/

Cloe, A. (n.d.). The Effect of Alcohol on Insulin Resistance. Retrieved March 14, 2019, from https://www.livestrong.com/article/435315-the-effect-of-alcohol-on-insulin-resistance/

Goldman, R. (2018, July 23). Why Is Quinoa Good for Diabetes? - Healthline. Retrieved March 14, 2019, from https://www.healthline.com/health/why-is-quinoa-good-for-diabetes

Longo, V. D., & Panda, S. (2016). Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan. Cell Metabolism,23(6), 1048-1059. doi:10.1016/j.cmet.2016.06.001

Longo, V., & Mattson, M. (2014). Fasting: Molecular Mechanisms and Clinical Applications. Cell Metabolism,19(2), 181-192. doi:10.1016/j.cmet.2013.12.008

Mercola, J. (2013, September 13). Why Exercising While Fasting Is Beneficial. Retrieved March 14, 2019, from https://fitness.mercola.com/sites/fitness/archive/2013/09/13/eating-before-exercise.aspx

Price, A. (2019, January 30). Why You Should Eat This 'Forbidden' Food. Retrieved March 14, 2019, from https://draxe.com/black-rice-nutrition-forbidden-rice-benefits/

Skin Deep® Cosmetics Database. (n.d.). Retrieved March 14, 2019, from https://www.ewg.org/skindeep/

Stevenson, S. (2017, November 08). Sleep Problems? Here's 21 Tips To Get The Best Sleep Ever. Retrieved March 14, 2019, from https://themodelhealthshow.com/sleep-problems-tips/

My Optimal Health/Weight Loss Workshop Explained (Phase 1)

**This is an explanation to my professor of the first module (or phase 1) of my weight-loss, optimal health online program. I’m currently working on my Master’s of Holistic Nutrition from Hawthorn University.**

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The preparation phase of a weight-loss program is key to laying a strong foundation for lifetime habits. Establishing trust with the client allows transparency and vulnerability and provides a meaningful starting point for which to make a realistic plan and set realistic goals. Face-to-face communication is optimal, whether sitting across from each other in an office or meeting place, or communicating via video-conferencing. Telephone conversations are less optimal, although more convenient, with email and texting to support all methods. Patient intake forms are also important to flesh out the information gained face-to-face and help provide insight into the whole person. I also have recorded short videos in workshop format explaining each step in my program for clients to reference at any time, as well as handouts and worksheets. I can release the entire workshop at once or “drip” the contents to the client, depending on how much they want to spend and how much personal involvement they want from me.

I have expanded my initial “Fitt Kitchen” concept into a broader program, combining nutrition with a weight-loss, fitness, and health-optimization plan that is introduced in four stages: alkalize, immunity-boosting, stress management, and fitness. Clients progress through the four stages as quickly or slowly as they need to, with special attention given to areas of weakness or struggle (Bauer & Liou, 2016, p. 162). For example, a person might need to spend a month in the alkalize stage before they move on to the immunity-boosting portion while another might spend two months in the first stage. Each stage builds on the prior stage and adds more habits/steps to master as the client progresses. The final stage focuses on fitness, but I encourage participants to move their bodies from the very beginning.

I will start off potential clients with the Client Information & Consent form, the Client Welcome Letter, the Food Frequency Form, the Medical History Questionnaire, and the Health & Wellness Goals in the intake packet. (Please see attachments for forms). In our initial meeting, I will dig deeper into the psychological aspects of their behaviors related to food, fitness levels, stress levels, etc. (The examples of such questions are also included in attachments.) I pre-arrange check-in times so clients can expect accountability and establish boundaries, payment, and office hours at this point as well.

When it comes to specific weight loss, my philosophy is to get a client eating whole food, focusing on nourishing their bodies rather than losing weight. The weight loss happens more slowly this way sometimes, but clients establish lifelong habits that help keep the weight off in the long term. A 1-2 lb. average weight drop per week is optimal (Healthy Weight, 2018, https://www.cdc.gov/healthyweight/losing_weight/index.html). This approach will require that I build trust and rapport with the client, as I’m asking them to seemingly put off a problem they sought me out to solve. Teaching them about “how” we are implementing each step will better support them initially, with more “why” introduced over time (Jordan, 2013, p. 90). Educating them about various bodily processes, including digestion, hormone balance, blood sugar regulation, etc. in simple and easy-to-understand language and concepts will further reinforce their efforts. I need to be careful not to overwhelm the client with too much, too fast, but I also don’t want to go so slowly that they lose interest altogether or lose momentum.

As a fitness professional I will encourage them to move their body throughout the program, but will introduce the majority of fitness instruction in the final phase.

Diet, lifestyle, and environmental exposures can affect the client’s success with weight, health, and fitness goals. Some examples of dietary barriers include limited budget, limited time to prepare whole foods, preference for certain tastes or textures, dislike of certain foods or textures, habits or rituals surrounding food, history of dieting, allergies, what’s worked in prior experiences, preconceived notions of dieting, etc. Examples of lifestyle factors which could be barriers include employment situation, existence or lack of a support system, sleep habits, habits or rituals surrounding food, exercise habits, mental health status, level of reliance on television and/or social media for entertainment/education/disconnection, amount of time spent on digital devices, education level, etc. Environmental exposures that could be barriers include living conditions, lack of access to quality food, possible addictions such as alcohol, tobacco, & illicit drugs, lack of access to healthcare, lack of support from family and friends, toxic exposure/exposure to obesegens, etc.(Schwartz, 2018, https://www.youtube.com/watch?v=J4iCleMyuwA).

My challenge as health coach is to problem solve with my client, as a team, each barrier, providing a work-around for potential challenges that may arise or that surface over time. Check-ins through texting and calls, even a voicemail, can help the client feel connected. The pre-recorded videos provide support around the clock. Finally the Facebook group provides support, friendship, and accountability with others participating in the program and takes the pressure off of me to be the constant cheerleader. (I will need to mediate the conversations, however, to make sure the information shared is positive, relevant, and productive.)

Clients begin Phase 1: Alkalize as soon as possible after our first meeting, depending on their goals, their personal timeline, and the amount of hand-holding they’ll need. I release the appropriate videos, add them to my private Facebook group, and check in on them based on our established agreement. Goals for phase 1 include the following: eat mostly plant-based, eat mostly organic, hydrate, drink out of glass or stainless steel containers, instructions to clean out their cupboards, how to read labels, ditch the soda (diet and sugar-full), stock up on healthy snacks, plan meals in advance (I encourage them to subscribe to a meal-planning service, at least at first), ditch the artificial sweeteners, eat whole-fat dairy, and I encourage them to follow some of my personal favorite Pinterest boards for inspiration.

I have an instructional video covering each topic in depth. After the client has watched the assigned video, we will chat, either online, by phone, or Skype, and dig deeper into the lessons according to the questions of the client. With so many topics covered, this could be a lot to expect for someone who is new to clean eating and active living, so I will pace the teaching according to each individual’s needs. We may spend days working on a specific item or breeze through a topic. Individualizing the content within the context of my program will help both with compliance and customer satisfaction.

I expect to spend at minimum of two weeks and maximum of two months on this first phase. It’s possible that a client may need to back-track and review as we move forward, or even skip steps if they’re already in place. My ultimate goal is to provide a streamlined, personalized service that caters to each client’s goals and price point.

References

Bauer, K. D., & Liou, D. (2016). Nutrition counseling and education skill development. Boston, MA, USA: Cengage Learning.

Healthy Weight. (2018, February 13). Retrieved March 6, 2019, from https://www.cdc.gov/healthyweight/losing_weight/index.html

Jordan, M. (2013). How to be a health coach: An integrative wellness approach. San Rafael, CA: Global Medicine Enterprises.

Schwartz, G. (2018, July 17). Intermittent Fasting: Current Research and Nutritional Protocols [webinar]. Retrieved from https://www.youtube.com/watch?v=J4iCleMyuwAlient’s goals and price point.

Find a Journaling Method That Works For You

I've recently started keeping a journal (a bullet journal, to be exact), and I'm excited to share with you what I've learned.

The act of keeping a journal has stereotypically been practiced for ages by teenage girls and avid writers, but mental health experts agree that we all can benefit by writing down our thought. Some of you will feel a ton of pressure at the thought of keeping a journal, but the science is clear. 

Journaling can help you:
*reduce stress
*manage anxiety and depression
*provide a "mind dump" to clear your mind
*get organized
*in lots of physical ways, too, like decreasing blood pressure and boosting immunity

Perfectionists tend to get caught up in what the journal looks like and how neatly each page looks. We can also get caught up in how much we should write and that it should be every day. There are actually many right ways to journal, and allowing for things to be imperfect is key.

By writing down our thoughts, whether in an orderly or disorderly fashion, we free up our brain to think more clearly, be more present.

No matter what your handwriting ability or time allotment, there is a journaling method for you.

Among the types of journaling are the following:
*Gratitude Journal (ex. write 3 things you are grateful for each day)
Gratitude Journal
*Free Writing (ex., set a timer for 5 minutes and just write whatever comes to mind) The Magic of Free Writing
*Morning Pages (ex., write three pages of longhand thoughts to clear the mind for the day) Morning Pages
*Keep a specific focus (ex., a food journal, an exercise log, including thoughts and feelings) How to Keep a Food Journal Without Losing Your Mind
*Bullet Journaling (my personal favorite-- short and sweet, organized and concise) Bullet Journaling

It might take several tries at different methods before you find one that works for you. Keep at it, the benefits are worth it.

Here are some more articles on journaling for your reading pleasure:
The Benefits of Journaling for Stress Management
What's All This About Journaling?
How Journaling Can Help You Heal
28 Ways Keeping a Daily Journal Could Change Your Life

Get that pen and paper ready!!

Always yours in health,

Stephenie Signature.PNG


sElf on a Shelf-- A holiday fitness challenge

Happy December, friends!

It’s a busy time of year, and often self-care falls low on the list of priorities. With this in mind, I thought I’d introduce a fitness challenge that is both fun and challenging.

sElf on the Shelf -- a wall sitting challenge!

Start at 10 seconds on December 1st and work up to 3:40 by December 22. 

Grab your friends and family and let's work those legs for the holidays!

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I’d LOVE to hear how your challenge is going! Take a picture of yourself doing your wall sit and post it on Instagram with the hashtag #fittbodiesselfonashelf and I’ll personally cheer you on your way to victory!

You’ve got this!

Always yours in Health,

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Avoiding Distractions

I’ve been thinking a lot lately about how much I let distractions dictate my life.

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Distraction is real. It is an energy-drainer, focus-stealer, relationship-tester, and overall problem with just about everyone these days (not just the teenagers), and not just me. 

"Just checking" our phones has turned into a major waste of time for many of us. A telling statistic is the average person checks their phone 150 times a day (The Model Health Show, Episode 307). That's time we could use to work out, meditate, shop for fresh produce, write a thank-you note, have coffee with a friend, read a book, take a walk, volunteer, play catch with your kids, or anything else that could boost our quality of life. 

Our phones aren't our only distractions. Sometimes we are our own biggest obstacle. In his article, "9 Ever-Present Distractions That Keep Us From Fully Living," blogger Joshua Becker outlines ways that we avoid being present with our thoughts, tasks, and the people around us. A quote under the first distraction, "the promise of tomorrow," goes like this: “We waste so many days waiting for the weekend. So many nights wanting morning. Our lust for future comfort is the biggest thief of life.” -- Joshua Glenn Clark

Being present is tough when our minds are bombarded with more information than ever before. In fact, it is said we take in 5 times more data a day than adults did in 1986! (The Chalene Show, Episode 102). This overload affects our ability to focus and complete tasks, and our attention span can take a dive. Some experts believe, based on a recent study, that we have a shorter attention span than a goldfish! Check out the article HERE and a rebuttal HERE (which I personally want to believe).

Awareness of what environments, situations, activities, things, or people distract us the most is the first step towards being present. The next is to set boundaries or rules to live by that enable us to focus when we need to without sacrificing time on our wonderful digital devices.

For your learning pleasure, the podcasts below are great to listen to on your commute, errands, etc., and can help give you ideas on how to minimize distractions and improve focus.  

 Episode 307, "The Model Health Show," with Shawn Stevenson, talks about "12 Tips For Conquering Distraction and Getting More Done."

 Episode 102, "The Chalene Show," with Chalene Johnson, talks about "How to Organize Your Brain-- Creating Laser Focus." (She's got other podcasts about focus HERE.)

I wish I could say I didn’t allow any distractions while writing this post, but, hey, I’m only human.

Always yours in Health,

Stephenie Signature.PNG