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: 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.**

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/

[Quick] Thoughts on Diet vs. Supplementation

          Foods, in a perfect world, provide all the nutrients we need, if we eat a balanced diet. Unfortunately, there are several factors that work against this philosophy. Factory farming over the years has depleted our soils, and the crops grown in these soils are much less nutritionally dense than they once were. Our factory farmed livestock are fed these plants (or worse), and the quality of meat has suffered. Add to this our rushed schedules, eating on the run, and fewer home-cooked meals, and even if the food were nutrient-dense, we lack the variety and wholesomeness that our diets once had. We can’t depend on food alone, anymore, to provide us with the full spectrum of nutrients we need to achieve optimal health.

            Supplementation alone isn’t the answer, either. Regulation of nutritional supplements doesn’t necessarily guarantee optimal nutrients. There is definitely a spectrum of purity and potency in the vitamin/mineral supplement offerings. And without blood tests and labs and consulting with knowledgeable health practitioners (hard to find in traditional medicine, and who tend to not take health insurance), how is the average consumer to know what to take and what is best for them? The average consumer may instead let price be their guide to choosing vitamins and minerals.

            I believe the answer is in the middle. We should eat the most nutrient-dense food we can find: organic, non-GMO, sustainably farmed, humanely-raised, etc., while taking the highest-quality supplements that we personally need based on consulting with an experienced health practitioner and related lab results. Doing so will bring us closest to the optimal health we aspire to. This is not the popular answer, nor is it the cheapest. But I believe it’s the best for where we’re at in the world of nutrition today.

xoxo,

PS-- Check out my 5-Day Clean Eating Guide to get started on your journey toward optimal nutrition.

Nerd-Out: Magnesium

(FOR THOSE OF YOU WHO LIKE TO NERD-OUT ON THE SCIENCE BEHIND NUTRITION, I WILL BE SHARING PORTIONS OF MY WRITINGS FOR MY MASTER'S OF SCIENCE IN HOLISTIC NUTRITION.)

Magnesium

I heard a few years back that magnesium supplements help improve sleep. At the time, I was educating myself on every single alternative way I could keep my breast cancer from coming back, and magnesium kept catching my eye. With the promise of better sleep, and thus improved immunity and decreased inflammation as a byproduct, I was smitten. I promptly purchased a giant bottle of pills from CostCo and began my journey with magnesium.

I have since learned that in addition to improving sleep, magnesium has been used throughout history to relieve headaches, muscle soreness and cramps, depression and anxiety, and improved heart and bone health (13 Amazing Magnesium Benefits, 2017, https://www.organicfacts.net/health-benefits/minerals/health-benefits-of-magnesium.html).

             This mineral is an important player in multiple functions and structures in the human body (Hidgon & Drake, 2012, p.169). Essential to healthy bone structure, 50-60% of magnesium in the body resides in the bones (Smolin & Grosvenor, 2013, p.465). The remaining magnesium is found inside cells, where it is associated with the negative charge on phosphate-containing molecules, regulates calcium homeostasis, is vital in the action of vitamin D, and interacts with many hormones (Smolin & Grosvenor, 2013, p.465). Magnesium is one of the most common cofactors in the body, playing a crucial role in glucose and fat breakdown, the production of proteins, enzymes, and antioxidants, the creation of DNA and RNA, and the regulation of cholesterol production (What is Magnesium?, 2018, http://www.ancient-minerals.com/magnesium-benefits/what-is-function/).

            Magnesium is essential for energy production, metabolizing carbohydrates and fats through several chemical reactions (Higdon & Drake, 2012, p.169). It’s required for the synthesis of essential biomolecules, plays a structural role in bone, cell membranes, and chromosomes, facilitates ion transport across cell membranes, and affects cell signaling and cell migration (Higdon & Drake, 2012, p.169). Magnesium is one of the six essential minerals, vital to optimal health, that can only be supplied in the diet (What is Magnesium?, 2018, http://www.ancient-minerals.com/magnesium-benefits/what-is-function/).

            Magnesium deficiency is rare, as a balanced diet provides abundant plant and animal sources of this mineral (Higdon & Drake, 2012, p.170). Kidneys are also able to limit excretion of magnesium in the urine when intake is low, a sort of self-monitoring system (Higdon & Drake, 2012, p.170). Certain conditions increase the risk of magnesium deficiency: gastrointestinal disorders, such as chronic diarrhea, Crohn disease, surgical removal of a portion of the intestine, and radiation-related intestinal inflammation; renal disorders, including diabetes mellitus and certain medications that increase urinary output of magnesium; chronic alcoholism, where gastrointestinal problems and increased urinary loss of magnesium are an issue; older age, when it is found that intestinal absorption of magnesium decreases and urinary output increases (Higdon & Drake, 2012, p.170). Signs of deficiency include nausea, muscle weakness, cramping, irritability, mental derangement, and changes in blood pressure and heartbeat (Smolin & Grosvenor, 2013, p.466).

            Magnesium toxicity has not been observed from ingestion of magnesium from food, but can occur with over-supplementation and with certain drugs (Smolin & Grosvenor, 2013, p.466). Impaired kidney function contributes of retention of magnesium as well (Smolin & Grosvenor, 2012, p.466). Symptoms include nausea, vomiting, low blood pressure, and cardiovascular changes (Smolin & Grosvenor, 2012, p.466). Some find even small doses of oral supplementation aggravates the gastrointestinal tract, with diarrhea being the leading side-effect (Higdon & Drake, 2012, p.175).

            Dietary sources of magnesium include leafy green vegetables (magnesium is a part of chlorophyll, the green pigment in plants), unrefined grains and nuts, meat, milk, and hard water (Higdon & Drake, 2012, p.175).

            Supplement sources are available as magnesium oxide, magnesium gluconate, magnesium chloride, and magnesium citrate salts (Higdon & Drake, 2012, p.175). Some forms are taken orally while others are absorbed transdermally, through lotions, oils, or bath soaks (What is Magnesium?, 2018, http://www.ancient-minerals.com/magnesium-benefits/what-is-function/). As stated above, some people find oral delivery of magnesium irritating to the gastrointestinal tract, even at small doses, so may turn to the skin delivery system for supplementation (What is Magnesium?, 2018, http://www.ancient-minerals.com/magnesium-benefits/what-is-function/).

            After tracking my food intake for a 24-hour period, my magnesium intake proves to be on track. My Dietary Reference Intake (DRI) is a goal of 320mg/day and my actual intake for the day was 306mg/day (Smolin & Grosvenor, 2010). I fell slightly low in food consumption of magnesium, but I spray a topical pure magnesium oil (magnesium chloride brine) on my abdomen every night for transdermal delivery, which is not reflected in the food journaling. The magnesium chloride brine I spray nightly on my abdomen provides me with an additional 330mg. This takes me to approximately 636mg/day of magnesium, well past the upper limit of my DRI.

            When it comes to my Suggested Optimal Nutritional Allowances (SONA), however, I fall woefully short of the 450-550mg/day recommendation with diet alone (The Suggested Optimal Daily Nutritional Allowances, 2017). The magnesium chloride brine I spray nightly on my abdomen provides me with an additional 330mg. This takes me to approximately 636mg/day of magnesium, past the upper limit of SONA. I experience no adverse gastrointestinal or other side effects with this daily dosage.

             Turned on to magnesium as a healing tool in my breast cancer journey, I am an ardent advocate of its benefits for a myriad of health issues from sleep disturbances to muscle aches and more. Best consumed through diet, it is also available in different oral and transdermal supplementations to ensure adequate intake of this vital mineral.

xoxo,

References

13 Amazing Magnesium Benefits. (2017, October 06). Retrieved February 11, 2018, from https://www.organicfacts.net/health-benefits/minerals/health-benefits-of-magnesium.html

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

Smolin, L. A., & Grosvenor, M. B. (2013). Nutrition: science and applications(3rd ed.). Hoboken, NJ: Wiley.

Smolin, L. A., & Grosvenor, M. B. (2010). IProfile: assessing your diet and energy balance. Hoboken, NJ: Wiley. Retrieved January 25, 2018.

The Suggested Optimal Daily Nutritional Allowances (SONA)[Online reading material for MSHN 515, Hawthorn University]. (2017).

What is Magnesium? How it Functions in the Body. (n.d.). Retrieved February 07, 2018, from http://www.ancient-minerals.com/magnesium-benefits/what-is-function/

Cinnamon Rolls and The Lessons They Teach Us

Ever heard of the Pareto Principle?

It’s a cause and effect theory first discovered by Italian economist Vilfredo Pareto in 1896. It states that 80% of effects come from 20% of causes. Pareto stumbled onto this theory in his garden, noticing that 20% of his pea pods contained 80% of the peas.

What does this have to do with health and nutrition?

What we do when it comes to what we eat and how we move our body can definitely affect our health.

I’d like to suggest that the Pareto Principle is FLIPPED when it comes to health and nutrition.

Here’s how:

If we eat “well” 80% of the time and indulge 20% of the time, our bodies adapt and we shouldn’t suffer too many ill effects of those indulgences. Although the 20% DOES count for a lot, the consistency of the 80% keeps us on the healthy path.

If we exercise 80% of our days and rest 20% of the time, we should be able to maintain a strong, healthy body. Taking some rest days will not diminish our strength, power, or endurance gains. In fact, research has shown that rest days actually ENHANCE our training gains.

If 80% of the time we get a decent night’s sleep, and 20% of the time we stay up late Netflix binging, our bodies will recover. Yes, it’s best to stay on a consistent sleep schedule, but life is fun and sometimes the fun doesn’t start until the kids are tucked away for the night.

You get what I’m saying?

So last weekend was Father’s Day, and the only thing my husband James wanted was homemade cinnamon rolls. Not the healthy kind I’m inclined to make (gluten-free, sugar-free, dairy-free). No. The delicious kind (gluten-full, sugar-full, and ooey-

Here’s a picture of the finished product. Don’t they look fabulous?

Now here’s what I really want to talk about—THE GUILT.

How many of you would indulge in this delicious treat and then beat yourself up for it the rest of the day? The reality for many people I work with is that they feel “bad” or “weak” when they partake of delicious, unhealthy treats. It doesn't need to be that way.

Here’s the thing—If you eat clean, nutritious, healthy food 80% of the time it is okay to take a bite (or 20 as I did) of something not-so-healthy and “get away with it.”

No guilt. No despair. No, you didn’t ruin your diet. You didn’t undo what you’ve been working so hard for.

You gotta live a little, right?

You just can’t eat like that all the time. Father’s Day comes once a year, so the cinnamon-y and cream cheese-y goodness is okay once a year. (We actually do cinnamon rolls Christmas morning, so that’s twice a year). Once or twice a year won't kill you. It won't even effect you much at all. It's the daily "treats" that are our downfall.

We need to plan out our indulgences so we can make sure that 80% of the time we are making good choices. Birthdays, holidays, and anniversaries can be calendared in advance. Work parties, neighborhood BBQs, and other social events usually give a bit of notice, too.

Plan for them.

Calendar your activities so you can make sure you’re eating and exercising 80% of the time. Then relax and enjoy the other 20%. It’s simple.

The flip side of the Pareto Principle—the 80/20 rule—making sure you’re healthy AND happy for a long, long time. Even if you're a health nut like me.

****Oh, and before I go, I thought you might like the homemade cinnamon roll recipe. 

Yours in indulgence,