Boost Your Immunity & Prevent Colds this Season

Boost Your Immunity & Prevent Colds this Season

Love Your Lifestyle 

People who engage in regular movement or meditation are less likely to get sick during the winter months. Getting outside during daylight helps your circadian rhythm and vitamin D levels.  Good sleep supports immunity and prevents colds. Here are 15 ways you can sleep better this season!  Prevent getting sick so you can have more time with your loved ones.

Devour These Delicious Delicacies

This is the time of year to build your defences. Boost these in your diet. Enjoy this season more!

Colostrum: By providing immune cells directly, colostrum encourages the body’s resilience to external viruses. Milk that comes from mammals during the first 72 hrs of their baby’s life that is particularly high in antibodies.

Ginger: There is plenty of scientific research supporting the use of ginger in several pathogenic conditions. This is one of the most used herbs world-wide,

Vitamin C: This powerful nutrient contributes to immune defence by supporting various cellular functions of both the innate and adaptive immune system. It protects against environmental oxidative stress. 42% of people do not eat enough Vitamin C.

Fish Oil:  Much of your immune system is housed in your gut.  Research indicates that DHA (docosahexaenoic acid) in fish oil helps gut immunity by supporting B cell function.  DHA is also one of the major building blocks of the brain.  This omega-3 fatty acid  is critical at all ages of life for optimal brain health.  It is preventative against SADD.

Probiotics: Probiotics are living microorganisms that are found in the gut.  They play an important role in regulation of host immune response.  We are learning everyday how to best target symptoms with strain specific probiotics that are more likely to adhere to the gut lining.

Zinc: This nutrient is well documented as a source of immune support.  Foods that are highest in zinc include oysters, crab and red meat.  Nuts, seeds, legumes, avocados, berries and apricots also have zinc.

Echinacea: The active substances that help support cellular immunity are phenols and alkylamides.  You know you have a potent product if it makes your tongue tingle.

Mushrooms: These work as antioxidants and immunomodulatory. Mushrooms such as Reishi (Ganoderma lucidum), Shiitake (Lentinus edodes), and Turkey tail (Colorus versicolor) protect immune cells.

Vitamin D Deserves Special Recognition

Low vitamin D levels may be one of the key reasons why acute respiratory infections are common during winter and spring. According to a recent study published in the British Medical Journal, vitamin D plays a critical role in enhancing immunity against viral, acute respiratory infections.  Cod liver oil is an excellent way to increase your family’s intake of vitamin D.  For prevention of diabetes type I and type II it is essential to optimize your vitamin D levels.  The blood marker you can ask for from your doctor is 25-OH-D.

 

And Finally My Favourite: Beta Glucans

Beta glucans are highly branched polysaccharides that are non-caloric and impart an immune benefit. These prebiotic foods are mainly found in fungi (mushrooms and yeast) and grains (oats).

One study showed that 9g of beta glucans from brewer’s yeast taken for 16 weeks was able to reduce the number of cold infections by 25% and the symptom score of those who got infected by 15% (1)

Fungal beta glucans have a stronger effect on immune response.  Beta glucans from oats have a more potent anti-lipidemic effect.  My store is nearly stocked with some of the best formulas for supporting your health long-term.  Stay tuned for its launch soon!

 

 

Depression & Allergies? Boost Methylation

Depression & Allergies? Boost Methylation

Optimizing methylation can help with depression, allergies and asthma.  A recent meta analysis showed “consistently lower methylation levels observed at all associated loci across childhood from age 4 to 16 years in participants with asthma.”  The findings of this meta analysis suggest that further investigation of  epigenetics is warranted.  This means a focus on how genes expressed.  

Our health is not determined by our genes.  Diet, environment and lifestyle are more important than we think.

I see women in clinic nearly everyday who are very low in specific nutrients.  This can have far reaching effects on methylation.  The cause is often a vegetarian or vegan diet that they are choosing because they believe it is more healthy. 

Methyl Folate

Specific genetic variations or SNP’s (single nucleotide polymorphisms) can inhibit methylation.  You may have heard of MTHFR.  It’s one of the most commonly talked about gene mutations.  It relates specifically to methyl folate.  The enzyme needed to make this nutrient active is inhibited.  Ensuring you have a folate rich diet is the epigenetic part.  We need 2-3 servings at least.  I say this because if you are a poor methylator you may benefit from more.

Chris Masterjohn, Phd has a handy phrase to help us remember where to find folate. The 3 L’s are Leafy greens, legumes and liver.  One serving is 100 grams so we need between 200 and 300 grams per day of:

  • Cooked vegetables. Fresh and local is important.  Use the water that you cook them in.
  • Double the amount if you are measuring raw vegetables.
  • Wash veggies before cutting, blending.
  • Folate degrades in frozen veggies so avoid any freezing or frozen products.
  • Liver can be weighed before cooking.
  • Legumes need to be soaked, rinsed and then cooked.
  • Buying sprouted legumes and pressure cooking speeds the process.
  • Some people can’t tolerate legumes even if they are prepared in these ways.

Environmental Toxins

Methylation contributes to detoxification of foreign chemicals and heavy metals. The liver is where most of this happens.  What is really fascinating is our cells are constantly adapting to the the demands of their environment.  Methylation is one of the key players that assists with this process.

This explains why how some people exposed to certain toxins feel little effect while others may be debilitated.

Methylation & the Brain

Proper methylation helps keep your brain flexible and focused.  It prevents negative thought patterns from taking over.  Associations between poor methylation and alzheimers have been researched.

Decreased methyl folate production is common.  There are up to 30 different kinds of MTHFR genetic variations making it difficult to convert folate into its active form,L-methylfolate.  Mania, mental illness and depression are linked to some of these mutations.

Allergies & Histamine Intolerance

When you are methylating well your body is getting rid of histamines.  At the root of most allergic reactions is an overload of histamine causing what some call a histamine response.  In the scientific literature this is called  mast cell activation syndrome (MCAT).  Mast cells mediate immunity and inflammation.  Methylating poorly contributes to MCAT.  Triggers like chronic stress and trauma can be triggers for MCAT.

Eat these key nutrients

  1.  Folate or Vitamin B9 requires 2 -3 servings per day of dark leafy greens, sprouted legumes or liver.  This essential nutrient cannot by synthesized in the body so must be ingested.  L-methylfolate is the active form that can cross the blood-brain barrier.  One key function of folate is to help produce serotonin, dopamine and norepinephrine.
  2. B12 needs to eaten frequently.  We can only absorb in a day what is required for that day.  Aim for 4-8 grams of liver, 8 grams of clams/oysters, 375 grams of animal protein, 3 glasses of milk or 3 ounces of cheese.  Research is being done to assess if nori and chantrelle/shitake mushrooms can provide B12 but this is not yet conclusive. In general vegans/vegetarians are at high risk for B12 deficiency.  This is a serious health concern.
  3. Choline:  Egg yolks are an excellent source of choline especially if they are soft.  One egg yolk has the same amount of choline as 50 grams of liver or 200 grams of nuts.  Two or three egg yolks per day meet our need but don’t eat 600 grams of nuts.  Cruciferous veggies are another source as is lecithin.  If you are supplementing try alpha GPC or TMJ.
  4. Glycine:  I’ve written at length about glycine.  Basically we need 1-2 grams of glycine rich collagen for every 150 grams of protein we eat.  You can also supplement with gelatin or have a high protein bone broth as your source of glycine

Who is at higher risk?

Anyone over the age of 65 needs to monitor these nutrients.  If you have a history of ulcers or gastritis you also are at higher risk for deficiency.  Vegetarians and vegans also need to be careful.  Poor absorption can indicate the need for supplementation but generally its best to get these essential nutrients from food.

Remember methylation can be the missing link in your health.  I want you feeling your best.

Glycine or Collagen?

Glycine or Collagen?

Glycine is the Amino Acid that Gives

Without knowing it, glycine is helping your body every day with muscle repair, cognitive function, metabolic health, and immunity. This amino acid assists in breaking down glycogen, fat and other nutrients to be used as energy at the cellular level.  When it comes to aging gracefully it plays a role with the important antioxidant glutathione as well as the human growth hormone.

In the brain glycine acts as neurotransmitter in a similar way to GABA. It is in fact released with GABA to calm or inhibit parts of the central nervous system.  Glycine modulates excitatory neurotransmissions as well, meaning that it can go both ways. This unique neurotransmitter helps with sleep, memory, mental performance, stress, anxiety and even severe mental illness. As a preventative measure for everything from fatigue to stroke this is a powerful supplement.

For stabilizing blood sugar research shows a significant benefit with 5 grams of glycine before each meal so 15 grams per day.  This amount would be difficult to get in either bone broth or collagen.  You’d need two full servings of collagen to get 5 grams of glycine.  With metabolic issues sky rocketing glycine can be an excellent therapeutic aid.

Anyone who over methylates can benefit from glycine because it buffers excess methyl groups.  Methylation is a biochemical process that has an impact on B vitamin status.  Without adequate B vitamins the body will generate less glycine.  Another problem that can happen is that glycine can produce oxalates instead.  This causes a different kind of pain in the joints and can lead to kidney stones.

By restoring gut health you also support immunity.  This is one of the far reaching benefits of glycine.  Given that digestive disorders and autoimmune conditions have reached epidemic proportions it’s worth ensuring you are getting enough glycine.

Where to Get Your Glycine

I mentioned above a few reasons to take glycine in its free form and how it can be difficult to get a therapeutic dose otherwise.  Collagen loading is one way to bring up the balance in the body.  This means taking high doses for a few weeks.

One of the reasons bone broth has finally received so much attention is due to this amino acid along with proline and arginine. However its difficult to know what dose you are getting when you make bone broth yourself.  If you purchase both broth and the label tells how much protein there is per serving then the amount of glycine is a 3:10 ration.  So you get 3 grams of glycine per 10 grams of protein.

Both collagen and bone broth can be taken for maintenance.  Testing B vitamins, metabolism and neurotransmitters through organic acids testing will let you know what is needed.

Types of Collagen: How to choose?  

Grass-fed, bovine sources of collagen provide both type 1 and 3.  What this means is that it targets muscle growth as well as the joints, skin, hair and nails.  This is because Type 3 has proline which supports creatine production.

The parts of the animal that are often wasted are used to make collagen. Grass-fed, pasture raised animals supports a healthy ecosystem in ways that industrial agriculture can’t.  The benefits to humans consuming small amounts of ethically raised animal products is well known.  This is especially key for those with compromised digestive health or autoimmunity.  For recovery from injury, surgery or to alleviate the damaging side effects of some medications it can be considered medicine.  Women who are pregnant, breastfeeding and caring for small children benefit as well.

Collagen harvested from fish can also be very nourishing and done ethically.  However marine collagen has a higher price point.  If its not then likely this is because the source is farmed fish.  The bioavailability will therefore be compromised as the molecules are larger and therefore less absorbable.  Well sourced marine collagen contains only Type 1 collagen which is the most bioavailable and often marketed for beauty reasons.

Type 2 collagen from chicken sources is especially rich in cartilage.  For anyone taking MSM and glucosamine this may be a replacement especially if you try a higher dose.

Optimal Health & Hormones

I mentioned the human growth hormone (HGH).  By building up and breaking down muscle we actually stimulate a cascade of positive physiological responses in the body that keep us feeling and looking great.  I like to think of collagen and glycine as supporting an active lifestyle and optimal health.  The liver loves glycine and the liver is what helps balance other hormones.

Here are all the ways that glycine supports your to feel your best:

  • Energizes:  whether you suffer from chronic fatigue or are an athlete this nutrient improves energy
  • Metabolism:  balancing blood sugar is key to metabolic health and weight maintenance
  • Muscle growth: for those who have lost muscle mass from illness or are enjoying the benefits of strength training
  • Sleep and Nerves: glycine has a positive, regulating effect on the central nervous system
  • Digestion: helps repair the gut by helping form the two key elements required for this which are gelatin and collagen
  • Aging: as a powerful antioxidant it prevents cellular damage and can slow the various ways that aging shows up
  • Immunity: by improving gut health we improve immunity
  • Injury repair:  this includes post-birth or surgery, joint or ligament injuries and harmful side-effects of medications

 

 

Collagen Supports Your Brain, Body & Beauty

Collagen Supports Your Brain, Body & Beauty

Why I Love Collagen

Collagen helps to balance the branch chain amino acids in our bodies.  This has far reaching effects.  Many of you understand the importance of balancing healthy fats to ensure you get enough omega 3’s.  There is a similar balance when it comes to amino acids.  Most of us get too much methionine and not enough glycine.  Glycine can be taken on its own or consumed in either bone broth or collagen.

The reason I love collagen is because of convenience.  I make bone broth but not as often as I need to consume it.  Collagen is convenient.  It can be added to my morning matcha, power balls or an afternoon workout drink.

Grace & Beauty

Collagen nourishes all of our connective tissue.  Its great for anyone who wants a faster recovery time post workout or is experiencing tendon or joint pain.  Connective tissue includes skin, hair and nails.  You may notice collagen being marketed as a beauty aid.  Certainly when we are pain free and nourished, we have a healthy glow.

Adequate amounts of glycine also supports phase two of liver detoxification.  This is often sluggish due to the modern lifestyle and the high stress that comes with it.  We can talk about this from an evolutionary standpoint and it makes a lot of sense.  We evolved eating a wide variety of foods that included some fish and animals.  We valued these sources of nutrient dense food by eating everything.  This gave us a balance of amino acids that nature provides.

Brain Health

Glycine is a neurotransmitter as well!   It has the ability to be both excitatory and inhibitory, meaning it can function both to stimulate brain and nervous system activity, or to quiet it.  Let’s put a few things together.

  • Calms the brain
  • Helps us sleep deeply to support repair
  • Supports organ function especially the liver which cleans our blood at night
  • Liver also regulates all emotions.  When it’s not functioning optimally, we tend to feel frustrated or angry.  When the liver is well we are able to grow in a direction that feels right
  • Grace is a feeling of ease with how life is.  This comes with a happy liver

Strong Bones Long Term

There is more collagen in our bones than calcium.  Remember this applies also to our skin, joints, ligaments and hair.  If you haven’t taken collagen before you can try taking it up to three times a day.  Ideally we’d have 30% of our protein from collagen rich foods.

 

Blood Sugar & Hormones

Protein can stabilize blood sugar so collagen can be an excellent way to support a higher protein intake.  Collagen is a great way to increase the cascade of dopamine first thing in the morning.  Patients report a huge benefit from beginning their day with a warm, protein rich breakfast.

If you aren’t a breakfast person collagen in your hot morning drink can suffice.  For hormone health this is a much better choice.  I often see people using caffeine and fat to suppress their normal morning appetite.  It works for awhile but then hormone and lipid markers start to go out of range.  Symptoms can include afternoon crashes, late night hunger, brain fog, thyroid problems and insulin resistance.

Is it Genetic or Environment?

Is it Genetic or Environment?

For a long time it was thought that mapping the human genome would lead to breakthroughs in medicine.

What we are seeing in recent years as the research matures, is environment weighs in heavier than genetics. In fact, environmental factors account for over 90% of what ends up expressing genetically. My teacher uses this phrase to illustrate the connection: “Genes load the gun but environment pulls the trigger.”

Mismatch Theory

This theory explains how evolutionary medicine can influence environmental factors and turn around the epidemic of modern disease. The mismatch between how we evolved to live and how most people are living today is problematic. For example, humans have not evolved to digest grains and the genetic leap that would allow us to is unlikely. However human infants digest lactose and this explains why in some places up to 90% of people have learned to be lactose tolerant as adults. Dairy can be an excellent source of nutrients and some people have adapted to use this as a food source. Genetically this is not such a big leap.

Mismatch theory isn’t only applied to diet but also lifestyle. Consider light, dark cycles and sleep. Insomnia is a real problem and has serious health consequences. Apply an evolutionary approach by dimming lights at night, using amber-coloured glasses if you must use a screen and ensuring adequate exposure to bright daylight for at least an hour during the day. Many people work indoors and forget that daylight anchors our circadian rhythm. Moving regularly during the day is also important and this allows our body to rest at night. Of course it is easy to overdo this as well so finding a balance is key. These lifestyle factors are linked to environment but harness our genetic memory to optimize health. This is how genetics can be applied in a practical day-to-day way.

Genetics: A gene can be present but may not express

Let’s look at the growing list of diseases linked through autoimmunity. Genetically we have been able to associate a group of genes called HLA (human leukocyte antigen) with several autoimmune conditions including juvenile onset of arthritis (1) and other heightened immune responses. Leukocyte refers to white blood cell which is part of any immune response.

Environment: includes all of the non-genetic influences beginning with conception 

Autoimmunity is linked with gut health. A huge proportion of our immune system is housed in the gastrointestinal tract through the GALT (gastro associated lymphatic tissue). New research shows that probiotics stimulate immunity but do not substantially increase populations of good bacteria. Feeding theses bacteria with prebiotics promotes the long term health of the human microbiome by increasing beneficial gut microbes. Not surprising breastmilk is full of prebiotics.(3) A diet high in cellulose from plant foods is also known to feed the good bugs. Acellular or processed carbohydrates leads to an overgrowth of dysbiotic or pathogenic flora. Complete proteins and a nutrient dense diet supports the repair and growth of the gut lining. Good fats help absorption and blood sugar.

Chemical and biotoxin exposure need mentioning as well. Exposure can lead to chronic inflammatory response syndrome in roughly 25% of people. Mold illness has been linked with the HLA gene as well. One person may be unable to clear this biotoxin from their system whereas another might end up in chronic pain.due to the HLA gene. This same person may be able to integrate diet and lifestyle choices that mitigate damage, reduce inflammation and prevent further health complications long term.

I’m working with a 21 year old male who was given high doses of NSAIDS throughout childhood and who now suffers poor gut health as a result. He is committed to lowering stress, changing his diet and repairing his gut. Functional Medicine offers an approach that he never found in conventional medicine where diet was never discussed. He was continually given more medication that never addressed the root cause. NSAIDS damage the gut as do most medications.

The benefit of an evolutionary approach is the simple lens it offers to complex situations. It harnesses the power of our genetics in a very practical way. Choosing the right diet can seem overwhelming but if we think of how we evolved to eat it is much more manageable. The same can be applied to sleep, movement other important lifestyle factors. The momentum of our genetics is thousands of years in the making so even small changes have enormous benefit.

1. http://www.ncbi.nlm.nih.gov/pubmed/14960534

Increase Vitality with these Five Missing Nutrients

Increase Vitality with these Five Missing Nutrients

Research shows that there are a few keys nutrients most people are deficient in. Find out why and what to do about it.

A nutrient dense diet is the best way to ensure that your body receives as many of the micro-nutrients it requires for optimal functioning. For over 95% of human evolution we only ate this way. Removing foods that cause inflammation decreases the chance of unwanted weight gain.(1) This approach is protective against all modern diseases that involve chronic inflammation. Eating real food increases energy and absorption.

When is this not enough? Factors that influence the bioavailability of nutrients include soil quality and health of the gastro intestinal tract. These environments are crucial factors to vitality.

Simple guidelines to increase nutrient value:

  • Local and organic support soil health. Grow your own plants and animals or support those who do grass fed, pastured and/or organic.
  • Broccoli and other plant foods that grows above ground ought to be eaten shortly after harvest. Each hour and day means a loss of nutrients.
  • Preparation impacts assimilation of food. Slow food supports digestion. For example, bone broth has key micronutrients that nourish the gut and brain.
  • Pleasure is key. Enjoy the whole experience of gathering, preparing and eating. Turn off devices at meal time. Physiologically we are hard-wired for regular celebration and rituals around sharing food.
  • Medicinal aspects of foods are real. Eat a wide and varied diet representing all the flavours. Include pungent, sour, bitter and spicy along with sweet and salty.

A few suggestions to consider when supplementing:

Gut health and thyroid function both require adequate Vitamin D from sun or daylight exposure. These are just a couple on a long list of tissues that use this important nutrient. If you are supplementing please have your levels checked regularly and take breaks. I check a few markers including parathyroid hormone, to ensure accuracy of levels. Toxicity is becoming more common and the effects can be serious and even fatal.

Vitamin D works synergistically with vitamin K2. K2 is responsible for transporting calcium to the bones and is protective against cardiovascular disease.(2) It is found in grass-fed hard cheese, ghee, butter, poultry liver and fermentable foods like kimchi, sauerkraut, beet kvass, kefir and natto (a fermented soybean product from Japan).

Magnesium is key for muscle relaxation and repair. It can also support deep sleep. Regular sleep is protective against heart disease and nearly all other health concerns. Many magnesium supplements come with calcium. I don’t recommend supplementing with calcium as recent studies show it accumulates in arteries.(4) The best form is magnesium glycinate.

Vitamin A is an important fat-soluble vitamin and is bioavailable through animal sources in the form of retinol. Cod liver oil provides both vitamin A and D. It has been used in small amounts as an age old immune tonic for good reason. Organ meats are an excellent source and naturally are consumed in small amounts.

Zinc is key for immune function and balances other micronutrients like copper which become elevated when there is excess inflammation. Zinc is more bioavailable in animal food because phytic acid in plant foods binds zinc. Organ meats, red muscle meats and shellfish are good sources. Pumpkin seeds are also a good source if prepared properly by soaking and sprouting. I don’t recommend supplementing with zinc over the long-term and I always look at the ratio of copper to zinc when working with a patient.

Keep in mind that our current lifestyles are higher in stress than any other time in our evolution. Stress is pro-inflammatory and this along with industrial food systems is why we are missing these key nutrients. An evolutionary approach is valuable and can help simplify some the complexities around lifestyle, medicine and diet.

1. http://dx.doi.org/10.2337/diabetes.52.8.2097

2. http://jn.nutrition.org/content/134/11/3100.full

 

Heart Health 101

Heart Health 101

Suppressing symptoms with pharmaceuticals to treat high blood pressure or cholesterol means missing the investigation as to why these are high in the first place.

 

We know that blood sugar issues and metabolic syndrome contribute to heart disease. In fact there are multiple factors that affect heart health and its worth looking into because often these can be treated and pharmaceuticals can be avoided along with the side effects.

Low cholesterol is known to contribute to disease and death in those with brain disorders and with mental health problems. Low levels are also dangerous for women and the elderly but we rarely hear about this. Conventional medicine is still treating cholesterol as though it is the problem when we know it is not. This obviously leads to more problems. 

Cholesterol is carried on lipoproteins. Science used to believe that it was the concentration of cholesterol on these particles that led to CVD but recent studies have disproven this. Damage to arterial walls occurs not by the cholesterol carried in these particles but by there being too many particles in the blood at once particularly LDL particles.

Those who are at highest risk of heart disease may have normal or low cholesterol but high LDL particles. If one of these people only has their cholesterol tested it may seem that they are in the clear. Those with high LDL-C but low LDL-P are still given statins to lower cholesterol and these drugs have some of the worst side effects.

Our body needs a certain amount of cholesterol. LDL-P carry both cholesterol and triglycerides. When there are more trigycerides then there is less room to carry cholesterol and so more LDL-P are produced. Checking triglyceride levels is crucial as is looking at thyroid health as this can also increase the LDL-P. Thyroid hormone increases LDL receptors. It is also involved with cholesterol production in the liver and cholesterol absorption in the intestines.

Speaking of intestines would you be surprised if I told you there is a link between the markers we’ve been talking about and gut infections? Cholesterol, LDL-P, tryglycerides and low HDL are all linked with H. Pylori infection to name one culprit. In fact treating the gut can result in lowered LDL-P with no other interventions.

Soluable Fiber: Plant Food

Want to improve your life span and quality of life? Soluable fiber increases clearance of LDL, improves insulin sensitivity and binds to cholesterol. It is found in most root veggies, some that grow above ground and in some fruit.

Healthy Fats and Good Chocolate

Macadamia nuts, almonds and olive oil provide excellent sources of good monounsaturated fat. Dark chocolate lowers blood sugar and LDL. It also improves insulin sensitivity.

CoQ10 and Polyphenols

Organ meats and vegetables have plentiful anti-oxidants. They along with polyphenols are protective. Eating a range of colorful vegetables, spices and teas are provides enough and supplementing from reputable companies is also good.

Fish is better than Statins?

Once study showed that eating cold water fatty fish was more effective at reducing death than Statin drugs. The benefits of consuming enough EPA, DHA and long chain omega 3 fats has several benefits to cardiovascular health. Keep in mind that recent studies show that fish is better than fish oil.

Sleep and Move

Of course having fun, feeling connected and enjoying life are crucial for heart health. Sleep duration needs to be between 7-9 hours per night for adults. College age, adolescents and children require more sleep. Devices have no place in the bedroom as the light exposure interferes with the suprachiastmic mechanism in the brain and is disruptive to deep sleep cycling.

Five Key Habits for your Brain and Cognitive Function

Five Key Habits for your Brain and Cognitive Function

Brain health is influenced by many factors and we know there are a few habits that support long term function.

 

The inflammatory cytokine model of depression shows the influence diet has on cognitive function. Omega 6 oils are linked to depression and are pro-inflammatory. One in four adults experience mental illness in the US and the standard American diet is high in omega 6 oils. (1) Depression is increasing at an alarming rate of 20% each year.

1. Protein and Fat

Supplementing with omega 3’s is an option, however quality is an issue. Keep in mind that grass-fed dairy, meat and pastured eggs all are high in omega 3’s whereas conventional varieties are much higher in omega 6’s. Cold water, fatty fish that is wild is an excellent source of omega 3 oils as well as the important fatty acids EPA and DHA. DHA has been shown to support brain function particularly in depression, bipolar disorder and ADHD . Comparatively, vegetarians and vegans ingest 30-60% less EPA and DHA.

Monounsaturated fats like cold pressed, extra virgin olive oil increase the production of ACTH which is an important neurotransmitter. All neurotransmitters are built from amino acids in the gut. Glycine, a component of bone broth, reduces psychotic episodes and improves cognition by acting as an inhibitory neurotransmitter. It will antagonize norepinephrine which helps regulate the stress response. Cholesterol nourishes the myelin sheath of the brain.

A staggering 30-40% of people do not respond to anti-depressants. One of the ways these function is to inhibit the stress response by lowering high cortisol levels. Although, it can’t be known if an individual has high, normal, or low cortisol without testing. As a result this may explain why so many don’t respond. Cortisol is anti-inflammatory and by lowering it without proper testing it could actually increase inflammation.

2. Caffeine has many benefits in moderation

Caffeine is known to exacerbate anxiety especially in the afternoon and evening. The resulting lack of sleep and improper light exposure disrupt circadian rhythm. Over 20% of people with insomnia develop depression. In addition, those at high risk are mother’s whose iron and fat intake is not optimal. Interestingly half the population are poor metabolizers of caffeine. There may be a link between those with a gluten intolerance.

3. Gut Health and Gluten

The number of people who have undetected celiac disease and non-celiac gluten sensitivity is growing. The connection between celiac disease and cognitive dysfunction has determined at least 22% of people are likely to experience both. An astonishing 57% of those with neurological dysfunction test positive for anti-gliadin antibodies. Clinically I’ve seen people who tested negative for gliadin which is the standard test and when I test other gluten specific antibodies they are positive. The disorders associated with gluten include: seizures, neuropathy, ADD, ADHD, autism, ataxia, anxiety, depression and schizophrenia.

4. B-Vitamins

Vegetarians and vegans are 68-83% deficient in B12. B12 deficiency is associated with alzheimer’s, dementia, cognitive decline, memory loss, depression, bipolar and psychosis. B12 absorption can be impaired by dysbiosis, leaky gut, inflammation, pernicious anemia which is autoimmune, alcohol, pharmaceuticals, low stomach acid and IBD.

Folate and B6 are needed for serotonin synthesis. Additionally, a deficiency of these also increases inflammatory homocysteine.

5. The Minerals: Zinc and Magnesium

Copper and zinc act as neurotransmitters in the brain. The ideal serum ratio is .7 copper – 1 zinc. Oxidative stress and inflammation reduce zinc and increase copper. Low zinc indicates inflammation.

Magnesium acts at the blood brain barrier to prevent stress hormones from entering the brain. Prevents anxiety and depression after a traumatic brain injury. Caffeine and stress in excess deplete magnesium. Too much calcium inhibits absorption. Calcium from food is enough for most people.

Magnesium is stored in our bones. Acid reflux, Crohn’s, colitis, kidney disease and alcoholism contribute to a deficiency. Proton pump inhibitors are used to treat reflux by masking the symptoms and these will also deplete the body of magnesium overtime.

The recommended dose between 500-700 mg/day. Food sources include: dark leafy greens, cacao, bananas, soaked nuts, seeds and legumes. Protein will be better absorbed with a diet higher in protein. Some pharaceuticals block absorption and create deficiency of magnesium including PPI’s, Lasix, digoxin, nitrofurantoin, anti-malaria drugs and bisphosphonates.

Symtoms and conditions associated with low levels include: muscle cramps, heart arrhythmias, tremors, headaches, acid reflux, increased risk of heart disease, hypertension, metabolic syndrome, type 2 diabetes, migraines, premenstrual tension syndrome, asthma and hypothyroidism.

I recommend magnesium gylcinate and suggest that people take one capsule at night along with eating a nutrient dense diet free of the phytates that bind magnesium. Loose stool results from too much and can be to help with occasional constipation. Taking magnesium before bed will help relax your muscles and supports good sleep.

This isn’t a diet. It is about being human.

This isn’t a diet. It is about being human.

An ancestral approach is much more than a diet.  Let’s start with a handful of startling facts from the industrial world:

  • 1 out of 6 children in the industrial world has a developmental delay
  • an infant as young as 1 has been diagnosed and treated with an anti-psychotic medication
  • depression is the number one disability in adult populations
  • 40 million have an anxiety disorder
  • 40 thousand suicides a year in the US alone

This is crazy! A disconnect has happened. It has led to an epidemic of chronic disease that is new. The effect on our children is most concerning. How we are living is undermining our health and particularly the ability of our brain function.

What are the solutions?   I asked this many years ago as I watched a friend develop schizophrenia. Diet changes help him a lot but the medications he was on were debilitating. Unfortunately meds are given more weight than diet in conventional medicine. And yes they are crucial at certain points. Limiting them is also very important.

A new patient in my clinic today was told that stress, diet and lifestyle have no role in her fibroids. Since the medication she was given didn’t work surgery has been suggested. Unfortunately these are the only tools doctors have. Patients are left knowing that changes are needed but not knowing what to do.

Intuitively I knew what was needed when I became ill and it wasn’t medication. When I found my doctor and mentor he reminded me of what I already knew. This information is in our bones.  He learned medicine in an oral tradition and so he shared his knowledge in this way. We need this kind of human connection.  As a First Nations man he talked about how we are all indigenous.  We all come from the same earth.  Tuning into our bodies and the genetic wisdom etched in our DNA is what reconnects us.  Its how we heal.

So yes, this is more than a diet.  The ancestral approach includes how we relate to all aspects of being human. Most people have a nature deficit.  A lack of intimacy, play and pleasure have been replaced with screen time.  Light exposure is raising our stress levels while good stress like exercise, learning and new experiences are being put aside.  We need these homeotic stressors to adapt.

“Cultivate strength of spirit.” Leni Wylliams

Leni Wylliams was one of my dance teachers when I was young.  Do you remember the words of someone you looked up to?  This phrase stayed with me.  Physical training and art strengthen our spirit.  Being immersed in nature helps us relax into being human.  Meditation allows us to live with confidence and dignity.  Anything that assists you in turning towards life, even the painful parts, is what keeps you well. Life is not about avoiding the storms, but about making sure we have the resiliency to endure them.

Noticing where we draw strength from is important.  What in your early years taught you to trust life?   Growing up on a farm and having a brilliant, stay-at-home mother gave me a good start.  At the time infant formula was being pushed and she didn’t buy into it so I was breastfed.  She taught me to honour the female body and to be skeptical of oral contraception.  She’s fabulous.  I pursued Functional Medicine because of how she raised me.  Listening to women and children is another way we can revolutionize the medical system.

Six Essential Nutrients to Consider 

Kindness

Confidence

Respect

Dignity

Being taken seriously

Feeling heard

 

 

Why Belly Fat?

Why Belly Fat?

“Why do I have abdominal weight gain?” – This is a question I often get from patients.

Basically it’s an imbalance of hormones beginning with our stress hormones and involving insulin.  You may have heard me talk about how cortisol is a glucocorticoid.  Gluco meaning glucose or blood sugar.  Cortisol meaning stress.

When we get stressed we either overeat or under-eat and this is why.  Both make sense from an evolutionary standpoint.  Overeating is a way of preparing for famine, and storing abdominal fat was how we did this.  Under-eating prepares us to flee as in the flight response when the predator is on our tail.  Keep in mind stress hormones are upstream from our sex hormones including testosterone, progesterone and estrogen.  These often get out of balance when there has been prolonged stress either perceived, or internally caused by physiology.  You may remember that cortisol, when functioning optimally, is an important anti-inflammatory.

One night of poor sleep can increase inflammation.  The problem is that no one want to hear this because we are all not sleeping well, especially those who are parents with young children.  What I notice when I miss lunch is I can’t rest at night.  The combination of stress, no food, and insomnia creates a cluster of other problems.  Simple changes at any one of these junctures goes a long way because all these systems are interdependent.

For example, the number one hormone imbalance affecting women and causing infertility is polycystic ovarian syndrome (PCOS).  It is strongly associated with insulin resistance, inflammation, and HPA axis dysregulation (hypothalamus pituitary adrenal).  Adrenal glands produce cortisol.

My doctor tells me to “Just lose some weight!”

This research suggests that high-intensity interval training (HIIT) is the most beneficial way for for women with PCOS to exercise. By improving insulin sensitivity, body composition, and endothelial function, HIIT targets several of the key components of PCOS.  This can all happen in the absence of weight loss which is interesting.  Often women with PCOS are told by their doctors to lose weight.  I hear over and over how this is not helpful and I understand why.  When a perfect storm is happening on a physiological level weight loss is not possible.  A body that is stressed will not be adapted to lose weight no matter what.  We also know most doctors don’t have the diet and lifestyle information to help.  HIIT can be an adjunct to other interventions that support hormone balance including a stress management program and the right dietary approach.  Many places offer HIIT classes, making this an accessible option.

HIIT improves insulin resistance.  In this study thirty-one women were assigned to either high-intensity interval training, strength training, or a control group for 10 weeks.  The HIIT group performed two weekly sessions with four minutes of exercise at 90 to 95 percent of maximum heart rate. This was separated by three-minute periods of moderate intensity exercise at 70 percent of their heart rate maximum . They also performed one weekly session of 10 bursts of maximal intensity HIIT separated by one minute of rest.

Strength Training vs Moderate Aerobic Exercise

In this study each woman chose her mode of exercise.  They regularly used a treadmill, bicycled, ran, or walked outside. The strength training group performed eight weightlifting drills with progressively increasing weight on gym equipment three days per week. The control group performed 150 minutes of moderate-intensity exercise per week.

After the 10-week exercise intervention period, it was found that insulin resistance improved significantly only in the HIIT group. HIIT also increased HDL cholesterol, improved endothelial function, and decreased body fat percentage.

I wrote another article about how resistance training is the number one form of exercise to integrate into your lifestyle.  The long term benefits outweigh all other forms and it is the antidote for our current culture.  For anyone who hopes to age gracefully this is the ticket. However this memo has not made its way to the mainstream yet.  Most medical research still focuses on aerobic exercise.  This is why I was so excited to see this article pop up last month.

 

 

New Research on Fertility

New Research on Fertility

Both women and men want to optimize health prior to conception.  Addressing underlying health concerns at this time is ideal.  Pregnancy, birth and caring for an infant is a time of joy.  It also requires a lot more energy than most admit.  Stress can be high. Get to know what keeps you both going and support this.  Know your weak spots before there is a baby.  Then you can create a support plan.

I ask my patients to allow two to three months to focus on their own health before conceiving.  This gives enough time address anything acute and level out stress.  A nutrient dense diet sets a baseline, stabilizes blood sugar and addresses deficiencies or intolerances.

Hormone testing can show a lot.  The lab I use includes a look at neurotransmitters.  Preventing post-partum depression and anxiety for both partners is highly recommended.  Our children’s stress response is wired to ours even as they are conceived.  The early years provide the foundation for a happy life if we tend to our own selves first.

Here is the latest research around fertility:

Daylight & Vitamin D

Vitamin D plays a role in the regulation of the female reproductive system and fertility. Vitamin D3 and increased sun exposure have shown to be positive for those suffering from PCOS (polycystic ovarian syndrome), endometriosis, and infertility.  Keep in mind that too much vitamin D can also pose a problem and this is why testing is important.

Going back to sun exposure this research indicates that shifts in the light/dark cycle disrupt the circadian system and the female reproductive system. For women looking to optimize their fertility and have a healthy pregnancy this information is important. Advising against shift work for their women who are hoping to become pregnant and reducing artificial light at night may enhance fertility. Wearing glasses that block blue light and normalizing sleep schedules are two helpful tricks.  The sleep/wake cycle is tightly linked to the light/dark cycle.  This is why early morning exposure to daylight and being outside for at a minimum of 15 minutes per day are crucial for restful sleep, healthy stress response and fertility.

Microbiomes: Oral & Genital

Healthy genital microbiomes increase positive pregnancy outcomes. Lactobacillus reduces the harm that spermicidal contraceptives and antibiotics cause. Treating gut health optimizes the immune system as well.  Infants receive their immunity from us as we pass them on during birth and breastfeeding.  Yes the skin also has a microbiome too!  It’s ideal to address infections and imbalances prior to pregnancy.  It becomes more difficult to resolve these safely until after breastfeeding is complete.  

Gingivitis is a common infection that occurs in the mouth.  It may affect a woman’s ability to conceive by causing a systemic inflammation.  Reducing carbohydrates in the diet while increasing antioxidants, omega-3 fatty acids, and fibre reduced periodontal inflammation.  Specific probiotics are used to target the oral microbiome.

The Functional Approach

I enjoy working with people who are committed to addressing the root cause.  Infertility rates are rising each year which is concerning on many levels.  Environmental toxins, high stress, poor food quality, and lack of sleep all play a role.  These are the trends and yet each patient is unique.  We investigate what’s happening for you. These discoveries increase connection and pleasure.  Both release oxytocin, the hormone of love.  Making simple changes that are specific to you can result in the arrival of a healthy baby.

 

Want Your Life Back?  Autoimmune Paleo Could Be It

Want Your Life Back? Autoimmune Paleo Could Be It

Digestive health was what got me into studying medicine so when new research comes out I get really excited.  Its fairly often that I have a patient with irritable bowel disease.  Until now the dietary intervention that I see work clinically hasn’t had research to back it.  This particular study is therefore a landmark and I definitely suggest glancing over the abstract.

New Research Backing the Autoimmune Paleo Protocol (AIP)

The participants of this study were all in an active flare of either Crohn’s or Ulcerative Colitis.  All were symptomatic and need to have received an endoscopy.  Labs included tissue biopsies, gut testing to assess the changes in the microbiome and 6 weeks of an autoimmune paleo diet.  This was followed by 5 weeks of maintenance and monitoring.  Their medications remained unchanged during the study.  Quality of life surveys were included. The average age of participants was mid 40’s and most had the disease for roughly 20 years.

The results were incredible: 73% went into clinical remission!  This is based on the standard indexes for each disease taken at 3 different intervals during the research.

Average Mayo score (disease activity) in ulcerative colitis patients

  • Baseline: 5.8
  • Week six: 1.2
  • Week eleven: 1.0

Average Harvey-Bradshaw index (disease activity) in Crohn’s disease patients:

  • Baseline: 7.0
  • Week six: 3.6
  • Week eleven: 3.4

These results are encouraging given that most others treatments for IBD come with multiple side effects.  An increased risk for infection is common.  These drug have mixed results with high variability.  But in this study four participants were able to discontinue some or all of their meds.

People who develop one autoimmune disease often develop more.  So this kind of dietary intervention is actually saving people’s lives.  I see it in my clinic and I hear the same from colleagues in Functional Medicine.

Treatment in conventional medicine usually includes suppressing the immune system with pharmaceuticals and invasive surgery which doesn’t get to the root of the disease.

What causes IBD?

Genetics:  231 single nucleotide polymorphisms (SNPs) within 200 different genes are associated with IBD risk. But genetics only account for a small proportion of the variance in disease.  In Celiac Disease only 8.2% can be linked to genetics and 13.1% in Ulcerative Colitis)

Environmental Factors: include gut dysbiosis, environmental toxins, and diet, among others play the biggest role.  Increased risks from eating a Standard American Diet (SAD) are well know whereas anti-inflammatory diets like AIP are known to offer relief.

Food Sensitivities: 65% of people with IBD have known food sensitivities. Some patients may not know which foods might be harming them.  An elimination diet like AIP is the gold standard for assessing food sensitivities. Alternately testing is available.  For my patients I always start with an elimination diet.  Once people start feeling better these dietary changes are really not as difficult to make as people think.

Making The Leap and the Commitment

When he was 3 years old, I took my son off of egg whites and gluten after he developed unrelenting eczema on his legs.  Both these foods are excluded in AIP.  I used both an elimination diet and serum blood testing.

His skin cleared up immediately.  Yes he wants to eat gluten sometimes and he has egg whites occasionally in baked goods but I monitor him.  Skin and lungs are connected and this is the first winter he hasn’t had a persistant cough.  He did have an asthma attack in the fall but so far this is the only one and it wasn’t severe. He doesn’t need to be on steroids.  This may be due to the herbs and other interventions I’ve implemented.

Having a limited diet is not always easy socially.  We both have to make the commitment for it to work.  The pay off is that he is thriving.  I’m pretty convinced that if I had followed the doctor’s suggestion to use hydrocortisone on his eczema and make no diet changes he would have multiple more serious concerns to manage instead.

Conventional medicine does a great job monitoring his lungs.  We are lucky to have met with an excellent pediatrician who we happen to know personally.  He is curious and open about what other treatments we’ve explored.  I know its not always like this.  Patients tell me every week how they don’t feel this level of respect from their care provider.  Functional medicine is holistic meaning it’s inclusive of allied professionals.  Its also evidence-based meaning we stay on top of current research and are always looking for more effective ways of treating patients.

Looking to the future I see an integrative model of medicine where lifestyle and diet are primary interventions for chronic conditions.  This kind of research is an important step in the right direction.

 

 

 

 

Kindness & other Essential Nutrients

Kindness & other Essential Nutrients

 

Every week a couple of my patients say or do something that strikes me.  “Thank you for being kind,” were the words of one woman.  I wasn’t being particularly kind in my mind.  What I was doing was taking her concerns seriously which she had expressed was a new experience for her.  In Functional Medicine we deliberately spend more time with patients.  We value the insights that emerge from listening to what’s happening to them.  We look at diet and lifestyle as primary interventions.  I also seek to understand how the mind is working for or against the process of regaining health.

Another patient commented on an article she read.  It stated that all protein comes from plants.  She was asking how then could her diet have played a role in the deficiencies that showed up in her lab work?  People can feel fine on a vegetarian diet for years.  Often this is followed by either a health crisis or a slower process leading to poor recovery, low immunity, hormonal imbalances, brain fog, fatigue or a host of other symptoms.

Nutrients that are essential for life are accessed by eating a wide variety of food.  For 66,000 generation humans ate meat, fish, fruit, vegetables, nuts/seeds, starchy tubers and other plants.  Macro nutrient ratios certainly varied geographically however no one was eating the refined foods we see on the shelves of every grocery store today.  We are adapted to thrive based on how we have adapted for most of our evolution.

Evolutionary biologist Theodosius Dobzhansky once said, “Nothing in biology makes sense except in the light of evolution.”

When our environment changes faster than we can adapt, a mismatch occurs.  This is what has happened with the advent of industrial agriculture.  Traditional agriculturalists knew to prepare grains and legumes properly to lessen the impact of nutrient inhibitors.  We also know traditional cultures were not vegan and those who ate mostly vegetarian didn’t do so by choice.  Let’s look at why.

Nutrient Inhibitors

Oxalate and phytate from grains and legumes inhibit nutrients absorption of calcium, zinc and iron for example. I see many patients with low iron.  At least part of the reason is because plant-based iron is impaired by things that people consume every day like coffee, tea, and dairy products. This explains why vegetarian diets are known to reduce plant-based iron absorption by 70 percent.  On the other hand, calcium is the substance that inhibits the absorption of iron from animal products.  Heme iron is highly absorbable and its much more cost effective to get it from food as opposed to supplements.

Vegetarian diets also have been shown to reduce zinc absorption by 35 percent. Plant foods containing zinc also contain phytic acid.  Someone may be consuming the recommended daily allowance (RDA) for zinc but if its all plant based they can still be deficient.

Precursor vs. Active Forms

EPA and DHA are the long-chain omega-3 fats.  Occasional a patient will say to me that they take a vegan or vegetarian source of these essential oils.  The problem is that little of the plant-based ALA gets converted into DHA.

Vitamin A is another essential nutrient that is widely misunderstood.  Beta carotene is the precursor that is found in plant foods and fortified foods. Retinol is the active form.  Humans are not good at converting beta carotene to retinol.  The RDA for retinol is a tenth of what our ancestors consumed and thrived on.  To get just the RDA  would require us to eat an enormous amount of plants like carrots, sweet potatoes and kale everyday whereas one serving of liver would be enough for the whole week.  I’m not suggesting that we don’t also eat vegetables. In fact I want everyone to eat the rainbow in vegetables but this isn’t enough.

If you go to your local butcher or the meat department at the grocery store, you’ll find out that liver often gets thrown out.  Doesn’t it make sense to use this instead supplementing out of a plastic bottle?

Nutrient synergy.

Most nutrients require the presence of other nutrients, called cofactors, to allow absorption.  We talked about the conversion of ALA to DHA.  The cofactors that this conversion depends on are zinc, iron, and B6.  Most vegetarians and vegans are unlikely to get enough in their diet of any of these essential nutrients.

The reason I suggest cod liver oil to most patients, especially in the winter, is because it nails all the points I’ve listed above.  Its a synergistic and bioavailable source of essential vitamins D and A in its active form.  It also contains EPA and DHA.  Eat some oysters and you’ll get a good dose of zinc, B6 and B12.  For iron, enjoy a serving of liver pate and you are set!  These are the real superfoods.

Creating Kindness

Most vegans need to supplement B12 and vitamin D at the very least to maintain health. Enough retinol, or the active form of vitamin A, EPA and DHA, zinc, iron, and calcium also needs to be consumed and absorbed for long term wellness.

Insomnia and anxiety or depression can be rooted in low iron.  This is an example of how a deficiency of one essential nutrient can have wide reaching consequences.

The opposite is also true.  When I start patients on an ancestral diet, treat the gut and rule out other causes of malabsorption they feel more alive and ready to make a difference in the world.  The potential of creating a kinder world rests on our ability to be healthy and well-resourced.  This is what preventative medicine is all about.

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Treating PCOS Effectively: What is the Real Cause?

Treating PCOS Effectively: What is the Real Cause?

What is PCOS and why should you care?

Polycystic ovarian syndrome affects 10% of North American women in their child-bearing years. It’s the leading cause of infertility and is on the rise. Syndromes are a group of symptoms that conventional medicine groups together.  PCOS is more of a pattern than a disease. Cysts on the ovaries are not always present. Acne, irregular cycles, weight-gain, facial hair growth and loss of head hair can be part of the presentation.

The Underlying Cause

Blood sugar plays a huge role in PCOS. Insulin is a hormone and it helps regulate sex hormones. PCOS is really an imbalance in hormones.

Stress has a huge influence on all our hormones. Environment also is a key factor, more than genetics even. Genetics express if triggered by an exogenous factor so we are back at lifestyle, nutrients and yes meditation. The habits that lead to blood sugar dysregulation are not genetics.  These are choices that we can change  PCOS is an epidemic and there is a lot we can do as far as education to influence this.

Insulin Resistance & Female Hormones

Insulin pulls sugar out of blood and escorts it to our cells. Eating refined foods means our bodies will stop responding to the massive overload that hits the blood at once.  Fibre in whole food is really protective on so many levels and this is one of them. The pancreas will continue to produce insulin despite high levels accumulating in the blood because insulin is overwhelmed and not responding. So now we have high sugar and high insulin in the blood.

FSH and LH are two important female reproductive hormones that are affected by insulin directly. Then in turn these affect progesterone and estrogen.  We have so much more control than the medical model suggests in terms of understanding how an individual is adapting.  Comprehensive hormone testing that includes metabolites of progesterone, estrogen and the androgens including testoterone.  Looking at blood sugar levels in at least two ways is also important.  A diagnosis can be helpful but only if the patient feels like she has options and is in control of her treatment.

Weight Gain is a Cause? Or a Symptom?

Old school doctors will tell patients to just lose weight. The problem with this is how? By any means? This will likely exacerbate the symptoms because the majority of weight loss measures promoted are extremely problematic.

Plus weight gain is not the cause! It’s a symptom. Yes weight gain, inflammation and other factors are part of the vicious cycle of insulin resistance and PCOS. But keep in mind certain hormonal imbalances make it very difficult to lose weight.  So what works for most people won’t make a dent no matter how hard a woman tries.  This is insanity.

A few important steps anyone can take to regulate blood sugar are:

1. Eat enough protein: our body has an innate stop button when it comes to protein. You will know when you’ve had enough. When we are nourished with longer burn foods, we don’t crave simple carbs and sugar.
2. Root veggies: get your carbs from the veggies that grow below ground. These also have a longer burn, are packed with vitamins and support the health of your colon. This is where we eliminate excess hormones like testosterone. Another problem of refined food is that it results in poor colon function and these hormones will be reabsorbed and recirculated.
3. Clean up all your beauty products especially beware of scents. Look through your cleaning products too. Our detox system is burdened by all of these and make it harder to eliminate hormones. They are full of xeno estrogens (xeno is bad). Stay away from plastics as much as possible.
4. Eat more healthy oil and fats. Omega 3’s are especially important. Studies show that androgens are lowered by diets higher in omega 3’s. They are also anti-inflammatory meaning less pain.
5. Chromium helps regulate blood sugar. It can be found in a variety of foods including grass-fed beef, eggs, broccoli and sweet potatoes. Most of us are deficient. Cinnamon regulates blood sugar too. Yes, food is medicine!

Conventional medicine has lost sight of prevention and treats PCOS as though it’s a disease that needs life-long medication. Birth control and metformin are often prescribed.  What is needed is a deeper look at what’s going on. In fact there are many ways to address PCOS that are natural.

6 Ways to Live Cleaner This Summer

6 Ways to Live Cleaner This Summer

I hear the word genetics used to describe conditions that we can’t control.  It’s true that there’s is a lot we have no control of.  When it comes to genetics we actually have a lot more power than we think.  Diet and lifestyle choices are heavy players. In fact 90% of what gets expressed genetically is due to factors within our control.

Here are 6 steps you can take to lessen the impact of living in today’s world:

1. Each day our bodies are exposed to thousands of chemicals.  One of the biggest culprits is personal care products.  This industry is completely unregulated. Luckily we have groups like the Environmental Working Group (EWG).  Moisturizer, toothpaste, shampoo, deodorant, and cleanser alike have hundreds of ingredients.  Most of these are chemicals that our detoxification system has to deal with.  It’s a huge burden and stress to our liver, lymph, lungs and skin.  Only choose products you trust with labels you can read.   If you aren’t sure use the Skin Deep Guide or the Healthy Living app to check a product.

2.  When it comes to food local and organic makes a huge difference.  Grow your own if you can.  Check the soil quality where your food is grown.  Since cost is a real factor use the EWG’s Dirty Dozen and Clean Fifteen.  These list can help you decide where its crucial to buy organic and where you can get away with conventional varieties.  These lists are updated each year so its worth having a look to see what this season holds.

3.  As my son enters school age the challenge of making lunches looms large.  Storing food safely is actually a big deal.  Plastic containers have hormone disrupting chemicals like BPA.  Even BPA free plastics have other chemicals that aren’t tested or safe for bodies.  Glass and stainless steel containers are the way to go.

4.  Water bottles are the same and the water that goes in them is also very important.  The EWG has a Water Filter Guide.  The Berkey is popular as are reverse osmosis systems like Radiant Life or carbon filters like Crystal Quest.  Make sure that whichever one you decide on removes chlorine, fluoride and lead along with other toxins.  Get your water tested regularly.  If you live in an urban area or a damp environment consider an air filter for your bedroom.  Open your window at night for fresh air if you live close to nature.

5. Household cleaning products are full of chemicals.  Use safer ones that have been tested by the EWG. They’ve tested thousands and have a free directory you can access to make sure you are using safe products in your home.

6.  Eat real food and drink two litres of water per day.  Manage stress, sweat often, play more and get enough sleep.  All of these play an important role in detoxification.  Help your body do its job and enjoy all the benefits.

Are Statins Really Necessary?

Are Statins Really Necessary?

Two  patients came in recently with high cholesterol levels.  One is a woman in her twenties and another is in her 60’s who recently decided to stop taking statins because of the side effects.

There are some medications that do more good than harm.  Statins are not in this category  This is one drug that is prescribed in cases where other interventions really ought to be tried first. When patients bring in labs with elevated cholesterol and other lipid markers I have a few ways I support them.  Those on Statins report serious side effects like  insomnia, muscle weakness, pain, abdominal cramping and the list goes on.  Having looked at the research I have a few suggestions.

Is cholesterol and saturated fat bad?

We now know that dietary cholesterol and saturated fat do not cause heart disease or raise blood levels of cholesterol.  What current research shows is metabolic issues, like insulin resistance, and inflammation play a much more significant role. Your risk of developing heart disease is not based on dietary fat intake.  Blood sugar dysregulation is more of a factor.

Vitamin K2 and Fat Soluble Vitamins

Vitamin K2 is only produced by grass-fed animals.  It can be found in pastured raised egg yolks, grass-fed dairy and animal products.  It is essential for bone health and protects against cardiovascular disease.  All fat soluble vitamins have a complex synergy so ensuring enough vitamin A and D from cod liver oil is also key.

Dietary Considerations

An ancestral or paleo type diet that is low in processed foods, removes industrial seed oils and increases healthy fats is a good choice for most people.  This nutrient dense approach is anti-inflammatory and includes important micronutrients.  Individualization is incredibly important and possible within this approach.  For example, those with insulin resistance, high triglycerides and low HDL will benefit from a low carbohydrate diet. For someone else who has high cholesterol but no insulin resistance, could enjoy a Mediterranean paleo diet.

A low carbohydrate diet means that 15% or less of calorie intake is from paleo-friendly carbs. This may increase LDL for 3-6 months but will then level out.  HDL increases on a low carb diet while metabolism and weight stabilize. Intermittent fasting can be a useful tool as well depending on blood sugar and stress response.

A Mediterranean diet includes more paleo -friendly carbohydrates. Aim for 25-30% of calories from fruit, starchy tubers, and full-fat dairy, white rice, or properly prepared grains. Focus more on monounsaturated fats like avocados, olives, and nuts, and long-chain omega-3 fats EPA and DHA found in cold-water fish and shellfish.

If you are concerned with heart health, focus on fish and monounsaturated fats. These reduce LDL, triglycerides, and inflammation. They increase HDL and lower blood pressure. Aim for a pound of cold water fatty fish each week. Those fish with high levels of EPA and DHA such as salmon, mackerel, herring, sardines, anchovies, and bass are excellent choices. Include shellfish like oysters, clams, and mussels.  Olives, olive oil, avocados, and macadamia nuts are great as well. All tree nuts can be included. Several studies prove several benefits to nuts in terms of cardiovascular risk factors like BMI, waist circumference, and systolic blood pressure.

Other Important Factors

I have written extensively about fermentable and soluble fibers.  Gut is the core of our health. Attending to the microbiome has clinically shown to regulate cardiovascular markers.

Antioxidant and polyphenols are found in many of the foods that are part of a paleo-type diet. A quality CoQ10 supplement may be one worth taking for a period of time.

Sleep is important.  Research shows we require 7-9 hours a night.  One night of lost sleep raises inflammation throughout the body.  Poor sleep has far-reaching effects including contributing to metabolic disorders.

Enjoying movement regularly supports a healthy weight, improves blood pressure as well as insulin sensitivity and lipid markers.

What if I have a family history?

Even with a family history of cardiovascular disease there are a number of steps you can take to prevent being on a statin.  Lifestyle and environmental factors are more relevant than genetics in most cases.  Without a trigger to activate the genetics there may never be an expression even with a strong family history present.

Keep in mind that people are diagnosed with familial hypercholesterolemia often without a full panel of all the relevant markers being done.  What’s important to test for is lipoprotein (a). Particle number for HDL and LDL are also important.

A functional approach is to do a full case review starting gut health, blood sugar, diet and cortisol regulation. Addressing these can bring people out of the high risk zone and provide a foundation for a happy heart and a long life.

 

 

 

 

Taking the Good Out of Food

Taking the Good Out of Food

 

A couple snapshots on food from clinic:

My patient, “I was thinking about fasting on bone broth. Do you think that would help right now.”

Me, “No. I do not.”

My patient “You mean its best if I keep eating?”

Me, “Yes. I’d like you to eat as varied a diet as possible. Please enjoy your food.”

My patient, “What a relief! I really didn’t want to stop eating.”

People with digestive discomfort often feel anxious around food. It can seem that eating is what is causing their symptoms. “If I could just get the perfect diet I would feel good again.” Under- eating is common and so is low body weight. But the problem isn’t food. The problem is an infection. Once resolved people feel better. The right diet does support the process but needs to be done with care and the right information.

The New Eating Disorder 

Orthorexia is any fixation with specialized or restricted diets.   Often people try one and then another. Like other eating disorders the underlying motivation often has very little to do with food or even health.   I see this in clinic and help people find a new, stable way to relate to food while referring out for support when indicated.

“So what you are saying is this ketogenic diet is making me GAIN weight?”

“Yes. I’d like you to eat a moderate to high carb diet because this is what your life requires. Your hormones will balance and your body will stop storing weight.”

Changing macronutrient ratios can be helpful. This is one way to vary diet and ensure adequate nutrient intake. Those eating lots of carbs could experiment with a less carbs and see excellent benefits.

A mother with a toddler who is training hard everyday will not benefit from ketosis. It sent this patient into a stress response and her brain likely thought it was a time of famine. Generally speaking mothers of small children are already giving a 110%. This is not a good time to fast. Fasting requires down time that’s just not available when there’s a little one.  When famine would hit, normal activity levels would also drop. Modern life makes this hard.

Carbs, Fats or Proteins?  

We have research on cultures where people thrived on carbs as their staple food. Others did well with protein or fat as their main energy source. Humans can adapt to any of these macronutrients as their baseline. Today we need to be careful with highly processed foods and anything that our ancestors wouldn’t recognize as food.

This decade carbs have been under attack. Last decade it was fat. Too bad people were told that industrial seed oils like canola and sunflower were safe alternatives to the so-called ‘bad’ fats that we have always consumed. The result is increased inflammation contributing to all chronic disease. Equally unfortunate is how sugar was added to low-fat food to make it taste better. Higher sugar means endless hunger. Diabetes and obesity are epidemic.

What about a Bone Broth Ketogenic Diet?

There is a trend of starvation in our culture that perhaps is us trying to mimic times of famine. It takes different forms and has been going on for decades. You may remember the lemon juice, maple syrup and cayenne cleanse of the 90’s. Bone broth is great for many reasons.  So is fasting under the right circumstance. Energy requirements and stress need to be low during a fast. Ketosis is only indicated in specific neurological diseases like epilepsy. Restricting food intake for longer contributes to weight issues, cortisol and hormone imbalances.

Physiological starvation is often going on in those who are overweight. Nutrients are not being absorbed and the body is therefore in a state of constantly searching for a way to stay alive. Storing weight, especially around the abdomen, is how we survived famine.  It also indicates stress has been high for a prolonged period of time.

Food is Not a Moral Issue

What all this comes down to is that food is not a moral issue. Certain foods are not inherently bad or good. Ideally food is nourishment for our bodies.  It plays a central role to the health of our families and communities. Yet we refer to it with words that add meaning which takes it into the moral realm when its not.  If a dietary ‘rule’ is broken, we aren’t deliberating hurting another. This is what would qualify it as a moral issue.

New research shows us how we’ve linked food with morality by using words like “cheat” or “bad”. Removing a specific food for a period of time can be helpful to see if your body is reacting to it. However, in the long term, a varied diet is best for both gut health and social connection.  I aim for my patients to have only one or two restrictions if necessary.

Our brains still plan for times of famine by seeking out high energy foods to consume.  Often high energy foods are extremely rich in taste as well.  An ancestral or paleo-type diet gives us a template to eat nutrient dense food and remove those that are highly processed with little nutrient value. This leaves room for a lot of variety.  Its also satiating without compromising health.

We are hardwired a certain way.  By learning about and embracing this we can thrive.  Our world has changed faster than we have adapted.  To explore this topic more I encourage you to check out Dr. Guyenet’s recent book The Hungry Brain. 

“In The Hungry Brain, I argue that the problem is not necessarily a lack of willpower or an incorrect understanding of what to eat. Rather, our appetites and food choices are led astray by ancient, instinctive brain circuits that play by the rules of a survival game that no longer exists.” Dr. Stephan Guyenet, Ph.D The Hungry Brain

 

 

 

 

Building a Healthy Gut Ecosystem

Building a Healthy Gut Ecosystem

A key differences between the way our ancestors ate and our modern diet is how much fermentable fiber we consume. Fermentable fiber is found in processed or acellular carbohydrates. We all know that vegetables and fruits are important for health. But which ones and why? The new term MAC, or microbiota accessible carbohydrate is now being used. It describes how fiber functions in the colon where the microbiome is housed. There is growing evidence of foods that feed the good bacteria.  For example grain based fibers as in those found in bran are not fermentable. They don’t have the same beneficial impacts.

Why Fermentable Fiber is Unique

Fermentable fiber selectively stimulates a limited number of favorable species of bacteria. Specifically it increases lactobacillus and bifidobacterium. Short-chain fatty acids like butyrate will increase as well. These are crucial in promoting cellular growth and supporting the absorption of minerals. Fermentable fibre increases the acidity of the colon making it less hospitable to pathogens like parasites and fungus. It improves gut barrier function and host immunity. Remember we are the host to these bacteria and when they thrive so do we.

Where to find these Microbiota Accessible Carbohydrates

Our ancestors ate a wide variety of wild plants that were high in these kinds of fibre. The difference with the plants we eat are they are cultivated for higher density of energy and less fibre. We also typically eat about 20 plants whereas they ate over a hundred. MAC’s with high amounts of fermentable fibres can be found in fruits, vegetables, legumes, starchy plants, nuts and seeds.

A Comparison Of Healthy Diets

Archaeological evidence of preserved coprolite deposits from the northern Chihuahua desert show what a typical male adult consumed. The dietary intake of inulin, a prebiotic also known as FOS, was about 135 grams per day. Jeff Leach from the American Gut Project lived with the Hadza. These modern-day hunter-gatherer eat an average of a hundred grams per day of fiber per day. Contrast this with the average daily fibre intake of a North American which is 10 to 15 grams per day.

Jeff Leach has conducted an informal study of modern people who identified with different types of diets. Those in this study have a bias towards eating better than the average modern person yet their fiber intake is still much lower than our hunter gatherer ancestors.

Omnivore 19g
Paleo 25g
Pescatarian 28g
Vegetarian 33g
Vegan 43g.

Keep in mind that those in the study were not assessed for nutrient status or any other markers related to health. What this study indicates is the importance of consuming more vegetables. We know that the liver functions better with a diet higher in vegetables. We now know the microbes thrive on the fermentable fibers and the prebiotics that are found in a variety of vegetables. For any diet where health or healing is the goal, this is crucial.
Recently a relatively healthy and informed patient of mine asked about his intake of veggies. Like many paleo types, he focuses on consuming enough protein, healthy fats and the right supplements. His lab work came back low in lactobacillus and bifidobacterium bacteria which is not surprising.

Reducing processed or acellular carbohydrates is important for a number of reasons. Including cellular carbohydrates like potatoes, legumes and white rice that are typically not considered paleo is beneficial. When cooked and cooled these are resistant starches. Resistant starches are fermentable fibres that are particularly beneficial to the colon. As their name indicates they resist being digested in the small intestine and instead feed the bacteria in the colon. Legumes have the added benefit of stabilizing blood sugar if they are tolerated.

What About Prebiotics?

Prebiotics are another type of fermentable fibre. They cause the good bacteria to multiply so there is an increase over time. The numbers will stay high despite stopping a supplement as long as enough fermentable fiber is in the diet. And we do need to supplement prebiotics as our foods no longer contain adequate amounts.

Prebiotic fibers decrease gut permeability and the toxic overload caused by leaky gut. Increasing your consumption also improves insulin sensitivity, inflammation and liver health. Everyone knows about probiotics but prebiotics are in fact more important. Probiotics don’t impact the gut flora in a sustained way. They are useful for immune response or repopulating specific species. They do not increase number of beneficial bacteria and once you stop there is no increase. This is because many species of probiotics are transient residents of the digestive tract. They don’t colonize. Probiotics do stimulate the immune system and certain strains are better in certain circumstances. On that note some strains can be detrimental in some disease states as well. For example, Saccharomyces boulardii can be good at treating yeast overgrowth or diarrhea caused by antibiotic use.  It should not be used in Crohn’s disease during a flare.

Research Pitfalls

A lack of fiber may explain why studies of high-fat diets show negative results. In these studies, they typically feed rats or humans a high-fat diet, but they do it in the context of a diet that is low in fibre. While this mimics people eating an industrialized diet, it ignores our evolution and the role that fibre plays in mitigating the harmful effect of these fat-fed microbes.

Four Steps to a Long and Pleasurable Life

Four Steps to a Long and Pleasurable Life

When the Body Speaks

The body generally tells us what we need to know. Often this occurs more readily when we are injured or sick. These interruptions to our daily life force us to tune in and listen to the body.  In particular when we slow down our bodies will sync up or entrain to the part of us that is healthy.  This mechanism is built-in to our genetics and is similar to what happens between mother and child or doctor and patient. Next time you are in pain notice what happens when your body is still and you will likely find that the inner physician speaks up.

Is it possible to Age Gracefully?

Research has proven a connection between mind and body. Harnessing this understanding along with our genetic history can show us how to live more fully.  For two million years of our evolution we lived embedded in our surroundings. Only in the last 0.5% of this time have adapted to agriculture and our current system of industrial food systems accounts for a tiny portion of this.  Archaeology indicates that bone health decreased as people began to homestead. The explosion of heart disease, cancer, diabetes and other chronic illness has specifically coincided with modern life.  There is a mismatch between how we are genetically adapted to live and the age of agriculture. To live a long, healthy life and age gracefully we can simply look to our ancestors.

What to Eat: it can be Simple

We know that our ancestors ate a wide variety of foods which is what I encourage my patients to do.  Enjoy a range of macronutrients such as carbohydrates, proteins and fats.  Choose foods with vivid colours and revel in the ritual of preparation. Each person has unique needs which change throughout a life span.  What is right for you can be discovered through experimentation although specific diagnosis or guidance can be important at times.  For example anyone with thyroid imbalances do better with a more consistent source of carbohydrates which will assist with the conversion of the T4 to T3.  Or, for example, anyone experiencing hypoglycemia needs to focus more on protein and to ensure fats are consumed with fruit to reduce blood sugar spikes as well as increase absorption.

Four Steps You Can Take

Once your metabolism is relatively stable it becomes easier to experiment because the need to eat is less urgent.  This is how our bodies are meant to function. If you need support to reach this place there are some simple steps that can be taken. First, focus on foods that with high levels of bioavailable nutrients and those that actually support the good digestive bacteria. Microbiota accessible carbs are best and what it basically comes down to is eating more vegetables; for example root vegetables are packed with nutrients that are easily assimilated.  Second, remove any foods that hurt your gut lining especially refined carbs and any known allergens. Third, stabilize your blood sugar which will reduce your risk of developing diabetes and dementia later in life.  Finally, add extra healthy fats to increase the assimilation of micronutrients.  A couple of examples are beta carotene and lycopene which absorb up to eighteen times more so eat your carrots with butter and add a dose of olive oil to your tomato sauce.

Facts About Fat, Protein and Micronutrients

Furthermore it is commonly understood that iron is made bioavailable by adding vitamin c but less known that non-animal sources are only 2-20% available partially due to phytate and oxalates reducing absorption.  This accounts for why up to 85% of vegetarians are deficient in this essential nutrient. Other nutrients that are often very low are vitamin D and E, B 6, zinc, calcium and magnesium.  This is because animal protein is the most nutrient dense and bioavailable source of many micronutrients.  Small amounts of well-sourced meat is a shift from the Standard North American diet and one worth taking. I encourage patients to view meat as a medicine and honour it in the way our ancestors did.

Fish and eggs are also foods we can look to as medicinal. Soft yolks are great sources of choline and lecithin that become more available once you add butter or any other fat.  Fish is our only bioavailable source of the essential long chain fatty acids DHA and EPA.  Flax and hemp oil contains ALA which is the precursor to these omega 3’s but are lacking the full benefit.  Enjoy a wide range of full fats and oils including avocado, macadamia, olive, palm, butter, and lard while avoiding all industrial seed oils including canola, safflower, sunflower etc.  Seed oils and refined carbohydrates make up for over 50% of the Standard North American Diet and is linked to nutrient deficiency, diabetes, obesity and heart disease.  Fat soluble vitamins like K2 have been proven to reduce heart disease and coronary calcification.  When you consider that one in four people is affected by heart disease it is worth ensuring that you are getting enough of this fat soluble vitamin.

I’ll be writing more about fats and oils soon.  Please send in any questions or comments.

Two Arguments for a Paleo Lifestyle

Two Arguments for a Paleo Lifestyle

Paleo is short for a nutrient dense, low allergic, anti-inflammatory and real food diet.  Using the word ‘lifestyle’ means we  include elements like sunlight, movement, pleasure, sleep and social support as key factors influencing health.  For the majority of our genetic and biological history we lived on a wide variety of foods and when the environment allowed, lived a life span similar to today but free from chronic illness.  The hunter-gatherer period lasted 66,000 years and during this time our brain development skyrocketed largely due the protein sources we began accessing.  Although we continue to evolve, with a range of individual variation, the evidence supports us to look to our ancestors so we can live a long and happy life.

Diseases of civilization are the epidemic of our time. Now over 80 autoimmune disorders are recognized with more added each year.  Cholesterol is not the cause of heart disease and LDL particle count is now known to be the best risk assessment tool we have but medical practice is slow to catch up.  Diabetes and dementia are growing at alarming rates and most concerning of all it is predicted that the majority of children today will live shorter lives than their parents.

For twelve years I’ve studied and worked in health both in clinical practice and in transformative education.  Like many who work in this field I have a story of recovering from debilitating illness using an ancestral or ‘paleo’ approach.  A vegetarian diet combined with a high intensity lifestyle training as a dancer throughout puberty led to a complete crash in my early 20’s. I was weak and contracted multiple parasites first from a farm and then from travel to Asia.  Using chlorine to purify my water as I climbed the Himalayas was the move that wiped out my gut bacteria and immunity.

Recovering my health was not a simple or short journey.  My aim as a clinician and educator is to make it much easier for others by offering the latest in medical research and nutritional science.  Even if we rule out the evolutionary perspective of the paleo movement, its focus on nutrient density and bioavailability is difficult to argue with.  Clinically I’ve witnessed results I couldn’t have imagined when people commit to the recommendations even for a short period of time.  The amazing part is that this lifestyle is so engaging and enjoyable that it’s not difficult to stick with for a lifetime.

So here goes.  Let’s discuss some of the most heavily researched proteins.  Gliadin is the peptide in gluten and like all grains it is very difficult to break down.  The unique problem with gliadin is that it is known to increase gut permeability which is the root of many autoimmune disease.  Grains are very low on the nutrient density scale and unless they are soaked or fermented the phytic acid content decreases the bioavailability of these nutrients.  Grains and legumes are seeds and therefore built to pass through mammals undigested in order to sprout elsewhere.  Prior to agriculture these were not used widely and any traditional culture who consumed them learned to pre-digest them through a long process.  Industrial agriculture has shown us that grains are not the long-term solution to a growing population because of the cost to top soil health.  Harvard scientist Matt Lalonde explains that for humans develop the ability to break down grains and legumes into food would take an evolutionary leap equivalent to growing wings.

Dairy on the other hand is another story from an evolutionary perspective.  As infants humans produce lactase and therefore it is a simple genetic step to continue producing.  In fact 33% of the world’s population have evolved to tolerate dairy and this happened for good reason.  Milk became more available as people started to farm and grains became our staple diet. Research shows that places that had diets high in grains experienced deficiencies of protein, vitamin A, calcium, magnesium and iron.  Infectious disease was also higher.  Under this pressure, milk became a way to mitigate some of these deficiencies. Evolution happens with time and pressure and this step didn’t require much time but the pressure was strong. People were not thriving with the onset of agriculture.  For example they were 5-6 inches shorter than their hunter-gatherer predecessors.

Soy is a unique legume and by looking at it we can understand a lot about inflammation in the body and the increase in allergies.  One benefit of soy is that it is a phytoestrogen however the downside is that it is highly allergenic.  This means that it doesn’t just cause sensitivities where inflammation increases but can also cause full-blown allergic reactions.  When the immune system is in high alert most of the time the body is not able to function optimally or even normally.  This is where we are seeing more people reacting to a wider range of foods or developing autoimmune problems.

Individuals wanting to recover health can begin by removing the foods that are known to cause problems in many people and then slowly reintroduce them.  There are also tests that can point you in the right direction.  Eating a diet full of real foods including some animal protein, fish and a wide variety of vegetables with some fruits is an excellent starting point.  This style of eating is very satiating and remarkably easy once you get started.  Understanding that the standard North American diet is made up of over 50% of foods that have no nutrient value but are high in calories and anti-nutrients or toxins is motivation enough to cut these foods down and then out of your family’s life.  Flours, sugars and industrial seed oils are leading to rising numbers of people who suffer from disease due to inflammation, malnutrition and depression.

The focus on local, organic and wild or pasture-raised food is powerful. It is the quickest way to stabilize your metabolism, mood, energy and weight.  For ongoing inspiration please stay connected as I’ll be offering bi-weekly articles to strengthen our resilience, interconnectedness and ability to co-create solutions.  Questions and comments are welcome.

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