Why is it known as the "Silent Killer"?
Hypertension is often referred to as the ‘silent killer’ in the medical world, as many individuals, completely unaware of it prior to their diagnosis. It is ‘silent’ because symptoms may not always be present and when they do manifest, they may be occasional and mild, typically ignored and attributed to external factors for example, a stressful day, sinus congestion, dehydration, strenuous activity and such.
Elevated BP is often detected either when an individual without symptoms goes in for a routine visit at their doctor’s office or at the other extreme, when their symptoms are at the worst and they end up in the ER!

If it is silent, what can I do? How do I know when I need to be worried?
Though symptoms may not always correlate to elevated BP, presence of minor symptoms causing annoyance or discomfort warrants immediate monitoring, especially if one or more of the risk factors mentioned further below are present.
Being aware of your numbers and regular communication and check-ins with your doctors, can ensure early detection and appropriate management. And here’s the good news: Hypertension is preventable and in many cases, when detected early, can be stopped from getting worse! Hypertension has been classified as a lifestyle disease and can be successfully prevented and/or managed with the consistent implementation of dietary and lifestyle changes, with or without medication, depending on the complexity of the case.
 The symptoms that you should watch out for:

• Headaches
• Fatigue
• Dizzy spells
• Visual changes – blurry vision, floaters
• Racing heart with mild activity or palpitations at rest and activity
• Heavy sensation in chest or chest pain
• Anxious feelings
• Dark urine (may indicate blood in urine)
• Ringing in the ears

Remember that these symptoms may be indicative of other diseases such as thyroid issues, diabetes and or hormone imbalances. If you are experiencing these on a frequent basis, it is critical to go in and see your doctor to rule out hypertension as the cause.
 
What are the risk factors that I need to be aware of?
The following risk factors can affect your blood pressure levels and  are categorized as modifiable versus non-modifiable.
You CANNOT alter the following risk factors, however, being aware them is critical in assessing your susceptibility to hypertension:

• Family history – especially if either of your parents had hypertension, your risk is elevated
• Age-  the older you are the more regularly you need to be screened.
• Sex: Until the age of 64, men are at a higher risk whereas, beyond age 65, women are more likely to be diagnosed (Find out with us why!)
• Race: Multiple studies have indicated that African-Americans are at higher risk

 
The following are factors that you CAN change to put odds in your favor to prevent/manage elevated blood pressure:

• Eat Well.
  • The Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension) have the most convincingly shown evidence to lowering blood pressure and improving all aspects of health related to the heart and circulatory system.
• Keep Moving!!
  • There is no dearth of research and cardiologists who support the fact that regular, consistent exercise is required to maintain a strong heart and lower your BP. Brisk walking is the most commonly recommended form of exercise with patients who have sedentary habits. It is also recommended that you discuss your exercise program with your doctor before you begin to avoid further risks or injury.
• Stop Smoking
  • Depriving your body of oxygen will only increase it’s need for higher blood pressure. If you need help quitting, work with a team of health professionals who can help you.
• Decrease Alcohol Intake
  • More than 2 drinks per day for men and more than 1 drink per day for women have been shown to increase risks for hypertension and cardiovascular events in general. Again, if you need help, work with a team of health professionals to help you wean off.
• Stress Management
  • Having an effective stress management technique for yourself, be it through spending quality time with loved ones, playing your favorite musical instrument or through meditation and breathing, is quite critical when it comes to keeping your BP under check. Online scrolling and playing digital games does not count!
• Sleep Apnea
  • This is a major risk factor that often gets ignored even though it is very highly correlated with hypertension. Even if you do not snore or have no lack of energy, ask your doctor about conducting a sleep study for you, especially if you have family history of cardiac events.
• Co-existing Conditions:
  • Diabetes, Obesity, Elevated cholesterol can all increase your risk of hypertension. The positive side is that lifestyle changes that help with treating hypertension, also help to address these & vice-versa.

In future blogs,I will discuss supplements to discuss with your healthcare practitioner, for both prevention and management of hypertension. Naturopathic medicine through the use of clinical nutrition and lifestyle medicine, can be a safe and effective  way to address hypertension, and related lifestyle diseases. If you would like to find out more, you are always welcome to request a free health consult on our website or by contacting our office via email or phone.
Until next time...this year, take that leap towards a healthier YOU!

It's the season for new beginnings! And many of us are trying to start (and keep!) new habits. At this time of the year, many people decide to eliminate one or more foods or food groups from their daily diet; some do it in pursuit of good health trying to "undo" the holiday overeating, some to get rid of annoying gastrointestinal symptoms like bloating, gas, unpredictable bowels, some others because it's a fresh start to the year and they have been waiting to implement their doctors' recommendations and many others in the hope of losing some weight. No matter what the reason, after 3 weeks of an 'elimination diet', it can be frustrating if you do not notice any positive changes whatsoever! 
There can be multiple reasons why you aren't seeing changes in your health. These are important to consider and address. Here I have listed these reasons in the order of most likely to least likely as I have observed in our clinical practice:
 
Reason#1: The eliminated foods/food groups aren’t problematic for you
Though this may sound like a very obvious reason it can often get ignored. Most elimination diets require you to leave out the “usual suspects” including:
 

• Sugar
• Wheat/gluten containing grains
• Dairy
• Red meat

 
However, in addition to these foods there are other foods that can be potential troublemakers. Since each of us is a genetically unique individual, besides functional deficits, some people may not have the ability to process all components of even seemingly healthy foods like fruits, vegetables, whole grains, nuts and seeds.
Consider getting a food sensitivity panel through your doctor. Food sensitivities are very different than food allergies and the one we offer at our practice tests for over 85 different foods! The information from that the test results reveal can be used to design a more specific elimination diet beneficial for you.
 
Reason#2: Increased intake of processed foods
In an effort to eliminate specific foods, people often start buying packaged foods that are labelled as being compliant to their diet. Labels such as gluten-free, dairy-free, low-fat, paleo etc. are very attractive but it is important not to overlook the actual ingredients list in any packaged food. Multiple chemical additives and preservatives often make their way into “special” packaged foods to help these foods taste and stay good. This is not always the case, but be sure to read the actual ingredients and rely more on fresh foods than packaged foods.
 
Reason#3: Food elimination is not enough!
Let’s say that you have persisted at least 4 weeks with an elimination diet designed based on a food sensitivity panel and have minimized use of packaged foods, and even then, you see no benefit or positive change in your symptoms or overall health- this most likely indicates that food may not be the root cause of your troubles. It is time to look at other factors influencing your health.
A weakened, diseased or sub-optimally functioning digestive system, adrenal or other endocrine imbalances or nutrient deficiencies are important factors to investigate when an elimination diet fails. Once these other factors are addressed, your practitioner may recommend repeating an elimination diet to assess if specific foods can aggravate or cause your symptoms to revert.

As a continuation of my previous blog, here is part 2 of the home cooking series. As a refresher, my goal with this blog series was to provide ideas and suggestions that can help save both time and energy while still keeping your home cooked meals healthy and tasty! Planning your meals 1 or 2 weeks at a time and preparing ingredients for those meals ahead of time takes the stress out of cooking at home. You can schedule  your "meal prep time" on the weekends or on a day of your choosing based on these 2 factors:

1. Assess what's available at home: in the fridge/freezer/ storage/pantry
2. Assess what you need, make a shopping list & get your groceries!

In my practice, there is  chart that patients receive in their initial few visits that helps them write out their meals for the week. It also allows them to complete both 1 & 2 listed above in relatively short time. Though it sounds very intuitive, you may be surprised at your own efficiency when you write/type your grocery list before you venture into the stores! A side- benefit of this exercise is that you are less likely to spend money on items that are not on your list (impulse purchases are more likely to happen if you are at the grocery stores and "planning meals as you go"!). This chart is nothing fancy, but a great organizational tool that helps you visualize the number of meals that you need to prep for & therefore, shop accordingly. I generally recommend that you only prep for one week at a time, as this is generally how long fresh groceries tend to remain usable. Of course, you can prep for 2 weeks at a time, and use the freezer as part of your battle plan...I mean meal plan :)

The meal planning chart has all of the following information: 

• Number of people in the household
  • family member/ friends/ roommates
  • Kids/ adults/ seniors with special needs
• Days of the week 
• All the meals you are prepping, i.e. breakfast, lunch, dinner, snacks
  • Include names of recipes on the chart
• Foods to exclude for allergy, sensitivity, religious or philosophical reasons

Once you have written down your meals and have the ingredients you need, start the meal prepping process! Essentially, your meal prepping strategy will belong to one of these 3 categories:

1. Prepare ingredients & store them for cooking on the day the meal(s) will be eaten
2. Prepare the actual meals and store appropriately in the refrigerator or freezer & heat/defrost when ready to eat
3. A combination of 1 & 2

Your strategy may vary between these 3 types based on your assessment of each week's schedule.Let's discuss each of these in detail below where I have included my suggestions to optimize efficiency:
1) Chop/cut/marinate/prepare ingredients & store them for cooking

• In Part 1 of this series, I recommended a food processor as a 'must-have'. You can choose to use a food processor or cut/chop all your veggies with the old-fashioned knife & cutting board. Though I know the food processor saves time & energy, I do enjoy chopping my veggies and fruit manually when I have some extra time. This is a great activity to do as a family!

• Reduce the amount of chopping by buying some of your vegetables & salads in the pre-cut packages available in most grocery stores. Watch out for added ingredients such as sulfites that are sprayed on vegetables to increase shelf life! Added sulfites can especially be a problem for people with skin conditions such as acne & psoriasis.
• Make the marinades & marinate tofu, tempeh, meats 
• Be mindful that some veggies & fruits can brown or spoil easily once chopped. Some examples include potatoes, bell peppers, apples. Use these in the earlier part of your week.  Sprinkling lemon juice on apples will lengthen the time for browning & storing chopped potatoes in water will keep them usable for up to 2 days.
• DO NOT wash spinach, kale, cilantro - these veggies need to be stemmed & stored wrapped in paper bags or kitchen paper towels for best storage life. Wash & chop right before use.
• Soak your beans! And throw out the water before you use them in your recipe. This simple procedure decrease the gas-causing properties of beans by altering some  lectins. Sprouting is another way to get the most nutrients out of your beans- the Air fryer can be very useful in sprouting your beans overnight! Or use the old-school way - wrapped in a wet cheese cloth & left in the oven (ensure the oven is not on!)
  

2)Prepare the actual meals and store appropriately

• This is my second choice in meal prepping  since this method invariably leads to over-use of the microwave oven, plus, the food storage science needs to be followed accurately to avoid bacteria/ fungi growing in your foods! That being said, pick the option that's best for yourself & your family. And try to make at least some meals on the day that they will be consumed.
• ​If you choose to prepare ALL your meals ahead of time, you need to have plenty of containers to store them plus adequate room in your fridge/freezer.
• It is best to cool cooked foods  to room temperature before freezing them otherwise the condensation from the steam will freeze to ice & add extra water to your meals when you defrost them - leading to a soggy entreé!
  
• Be vary of texture changes in some foods when you re-heat before eating. This is especially true of beans & green leafy vegetables.
• If you have leftovers from a previously frozen meal, it is best not to re-use this especially when meat is part of the ingredients. Food wastage is another reason this is my second choice of meal prepping!

I hope by now you are excited about starting to cook at home! By using both meal planning, meal prepping and time-saving cooking gadgets, you will be dishing out delicious meals that you can enjoy in the comfort of your home. Do not be afraid  to experiment with new recipes! I often look at recipes in books and online but end up using them as inspiration, ultimately  modifying the recipes to meet the criteria that I consider most important in a meal: packed with nutrients, free of additives & unnecessary chemicals, tasty, can be made in 30 minutes or less!!

If you have enjoyed reading this series, please send me a note or add a comment to let me know! Until next time....hope you enjoy your home-cooked meals!

​One of the first recommendations you will typically receive in my practice, is to start cooking your own food! There are many reasons for this recommendation,the first and foremost being: you have full control of what you eat! And what you eat is what fuels your body, and if your body is receiving the right "fuel", it is most likely to function efficiently, without trouble i.e. symptoms or illnesses.  So if you are to take control of what you eat, you must put in the effort for making as many of your meals as possible. Of course, a trip to the restaurant  or ordering take-out can be left for special occasions or for long days that you could not anticipate or for which you could not prep ahead. Last September, even the American Medical Association (AMA) released recommendations for home cooking. Based on the American College of Preventive Medicine's (ACPM) guidelines, the AMA recommends  "prescribing" home cooking to patients to reduce the risk of obesity and type-2 diabetes since it helps with:

• portion control
• lower sugar and salt levels
• no or low artificial  additives and preservatives
• more choice with type of vegetables and fats

Needless to say, there are additional mental-emotional benefits of family members participating in shopping, preparations and the cooking process.  

Knowing all of this helps the patients get motivated but very often, when they are not used to cooking at home, this simple prescription can be very daunting and often can increase patients' anxiety around meal preparation and planning; and if not given the right tools/resources, can ultimately result in patients sliding back into old, comfortable but not healthy, eating habits.
In this 2 -part series, I am excited to share ideas that I commonly discuss with patients to alleviate this type of anxiety & get them settled into cooking at home with ease! I hope these will be helpful in your efforts towards a healthier lifestyle! Let's begin!

If you have ever tried opening a wine bottle without a wine bottle opener or cutting veggies with a blunt knife, you already know the importance of having the right tools for the right job! Today's fast paced kitchens need gadgets & tools that can save us time AND energy. Here are my 4 of my favorites and "must-haves" in any kitchen with a summary of their most important features:

1. The Instant Pot​  (aka IP) 

​          ​You  probably have heard raving reviews about it and are skeptical about it. So let
          me tell you this:  all my skepticism (and there was a huge chunk of it!) flew out the
          window from day one of using it!...and now I am the proud owner or not one but 
          two of Instant Pots! Here's why I highly recommend it:

• Requires minimal monitoring once program is selected (this is great win!)
• Safe pressure settings to cook lentils, beans, whole grains fast!  The cooking time is very short  compared to stove top cooking
• Can "do-it-all": Sauté, Simmer, Steam, Cook, Warm! Choose pre-set programs for specific foods that can also be modified based on your preferences
• Some models have delay start options 
• Can also work as a slow cooker for specific recipes
• Friendly for oil-free cooking and minimal loss of nutrients - It's great for soups, stews, bean chili, porridges, multi-grain nourishing recipes
• Many online IP enthusiasts have blogs, recipes dedicated to IP cooking & there is no shortage of ideas. Look for one-pot meal ideas!
• Saves: Time, Energy, Nutrients 
• Side note: Proud to boast that it was invented by a team of  Canadians :-) The goal was to reduce cooking time for busy professionals so as to decrease their dependence on fast food!  Isn't that the goal with home cooking for everyone? Suffice to say, this product  has met that goal! 

​     2.   Food Processor
​​           There are lot of choices when it comes to a good food processor. Choose one that
           suits your family's needs. It is great for meal prepping and when cooking large
           quantities. Here's what it can help with:

• ​Chops or Grates vegetables/ fruits
• Making dry or wet mixtures: Blends and/or mixes vegetables, fruits, nuts, seeds,    powders into batter for patties or baking
• Powders nuts and seeds for salads, gravies and gluten free baking
• Saves: Time, Energy
• Great for making a colorful salads &  blending leftover veggies for soup!

     3.  Hand Held Blender
​         Again, there are many choices with brands and additional attachments for          
        whisking, batter mixer etc. A simple one will suffice & here's why:

• Awesome device for  making soups, gravies, salad dressings and dips! Insert the blender in the cooking pot or serving bowl directly and blend!
• Most can be used in hot & cold foods  though watch out for the splatter!
• Much more convenient than having to transfer ingredients into a blender then transfer back into a cooking pot/ serving bowl. 
• Saves: Time, Energy, Spills (no transferring required!), Nutrients

     4.  Air Fryer
          This is a relatively new addition to my list of must-haves and I am still exploring  
          new recipes! Here are the main features:

• Cooks faster than conventional ovens with circulating hot air - not gas!
• Especially great for small batch cooking
• Great for oil- free or minimal oil cooking 
• Wonderful for making quick snacks and entrées - carrot/sweet potatoes chips,  crispy tofu, roasted potatoes, grilled chicken/fish
• Just like the IP, there is no shortage of recipes & ideas online through blogs, FB groups
• Saves: Time, Energy (yours & your home energy!), Gas (not a an oven!) 

As you probably noticed, there was a lot of repetition above that was intentional: "Saves Time & Energy". That is the recurring theme of this blogpost. Cooking at home should be enjoyable and not burdensome. After cooking a tasty, healthy meal, you should still have energy to enjoy it with your family; that's what makes it all worthwhile!
Empowering patients to help them take charge of their health is the goal of naturopathic medicine and the constant effort in my practice. Please note, that I do not have any financial gains in any of the appliances listed above! I am passionate sharing ideas that help with living a healthy lifestyle and have received a lot of feedback from my patients, that specific tips like these help them in transitioning to cooking at home.

Next week, in Part 2 of the home cooking series, I will share some tips & ideas for efficient meal planning & prepping. 
​
Please feel free to share your comments & feedback below!

The psychosocial impact of acne is well-known and is severe enough to be the subject of several major studies in prominent journals. Acne is THE most common skin condition in the US affecting approximately 50 million Americans each year.  Depression, anxiety and lack of self-confidence due to facial acne  leads to time-off from school and work and the costs associated with this loss of productivity has been estimated to be as high as $400million (Statistics 2013)!! If that number is not staggering enough on its own,  the total cost of acne treatments combined with the cost of lost productivity were approximated to be $1.2 billion!

Numbers aside, in my practice I have personally witnessed and documented the social difficulties experienced by patients suffering from varying degrees of acne. Besides the physical discomfort, the negative impact of persistent acne on a patient's overall well-being varies based on many factors including their perception and understanding of the disease, underlying self-esteem issues and extent of support from family and friends. In this era of social media, the age group of 10-20 years olds are affected the most. So while counseling and use of psychotherapy and can help with many of these self-esteem & confidence factors, it still remains important for the patient (in their own words) - to 'get rid of the acne'! Almost all these patients usually have been through some combination of the following conventional treatments for acne:

• Topical / oral high dose vitamin A 
• Topical/oral antibiotic 
• Topical salicylic or azelaic aid
• Topical/ oral steroids
• Oral contraceptives
• Oral anti-androgen

Though some or all of these treatments can be effective in suppressing new eruptions, upon termination of the treatment,  the acne returns and sometimes at an intensity worse than prior to the treatment! 

So what else can be done?
Most acne sufferers already know that acne is not just 'skin-deep' and there is more to it's story - i,e. cause and recurrence.There are many naturopathic herbal remedies that can help with acne  symptoms, but I have observed for  a long time now  that there is one thing that seems to be the underlying root cause for the presence and persistence of acne vulgaris. The one thing that can be linked to all of the factors  often listed as its cause such as:

• Excessive sebum production & faulty keratinization leading to clogged pores
• Presence of the bacteria  Propionibacterium acnes or P.acnes
• Excessive inflammation in the skin​
• Insulin-resistance 

​
What is that one thing?
If you follow my blog, it is likely that you have guessed the answer. It is in fact the state of your gut!

The gastrointestinal tract, the source of your nutrients also harbors a large percentage of your immune cells and major immune modulators - your intestinal flora of bacteria, archae and viruses. This microflora (also known as the microbiome) can change based on a person's diet, environmental factors, disease states, toxin exposure and yes, hormonal changes. The influence of the microbiome on our hormones  and vice-versa is a major field of study in the scientific world right now and even though its implications are yet to be fully understood, current studies have sufficient data to define what a  healthy microbiome constitutes and it's potential impact of an unhealthy one on various systems of your body. 

In 2017, an interesting study by Clarke et al. was published in the International Journal of Molecular Sciences. It summarized how plant-based herbal supplements can influence the microbiome, which in turn influences the levels of inflammation and androgen production leading to a targeted impact on the skin.  Following a diet that includes low-glycemic foods and lots of fiber rich plant-based foods does not just influence blood glucose levels, but also shifts the microbial balance in favor of lower inflammation and therefore, lower permeability of the gut. With a gut lining that is very selective about what is being absorbed into your bloodstream and then being transported to various organs including the skin, the rate of new lesions goes down significantly. Plus, older lesions and scars heal much more rapidly with the use of appropriate non-toxic cleansers and healing agents, when the gut microbiome is truly balanced- that is, topical treatments are more effective when combined with the treatment of the underlying cause.

The diagram below from the study mentioned above, provides an insight into the interconnected process :
​

Like each year, January is the month when we set our health goals for the year and are determined to follow through until...life's gets busy again! End of January is typically the time when your resolutions are being tested and how the rest of the year goes depends on what choices you make now. To help you with just one aspect of this year's resolution, that is, eating healthy, here is a checklist of 5 things to avoid when we must rely on processed and packaged foods, especially for snacks. 

As a reminder, healthiest options such as fruits, veggies, nuts and seeds for snacks should be at the top of the list and processed & packaged foods should be used occasionally when hosting an event, travelling or just needing a change in taste. If you have children, you know the need to have a huge stack of snacks available at short notice for those sudden hunger pangs, last minute play dates or times when fruit just won't satisfy those tiny taste buds!
 
The golden rule when choosing packaged foods is of course: Read the Ingredients! Not just how many calories, fats or sugar is in each serving size. Know what exactly you are eating. To make this process quick and efficient (and less confusing) here are the 5 main ingredients/ingredient categories that should watch out for and avoid when choosing your packaged snacks:

• Artificial colors and flavors
  • Multiple studies have confirmed the negative effects of artificial food coloring and revealed a link between the chronic consumption of these with conditions such as ADHD, dermatitis and other neurological and inflammatory conditions. Yet, since these additives are currently FDA approved and they continue to be present in snacks. 
• High-fructose corn syrup (HCFS)/Corn syrup
  • The strong link between the consumption of foods with HFCS and obesity, insulin resistance and high triglyceride levels  has now been very well established (Review in 2018). The risk is higher when its consumption is on a regular basis. A note of caution here: whether the syrup is derived from organic, non-GMO corn or conventionally grown corn, it still has the same negative effect. 
• Chemical preservatives or stabilizers
  • These are added to many packaged foods to increase shelf-life and enhance the taste of the food product.They possess zero nutritional value! Often with some reading you will be able to tell chemical yet benign ingredients, for example, baking soda (listed as sodium bicarbonate) from other risky chemicals such as added  sulfites, nitrates and nitrites.These have been linked to many types of gastric and colorectal cancers, though some studies question the direct correlation. Monosodium glutamate or more commonly known as MSG or Ajinomoto has been commonly associated with triggering headaches and migraines, and it’s full impact on the gastrointestinal and neurological systems is yet to be understood.
• Artificial sweeteners/low glycemic sweeteners
  • Aspartame was under scrutiny for a long time due to its potential carcinogenic effects. Though many food companies and large studies claimed that there was 'no direct link’ with consumption of aspartame and specific types of cancer, many major food industry giants have recently decided against it’s use. In many patients it has the ability to trigger headaches & migraines.
  • Other low glycemic sweeteners such as sorbitol and mannitol can trigger gastrointestinal side effects such as severs bloating, gas and abdominal pain in some patients with IBS  or SIBO
• Hydrogenated or partially hydrogenated fats
  • These are more commonly known as Trans Fats and have adequate research to support their ill-effects on cardiovascular health. Since the 1990s, Denmark and Netherlands have reduced  the amount of trans fats in processed foods, including popular foods such as french fries and other European countries are following this trend. In the US, starting in 2006, only foods containing 0.5g or less  could be labelled as ‘"Not a significant source of trans fat".​

In naturopathic medicine, since the the focus the is on treating the root cause instead of symptom relief, I always begin with investigating these three main factors that may be responsible for irritating your bowel system:
 
1) Anything coming in contact with the lining of the bowels
Investigating foods that you eat on a regular basis to check for food sensitivities and delayed allergic reactions is critical. Most common culprits in this arena include dairy, gluten containing grains, corn, nuts, soy but you maybe sensitive to a food that is generally considered healthy and nutrition packed. Examples of such foods include:

• Nightshades such as tomatoes, potatoes, egg plant, bell peppers.
• Foods with naturally occurring/added sulfites such as sauerkraut, wine, dried fruits

Besides food, medications, supplements and unfiltered tap water are other causes for     
irritating the intestinal lining and are reviewed as well.
 
2) Imbalance in the gut flora
Whether it is due to a recent course of antibiotics or an extended period of stress, the balance of normal friendly bacteria in the digestive system can be greatly affected.  There are multiple species and strains of bacteria, viruses, fungi and archaea that live in the digestive tract and some have a much more beneficial presence than others. The beneficial strains assist in functions such as digestion, absorption, immune signaling and even neurotransmitter balance. The non-beneficial strains may not be pathogenic (i.e. disease causing) but still be contributing to IBS symptoms by competing for resources with the beneficial bugs.
 
3) Lack of adequate enzymes leading to improper digestion
Chronic stress, antimicrobials and medications can negatively affect the production of the natural digestive “juices” such as enzymes and hydrochloric acid (HCL), that are crucial for the appropriate break down of foods into the macro and micro nutrients. These macronutrients such as carbohydrates, proteins and fats need to be further broken down into the building blocks for our body to assimilate and utilize for its various functions. When foods are improperly digested, symptoms such as gas, bloating, pain can result in the short-term but can have a much more serious long-term impact due to resulting nutrient deficiencies and chronic disease.
 
Identifying and correcting these three factors frequently result in both immediate symptom relief and the long lasting benefit of ‘calmer’ and ‘not so irritable’ bowels. With such a multifactorial approach, patients often report that their bowels appear to be less affected by their mental-emotional state, indicating a much more resilient digestive system.
 
If you or someone you know, suffer through the inconvenience and social withdrawal associated with  IBS, please contact our office to set up a free consultation. 

Continuing my series of blogs on the principles of naturopathic medicine, our next principle, which explains why NDs make an effort at every single visit to educate their patients: Doctor as Teacher.
 
The origin of the word ‘doctor’ comes from the Latin word ‘doctor’ which means ‘teacher’, which in fact originates from the Latin verb ‘docere’ = “to teach”. I was not aware of this fact until my undergrad years, when I chose a course purely out of interest, about the Latin and Greek origins of English words. What a fascinating fact this was! However, I only truly understood the meaning of the word doctor and this principle, once I had joined naturopathic school.
 
Now, having been in clinical practice for over 10 years, it is obvious to me why my duties as a doctor are intertwined with that of an educator. And for you see it as obviously as me, I just listed the primary responsibilities of a traditional teacher inspired from my daughter’s wonderful school teachers:

• Communicate & teach new ideas in an effective way so students are able to learn the information and skills
• Allow students to think independently, ask questions and help them find answers
• Educate students about various tools and resources and how to utilize them
• Provide support to students when facing challenging situations either with their assigned work and/or life situations
• Monitor students’ progress and make necessary recommendations to rectify poor performance in specific areas, while acknowledging their hard work
• Cheering students when they accomplish their goals!

Now, if you were to go back and read those responsibilities and replace the word ‘student’ with ‘patient’, it easily explains the why the Doctor is also a Teacher. The curriculum and goals are unique to each patient!
 
As a naturopathic doctor, I educate my patients about their health, actions they can take to correct a deficiency, to improve their energy, to reduce the risk of a heart attack or stroke and sometimes about something as simple as home care remedies for fighting off a cold. I allow them to ask questions and provide answers when I can, or refer them to specialists when necessary. I make them aware of various health resources available to them and how they can be used to their benefit. It is also my role to monitor their progress and explain what they need to change. Besides providing a treatment solution, I also provide ongoing support and coaching, so they can implement their treatment plans and achieve their health objectives.
 
I would like to end this blog, with a special note for my patients. As much as I am a ‘teacher’ for them, each & every patient has been a teacher for me! I have learned from my patients about resilience, inner strength, happiness, the ability to fail and yet keep going and most importantly, the importance of being compassionate and need for constant learning. Thank you for giving me an opportunity to be part of your healthcare team.
 
Sign off for today – the real Day# 4 (yesterday was a typo!)
​

The above quote gives an insight into the next two principles of naturopathic medicine: Treat the Whole Person and Treat the Root Cause.
The same disease can manifest as different symptoms for different patients. If you identify why the patient has a particular disease, that is, why this patient and not another, you may be able to treat them much more effectively. I thought the best way to illustrate these two principles would be through patient stories as case examples.
 
Both patients A & B in the stories below had identical major concerns and official diagnoses at their initial intake visits but since the root cause of the problem and the patients were very unlike each other, so were their treatment plans and corresponding results:
 
MAIN CONCERN: Difficulty losing weight and keeping it off, tried many diets/ programs
MAIN DIAGNOSIS: Obesity
Other official diagnosis common to both cases: Type 2 Diabetes, Hypertension, High Cholesterol

Patient A:

• 51 year-old single male weighing 340lbs.
• Lives alone, does not like to get out of the apartment for any reason except for work and to pick up food when not ordering pizza
• Diet: Fast food – delivery and drive-thru places only. Mainly pizzas, burgers, fries. Fruits: maybe an orange occasionally. Vegetables: potatoes. Microwavable TV dinners.
• Lifestyle: sedentary, hates to move as joints hurt, does not have any friends and does not like to interact with people as self-conscious about his overweight appearance
• Medications: many!

 
Root Cause Assessed to be:

• Partially loneliness, zero social interaction compounding the problem of sedentary lifestyle with no desire to move/walk/ exercise.
• Classic “overfed but undernourished”- excessive intake of carbohydrates, dairy and animal fats, trans-fats, additives, flavorings with little nutritional value

 
Initial Recommendations:

• Gradual lifestyle and dietary changes with weekly check-in visits.
  • These  changes included incorporating fresh fruits and vegetables daily
  • Eliminating animal proteins & fats except fish
  • Cooking food at home with recipes provided as a starting kit,
  • Adopting a dog with the 2 fold  intention of providing a companion and encouraging him to get 30 minutes of exercise  by walking the dog twice daily.

 
Result in 6 months:

• Patient A** lost significant amount of weight (almost 80 pounds) and had sustained the weight loss rate at >10lbs per month.
• He was no longer diabetic and did not need his blood pressure medications. Cholesterol was normal!
• He was now a proud dog parent and had made friends and was beginning to consider a relationship.
• His self-esteem had improved dramatically and was considering other forms of exercise
• Decided he would like to be 100% vegan long-term and had no desire or temptation to add animal products back to his diet, even occasionally. YAY! 

 
**He went on to lose over 200lbs by the end of his complete treatment and is now an animal rights activist and marathon runner. Yes, you read that right- not a typo, You can read more about him and his complete weight loss journey in his book named, Walking with Peety.

Patient B:

• 57 year old female in steady long-term relationship,no children weighing 360lbs
• Proud owner of 2 cats
• Diet: vegan by choice with occasional intake of eggs/fish/ice cream. Craves sweets especially after dinner; sometimes craves dairy
• Both her and her partner cook at home, and try new vegan recipes, eats out occasionally. Does not eat too many processed foods except the vegan ice cream. Skips breakfast, eats healthy lunch & dinner.
• Lifestyle: sedentary now, used to be very active in sports when younger. Stopped playing after knee injury. Likes to meet with friends and travel.
• Medications: None- Does not like to take medications.

 
Root Cause Assessed to be:

• History of “yo-yo” dieting and lack of regular exercise due to knee pain and work hours.
• Tests revealed hormonal imbalance with estrogen dominance, adrenal fatigue, a sub-optimal thyroid function and possible gluten sensitivity

 
Initial Recommendations:
Counseling provided on healthy, balanced vegan diet and frequency of visits set at every 2 weeks.

• Eliminate all gluten containing foods. Ok to eat fish and eggs but no milk products.
• Digestive enzymes and probiotics to optimize nutrient absorption from food and rehabilitate gut from years of gluten exposure
• Must have regular eating patterns especially follow the rule: do not skip breakfast
• Anti-inflammatory supplements to decrease inflammation & pain in knees.
• Thyroid  hormone prescription and appropriate adrenal support
• For Exercise: Swimming 2-3x/week and or stationary bike 2x/week for at least 30 minutes

 
Result in 6 months:

• Patient B lost 15 lbs with average loss of 2.5 - 3 lbs per month
• Her energy was improved and she was wearing clothes 2 sizes down!
• Not diabetic anymore, but still prediabetic.
• Blood pressure was still slightly elevated
• Cholesterol was lower than when she stated but still higher than normal
• Cravings for ice cream & sweets still present but has better awareness of eating patterns.
• Exercise was regular at 2x/week swimming only due to extended work hours
• Wants to continue on current program i.e off gluten, reduced sugar, healthy meals at regular intervals and will work on adding exercise to her routine.

 
Patient B is still an active patient is continuing to lose weight at her steady rate of 3 lbs/month. She has recently been diagnosed with Sleep apnea and upon correcting that she lost > 5lbs in one month and no longer has elevated BP.

As you realized, both patients were very different: male vs. female, single vs. in long term relationship, lonely  vs. socially active and more. Therefore, the investigation was very different for both even with the exact same diagnoses! Both had positive outcomes, though with varying degrees, and were content with their results. That is the power of Naturopathic Medicine!
 
Signing off for today! Day4 #NatMedWeek.
Be sure to call us if you  need help with your weight loss journey

​As you can see, even our smartest devices are unable to repair themselves for smallest of problems. Whereas the human body has a tremendous capacity fro healing and full recovery, when given the adequate support and care. There are limitations of course and the extent  recovery depends on several factors including, genetics, a person’s nutritional status, ability to follow self-care instructions and follow through with rehabilitation.
 
Naturopathic Doctors focus on removing any obstacles to full recovery such as improper diet, lack of sleep routine and lifestyle modifications and providing additional support with healing herbs and supplements. Symptomatic relief such as for pain in the case of injuries, is given equal importance and typically treated with homeopathic and herbal supplements that are more effective, not addictive and have less side-effects than OTC or prescription medications. Pain or symptom relief is particularly important from the perspective of supporting mental-emotional health that can contribute majorly to the healing power of the body.
 
As a Naturopathic Doctor, when I think about the healing power of the body, elaborate diagrams of immune cells, long lists of  pro-inflammatory versus anti-inflammatory cytokines and all the nutrients involved in the process that we studied in naturopathic medical school, flash across my mind all at the same time. Yet, for the human body, it is a simple, well-defined process. 
My respect for this healing power increases daily as I  realize that all of that "simple complexity"  has not yet been duplicated in man-made devices even with seemingly rapid progress in the field of AI (Artificial Intelligence).
 
Leaving you with those thoughts, until tomorrow, Happy Day2 of  #NatMedWeek2018!

During Naturopathic Medicine Week this year, each day I hope to elaborate on each of the 6 principles that define the practice of Naturopathic Medicine. The reason being that these principles are what unite our profession. Licensed Naturopathic doctors (NDs) may choose to include some or all of the modalities in their practice such as, clinical nutrition, botanical medicine, homeopathy, hydrotherapy, pharmacology, IV nutrition and physical medicine, but the treatment plans are still created based on the six guiding principles. 

Today we begin the first and foremost principle which is familiar to people as a being a part of the original Hippocratic Oath: “First, do no harm”

Sounds simple enough and may seem self-explanatory - the treatment recommended by a doctor should not cause further harm to the patient. However, this simple phrase has a much deeper meaning when applied in Naturopathic Medicine. Two main implications of this principle are:

1. Start with the least invasive therapies such as diet and lifestyle modifications and incorporate progressively more invasive therapies as needed since more invasive therapies may be more effective but have the possibility of unwanted side-effects 
2. Do not hesitate to start with, recommend or refer for invasive therapies if your assessment indicates that IS most beneficial to the patient’s health, thus, preventing more harm. For example, if a patient has a malignant tumor, the best treatment, though heavily invasive, may be to refer them for surgery. This will prevent the cancer from metastasizing (spreading) to other parts. Less invasive therapies maybe beneficial post-surgery for such a patient.

As you can see, a simple phrase can have a complex meaning based on the context – in this case, the context is presented by the patient. More commonly than not, on a daily basis, most NDs see patients for whom the #1 scenario is more applicable and I have chosen to elaborate “first, do no harm” in that context.
​

The initial intake visit with most NDs is at least an hour long in order to assess how multiple factors in a patient’s life may have contributed to and shaped their current state of health. This is what provides the context. This includes recording past injuries, surgeries, major illnesses, major life changes such as job change/loss, current living conditions & strain/status of relationships, dietary habits, drug & food allergies, exercise routine, social & lifestyle preferences and spiritual practices. This gives the doctor a 360 degree view of what makes the patient who they are and what changes can be made to stop further harm.
After a thorough history, physical examination and assessment, treatment recommendations that follow the use of the least invasive therapies come into 4 major categories:

• Stop/Eliminate actions:
  • That are detrimental to patient’s health and have known well-established negative outcomes such as smoking, excessive alcohol & recreational drug use. If a behavior has been diagnosed as an addiction, the patient will be referred to an appropriate rehabilitation center/specialist
  • That contribute to disease process all already in progress, example, increased intake of salty foods by patient who has elevated blood pressure

 

• Change/Transition to behaviors that Support health improvement
  • Increased reliance on fresh foods with decreasing intake of processed, packaged, fast foods that can multiple additives, preservatives and have very little nutritional value in terms of vitamins, minerals, anti-oxidants. Eating foods heavily laden with artificial colors and flavors can do more harm and no good to your health
  • Decreased screen time and spending time outdoors or interacting with friends, family and community members
    
    
• Start new actions that contribute to good heath:
  • Eating at regular intervals daily
  • Having an exercise routine based on a person’s need, ability and limitations. For example, if a patient complaints of knee pain, walking should not be their primary exercise- i.e., prevent more harm to the knees
  • Spending at least 10 minutes a day for meditation/prayer and at least 10 minutes doing an activity that is relaxing
  • Having a regular sleep routine

 

• Prevent internal imbalance:
  • Prevent dehydration by ensure adequate water intake. Water is essential for proper functioning of all organs in the body and adult bodies contain 50-65% water. Without adequate hydration many organs & organ systems operate at sub-optimal levels, especially since it is most essential for our main nutrient delivery and transportation system- blood circulation
  • Depletion of nutrients by regularly checking for deficiencies and supplementing as needed
  • By ordering functional tests to check for sub-optimal functioning of organ systems, such as the digestive tract that is our main source incoming nutrients
  • Support any organ systems that require additional support with botanicals, supplements or even medications (or refer you to an MD who would prescribe the medication depending on the State you live in).
    • Opposite to popular belief, NDs support the use of prescription medications as and when necessary based on the patient’s need. This resonates with the “First, do no harm” principle. For example, if a patient’s blood pressure is highly elevated putting them at risk for a stroke or cardiac event, this patient will be prescribed medication to lower the BP first. Then, factors contributing to the elevated BP can be addressed. 

On this first day of Naturopathic Medicine Week, I hope this article gives you some insight into how our first and foremost principle is incorporated in practice. Look out for other posts this week regarding our 5 other principles. I would like to sign off today with this philosophical quote by Voltaire that I find very interesting:
​
"The art of medicine consists in amusing the patient while nature cures the disease"

Please be sure to call us for any of your health needs and will be happy to assist you. Thank you for reading and be sure to share if you would like to join me  in creating more awareness about licensed Naturopathic Doctors! 

Causes of inflammation in the gut.
The inflammation in the GI tract can stem from one or more of the following, and each factor needs to be addressed in order to lower the inflammation:
 

• Food intolerances, sensitivities and allergies
  • These are very common in persons suffering from severe seasonal allergies like hay fever, and should be identified first. There are several tests available to determine the foods that maybe burdening your immune system. Blood tests that report both IgE (immediate sensitivity) and IgG (delayed sensitivity) to a range of foods are recommended. Skin-prick  tests and oral food-challenge tests can be used additionally to determine a person’s true set of food reactions. As always, correlating blood test values with  clinical findings is important and clinical discussion is warranted  before eliminating foods. Since elimination diets can be perceived as limiting, a thorough review with patients on what can be eaten is critical in order to ensure a balanced diet and especially, avoid nutrient deficiencies.
• Dysbiosis
  • An imbalance in the healthy cohort of bacteria that reside in our GI tracts can stimulate inflammatory cytokines, causing the GI Tract to be constantly inflamed. Treating this imbalance with the appropriate change in diet and supplementation with probiotic strains can lower the overall inflammation in the gut. Prevention of dysbiosis is possible if effective measures are taken while undergoing treatment with antibiotics for any infection.

• Infections
  • Some infections in the gut may not cause overt symptoms such as diarrhea, fever, cramps, heartburn or gas, but can contribute to the imbalance in the microbiome. I often refer to these as ‘latent infections’ that may present themselves when the conditions are right, for example, when the healthy set of bacteria maybe lowered in concentration after the course of antibiotics or a stressful event.
• Unhealthy diet
  • Eliminating allergenic foods is not the only factor involved in creating a healthy diet plan. A diet also needs to be well-balanced for the specific needs of each individual. As you are probably aware, there is much debate in the medical world right now about what constitutes a truly healthy diet. For the purpose of this article, rather than get into a lengthy discussion, it seems appropriate to highlight the common aspects of an unhealthy diet as agreed upon by most doctors. These aspects of an unhealthy diet are listed below:
    • High in processed foods with additives, colors, preservatives, salt, sugar, trans fats
    • Low in fiber, healthy fatty acids, necessary vitamins and minerals
    • Low in fruits and vegetables, that sustain the healthy microbes in the gut
    • High intake of caffeine, alcohol,carbonated beverages
    • Inadequate water intake

 
On a side-note,  the concept of ‘histamine-intolerance’ is being investigated by researchers. Some people have a genetically reduced ability to breakdown histamine and may need anti-histamine medication on a regular basis to keep their allergies at bay. More research is needed to support this idea. Also, as already established research indicates, genes are not your destiny. They can be turned on and off with changes in the cellular environment, which in turn can be affected by a myriad of factors, including your microbiome and overall, gut health.

In conclusion, keeping your gut healthy by eliminating common food allergens and attending to other gut health factors, can have a tremendous impact on your tolerance to the seasonal increase in pollen,mold and other environmental triggers. You do not have to suffer from allergies! To take control of your health, initiate the first step and begin the healing your gut inflammation. As your  gut/GI inflammation improves,  you may actually become that person who gets through allergy season without a sneeze or a sniffle! 
​
If you have any comments or questions regarding treatment of allergies at our clinic, please post them in the comments section or you can email us at info@coreintegrative.com. 
 
Wishing you an allergy-free spring!
Preeti Kulkarni,ND

​Being a naturopathic doctor, I frequently get asked questions regarding supplements. Questions such as, what supplements need to be taken on a regular basis, or which supplements can help boost the immune system or prevent onset of long term disease. Sometimes I get questions about safety, brand recommendations or whether a specific product making headlines in the news is really as good as it sounds.
 
For most of these questions, my immediate answer is usually the same: it depends.
 
It depends on multiple factors such as your lifestyle factors, your current underlying health concerns and dietary habits. I then continue to explain that all of this information combined is what helps me make the right recommendations for my patients. With my patients, I have the privilege of being able to evaluate their needs and then choose exactly what supplements they will need to take and for how long. Some maybe necessary for a short while to help recover from acute symptoms but some may need to be taken for much longer in order to resolve nutrient deficiencies or correct an underlying functional disruption. With friends and new acquaintances, I do my best to educate them about the need for such a complete evaluation to accurately assess the right supplements that would benefit them.
 
However, I recently realized that when someone asks ‘what should I take for …..?’, the explanation for need for evaluation aggravates rather than helps the person asking the question (I have been there!). This is the reason that I spent a some time thinking about how I could answer these supplement related questions. The first question that I asked myself was: Are there any supplements that I could potentially recommend to anyone without an elaborate history? The answer is yes!
 
I realized that there are three supplements – or categories of supplements- that I usually prescribe with specific dose and brand recommendations for my patients (who have had a formal evaluation) and these can also be recommended at a maintenance dose to family, friends and general acquaintances, after obtaining just a few details. These 3 types of supplements are often a part of many of my patients’ long term disease prevention and optimal living health plans. Since optimal health begins in the gut, it is no surprise that 2 of these 3 supplements support the digestive system.
 

Based on my review of research studies and clinical experience, I believe that these can be beneficial for most people to support good health:
1) Probiotics. 
This is the one supplement group from which almost everyone can benefit. Probiotics are available in capsule, powdered and even in health drink forms and all have different combinations of bacterial strains. These are the strains of bacteria present naturally in our intestinal tract and science is just beginning to understand the complete impact of our symbionts or ‘house guests’. 
For many reasons including super-clean environments, liberal use of antibiotics and chronic stress, most people have either low levels of these beneficial strains or an unhealthy gut environment that allows foreign, disease causing strains to grow rapidly compared to the healthy strains. A proper balance of these microbes, can help with keeping the immune system up to speed, having healthy skin, improving allergy symptoms, alleviating IBS symptoms (irritable bowel syndrome) and in general, in optimal digestion and absorption of nutrients. This ecosystem of microbes in our gut is very dynamic and can change depending on the person’s diet, lifestyle, medication intake, stress and environmental exposures.
How do you choose one that is right for you? Assuming you do not have any major diseases relating to the digestive system (parasites, bacterial overgrowth, infectious diarrhea), choose a probiotic supplement that is appropriate for your age, gender and mild symptoms like constipation or gas. If taken correctly, symptom relief  is observed in two weeks to a month, usually with many ‘side-benefits.​

2)Digestive enzymes
​Two commonly used the phrases: ‘fight or flight’ and ‘rest and digest’ define how our body reacts to internal and external stimuli. These are evolutionary mechanisms that are designed to help our body focus on the task at hand when necessary or relax and enjoy our meals. Our busy lifestyles  demand that we fit more and more in our daily schedules and balance various responsibilities, rarely allowing us to be free of stress and in the rest-digest mode. When we are under stress constantly, our digestive system and reproductive systems are ‘put on a back burner’ and priority is given to ensuring a rapid heartbeat and blood supply to the brain, lungs and organs vital for a good stress response. Chronic stress therefore, can lead to sub-optimal function of our digestive system and taking digestive enzymes with meals, while simultaneously working on stress management and incorporating a good lifestyle, can help prevent nutrient deficiencies and other diseases.
Choosing an enzyme is more work than probiotics, however, start with a combination that contains enzymes that help with digesting different food groups like carbohydrates (lactase, amylase), proteins (proteases) and fats (lipases).

3) B-complex
The recommendation of this supplement is related to the stress response mentioned above. I often recommend a B-complex over a multivitamin because the vitamins in the B group (B1,B2,B3,B5,B6,B12) tend to be rapidly utilized by our fight or flight system, physiologically known as the sympathetic nervous system. Taking Vitamin B’s in their active form is important for proper absorption and assimilation to feel their benefits. Women who are on birth control pills and people with acid reflux that have been on acid-suppressing medications (proton-pump inhibitors such as Prevacid) tend to lose B-vitamins rapidly and a proper repletion will prevent some of the side-effects of these medications. Additionally, B-vitamins are water soluble and are readily discarded from the body when an excess is detected, making them highly unlikely to accumulate in tissues and cause negative effects.
For choosing a B-complex, speak with your doctor first, especially if you are on any prescription medications, to ensure there are no interactions.  

Many of you are probably thinking: why is a multivitamin not mentioned in the above supplements?
There are many reasons for this but I will mention some that are most critical:

• In my opinion, a multivitamin by itself does not have great benefits on it own and we have seen this in the scientific literature over and over again. If you have an unhealthy diet, lifestyle and an improperly functioning gut, taking a multivitamin is not going to reverse the ill effects or correct your deficiencies. You will benefit multifold if you focus on changing your diet, lifestyle and maximizing your nutrient absorption from food daily by balancing your gut flora and optimizing digestion with enzymes.​
• A multivitamin formula often contains minerals too. These should not be picked randomly as some of the components can be harmful rather than helpful depending on each person – again a statement for individualizing supplements. For example, post menopausal women and men need to ensure their multivitamins are iron-free; patients recovering from cancer should not take any supplements with copper in them.

• Multivitamins for long-term use need to be carefully chosen for each patient and should be a part of and not a replacement for a well designed nutrition and lifestyle program.