Category Archives: Functional Medicine

The New Fab 5

In the Functional Nutrition analogy of the Fab 5, Karamo is totally probiotics, Antoni is SCFA, but who would Jonathan be??

While most of us think of Queer Eye when we hear of the Fab 5*, in functional medicine nutrition model this refers to a different group of fabulous:

1) Omega-3 fats

2) Fat soluble Vitamins (A,D,E,K)

3) Glutathione (a master antioxidant and major component of liver detox)

4) Probiotics

5) Short Chain Fatty Acids (SCFA)

These five tend to be sorely lacking in the modern body and are best influenced by dietary intakes. Fatty cold water fish, cultured foods, loads of vegetables (esp. crucifers for glutathione) and organ meats can have you covered here, and exercise can also increase probiotic diversity, SCFA production in the gut and raise glutathione levels (who knew??)
While supplements are extremely helpful for those who are extremely depleted or chronically ill, starting with the foundation of a healthy diet and exercise is the cheapest, most impactful way to get you there. Here’s how:

A) Include organ meats 1-3 times a week; pate, heart, gizzards, mixing liver in meatballs or burgers, and drinking bone broth are great ways to do this. Organ meats are a great source of fat soluble vitamins and trace minerals. I FINALLY found a pate recipe that I really enjoy (I detest liver) after years of looking in Mickey Trescott’s Nutrient Dense Kitchen. It has been a total game changer.

B) Get a combination of high intensity, high impact movement and more relaxing, low intensity movement weekly. Walk as much as you can (our ancestors easily did 8-10 miles daily) and aim for short, high intensity intervals of 30 minutes or less 2-4 times weekly to boost glutathione levels and promote healthy gut bacterial diversity.

C) Consume cold water fish 3 times a week or supplement with omega-3 fatty acids (including a GLA to ensure appropriate balance of fatty acids when supplementing). Omega 3 fats preserve brain and heart health and keep inflammation at bay.

D) Consume cultured/fermented veggies daily from a variety of sources to easily introduce billions of probiotics into your body. Start with 1 tablespoon and work your way up to 1/2 cup depending on your needs. Kefir, sauerkraut, kombucha, kim chee, and many other options are out there! These foods promote healthy gut flora and crowd out opportunistic infections. Buyer Beware — if these foods are not refrigerated, they do not contain active, live cultures. They must be refrigerated to prevent exploding jars of ferments, so if you see a shelf stable kraut know it is a dead kraut.

E) Fat soluble vitamins are prolific in your cold water fish, organ meats as well as egg yolks. Vitamin E is found in nuts, seeds, and olive oil. Vitamin K is most abundant in green vegetables, so load those plates high! Check you levels of Vitamin D in both summer and winter so you can determine appropriate supplementation, if needed. These vitamins are crucial for immune health, bone health, cancer prevention and more.

F) Focus on vegetables! Population studies indicate that the healthiest people consume more vegetables, with 10 or more servings of produce daily demonstrating the greatest benefit. Vegetable fibers directly feed gut bacteria, and they in turn produce short chain fatty acids, which serve as fuel for the cells that line the gut wall. These cells directly impact immunity, gut health and brain health, but lack of integrity in the gut is associated with disease throughout the body, from Parkinson’s and Alzheimer’s to heart disease and osteoporosis. 

A diet rich in fermented, raw and cooked vegetables, nutrient-dense organ meats and seafood, with appropriate levels of exercise can keep you strong, energized and vibrant for all the years of your life. Increased levels of environmental and social stressors coupled with decreasing nutrient density from poor soil and increasing carbon dioxide rates have loaded extra demands upon the body, requiring even more attention to nutrient density to maintain health than was needed just 20-30 years ago. 

That said, increasing demands upon our time and energy can make it even harder to accomplish this. Lack of familiarity with foods like organ meats, or poor experiences with vegetables growing up make it incredibly difficult to bring these foods back into regular fare, even when we know we should. My generation experienced a great deal of gym class trauma and soggy canned spinach that turned many of us away from the very things we needed to thrive. But now we are all adults, and it is up to each of us to overcome our history to serve our future. It took me five years to find a way to eat liver that I enjoy, so don’t give up! Where there is a will there is a way.(A special thank you to Dr. Eric Dorninger for introducing me to the power of the Fab 5!!)

Need help making the changes you want to? Book a Complimentary Discovery Call to see if Vibrance can support you!

 
 

Why I Aim for 10 a Day

My goal every day is to get 10 servings of vegetables.

I know – that sounds insane, right? Especially if, like 87% of Americans, you aren’t meeting the government recommended 5 a day for vegetables and fruits.

When I began studying nutrition over 25 years ago, it was to justify my position as a vegetarian to concerned family members. It was the first time the concept of ‘food as medicine’ had ever been presented to me. I was blown away that this was not common knowledge, not discussed, and that so much suffering (both animal and human) could be avoided.

While I am no longer a vegetarian I have never wavered from my interest in how we can use food to prevent, mitigate, and recover from disease. Food is still the most potent medicine we have available to us, and yet it is still the most overlooked for much of the population. Whether or not one is a vegetarian or vegan, plants remain the most potent, healing foods available to us.

Researchers who study populations are now saying that the 3-5 a day that is recommended is not enough if our goal is to be healthy and vital for the duration of our lives. They are now recommending 10 servings a day of fruits and vegetables. The populations who regularly consume this much are the ones who have the least risk of disease and live the healthiest into their elder years. While the industrialized nations have looked to science and technology for sustaining life, those in traditional, poorer cultures have maintained what we long for by consuming abundant produce. Once you get past the challenge of clean water, proper sewage and the immediate dangers of war, the key to a long, happy life is community and a diet rich in vegetables.

A study published in 2010 demonstrated that just 4-6 servings of produce reduced your risk of stroke by 32%! So if you get your 5 a day, as recommended by the USDA, you are doing very well! You are making a definite impact in your quality of life, and probably feel that benefit. These same researchers also looked at folks who consume 6 or more servings of produce daily. Their stroke risk was reduced by 69% over those who consumed less than 3 servings a day. There’s similar, consistent evidence for vegetables preventing 9 of the top 10 causes of death in the United States (the exception being unintentional accidents). The more produce we consume, the less chances we’ll die from Alzheimer’s, heart disease, stroke, chronic lung disease, kidney disease, cancer, diabetes, even pneumonia and suicide. The research is there.

None of us know how much time we have on the planet. I want as many years as possible to be vital, mobile, alert, and pain-free. The diseases that knock out most of us are expensive, chronic, and take decades to finally kill us off. Those last 15-30 years are not easy ones….and the new generation is being diagnosed with some of these diseases (like type 2 Diabetes) before they are even old enough to vote. I’d rather avoid such diseases altogether, and like my great-grandmother, remain active and engaged in my community until mere months before I pass.

Do I get 10 servings of vegetables a day? Sometimes. When I am aiming to, I reliably get between 7 and 10 servings. When I get caught up in life I get about 4-6. However, before I committed to seeking out 10 a day getting caught up in life meant I only managed 1-2 servings in a day. The difference I personally feel maintaining a minimum of 4-6 instead of 1-2 is remarkable. My clients express the same outcome. It shows up differently for different people – most of us find our digestion to be more regular and, dare I say it, delightful. Some also get the added benefit of improved moods and better energy. Some find chronic pain disappears. Others are able to come off blood pressure meds and find their blood sugar back within normal limits. One of the adventures of taking people on a journey to increase their veggies is that we don’t know what the outcome will be – only that it will be good. It’s a fun trip to take!

 

Regardless of whether you ascribe to a vegan, paleo, Mediterranean or even ketogenic diet, you need an abundant of produce to thrive. And nearly all dietary modalities attributed to reversing chronic disease, such as heart disease or multiple sclerosis, have their root in a diet high in produce. Vegetables provide antioxidants that protect cells from pollution as well as the wear and tear of daily life. They provide fiber to help regulate bowels and feed the beneficial bacteria that produce certain vitamins as well as help regulate the immune system, mood, and maintain healthy cholesterol levels.

 

 

Park, Y. (2010). Intakes of vegetables and related nutrients such as vitamin B complex, potassium, and calcium, are negatively correlated with risk of stroke in KoreaNutrition research and practice4(4), 303-310.

Aune, D., Giovannucci, E., Boffetta, P., Fadnes, L. T., Keum, N., Norat, T., … & Tonstad, S. (2017). Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studiesInternational journal of epidemiology46(3), 1029-1056.

 

Will You Be the Next Diabetes Case?

Earlier this year I kept hearing a well known doc in the functional medicine space proclaiming that half of Americans were diabetic or pre-diabetic. I’ll be straight with you – at first I thought it was an exaggerated claim made by skewing the research. Then I heard it again from someone else that I perceive to be a bit more grounded. So I decided to get to the bottom of this ridiculous claim – only to find it was accurate.

There are 2 pre-diabetics and 1 diabetic in this group – but they all think it’s gotta be you.

According to the United States Centers of Disease Control, 10% of American adults are already diabetic and 35% of Americans have beginning stages of the disease (pre-diabetes). This means if you are reading this in a room with at least one other person, one of you is likely that statistic.  If you are pre-diabetic and do nothing, you will become diabetic within 5 years’ time.

This is bad, bad news, people. BAD NEWS.

Diabetes is very expensive and terribly debilitating. Diabetics often end up blind, with heart disease, or even lost digits and limbs. Diabetes is also the largest cause of kidney failure in the USA. Diabetes isn’t just about having your blood sugar out of whack. It takes a steady, damaging toll on the rest of the body. The typical form of managing it – with insulin – often leads to weight gain (which ironically leads to increasing insulin resistance and heart attack risk) and insulin itself is very hard on the body when chronically elevated.

Type 2 Diabetes – the kind most adults have – is a disease of lifestyle. This is not about ‘faulty genetics’ although you may have a genetic predisposition. This is about living a lifestyle and consuming a diet that the body cannot handle. With nearly all chronic disease, we can think of genes as the weapon and lifestyle being the finger that pulls the trigger.

Type 2 Diabetes can be put into remission through diet and lifestyle, especially when caught early. If you are diabetic or pre-diabetic, your doctor may or may not have mentioned this to you. This past weekend I met two diabetic women – one was not given ANY nutrition information to manage or improve her condition and the other was told information that actually made her condition much worse (eat a high carb, low fat diet). The second has since discovered a different way of eating which has caused her to lose the 70 pounds she gained on insulin and is slowly improving her diabetes after 30 years with the disease.

Clinical research shows that newly diagnosed diabetics can achieve remission in as little as 4 months. For those who are still children (type 2 diabetes now comprises 45% of all diabetes cases in children) glucose levels can be stabilized in as quickly as 90 days and many achieve remission that lasts at least 2 years (ie – until the study ended). The same results can be seen with pre-diabetics. I have witnessed normalization of labs within a 90 day window.

Diabetes treatment costs over $13,000 per year. This is not something our health care system can afford and we needn’t be burdened by the cost at all as the disease is totally preventable and can be improved or put into remission through lifestyle changes. By taking the traditional route of management through medication complications will arise as the disease progresses.  Medications to control cholesterol, blood pressure, and stave off heart disease pile on as the body wears down. This has become so commonplace in our country that many think of it as an inevitable part of aging.
IT IS NOT.

Given these recent statistics, I urge you to get some key labs done at your next check-up. Ask your doctor to test for Hemoglobin A1C (HgA1c), fasting glucose, and fasting insulin levels. Hemoglobin A1C is a marker for chronically elevated glucose levels and will let you know if you have had high glucose for 3 months or longer. Your fasting glucose and insulin is a snapshot of existing levels in the blood at the time of the lab draw. C-Reactive Protein (Crp) is also a good marker to test for, as it indicates overall elevated inflammation in the body, which can drive both diabetes and heart disease. If you have not had a physical in at least 2 years please schedule one. Prevention is so much easier to work with than disease.

For those who knowingly have pre-diabetes or diabetes, you can take back your health by switching to a higher fiber, higher protein whole foods diet and by getting in regular exercise. You’ll need to eat a lot of colorful vegetables to reduce inflammation and stabilize blood sugar levels. Exercise is crucial as well; you needn’t get a membership at a Crossfit gym – even walking facilitates insulin sensitivity and both reduces the risk of diabetes and facilitates remission from diabetes. The most important thing is to get moving in whatever ways you can and to switch your diet immediately to reduce further damage and allow the body to normalize. If you’d like to talk further about how diet can impact diabetes please schedule a complimentary 15 min Discovery Call with us!

 

Resources:

Centers for Disease Control and Prevention. (2017). New CDC report: More than 100 million Americans have diabetes or prediabetes.

Sarathi, V., Kolly, A., Chaithanya, H. B., & Dwarakanath, C. S. (2017). High rates of diabetes reversal in newly diagnosed Asian Indian young adults with type 2 diabetes mellitus with intensive lifestyle therapy. Journal of natural science, biology, and medicine8(1), 60. (Read full study here)

McInnes, N., Smith, A., Otto, R., Vandermey, J., Punthakee, Z., Sherifali, D., … & Gerstein, H. C. (2017). Piloting a remission strategy in type 2 diabetes: Results of a randomized controlled trial. The Journal of Clinical Endocrinology & Metabolism102(5), 1596-1605.

Are Your Supplements Full of Shit?

Supplement quality is a constant challenge here in the United States for many reasons. One of the main challenges is that the FDA, the government agency responsible for ensuring safety and efficacy of supplements, is heavily employed by individuals with significant ties to commercial supplement interests.  Another challenge is that funding for the FDA is limited enough that reliable, consistent enforcement of existing laws is laughable, at best. There is simply not enough manpower to enforce current laws on the books, so it takes significant consumer harm and backlash to get investigations underway.

Despite this, the New York Attorney General conducted an investigation in 2014 and 2015 on common supplements one can purchase over the counter. The degree of label misrepresentation was astonishing and, quite frankly, morally reprehensible.

screenshot-2016-09-28-21-25-11

In the graphic above, you can see that most of the supplements tested had no traces of DNA matching the labeled material being tested. There is some argument that the method used (DNA barcoding) may be inaccurate as an extracted, dissolved, crushed or otherwise altered plant may have altered DNA that was not detected as it was compared to whole plant DNA.  Even if this were so and it accounted for the Attorney General’s findings, it does not excuse the fact that GMP standards (the standard by which supplement companies are supposed to adhere to) were not met in over 50% of the 450 companies inspected by the FDA. Note that the FDA does not even have enough resources to inspect all operating facilities in the USA.

The GMP stands for ‘Good Manufacturing Practices’. This is the absolute basic level of quality a manufacturer is expected to adhere to – maintaining sanitary facilities, preventing cross contamination, documenting of procedures, the ability to trace batches and systems to recall products if necessary, etc. The GMP has no enforcement of quality of the product or the raw materials in the product. Over 50% of tested facilities had violations ranging from no written formula available for their product and no concerns for cross contamination of major allergens to products contaminated with rat feces. So yes, you supplement may literally be full of shit.

Basically in the GMP we have a set standard that is unenforceable and so it can’t even assure us that what is on the label is in the label. Investigations consistently show that there are major problems with the supplements most Americans have access to. Consumer Labs reports 1 in 4 products has a major problem – from significant deviation of the amount in the product vs what is listed on the bottle, to rancid oils and products that won’t break down in the body – the ‘expensive urine’ you’ve been warned about.

What on earth do you do?!?!

Well, according to the graphic above, it would seem best not to get generic supplements available from big box stores.

Beyond the FDA are some consumer watchdog groups that are our best bet for quality assurance – many of these were created before the GMP standards came into play, but remain a higher quality than what the FDA can assure us right now:

ConsumerLabs.com is a for profit company. A supplement company can pay them to have their product tested for quality and carry the Consumer Lab seal of approval. If that product fails to meet criteria it will not be listed on the website. However, if Consumer Lab purchases the supplement from a store and the supplement fails they will post results on their website. So it’s a ‘give us money and you can choose to post results or not’ situation, unless they purchase the product from a store, much like you would, and test it themselves.

A Consumer Labs seal of approval will assure that:

  • contains the key ingredients listed on the label in the declared potency and amounts; it does not contain harmful levels of specified contaminants using stringent limits, for example, California Proposition 65.
  • Product disintegrates or dissolves per USP standards (75% or more dissolves in less than 60 minutes time)
  • The product contains the tested ingredients listed on the label in the declared amounts and of high quality; any health claims must comply with FDA regulations.

USP – United States Pharmacopeia. This third party non-profit tests ingredients, finished products and conducts facility audits. Learn more about the USP here.

A USP certification assures that:

  • The product contains the ingredients listed on the label in the declared potency and amounts; it does not contain harmful levels of specified contaminants; and it has been manufactured according to FDA current GMPs and USP GMPs.
  • Absence of ingredients with known safety risk; appropriate allergen labeling; meets acceptable levels of specified contaminants, based on toxicologic concerns; testing per California Proposition 65 for labeling purposes.
  • Product disintegrates or dissolves per USP standards.
  • Product label has an accurate list of ingredients in the stated amounts. All claims of fact, either stated or implied, must be supported by data, consistent with USP program requirements. Any health claims must be within FDA regulations.

NSF – the NSF is a non-profit organization that tests a variety of consumer products. The NSF dietary supplements certification program assures the following:

  • Label claim review to certify that what’s on the label is in the bottle
  • Contaminant review to ensure the product contains no undeclared ingredients or unacceptable levels of contaminants, including >200 athletic banned substances for Certified for Sport products; it has been manufactured according to FDA’s current GMPs.
  • All claims of fact made for the product, either stated or implied, must be accurate, consistent with NSF program requirements, and meaningful in terms of the benefits offered.

Therapeutic Goods Administration of Australia – considered the most stringent and vigorous of certifying bodies, the TGA requires the same amount of testing for supplements as done for pharmaceutical drugs, as Australia does not distinguish between supplements or drugs. Down under, your multivitamin is considered ‘complimentary medicine’. Very few companies in the USA are certified through TGA. This is considered the gold standard worldwide.

Make sure that the company you use has the final product being tested to ensure that what is on the label is in the label, that contaminants are absent. You can contact them directly and ask them what they are doing for quality assurance and ask for proof if you do not see it on their website or you can check out Consumer Labs.

Thorne Research is a company that has transparent, clear quality assurance that they openly share with their customers. Many companies will not have their quality assurance clearly listed on the website, nor will they even have a number to call to get information! Pharmaceutical grade supplements that are available from practitioners will often meet these higher standards, share them openly, and remain consistent in testing to assure quality. This is precisely why licensed professionals use them; a quality standard is essential to producing reliable results for patients. You can read Thorne’s Quality Assurance here. Other supplement companies with pharmaceutical grade quality include Metagenics, Pure Encapsulations, Xymogen, Douglas Labs and Seeking Health. These are typically not found in supplement stores, although if there is a Pharmaca near you you may find some of these companies there.

If you would like shop for supplements that are GMP certified and practitioner grade check out the VIBRANCE Nutrition Dispensary. You can find many supplements available only at your doctor’s office, such as Pure Encapsulations, Seeking Health, Metagenics and more. Sign up for our newsletter and email me if you’d like a 10% discount on all supplements through Fullscript!

Purchase products through our Fullscript virtual dispensary.
Resources:

Knight, Peter, ND. (2016). Whole Foods Nutrition and Supplementation: Week 10: Lecture 2: Quality Issues in the Dietary Supplement Industry [class notes]. 

O’Connor, Anahad. New York Attorney General Targets Supplements at Major Retailers. New York Times, FEBRUARY 3, 2015. Accessed online 27 September 2016

THE EDITORIAL BOARD. Conflicts of Interest at the F.D.A. New York Times, APRIL 13, 2015. Accessed online 27 September 2016.

Unknown. (2016). Quality Certification Programs for Dietary Supplements. JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS. Volume 116 Number 9