Sunday, August 26, 2018

Medical Detox - the basics

If you've followed this blog so far, I have been writing about hormone balance and the health consequences of being out of balance. I've covered the why of detoxing in a previous post. Today I will explain the basics of working with a Functional Medicine doctor (or Integrative practictioner) like myself to do a guided medical detox.

 As you can see in this photo, there are lots of different detox supplements out there. How do you choose one that will work for your situation? That is one of the reasons for getting medical guidance.

It is especially important to get help with doing a detox if you have any metabolic disorders (high blood pressure, diabetes, high cholesterol, overweight, menopause, autoimmune disorders, hypothyroid, etc.) precisely because your individual set of circumstances will impact the way you should proceed and a Functional or Integrative practitioner can make recommendations to individualize the process for you so that you don't suffer any bad side effects.

After an initial physical exam and laboratory evaluation, your practitioner should be able to suggest a detox that will work for your lifestyle, motivation and goals. It is important to note that most toxins are stored in fat tissue and you should do a detox before you lose weight so you don't release all the toxins into your body and move them around to your brain or bones!

 There are 'detox kits' that usually include a medical shake mix like the one pictured and a detox supplement to improve your detox pathways. These kits include suggestions of how to best utilize the shake and supplement to achieve the maximum results. Your practitioner can tailor the suggestions to meet your needs.

To move toxins out of your body efficiently your practitioner can help you improve the performance of your kidneys, liver and lymph systems - the main pathways by which toxins are removed. You may also need to use a fiber supplement to increase the frequency of your bowel movements.

Since many toxins are secreted into the colon for elimination, if you don't have at least two bowel movements a day during the detox you may be reabsorbing the toxins and storing them away in various body tissues, including your bones and brain! You definitely do not want to do that.

Your practitioner can help you find the right fiber supplement for you. I have a sensitivity to oats, which are an ingredient in many fiber supplements, so I found this one from Vital Nutrients that doesn't have oats in it.

When I prescribe a detox I always recommend taking a few days to plan meals and get groceries since the therapeutic foods that help the detox pathways are the key to getting the best results. If you eat inflammatory foods or foods that slow down the metabolic pathways that need to work at full capacity to move toxins, then you will not get good results and may even do damage to your health.

I also recommend picking a time frame that will allow you to follow the detox plan without getting into situations that will defeat you. Most detox programs require a commitment of 10-28 days, depending on how much you want or need to achieve. It would not be a good choice to start a detox the week before vacation or a holiday or travel.

You will get the best results when you can cook your own meals and eat organic foods, so you should plan ahead and choose wisely. I think it is good to do a short detox at least once a quarter and plan a longer detox in January just after New Year's. I'll be doing another short detox in early October and blogging about it.

Meanwhile, we have covered several ways to help balance hormones - reducing inflammation, detox and practicing self care and mindfulness. Next week we will talk about the adrenal glands because if they aren't functioning properly all of your other hormones can be thrown out of balance.

I leave you with my organic arugula salad. Yesterday was a day when all the stars aligned and I was able to get to the Farmer's Market early enough to snag some hydroponic arugula before it sold out and one of the vendors had fresh picked figs. I had just bought a new goat cheese to try and some organic walnuts and so a salad was born.

Arugula Salad with goat cheese, figs and walnuts:

The goat cheese was Vermont Creamery 'smoked pepper jelly'. I dressed it with himalayan salt, fresh cracked black pepper and organic olive oil and white wine vinegar. It was yummy!

Sunday, August 19, 2018

Unexpected Detour

My plan was to post about working with an Integrative or Functional Medicine practitioner to do a supervised detox this week. In last week's post, I wrote about the basic principles of a detox and why you might benefit from an occasional detox. BUT - sometimes Life gets in the way and our best laid plans go by the wayside. This was one of those weeks!

I work in a fairly busy Integrative/Functional Medicine/Chinese Medicine clinic and we are transitioning to an EHR (Electronic Health Record) for the first time from paper. Paper is very inefficient so eventually, once we are all familiar with the system and have customized it for our purposes, we will be able to store the paper charts and just work on the computer but right now our charts aren't scanned in and it has been a little crazy to say the least!

So I realized on Friday, when we were having a Team Building day (and I had to go back to the office afterwards to finish my digital 'Task list') that I had not mentioned one of the most important components of ongoing detox - Self Care.

In our hectic modern society, we tend to work overtime during the week and overextend ourselves on the weekends. This leaves our adrenal glands - tasked with handling day-to-day challenges - without any reserves and sometimes just depleted to the point of exhaustion.

Taking time for self-care by literally stopping to smell the roses or reading a book or just hanging out with a friend doing nothing can allow you to put some 'money' back in the adrenal 'bank'.

SO - instead of researching my post and writing it yesterday, I went with a friend to Gibb's Gardens near Ball Ground, Georgia, which is just northwest of where I live in Alpharetta. Around every bend in the garden path is a new delight to appreciate, if you take the time to notice and be in the moment - a practice called mindfulness.

I recommend developing a mindfulness practice as part of an ongoing self-care regimen. Mindfulness allows you to connect with what I like to think of as your 'primordial self' - the you that you were before you were born and Life happened to you. This self doesn't have an Ego to tend but is perfect in every way and connected to the Source of all Being. When you connect to this Self, you can be more grounded, more compassionate, more loving, more present - you can receive from the Giver of all things whatever you need to be content.

When I first got started practicing mindfulness, I read some of Jon Kabat-Zinn's books.  I like Mindfulness for Beginner's and Full Catastrophe Living but he has many from which to choose. I also recommend Search Inside Yourself by Chade-Meng Tan which was written to explain both the personal and corporate benefits of mindfulness. I like it because each chapter is short and sweet and usually has a mindfulness exercise to try.

I also recommend to patients that they combine movement and mindfulness in some way to improve brain health. This could be yoga, tai chi, mindful walking, qi gong or visiting a garden and stopping to notice butterflies like the one above. So I was practicing what I preach by taking a break when my body was telling me I needed a break and so our discussion of a medically supervised detox will have to wait until next week.

Meanwhile, get out there and be mindful so your brain and adrenal glands can be healthier! That will help you have more balanced hormones and help your body avoid the possible diseases that result from being over-stressed.


Sunday, August 12, 2018

Detox to balance hormones

In last week's post I began to discuss hormones and how imbalances can contribute to the development of diseases. The first step we covered to help improve hormone balance was reducing inflammation. This week I want to talk about the second step to help improve balance - detox. If you are unfamiliar with detox, this post will be a primer. 

I should explain that when I speak about detox I am talking about a metabolic detox, not getting off drugs or alcohol! 

Why do we need to detox? Glad you asked.

Our environment has been polluted by harmful chemicals, many of which directly affect our hormones to induce imbalance and disease. These are commonly referred to as endocrine disrupting chemicals - EDCs.

You may have heard about BPA (bisphenol A) in plastic bottles and packaging. The ZRT hormone assessment mentioned last week includes an assessment for BPA because it mimics estrogen in the body. If you think you are safe because you don't use plastic, think again. BPA is used to line cans containing food and it coats cash register receipts. 

Here is a list of the top ten EDCs as researched by the Environmental Working Group (EWG). If you read through each hazardous chemical group in the publication (download the pdf), you will see that our air, water, soil, personal care products, our bodies and food are all contaminated. THAT is why you need to detox.

<- Detox teas

If you've never done a detox or have a lot of metabolic problems like diabetes, high blood pressure, heart disease, autoimmune disease or cancer, you should first work with a Functional Medicine practitioner like myself to prepare yourself for a detox.

If you aren't able to work with a doctor, you can encourage gentle detoxification with teas like these made by Pukka or an organic dandelion tea and by eating cleaner foods to help lower the toxic load in your body. If you message me, I can send you a detox food list to help your detox pathways work better. Eating colorful foods and being strategic with your food choices can improve your ability to detox.

Your liver is your main organ of detoxification. It is in the liver that substances are transformed, in what is called Phase I of the detox process, mainly by enzymes in the Cytochrome P450 family, into polar molecules that are then either moved into bile for excretion or further changed via the Phase II detox pathways.

Your hormones are metabolized via the Phase II pathways - after having been changed in the Phase I system - by conjugation with moieties that allow your body to then excrete the conjugated molecules. Estrogens end up conjugated through glucuronidation and are then moved into the bowel for elimination.

If you don't have good bacteria in your intestines, some non-beneficial bacteria (like the families that thrive on sugars and carbs) can uncouple the estrogens from the glucuronide moity, which allows the uncoupled estrogens to be reabsorbed and go back into circulation. This is one of the ways you can end up with excess estrogens and hormone imbalance.

Your body also moves toxins out through your kidneys and lymphatics via urine and sweat. Lymph can also move toxins into your intestines for elimination so having regular bowel movements is very important for detoxification.

Help your kidneys work better by drinking water. Hydration is another important way you can help your detox pathways on a daily basis. Your minimum daily water requirement can be calculated by taking your weight in pounds and dividing by two. If you weigh 140 pounds, drink 70 ounces of water a day minimum.

You can help your lymphatics by exercising to improve lymph flow and increasing your sweat production. Getting a massage also improves lymph elimination and using an infrared sauna can help you detox with increased sweat.

So to sum up:

  • Find out where you are being exposed to toxins in your food, water and environment and remove toxins as much as possible by eating clean foods (use the Environmental Working Group list to know which foods have the highest pesticide burdens).
  • Know where Endocrine Disrupting Chemicals come from and get rid of them to help balance your hormones.
  • Hydrate adequately every day.
  • Drink green tea and detox teas 
  • Eat colorful foods and plenty of fiber to have 1-2 bowel movements daily
  • Exercise regularly
  • Sauna to increase sweat and get a massage if possible to improve lymph flow
Next time I'll cover doing a doctor-supervised metabolic detox. Meanwhile, here's another detox shake you can make:

Pear Detox Shake

1/2 - 1 cup greens (kale, spinach, chard, red butter lettuce)
1 frozen or fresh pear, in chunks
10 frozen cherries
1 T ground flaxseed
2 T MCT oil
dash cinnamon
2-4 peppercorns
Vegetable protein to provide 15-22 grams protein
1 shot organic aloe (if available)
8-12 ounces hemp milk or cashew milk

You can make this a chocolate shake by adding 1 T organic cacao powder, 2 T organic cacao nibs.

Blend in a high speed blender and enjoy. Add extra liquid if needed to get the right consistency.

Happy detoxing!

Sunday, August 5, 2018

Hormonally speaking..

What do you think of when someone mentions hormones? Most of us think of the sex steroid hormones. For women, this translates mostly to estrogen and progesterone and for men, mostly testosterone. Here is one of the teaching tools I use in practice (not an exhaustive list) when addressing the sex steroid hormones:

<- Steroid Hormone Cascade

This flow sheet is from a ZRT urinary metabolites report, just one of the options for assessing hormones.

You might notice (sorry for the tiny print) that cholesterol is at the top. It is the backbone of all of the other steroid hormones. Most patients are surprised to hear that.

I recently had a very stressed patient whose cholesterol had gone up in the last six months, despite her efforts to control it with diet, lifestyle and supplements.

If you look down the line flowing second from the left you will see cortisol. Cortisol is the main hormone from the adrenal gland that helps your body manage any stressors. Stressors can be good or bad, happy or sad. Divorce, moving, a new baby, death of a loved one - all are stressors. In the metro Atlanta area traffic is a stressor! Just making a Target run can add a little stress to your day.

So, I explained to my patient that her body may be making more cholesterol in order to meet the demand for cortisol. As I told her, cholesterol is the brick and when you need to build a house you will need more bricks. So if you experience daily stress for a prolonged period of time, you can see that the demand for cortisol might throw the other columns out of balance.

Hormone imbalance is the root cause of many symptoms, like PMS, PCOS, fibroids, ovarian cysts, irregular menses, weight gain, mood changes and libido changes. Since I get questions about managing hormone imbalances and see patients every day that are suffering from one or more imbalances, I thought maybe over the next few weeks we could cover hormones and how imbalances impact your health and what you can do about them.

There are hundreds of other hormones in the body but a few that will be important in this discussion, besides the sex hormones already mentioned, are the thyroid hormones that regulate our metabolism, melatonin, the hormone that regulates sleep, and the hormones that impact appetite and blood sugar control, leptin and insulin.

One very important factor in hormone imbalance is inflammation. We become inflamed because our food is inflammatory and our environment is inflammatory. Foods are either intrinsically inflammatory (containing too much sugar or omega 6s) or become inflammatory through processing or cooking methods or overconsumption.

One of the tools I get from IFM is a chart developed by nutritionists called the Phytonutrient Spectrum. It illustrates the positive effects of eating a rainbow of colors. The foods that are listed as anti-inflammatory include red foods - apples, red beans, beets, blood oranges, strawberries, rhubarb, tomatoes and watermelon (the actual handout has many more examples), yellow foods like apples, bananas, corn, ginger, pineapple and summer squash, green foods including (again not an exhaustive list) apples, asparagus, broccoli, celery, greens, okra and zucchini, and purple foods like bell peppers, berries, cauliflower (yes, it comes in purple), eggplant, figs, prunes and purple or black rice.

Just adding color to your diet will add natural anti-inflammatory properties to help lower your overall inflammation and balance your hormones. The best way to eat many of these foods is raw but some actually deliver more anti-inflammatory properties when lightly steamed or baked (broccoli's impact is increased with light steaming, tomatoes increase their lycopene content when baked but have more vitamin C raw).

The worst way is to blacken foods. The blackened parts are called Advanced Glycation End products or AGEs and they increase oxidative stress and inflammation (which accelerates the aging process).

<- Red, Yellow, Green & Purple!

Most people don't realize that dairy and animal fat are the most inflammatory foods because of the high omega 6 content. Most omega 6 fatty acids convert to arachidonic acid, which is mostly inflammatory in the body. There is a great book called The China Study that follows the adventures of a cancer researcher who set out to find out why children overseas in food impoverished areas suddenly began having liver cancer. I highly recommend it to anyone wanting to know the impact of what we eat on our risk for disease, including cancer. He also covers how corporate influences affect governmental agencies like the FDA, which was originally created to protect the health of the public but with corporate interests involved, not so much.

Besides adding color to your diet, you can take anti-inflammatory supplements like turmeric, ginger, boswellia, fish oil and resveratrol. Work with a Functional Medicine (like myself) or Naturopathic or Integrative doctor to determine the right doses for you. In general, you won't get therapeutic doses at a Target, Walmart or GNC and those cheaper supplements may contain contaminants so don't waste your money.

Exercising is another good way to lower inflammation, if you don't overdo it. Start slow and gradually work up to 30 minutes at least 5 times a week. I usually have patients start with some stretching and work up from there, incorporating breathing to also help lower stress.

So to sum up - lowering inflammation is one way to help balance your hormones. Avoid dairy and beef and pork (meats with the most animal fat), avoid processed foods (tend to have a lot of omega 6 fatty acids), eat more colorful foods, avoid sugar (or foods that turn into sugar like white bread, white rice and white potatoes), take anti-inflammatory supplements and get off your rump and move!

I'm doing a detox this week to help my body get rid of unwanted endocrine disrupting chemicals and other environmental toxins that can cause inflammation and hormone imbalance so next week will be a primer on detox. I like detox shakes so am sharing my watermelon shake recipe today. You will need a vegetable protein shake powder. There are formulations made specifically for detoxing, which I'll cover next week.

Watermelon detox shake:

Watermelon, chopped, approximately 2 cups
1/2 frozen pear (if you use fresh you'll need more ice)
1 ice cube of pomegranate juice, frozen
1/2 c spinach
juice of 1/2 lime
3 T MCT oil
1 tsp flax oil
Protein shake powder to provide 15-22 g protein(unflavored or vanilla)
8-12oz coconut water

Place all into the carafe of a high-speed blender and blend.

I use a Vitamix but any high-powered blender will do. Enjoy!