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Archive for November, 2018

826 holidays and Hashimotos

If you are on an elimination diet for your Hashimoto’s hypothyroidism, the holidays might be a source of serious anxiety. Sticking to a specialized diet can be enough of a challenge on a normal day. When we add in travel, unfamiliar restaurants and grocery stores, family events and social outings, the challenge — and potential consequences — can seem insurmountable. However, with some good planning you can not only survive but thrive during the holiday season.

Below are time-tested suggestions to help you navigate the holidays with ease when you have Hashimoto’s hypothyroidism.

Plan ahead

Look at your holiday schedule to see which events or plans pose challenges. Write them down and plan out what you need to do to avoid pitfalls.

Travel. Whether you drive or fly to see family and friends, plan ahead for your food options.

Airlines allow you to bring pre-made food even if it’s in a soft-sided cooler pack.

However, airlines won’t allow you to carry on any items in glass jars so make sure your pre-made items are canned or in a box.

If you are unsure about what you can bring on a plane each airline has a webpage where the food rules are listed.

Easy items to bring on the airplane or in the car include:

  • Canned fish
  • Nuts
  • Seeds
  • Protein bars
  • Chips
  • Dried fruit (but not too much!)
  • Coconut butter packets (not in a jar)
  • Nut butter packets (not in a jar)
  • Homemade energy bars
  • Jerky
  • Cut fruits and veggies

If you are driving overnight bring along a pre-made dinner and breakfast in a cooler.

If you plan to eat in restaurants along the way, research them in advance and call ahead if needed to verify gluten-free or other diet needs. Trying to figure it out in the car is likely to create poor results and leave you either hungry or sick.

Bring digestive enzymes to help your system break down food proteins.

Bring Gluten Flam by Apex in case you get glutened.

Stay hydrated — it’s one of the best remedies for recovering from food reactions.

Being a guest at a party or holiday meal

Educate your host. When your host is aware of your food limitations and the medical reasons for them they are in a better position to support you. Explain your diet and why it’s important for you to stick to it.

Send a list of ingredients you can eat or even a couple simple recipes well in advance so they can accommodate you (keep in mind their kitchen may not be gluten-free).

Bring your own food. When your host understands the importance of sticking to your diet they may welcome you bringing your own dish.

Bring food to share. It helps others to appreciate your dietary protocol when they can try your food. Bring something simple but delicious such as soup or pumpkin pie. They may not even realize it’s different — until you tell them. You may even provide a welcome surprise for another guest with food allergies who didn’t plan ahead.

Eat ahead of time. If you are unsure about what will be served, eat ahead. You can also tell the host ahead of time that you need to eat light due to a medical issue.

Always have an emergency snack in your purse and car. You never know when you’ll find you can’t eat what’s offered or get stuck in traffic or at an appointment. Having an emergency snack on hand can make or break your day. See the food list above for ideas.

Family and friends’ attitudes

This can be one of the hardest parts of the holidays for those on a restricted diet. The hard work of smoothing this over likely has to start with you, but the effort can really pay off.

Educate your family and friends. Explain your health condition and how your special diet helps it. Also explain what symptoms you experience when you eat the foods you are supposed to avoid. Not everyone will want to listen, but those who do are more likely to become your allies.

Find an ally. If someone in the room is on your side, whether sibling, parent, partner, or friend, it can make a big difference when others pressure you to “Just have a slice of pie!” Decide on a secret signal to let them know to speak up on your behalf in front of others.

Direct the conversation elsewhere. Nobody wants to spend the whole party telling the crowd about their Hashimoto’s brain fog, IBS, arthritis join pain. Try not to draw attention to your special food, and if asked, give a simple answer such as, “I’m on a medical diet for health reasons.” The use of the word “medical” tends to get more respect than other options.

If someone refuses to understand, or if you receive rude comments, share a link to the “Spoon Theory” of chronic illness.

Host your own event

One great way to enjoy holiday food is to host your own event. If you have the reserves, cooking a full meal for family and friends can be a great way to show them how amazing your “weird” diet is. It can also help bridge the gap of understanding and respect that commonly emerges in family groups.

If you don’t have the bandwidth for hosting a dinner party, create a potluck with specific food rules. Assign some dishes and explain why you need to keep certain foods out from under the roof.

More and more areas have autoimmune paleo, or AIP meetup groups, and the holidays are a great time to organize an AIP potluck. Many people on special diets have nobody who understands. Having a room full of people who understand and appreciate their needs — not to mention a room full of foods everyone can eat — can create new friendships and really make the holidays shine again.

Falling off the wagon

The holidays are about celebration and sometimes a bit of excess. If you fall off the wagon don’t punish yourself. Just get back on and keep goimg. If you start each day with intention it’s easier to stay on track.

However, don’t use the holidays as an excuse to throw caution and dedication to the wind. You worked hard to get where you are, do you really want to backtrack to square one?

Learn to say “no”

The holidays are full enough of stress. Sometimes we get invitations to events we’d rather not attend, unwanted requests to help with tasks or events for community or kids, or pressure from friends and family to try foods we know we ought not to eat.

It’s hard for most of us to say no especially when we’re worried about hurting the feelings of friends or family. But remember, your health is paramount and sometimes a “no” is the most appropriate and self-loving answer.

A simple way to say no is, “No, but thanks for asking.” Don’t give justification or any reason for them to attempt to dismantle.

Saying no can be difficult and scary for those who aren’t used to using it. However, the more you practice, the easier it gets and the less “bad” you will feel for saying it.

Ask my office for more advice on managing your Hashimoto’s hypothyroidism through diet and functional medicine protocols.

 

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825 NSAIDs heart risk

Many of us reach for ibuprofen, aspirin, or another non-steroidal anti-inflammatory drug (NSAID) when we have chronic pain or inflammation. But despite their easy access, these drugs present serious health concerns. While we’ve known for some time that NSAIDs increase the risk of heart attack, but a recent literature review showed that all NSAID types were associated with increased heart attack risk, and the risk was greatest during the first month of use.

Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of heart attack.

Greater risk was associated with higher doses.

When used for longer than one month, the risks did not appear to exceed those associated with shorter use duration.

Daily doses of 200 mg or more of celecoxib, 100 mg or more of diclofenac, 1200 mg or more of ibuprofen, and 750 mg or more of naproxen for just 8 to 30 days could raise heart attack risk.

For perspective, the recommended safe dose of ibuprofen is 1200 mg for menstrual pain — the same dose seen to raise heart attack risk — and 3200 mg for arthritis pain or fever.

Is a daily aspirin safe?

Many doctors recommend taking an aspirin to stop an impending heart attack, but as for daily use, aspirin’s heart benefits may be overshadowed by other concerns.

A 2018 study states, “The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.”

NSAID risk not limited to heart attack

NSAIDs such as aspirin, ibuprofen, and naproxen are the most prescribed medications for painful conditions such as arthritis, bursitis, and tendinitis. They come in many strengths and formulas in both generic and brand-name forms. Not only pain relievers, NSAIDs also reduce inflammation and fever and help prevent blood clotting.

NSAIDs work by preventing the COX (cyclooxygenase) enzyme from doing its jobs.

COX has two forms, each with its own duties:

  • COX-1 protects the lining of the stomach from digestive acids and helps the kidneys maintain function.
  • COX-2 is involved in the synthesis of prostaglandins that cause pain and inflammation in the body.

Traditional NSAIDs block the actions of both these COX enzymes, which is why they can cause upset stomach while relieving inflammation and pain.

COX-2 inhibitors are special because they only target the enzyme that stimulates the inflammatory response. Because they don’t block COX-1 activity they don’t cause the stomach upset commonly associated with NSAIDs.

However, COX-2 have serious side effects including abdominal pain, nausea, indigestion, and in rare cases, abdominal bleeding. Before use, talk to your doctor if you have a history of angina, heart attack, stroke, blood clot or hypertension or if you are sensitive to sulfa drugs or other NSAIDs.

Because NSAIDs block the stomach-protecting qualities of COX-1, they can cause stomach upset and bleeding, so take them with food to minimize risk. Other common side effects include:

  • Heartburn
  • Gas
  • Bloating
  • Vomiting
  • Nausea
  • Diarrhea
  • Constipation
  • Mild headache
  • Dizziness
  • Difficulty concentrating

If you have a health condition such as diabetes, liver or kidney disease, asthma, history of stroke or heart attack, Crohn’s disease, or pregnancy, talk with your health care practitioner before taking NSAIDs.

NSAIDs linked to leaky gut

An additional reason to avoid NSAIDs is their ability to promote leaky gut. In leaky gut, inflammation and damage to the lining of the small intestine causes it to become overly porous. This allows undigested food and pathogens such as bacteria and toxins to pass into the bloodstream, triggering a cascade of inflammation and pain throughout the body.

Quell pain without pills

Americans are in increasingly in pain from chronic inflammation caused by poor diet, stress, inadequate exercise, toxic load, sleep deprivation, unaddressed autoimmunity, and other factors of modern life.

Pain is the body’s way of telling us something is wrong. It’s important to address its cause early so you don’t suffer long-term effects.

In functional medicine, we address pain from various angles, and while pharmaceutical drugs may be necessary sometimes, there are many ways to reduce pain without taking drugs.

Anti-inflammatory diet. The foundation of any pain management plan, your diet should exclude foods known to wreak havoc on the immune system. Many patients do well by removing triggers such as gluten, excess sugars, processed oils, eggs, dairy, nightshades, and nuts.

Sleep. Getting enough sleep is one of the most underrated ways to reduce pain and inflammation. The amount of sleep you get directly affects the amount of pain you will feel in the following days. To improve your sleep, avoid screen time in the evening, stick to a regular bedtime and wake-up time, and work on balancing your blood sugar.

Yoga and meditation. These practices help quiet the brain and assist the transition from “fight or flight” mode to “rest and digest mode” where our bodies can heal.

Hydration. It’s easy to forget to drink water when we’re busy. We are made primarily of water, and dehydration adds to chronic pain. The best way to hydrate is to drink small bits all day long. Minimize caffeine and alcohol intake because they serve as diuretics.

Moderate exercise can reduce inflammation and relieve pain associated with immobility (just don’t overdo it or you’ll cause more inflammation).

CBD oil. Proving to be one of the best pain-relief options, many patients prefer CBD over opioids. Myth bust: CBD sourced from hemp is not psychoactive.

Boswellia. Available both as a tincture and as pills, this tree-based resin is known for its anti-inflammatory compounds and is said to rival the anti-inflammatory power of NSAIDs. Take it with a meal to avoid gastric upset, and check with your doctor if you are pregnant or breast feeding.

Turmeric and resveratrol. Powerful anti-inflammatories independent of each other, research shows they are much more effective together.

Support glutathione. The body’s master antioxidant, glutathione helps you detoxify, helps immune function, and shields cells from inflammation-based oxidative damage.

White willow bark is commonly used in place of aspirin for inflammation and pain.

Test for the root cause. Sometimes the cause of pain isn’t obvious such as a sprained ankle. A functional medicine practitioner can test you for nutrient deficiencies, underlying infections, imbalances in hormones, and environmental toxin exposure that contribute to chronic pain.

Managing chronic pain requires a commitment to diet and lifestyle changes, but when it’s done right, enjoying a pain-free life is possible. If you suffer from chronic pain and want to know more about how functional medicine can help you, please contact my office.

 

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824 organic foods less cancer

Many people eat organic food because they believe it is better for their health, yet until recently scientific evidence of its benefits has been in short supply. Now a new study adds weight to previous research suggesting an organic diet may reduce the risk of certain types of cancer.

The French study, published in the Journal of the American Medical Association (JAMA), surveyed nearly 70,000 subjects, mostly women, to determine whether an organic foods diet was related to a reduced risk of cancer during a five-year study.

Results showed that subjects who consumed organic foods most frequently had a surprising 25 percent fewer cancers than those who never ate organic. Organic foods were most strongly linked with much lower incidences of postmenopausal breast cancers and non-Hodgkin’s lymphoma.

“We did expect to find a reduction, but the extent of the reduction is quite important,” said Julia Baudry, the study’s lead author. 

The study was consistent with findings from a previous British study that followed more than 600,000 female subjects for nine years and found consumption of organic foods linked to a 21 percent reduced risk of non-Hodgkin’s lymphoma.

While subjects in the UK study only responded to one question about how often they ate organic food, participants in the French study gave more detailed information about three 24-hour records of their intake, including:

  • How frequently they consumed 16 different types of organic foods, including produce, dairy, soy, meat, fish, eggs, grains, legumes, flour, oils, condiments, wine, coffee, teas, and more.
  • Information about education, occupation, income, smoking habits, and more.

People who eat organic tend to have higher incomes and more years of education than those who don’t. The study adjusted for these factors as well as physical activity, use of alcohol and tobacco, weight, and family history of cancer.

Those who most frequently consumed organic foods had astounding results:

  • 76 percent fewer lymphomas
  • 86 percent fewer non-Hodgkin’s lymphomas
  • 34 percent reduction in post-menopausal breast cancers

The reduction in lymphomas might be expected as former studies revealed a higher rate of some lymphomas among farm workers exposed to certain pesticides.

This brings up two questions:

  • Is the reduced risk of cancer associated with organic food liked to the reduced pesticides used in organic farming?
  • Does an organic diet reduce breast cancer risk because many pesticides are endocrine disruptors that mimic estrogen function, and hormones play a role in breast cancer?

Are pesticides to blame?

Previous research has shown that those who eat more organic foods have lower levels of pesticide residues in their urine, and a recent study showed that consumption of pesticide-laden foods directly increases levels of urinary pesticides.

The UK and French studies did not measure urinary pesticide levels, which has earned criticism from Harvard nutrition experts who have called for long-term studies to confirm results and learn more about why organic foods reduce cancer risk.

“Natural” doesn’t mean “organic”

As we learn more about the effect of environmental toxins on our health, increasing numbers of people are reading food labels. We all want foods that are safe, healthy, and made using practices that align with our values.

Yet food marketing can be misleading and it’s important to understand food labeling terms, in particular “natural” versus “organic.”

The USDA sets strict guidelines for organic food production and labeling.

Organic. Products can be labeled “organic” only if they are independently certified as meeting USDA National Organic Program standards.

Natural. With the exception of meat and poultry, the term “natural” is unregulated. Foods labeled “natural,” “all natural,” and “100% natural”  might contain artificial ingredients, pesticides, herbicides, growth hormones, antibiotics, and GMOs.

Five USDA requirements for foods to be labeled organic:

1. Produced without genetic engineering. GMOs (genetically modified organisms) include the transfer of genetic information from one species to another to achieve a desired trait. While supporters of GMOs claim there are no dangers, many scientists warn that not enough research has been done to determine long-term risks to the environment and to those eating these foods. Use of GMOs has led to increased use of the toxic herbicide glyphosate, now classified as a probable human carcinogen.

2. Produced without sewage sludge. Conventional farming practices include application of sewage sludge to fields. This can introduce contaminants such as heavy metals to soil and foods.

3. Produced without ionizing radiation. Commonly used to preserve and increase the shelf life of conventionally-produced spices, meats, and fresh produce, this process is hotly contested.

4. Produced with allowed substances. In order to prevent harm to the environment or interfere with the nutritional value of food, the USDA has a long list of barred substances such as synthetic herbicides, pesticides, and ash from burning of manure.

5. Include only allowed ingredients. Certain packaged foods that are labeled as organic are allowed to contain certain non-organic ingredients. Artificial colors, flavors, and preservatives are not allowed.

How do I know if food is organic?

According to Organic.org, the USDA has identified for three categories of labeling organic products:

  • 100 percent Organic: Made with 100 percent organic ingredients.
  • Organic: Made with at least 95 percent organic ingredients.
  • Made with Organic Ingredients: Made with a minimum of 70 percent organic ingredients with strict restrictions on the remaining 30 percent including no GMOs (genetically modified organisms). Products with less than 70 percent organic ingredients may list organically produced ingredients on the side panel of the package but may not make any organic claims on the front of the package.

The USDA Organic seal means facilities and farms that are organic-certified must have an organic system plan and records that verify compliance with that plan and are inspected annually and randomly.

Conventionally-grown produce has higher residues of herbicides and pesticides. A recent report by the Environmental Working Group even found notable levels of glyphosate in all the samples of mainstream breakfast cereals tested.

Conventional animal products are more likely to contain antibiotics, growth hormones, and heavy metals than their organic counterparts.

While more studies are needed to determine why organic foods are associated with lower risk of cancer, when you look at the USDA requirements above, you begin to see why foods that are not grown organically may pose health risks — not only to humans, but to animals in the environment.

And as we see more results come in, foods we formerly thought of as “healthy” and “wholesome” may now shift to the “dangerous” list.

Get to know your food labels, and as much as you can and choose organic foods for the health of you and your family. You can learn more about organic foods by going to the website of the Organic Consumers Association.

 

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823 antibiotics rupture tendons

Most of us have taken antibiotics to treat infections, whether for a nasty bug, a bad scrape, or after surgery. We tend to trust doctors’ recommendation, however, new data about the alarming side effects of a class of antibiotics called fluoroquinolones makes it clear they should only be used as a last resort.

Fluoroquinolones are a class of broad-spectrum antibiotics commonly prescribed for infections of the kidneys, urinary tract, sinuses, and respiratory tract.

Known by names such as Cipro (ciprofloxacin), Cipro XR, Proquin XR, Levaquin (levofloxacin), Floxin, Noroxin, Avelox, Factive, and certain generics, any drug ending in “floxacin” is in this class.

The side effects — sometimes called “getting floxed” — are so severe, the Food and Drug Administration warns to avoid taking this family antibiotics unless there is absolutely no another option.

Fluoroquinolones increase risk of tendinitis and tendon rupture

While fluoroquinolones are known for various side effects, one that may come as a surprise is increased risk of tendinitis and tendon ruptures.

Fluoroquinolones have been shown to weaken and disrupt the underlying structure of tendons. Researchers propose the following causes:

  • A boost in levels of enzymes that damage soft tissue.
  • Interference with the way our bodies replicate DNA, essential to repair of minor damage that running might cause.
  • Disrupted blood flow to collagen in the muscles and tendons.

The Achilles tendon seems to be particularly susceptible, making fluoroquinolones especially problematic for runners.

The average person taking fluoroquinolones has a 70 percent greater risk of tendinopathy and a 30 percent greater risk of full rupture than someone taking a different class of antibiotics.

Signs might include tendon, join, and muscle pain, sometimes soon after taking the drug. However, the side-effect risks can continue for weeks after you stop taking the drug.

The higher your dose and the longer you take fluoroquinolones, the greater your risk of tendon problems.

The most vulnerable populations include:

  • Older people
  • People with kidney disease
  • Patients taking corticosteroid medications

Fluoroquinolones: a long history of side effects

Fluoroquinolones have been required for years to carry warnings to alert doctors and patients of increased risk of certain health issues. As time has revealed the true severity of the effects, the FDA has raised the bar and required them to carry its sternest “black box” warning.

Side effect alerts include:

  • In 2008, the FDA added a black box warning to fluoroquinolones regarding the increased risk of tendinitis and tendon rupture.
  • In 2011, the risk of worsening symptoms for patients with myasthenia gravis was added to the labeling rule.
  • In 2013, the FDA required labeling updates to reflect potential for irreversible peripheral neuropathy (serious nerve damage).
  • In 2016, the FDA enhanced warnings on all fluoroquinolones to the “black box” level regarding disabling and potentially permanent side effects involving tendons, muscles, joints, nerves and the central nervous system.
  • Because the risk of these side effects generally outweighs potential benefits to patients with acute bacterial sinusitis and uncomplicated urinary tract infections, the FDA determined that these drugs should only be used for as a last resort after other antibiotic classes were tried unsuccessfully.
  • As late as July 2018 the FDA announced a labeling change to strengthen warnings about the risks of mental health side effects and severe blood sugar disturbances.

Blood sugar disturbances. Both high and low blood sugar are already included as a warning on most fluoroquinolone labels, however the FDA added that these low blood sugar levels can lead to coma.

Mental health side effects. Across the fluoroquinolone antibiotic class, a range of mental health side effects are already described on the drug labels, including disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium. The revised labels will make these side effects more prominent and more consistent across the drug class to better alert doctors and patients.

Fluoroquinolones help create antibiotic resistant bugs

Another reason to avoid this class of drugs is they appear to be especially good at creating antibiotic resistant bugs.

The effectiveness of fluoroquinolones at destroying bacteria associated with certain infections has dropped from 100 percent to about 70 percent.

Only use fluoroquinolones as a last resort

The spread of knowledge about the increased FDA warnings seems to be slow. While medical groups such as the American College of Obstetricians and Gynecologists, the Infectious Diseases Society of America, and the American Thoracic Society have stopped recommending fluoroquinolones as the first line of defense, studies show little reduction so far in the prescription of fluoroquinolones outside of hospitals.

The FDA recommends that whether you are an athlete, if you have a common infection such as bronchitis, sinusitis, or a simple urinary tract infection, don’t agree to take these drugs unless you have no other option.

If your doctor wants to prescribe fluoroquinolones, make sure to tell them about any history of kidney disease, steroid use, or any previous issues with your tendons or muscles.

And remember that other serious side effects are possible, including nerve damage, confusion, hallucinations, and blood-sugar related coma.

Please contact my office for more information about how to treat infections without this dangerous class of drugs.

 

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