Author Archives: Dr. Peter Knight

An Apple a Day…

Ever wondered if there is any truth in that old saying “an apple a day keeps the doctor away”?

Apples from L to R: Grimes Golden, Baldwin, Black Oxford, and Esopus Spitzenburg

Turns out, there is!

In 2015 The Journal of the American Medical Association published a study looking to see if apple consumption was associated with fewer doctor’s visits.  While the study did not find a decrease in doctor’s visits in those who reported that they regularly consumed apples, it did find a significant decrease in prescription medication use in apple consumers.

While apple consumption may not be a panacea, it can be a delicious way to improve your health.  Consuming apples can  be beneficial for lowering cholesterol, decreasing inflammation, promoting weight loss, optimizing digestive function, protecting against lung and colon cancer, diversifying the microbiome and lowering asthma risk.

The health benefits of apples are thought to be due to the presence a high number of antioxidant compounds along with the fiber and pectin content.  Many of the antioxidant compounds in apples are found in highest concentrations in the skins, so for greatest benefit, do not peel them.

According to the Environmental Working Group, apples are among the 12 foods with the highest pesticide residues on them. Because of this, organic or minimally treated apples are best for individuals wanting to avoid pesticide associated health risks.  The skin contains the highest concentration of pesticide residue, so if left with no other option, peel nonorganic varieties.

There are many ways to enjoy apples, from eating them fresh off the tree, to making apple sauce, and apple pie.  Below is a recipe for a wheat free Caramelized Apple Pancake. Enjoy!

Caramelized Apple Pancake

Ingredients:

  • 1 cup plain soy, rice, or cow milk
  • 1 large egg lightly beaten
  • 3 Tbsp. grape seed, coconut, or canola oil
  • 1 cup oat flour
  • 2 tsp baking powder
  • 3 Tbsp. maple syrup
  • 2 large apples, cored and cut into ¼ inch thick slices
  • 1 tsp cinnamon
  • Zest of ½ a lemon and a splash of lemon juice
  • ½ cup walnuts chopped.

Preheat oven to 500.  In a medium bowl, combine milk, egg, 1 tbsp. maple syrup, and 1 tbsp. oil.  Add in flour, baking soda, and salt.  Stir until combined.  Heat a cast iron or other oven proof skillet over medium high heat. Add 1 tbsp. oil.  Put apples in pan in single layer.  Allow to cook 4 minutes or until they begin to brown. Carefully flip apples and continue to cook until browned on second side.  Add 2 Tbsp. maple syrup, cinnamon, and walnuts.  Toss to just coat apples. Remove from heat. Using a pastry brush or piece of paper towel, coat sides of pan with oil.  Pour in batter.  Put in oven on middle rack. Reduce oven to 425 and cook for 12 minutes or until top is beginning to brown and the pancake is cooked. Slice into wedges and serve.

Davis MA, Bynum JP, Sirovich BE. Association between apple consumption and physician visits: appealing the conventional wisdom that an apple a day keeps the doctor away. JAMA Intern Med. 2015;175(5):777-783.

Can You Trust Your Supplements?

images35DGQ9E6If you are like more than 50% of Americans you took one or more dietary supplements today. The use of dietary supplements has been increasing over the past 20 years. What you once could only find in health food stores is now available in drug stores and grocery stores. It has even become common for conventionally trained medical doctors to recommend multivitamins, fish oil, probiotics and vitamin D. Most of the patients that I work with are taking multiple supplements before I start working with them.

While I recommend dietary supplements to many of my patients I do have concerns about the safety, interactions, and quality of dietary supplements. I will be addressing safety and interactions in future blogs, but in this blog I want to focus on quality issues with dietary supplements.

A quality evaluation by the company Consumer Labs found that 20% of the vitamin D products that they tested failed their quality testing. Two products contained almost twice as much vitamin D as was listed on the label, once product contained unacceptable levels of lead, and two products did not disintegrate within the expected 30 minutes.  A popular national grocery store chains  calcium with  vitamin D product  contained 175% of the amount of vitamin D on the label and still had not disintegrated after an hour. So while you might save a little money on buying the grocery store brand  calcium and vitamin D  if it doesn’t break down in your digestive tract you might as well be throwing your money away.

In another evaluation Consumer Labs found that 16 of 42 multivitamins tested either had less of a nutrient or nutrients than the label stated, had more of a nutrient or nutrient than the label stated, or didn’t dissolve under normal circumstances. While the benefits of taking a multivitamin can be debated, if you are taking a multivitamin it would be good to know that it contains the amounts listed on the label and also that it is going to dissolve in your stomach as opposed to in the sewer.

Several years ago an analysis of Ayurvedic herbal products purchased from health food stores in the Boston area found that over 20% of them contained dangerous levels of lead, mercury, and arsenic. While the amounts in a single pill were not enough to cause a problem, if you were taking them every day for months, the toxic exposure could begin to have serious health consequences.

A study done at my alma mater Bastyr University looking at the quality of probiotic supplements found that only one product out of twenty contained exactly what the label claimed it to contain.  30% of the products were contaminated with other organisms not listed on the label and 20% had no growth of any bacteria.

These examples unfortunately are just the tip of the iceberg. Other issues have included adulteration with anabolic steroids, high levels of toxic solvent residues, failure to contain the herb  species listed on the label, and inclusion of rancid oils.

While I have a great appreciation for dietary supplements, it has become clear to me that there is a great deal of variability in the quality of products sold as dietary supplements in the United States. While there has been an increased effort by the FDA to enforce basic quality standards, the supplement industry remains largely under regulated. The FDA does now require supplement companies to follow specific good manufacturing practices (GMP) in regards to the manufacturing of the product, but there is not the infrastructure to adequately enforce these and even if they did there is concern that the FDA standards may not be adequate enough to ensure that supplements are safe, free of contaminants and contain the substances that the label says that they do. The GMPs also don’t regulate the effectiveness of the product, the forms of the ingredients, where the herbs and nutraceuticals come from, or whether or not the additives or fillers used might have negative effects.

Fortunately there are some companies that have taken it upon themselves to make sure that they are producing high quality products. These companies not only follow the FDA regulations, they go beyond these standards to ensure that when you buy one of their products it contains the ingredients they say they do, in the amounts listed on the label and have been tested to make sure that they do not contain heavy metals, rancid oils, microbes, pesticide residues, solvents, or pharmaceutical drugs.

Buying dietary supplements through large online retailers can seem like a convenient and cost saving method.  Unfortunately there have been numerous recent  reports of counterfeit supplements being sold on Amazon including fake products made to look like products by the popular supplement companies NOW and Host Defense.

To make sure that my patients have access to high quality dietary supplements that they can trust I have partnered with the online dispensary Fullscript.  Fullscript carries supplements by companies that adhere to the highest quality standards and makes sure that the products products that have been meticulously selected and monitored, stored, and shipped with care.  For more information about Fullscript’s quality practices, click here.

If you have not yet signed up with Fullscript, click here to get started.

So the next time you are tempted to buy that cheap bottle of vitamins remember that you may be getting more (or far less) than you paid for!

The Garden Within

“The successful gardener has always known you don’t need to master the science of soil in order to nourish it. You just need to know what it likes to eat- basically organic matter- and how, in general, to align your interests with the interests of the microbes and the plants.  The gardener also discovers that, when pathogens or pests appear, chemical interventions “work”, that is, solve the immediate problem, but at a cost to the long-term health of the soil ad the whole garden.”  -Michael Pollan The New York Times May 19th, 2013

While this quote may seem like it is from an article about organic gardening, it is from an article entitled “Some of My Best Friends are Bacteria” in which author Michae Pollan compares the microflora of our gastrointestinal tract with the soil microbes of a garden.

As an avid gardener and as a naturopathic doctor with a strong interest in gastrointestinal health, this comparison is one that I frequently think about while I have been tending my garden beds this summer.

In gardening we learn that if we nourish and build good soil the plants will grow well, and we will have a good harvest year after year. Plants tend to be resilient to diseases, and pests are often controlled by the beneficial insects that are attracted to a healthy diverse garden. In industrial agriculture (as well as in many backyard gardens), the focus is on getting the plants to grow as quickly, uniformly, and in as high of a volume as possible.  The soil is depleted and does not contain the diversity of soil nutrients and microbes and so high levels of synthetic fertilizers must be given to the plants.  The plants are susceptible to many diseases and pests and so they have to be treated (or genetically modified) in order to survive.  This practice needs a high level of input, produces food deplete in nutrients and is not sustainable.

Our gastrointestinal tracts can be thought of in a similar way to the soil of the garden.  The trillions of bacteria that inhabit our intestines play an integral role in promoting the health of their host (us).  If we create an optimal environment for them to grown in, provide them with the nutrients that they need to survive, and ensure that we are growing a diverse population we will be rewarded with vitamins, decreased inflammation, optimal weight management, balanced immune function, and production of calming neurotransmitters to name but a few of the benefits. 

If we create a less hospitable environment by starving them of the nutrients they need, killing them off with antibiotics from varied sources, and live our lives in such a sterile way that we don’t allow for diversity in our gut microflora, we may end up with many negative health consequences including increased inflammation, obesity, diabetes, allergies, gastrointestinal illnesses and autoimmune diseases to name but a few.

Our knowledge of the importance and influence of our gut microflora is in its relative infancy.  While there is a great deal of research being done to learn more, we do not know enough to always have certainty as to what bacteria are “good”, what bacteria are “bad”, and what the effects of differences in the diversity of the bacteria may have on our health.

We do know enough to know that it is important to nurture and foster our garden within.  While it can be changed by external influences, the microbial community is relatively stabilized by the time we are three years old.  Exposure to bacteria through vaginal birth and breast feeding seems to have the major influence on how this community develops.  While we can’t go back and change what occurred before we were three, there are steps that you can take to “help your garden grow.

  • Eat food, mostly plants, not too much”.  While this quote is from an earlier Pollan work, In Defense of Food, its wisdom holds true for creating a healthy microflora population as well.  The fibers and other polysaccharides in plant foods serve as the prime food supply for our bacteria.  The parts of the plant foods that we can’t digest, our gut microbiome can.  People consuming a diet high in plant foods and lower in animal foods seem to have a greater biodiversity of gut bacteria.
  • Limit intake of processed foods. Processed foods tend to be void of the polysaccharides and fibers that feed our gut bacteria.  Foods high in refined carbohydrates and sugars seem to feed less beneficial species of bacteria as well as encouraging the overgrowth of yeast species.  Processed foods can also contain chemical compounds that can inhibit the growth of our gut bacteria and create a less hospitable environment for them to grow in.
  • Eat more fermented foods.  Naturally fermented foods such as sauerkraut, kim chi, yogurt, kefir, and kombucha contain beneficial bacterial species that can help colonize the intestines and promote the growth of the good bacteria already present.
  • Eat foods high in prebiotics that help to feed your gut bacteria including garlic, onions, leeks, Jerusalem artichokes, dandelion greens, asparagus, bananas, legumes, oats, and avocados.
  • Don’t eat on the run or when you are under stress.  Eating quickly or when you are stressed can decrease your ability to digest your food and can lead to overgrowth of potentially problematic gut bacteria.
  • Engage in stress reducing activities such as meditation, yoga, journaling, walking or exercise.  High levels of stress hormones can decrease the population of beneficial gut bacteria.
  • Consider taking prebiotic and probiotic supplements.  Prebiotic supplements can help to feed and diversify your microbiome. Probiotic supplements can help to modify the environment in your gastrointestinal tract to help to encourage the growth of a healthy microbiome.  You can find my recommendations for prebiotic and probiotic supplements for general health at Fullscript.
  • Go slow when introducing prebiotic foods and supplements.  Consuming large amounts of prebiotics can cause an increase in intestinal gas production.  To prevent this from happening, it is best to start with a small amount and gradually increase it.

If you would like to know more about the ecology of your gastrointestinal tract, there are stool tests that can identify the bacteria, yeasts, and parasites present.  Based on the results of these tests I can make more specific recommendation on how to optimize your “garden within.” 

For more information or to schedule an appointment call (207 805-1129) or email my office.

More Summer Recipes from the Omnivore’s Delight Archive

Tomato Salad

Ingredients:

  • 2 ½ pounds ripe tomatoes, preferably of different colors coarsely chopped
  • 1 tsp salt
  • 1 tsp dried oregano
  • 1 tbsp balsamic vinegar
  • 3 tbsp olive oil
  • 1 clove garlic minced or pressed
  • ¼ tsp red pepper flakes
  • ¼ tsp fresh ground pepper
  • 1 cup fresh basil leaves

Mix tomatoes with salt, place in a colander and allow to drain for 15 minutes.

Combine olive oil, vinegar, pepper flakes, oregano, and pepper in a small jar. Shake well to combine.

Place tomatoes and basil in a bowl. Drizzle with enough dressing to coat tomatoes evenly.  Adjust seasoning as necessary.

This salad is great on its own, or can be served with fresh mozzarella and stale crusty bread chunks to make the Italian salad panzanella.

Melitzanosalata

Ingredients:

  • 2 large eggplants
  • 3 tbsp fresh lemon juice
  • 3 medium cloves garlic minced
  • ½ cup olive oil
  • ½ cup chopped parsley
  • Salt and pepper to taste
  • A dash of tobacco (optional)

Preheat oven to 400.  Using a fork, poke holes all over the outside of the eggplant.  Place on a baking sheet and roast for 30 to 40 minutes, until soft.  Remove from oven and allow to cool enough to handle.

Cut eggplants in half lengthwise and scoop contents into bowl of a food processor. Add garlic, lemon juice, and olive oil and pulse several times to combine.  Add parsley, a pinch of salt and pepper and process until combined.  Adjust seasoning.  Can be served with mixed greens as a salad or as a dip or spread.

Verdure a Scapece

  • 1 medium eggplant
  • 4 bell peppers, preferably red, yellow, and orange
  • 2 zucchini (1.5 pounds)
  • ¼ cup olive oil, plus more for brushing the vegetables.
  • ¼ cup balsamic or white wine vinegar
  • 2 garlic cloves minced
  • 2 oil-packed anchovies, chopped
  • 1.5 tbsp fresh mint or oregano, minced

Combine olive oil, vinegar, garlic, anchovies, and mint in a small bowl or jar and mix until well combined

Cut eggplant and zucchini into slices about ½ inch thick.  Cut each pepper in half lengthwise, removing and discarding the membranes and seeds. Cut each half in half again.

Prepare a medium hot charcoal or gas grill, or preheat the oven broiler.  Brush eggplant and zucchini slices lightly with olive oil and grill on each side for 5 minutes, or until the slices are dark brown on both sides.  If using broiler, broil directly under element for 5 minutes on each side or until dark brown on each side.  Remove to a deep dish or platter.

Place pepper halves skin side down on grill or skin side up under broiler.  Cook until the peppers are slightly blackened and the skin is starting to blister. Remove to platter with eggplant and zucchini.

Pour dressing over hot vegetables, cover, and set aside at room temperature to marinate for at least two hours before serving.  Can be refrigerated overnight.  Bring to room temperature before serving.

Jicama Mango Salad

  • 1 medium jicama, peeled and chopped into ¼ inch cubes
  • 1 small white onion chopped
  • 1 tsp salt
  • 1 medium mango peeled and cut into ¼ inch cubes  (Can use frozen mango)
  • ¼ tsp freshly ground pepper
  • 2tbsp lime juice
  • 2 tbsp lemon juice
  • 2 tbsp chopped cilantro leaves

In a colander, toss jicama and onion with salt.  Allow to sit for 15 minutes. Rinse and put in a large bowl.  Add mango, lime juice, lemon juice, cilantro, and pepper.  Toss to combine, adjust seasoning to taste.  Serve immediately, or refrigerate until serving.

How to Prevent Heartburn this Summer

Summer is a time for barbecues, picnics, and quick and easy meals. It can also be a time of increased heartburn. The term “heartburn” is a misnomer. The sensation of burning around the diaphragm has nothing to do with the heart. This sensation occurs when stomach acid moves up into the esophagus (it’s supposed to stay in the stomach!) This is a very common complaint in today’s society affecting over 60 million Americans.

For more about the importance of stomach acid and the actual causes of heartburn, see my previous post “Stomach Acid is Good for You!”

Here are a few tips to help you stay heartburn free this summer (or any time of the year.)

  • Don’t rush when you eat. By slowing down and eating in a more mindful way you will enhance your body’s digestive abilities and be less likely to overeat. Taking 5 deep breaths before eating can help to put your body in a more relaxed state, ready to digest.
  • Avoid trigger foods. If you are prone to heartburn avoid foods that may exacerbate it including fatty foods, coffee, chocolate, mint, sugar, alcohol, citrus fruits, spicy foods, and dairy products.
  • Wear loose-fitting clothes. Tight fitting clothes can place added pressure on the stomach and exacerbate heartburn.
  • Use digestive bitters. Combinations of bitter herbs have been used to aid digestion for centuries. Digestive bitter formulas can help to stimulate digestion and decrease the occurrence of heartburn when taken before the meal. The best results occur when the bitters are taken in a small amount of room temperature water, 10 to 15 minutes before the meal.  You can buy my favorite digestive bitters through the online dispensary Fullscript by clicking here.
  • Elevate your head when you sleep. Elevating the head of your bed by six inches can help gravity keep the acid in its place. Studies have shown that for those suffering from nighttime reflux, this simple solution can be more effective than antacids or acid suppressing medications.
  • Chew DGL tablets. If you do experience reflux, try chewing a couple deglycyrrhiziated licorice (DGL) tablets before reaching for the antacid. DGL helps to coat the esophagus and stop the burning sensation without suppressing acid production. For best results, the DGL tablets should be chewed well before swallowing. Chew two DGL tablets either right before or right after your meal.  If you experience nighttime heartburn, you can also chew two tablets before bed.  You can buy my favorite DGL through the online dispensary Fullscript by clicking here.

If after trying these solutions you are still experiencing heartburn, call to schedule an appointment with Dr. Knight to help determine the underlying causes of your heartburn so that you can get lasting relief without long term negative effects.

Stomach Acid is Good for You!

If you have been watching television in the past decade you have seen the commercials. People suffering from heartburn and indigestion are magically cured by taking a little purple pill that combats the evil effects of stomach acid. No need to change your diet or other habits. Just pop a pill and everything will be ok. Just don’t pay too much attention to the list of possible side effects at the end of the commercial.

Acid blocking medications are the number one selling drugs in the United States accounting for annual sales of more than $13 billion a year. Once only available by prescription they are now available over the counter at your local drug store. With so many people buying drugs to combat stomach acid you would think that it was a horrible thing that we would want to get rid of. Thank goodness we have all of these options, whatever did we do before?

However, there here is another side to this conversation. For the majority of people, the symptoms of heartburn and acid reflux are typically not caused by an over production of stomach acid. In fact, the majority of people suffering from heartburn and reflux actually have low production of stomach acid In addition, suppression of stomach acid can have long[1]term adverse consequences.

How can this be? Stomach acid is produced by cells that line the stomach. The production is increased in response to food and begins the process of breaking down the meal you just ate. The stomach acid is hydrochloric acid; the same hydrochloric acid that you used in high school chemistry class and that can burn a whole in metal. In order to prevent the acid from burning a hole in the lining of the stomach, the cells that line the stomach produce a layer of mucous that protects the lining and allow the acid to do its job.

When you experience heartburn or reflux some of the stomach acid finds it way up into your esophagus. While your stomach has a nice protective coating, your esophagus does not. So, when the acid accidentally comes up into the esophagus you experience a burning sensation.

At the bottom of the esophagus is a gate called the lower esophageal sphincter (LES). The LES is designed to allow food and liquids to enter the stomach from above, but should prevent the contents of the stomach from coming back up into the esophagus. A number of things can decrease the effectiveness of the LES including smoking, obesity, food allergies, and low stomach acid. When the acid production. is decreased it is more likely for acid to find its way back into your esophagus and cause you pain and discomfort.

Taking an antacid such as Tums, a proton pump inhibitor such as Prilosec, or an H2 blocker such as Zantac do work to decrease the symptoms of heartburn. The proton pump inhibitors are able to suppress stomach acid production by greater than 90%. With very little stomach acid in the stomach there is little chance of the acid finding its way up into the esophagus and so you don’t get reflux or heart burn. The drawback is that you are left without stomach acid.

With low levels of stomach acid you are not able to adequately digest the food that you eat and are more likely to have gastrointestinal issues such as heartburn, reflux, irritable bowel syndrome, diarrhea, constipation, gastritis, gall bladder disease and paradoxically heartburn and reflux. Low stomach acid is also associated with an increase in overgrowth of the small intestine with problematic bacteria. In addition to gastrointestinal dysfunctions, low stomach acid production is also associated with increased risk of numerous disease states outside the gastrointestinal tract including asthma, food Allergies, pneumonia, rheumatoid arthritis (and other autoimmune conditions), depression, rosacea, eczema, anemia.

So next time you are experiencing heartburn, instead of cursing stomach acid and reaching for a pill, think about why you might be having heartburn and work on fixing the underlying cause as opposed to using a treatment that may cause more harm than good. For my tips on preventing heartburn, click here.

Summer Recipes from the Omnivore’s Delight Archive

Strawberry Salsa

Ingredients:

  • 2 cups diced strawberries
  • ½ jalapeño pepper
  • 1/4 of a medium white onion, finely minced
  • ½ cup cilantro, chopped
  • Juice of ½ a lime
  • ½ tsp salt.

Remove seeds and ribs from pepper. Mince into small pieces. 

Combine berries, pepper, onion, and cilantro in a small bowl.  Pour lime juice over the top and sprinkle with salt.  Mix to combine.  Serve with chips, or try on grilled chicken or salmon.

Jicama Mango Salad

Ingredients:

  • 1 medium jicama, peeled and chopped into ¼ inch cubes
  • 1 small white onion chopped
  • 1 tsp salt
  • 1 medium mango peeled and cut into ¼ inch cubes  (Can use frozen mango)
  • ¼ tsp freshly ground pepper
  • 2tbsp lime juice
  • 2 tbsp lemon juice
  • 2 tbsp chopped cilantro leaves

In a colander, toss jicama and onion with salt.  Allow to sit for 15 minutes. Rinse and put in a large bowl.  Add mango, lime juice, lemon juice, cilantro, and pepper.  Toss to combine, adjust seasoning to taste.  Serve immediately, or refrigerate until serving.

Sesame Garlic Snap Pea Salad

Ingredients:

  • 1 pound fresh sugar snap peas
  • 3 Tbsp toasted sesame oil
  • 1 Tbsp seasoned rice wine vinegar
  • 1 tsp red pepper flakes
  • 1 clove garlic smashed and chopped
  • ½ tsp salt
  • 1 Tbsp sesame seeds

Put the snap peas in a medium bowl.  In a small bowl, whisk together the sesame oil, rice vinegar, pepper flakes, garlic, and salt.  Pour dressing over the snap peas and toss to coat well. Sprinkle on sesame seeds and toss again to distribute them.  Refrigerate for at least 15 minutes before serving.

Cooling the Flames of Chronic Inflammation

We are all familiar with inflammation. The redness, pain, and swelling that accompany a sunburn, a cut, a sprained ankle or a cold cause us short term discomfort but are signs that our bodies immune and repair functions are working well. These kinds of inflammation are good, and we need them to survive. They go on for only a finite period of time and then resolve. The problem occurs when the body is exposed to chronic inflammation over long periods of time. An overactive immune response and too much inflammation can result in conditions we associate with inflammation such as allergies, arthritis, asthma, and autoimmune conditions such as lupus and rheumatoid arthritis. In addition, inflammation can be at the root of chronic health conditions such as heart disease, obesity, diabetes, Alzheimer’s disease, depression, and some forms of cancer. While acute forms of inflammation such as a cut or chronic inflammation such as joint pain can be obvious, in many cases we may be having chronic inflammation without even noticing it. This smoldering fire, if left unchecked, can go on for years before we develop an obvious disease state. Some of the causes of this hidden inflammation are:

  • Food allergies/sensitivities
  • Diets high in refined carbohydrates and sugar
  • Diets high in processed foods
  • Diets high in “bad” fats such as trans-fats and excess saturated fat and low in “healthy” fats such as those that come from cold water fish and flaxseed.
  • Chronic environmental allergies such as mold and dust mites
  • Toxic exposures
  • Chronic viral, bacterial, or fungal infections
  • Stress

Because chronic low-grade inflammation is not always obvious, it can be difficult to figure out the cause and to make changes to decrease it before it has effects on your overall health. Fortunately, there is a blood test that can be done called HS-CRP or high sensitivity C-reactive protein that can indicate whether or not chronic inflammation is an issue for you. If your HS-CRP level is elevated, the next step is to make dietary and lifestyle changes that help to decrease inflammation such as:

  • Eat whole foods, minimally processed diet.
  • Limit intake of dairy products and when you do consume them, make sure they are organic.
  • Limit intake of animal products and choose grass fed, free range and wild game meats when you do eat it.
  • Include wild cold-water fish such as Alaskan salmon, halibut, mackerel, and sardines into your diet.
  • Limit foods containing refined sugar and refined carbohydrates. Avoid foods containing high fructose corn syrup.
  • Avoid foods containing hydrogenated oils or transfats.
  • Choose omega 3 eggs from chickens that have been fed flax seeds.
  • Include oils in your diet that are high in omega 3 fatty acids such as flax seed, walnut, and pumpkin.
  • seed.
  • Include anti-inflammatory spices in your cooking such as ginger, turmeric, curry powder, garlic, onions, and cinnamon.
  • Include at least 5 servings of vegetables in your diet each day, including anti-inflammatory options such as broccoli, beets, kale, cauliflower, chard, and sweet potatoes.
  • Take dietary supplements that help to decrease chronic inflammation such as curcumin, black seed, and fish oil.  You can order these through the online dyspensary Fullscript.

In addition, it may be necessary to investigate the underlying causes of inflammation such as food allergies/ sensitivities, environmental allergies and toxicities, nutritional insufficiencies, or chronic infections. Discovering the cause of the “fire” can help you to be able to put it out and decrease your risk of developing a number of chronic diseases.

I can help to investigate if you are having chronic inflammation, what is causing it and develop an individualized health plan to help to decrease inflammation and help you on the path towards optimal health. Call today for more information or to schedule an appointment.

Order supplements through my Fullscript store.

Are Dietary Supplements Sending People To The Emergency Room?

emergencyI routinely recommend the use of dietary supplements as part of my treatment plans with my patients.  Because of this my ears perked up when I heard a story on NPR a couple of weeks ago about the high number of people ending up in the ER due to adverse events related to dietary supplements. The story was about a study in the New England Journal of Medicine published on October 15th that found that an estimated 23000 emergency room visits each year were attributed to dietary supplements.

Now I am of the belief that it would be ideal to prevent any visit to the emergency room and so I was curious to look into the details of the study a little bit further.  23,000 sounds like a large number, but when you take into account that there are 136 million ER visits each year, this ends up being a very small percentage of total ER visits- .019% to be exact. To put this into perspective, 731,000 ER visits were associated with adverse events to the medical use of prescription drugs, 775,000 pediatric visits were for injuries associated with organized sports, 1.2 million visits were due to alcohol ingestion as the primary cause, and over 76,000 were for fire arm related injuries.

According to 2011 data 166 million Americans use dietary supplement and so there is only a .015% chance that someone taking a dietary supplement is going to end up in the ER because of an adverse event.   As I said, I feel that any preventable ER visit is too many, but taking dietary supplements seems like a relatively low risk behavior and not worthy of devoting the media attention to it that it has received.

Looking at the study even more closely, 20% of the visits were due to accidental ingestion by children under the age of 4. While this is a serious issue, it has nothing to do with the supplements themselves but instead has more to do with the childproofing of the home.  Of the close to 3000 visits that were attributed to those over the age of 65, over 60% were because of swallowing issues. Again this is a serious issue, but has less to do about the safety of the dietary supplements themselves.

This is not to say that there were no actual adverse events associated with supplements use. The products responsible for 42% of the total ER visits were supplements marketed for energy and weight loss. Many of these products contain stimulants and ingredients that are not really dietary supplements but instead should be classified as undeclared active pharmaceutical ingredients. While I agree that many of these supplements pose potential harm and should be taken off the market, the actual risk is still relatively low.

Just a Spoonful of Honey…

Camp 2013 025Last year, my wife and I began our latest hobby, beekeeping. Over the course of the summer our hives built up from fledgling colonies to robust pollinating and nectar collecting forces.  Despite getting our fair share of stings, by August we managed to harvest over 50 pounds of honey. This amount is staggering when you consider that it takes 12 bees their entire lives to produce 1 tsp of honey and that on average bees have to visit 2 million flowers to produce 1 pound of honey.  While 50 pounds sound like a lot, if all goes well, we may end up with four times that amount this year.   We have enjoyed eating and sharing our honey over the past nine months and have been constantly looking for new ways to use it in cooking.  While I think that honey is delicious, as a doctor I have been intrigued by the myriad of benefits it can have on our health as well.

While the rise in the interest in bees and beekeeping is a relatively new phenomenon, the use of honey as medicine is not. The Egyptians were using honey as medicine more than 4000 years ago and would put some in their burial chambers to take into the afterworld.  As a testament to its antimicrobial and antioxidant properties, samples of honey found in Egyptian tombs have been found to be perfectly preserved and still edible.

CSC_0125One of the prime ways that the Egyptians used honey was for dressing wounds.  Honey is still used for wound healing today and studies have backed up its effectiveness.  Honey acts a perfect wound dressing since it cleans the wound, acts as an antimicrobial, stimulates tissue regeneration and reduces inflammation.  Honey has been found to be useful in in a wide range of wounds including abrasions abscesses, bed sores, ulcers, surgical wounds, and burns.

In a time when pharmaceutical antimicrobials are becoming less effective against bacterial infections, honey has shown promise as antimicrobial agent inhibiting the growth of over 60 species of bacteria including MRSA. Unlike conventional antibiotics it does not appear that honey leads to the development of antibiotic resistant strains of bacteria.  Honey also does not seem to negatively affect our beneficial gut microbes and has even been shown to increase levels of Lactobacillus and Bifidobacteria.

Honey has other benefits for the gastrointestinal tract in addition to its impact on the microbiota.  Honey has been shown to speed the healing of gastric and duodenal ulcers and also to decrease inflammation of the stomach known as gastritis.  Use of diluted honey has been found to speed the recovery from cases of infectious diarrhea and gastroenteritis.  Taking a teaspoon of honey before meals has been found to decrease the incidence of heart burn or gastro esophageal reflux.

While the idea of pouring honey in your eye may sound strange, eye drops made from hone have been found to be helpful for various ophthalmological conditions including conjunctivitis, blepharitis, dry eyes, keratitis, corneal injuries and even chemical burns.

I typically recommend patients with increased cardiovascular risk and elevated cholesterol avoid sugar, but honey intake may actually decrease cardiovascular risk.  When natural honey was compared with artificial honey made of fructose and glucose, the natural honey was found to lower total cholesterol, LDL cholesterol, triglycerides, and CRP, a marker for inflammation.  In addition it caused a slight increase in the more beneficial HDL cholesterol.    Honey was also found to lower blood pressure and its high antioxidant content may further reduce cardiovascular disease risk.

Coughs in children can lead to sleepless nights for both the child and their parents.  A double blind placebo controlled study reported in the journal Pediatrics in 2012 may help give relief to children and their parents.   Children with night time coughs caused by an upper respiratory infection given a spoonful of honey before bed decreased coughing and improved sleep.  Just keep in mind not to use this remedy in children under 1 year of age as there is a small risk of botulism.

In addition to the properties that I have mentioned that have been studied, numerous anecdotal claims about honey’s healing properties exist.  One of the ones that I hear most frequently is the use of local honey to reduce the severity of seasonal allergies.  While studies looking at this effect have not been conclusive, my own experience has shown it to be beneficial.  When using honey for this use it is important for the honey to be as local as possible so that you are getting exposed to the pollens in your area.

a-jar-of-honeyWhen buying honey it is important to know that all honey is not the same and that much of what is sold as honey is actually not honey.  A study from 2011 found that 75% of what is sold as honey has actually had the pollen filtered out of it.  The removal of the pollen appears to decrease the beneficial properties of the honey and definitely decreases it effect on seasonal allergies.  When buying honey it is important to remember that you get what you pay for.  It was also found that inexpensive “honey” from China was actually honey diluted with high fructose corn syrup.

When you buy honey it is best to buy raw honey and the honey should say on it where it was collected.  If you are not able to find local raw honey in your grocery store, try looking at health food stores, farmers markets, or even stores devoted to the sale of honey, bee products and beekeeping supplies like Portland’s The Honey Exchange.  Owners Phil and Megan Gavin have a wide selection of local and non-local raw honeys and can tell you about where the honey comes from, what it tastes like and always have a number of delicious honeys available for sample.  You can also look inside their observation hive and see the bees in action.

For a refreshing thirst quenching summer time treat try this recipe for a honey rhubarb drink from Poland that combines that tang of rhubarb with the sweet floral taste of honey.

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