Iron: Why Many Women Need to Supplement

Posted by on Aug 29, 2017

Fatigue is the most common complaint doctors see in their office. The causes of low energy are numerous, and often there isn’t a single culprit. However, in women of reproductive age, low iron can be a common cause of or contributing factor to low energy. Many of my patients have been told to supplement iron in the past, but they haven’t been told why or for how long. Let’s explore the subject. When considering any nutrient in the body, we have to think about 3 factors: how much of it are we taking in (diet or supplement), how much of it is getting absorbed in our digestive system, and how much are we losing. With iron, we know that menstruating women are losing it every month during their period. Women with heavy periods are certainly at risk for iron deficiency and anemia, but even a normal period over time can deplete our iron stores. Regular bleeding can make maintaining iron levels an uphill battle.   Iron intake can also be an issue for women depending on dietary preferences. Iron is highest and most absorbable in animal foods, particularly liver (not exactly a dietary staple). Red meat, dark poultry meats, and shellfish are other good animal sources, although many women restrict these foods for ethical or health reasons. Vegetarian iron rich foods include dark leafy greens, nuts and seeds, legumes, dark chocolate, blackstrap molasses, and fortified grains. However, plant sources of iron can be challenging for our digestive system to absorb.   Iron is a finicky nutrient. It needs certain things to support its absorption, and its absorption can be blocked by common nutrients. To support iron absorption (particularly the harder-to-absorb non-heme iron in plant foods), it is important to have plenty of acid present. Our stomach produces acid when we eat in a relaxed and mindful fashion; eating on-the-go or while stressed can prevent adequate stomach acid. Adding acidity to food (i.e. a squeeze of lemon juice to sautéed kale) can be helpful. Iron supplements generally address this by adding vitamin C (ascorbic acid).   The two peskiest iron inhibitors are calcium and phytic acid. If you are eating a calcium-rich meal (such as one with lots of dairy foods), this is not the ideal time to emphasize iron-rich foods. Same thing goes for supplements; don’t take your calcium and iron supplements together.   Phytic acid is fairly ubiquitous in plant foods and less well-known. You’ll find it in nuts, beans, whole grains, tofu, and more (in other words, healthful foods you are encouraged to eat). It may not be possible to limit or avoid phytic acid in iron-rich meals, so the best that can be done is to...

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Understanding SNP’s Using I Love Lucy

Posted by on Aug 2, 2017

  One of the major challenges in my practice is relaying information about single nucleotide polymorphisms (SNPs) in a way that’s accessible and empowering for my patients. The acronyms alone make it daunting to approach: MTHFR, COMT, MAO, VDR, UGH (okay, that last one was mine). Genomic medicine can be a powerful tool for improving and optimizing health, so with that in mind, let’s try to decode the alphabet soup. My favorite analogy for explaining SNPs comes from an episode of I Love Lucy called “Job Switching.” In the famous episode, Lucy and Ethel get jobs on a factory line wrapping chocolates. Being amateurs, they can’t quite keep up with the pace of the conveyer belt. As chocolates slip past and they grow increasingly desperate to keep up, the ladies begin shoving chocolates in their mouths, down their shirts, and everywhere else to prevent unwrapped chocolates from continuing down the line to the next worker. It’s slapstick at its best, and also provides a helpful mental image. Molecules are made and used by every cell in our body to drive every bodily function (metabolism, digestion, hormone signaling, etc.). Each molecule is made from precursors by a series of enzymes. Molecules are like the chocolates, starting as raw ingredients that step-by-step get turned into the packaged final product. Enzymes are like the factory workers, each one doing a small step in the assembly line over and over. SNPs are genetic glitches that make our enzymes slower and clumsier, like Lucy and Ethel. When one enzyme is inefficient, it prevents the assembly line from running quickly and smoothly. Fewer final products are produced, and more half-finished intermediates persist (stuffed in our enzymes’ blouses). The problem can be made worse by inappropriate supplementation. For example, people with the MTHFR SNP are less efficient at activating their B vitamins (particularly folic acid and B12) for energy, DNA production, and many other important functions. Supplementing these individuals with B vitamins in their inactive state is like speeding up the conveyer belt on Lucy and Ethel; not only will there not be more finished molecules, but there will be more half-finished intermediates lying around. Does having a SNP mean someone is forever doomed to taking a specific (and often costly) supplement? Not at all! Lucy and Ethel were fine at their job when the conveyer belt moved at a pace they could handle, and the same is true for our inefficient enzymes. If we reduce the burden on the enzymes by eating clean foods, breathing fresh air, exercising, reducing stress, and sleeping well, then often temporary supplementation is all that’s needed until the system works more harmoniously. It’s also important not to look at SNPs...

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Spring Cleaning For Home & Body

Posted by on May 31, 2017

In Chinese medicine, spring is an excellent time to cleanse and renew. Much like the buds sprouting on plants outside, the body is energized and ready to emerge from its winter dormancy. The buzzword “detox” can evoke thoughts of deprivation with a dash of lemon-cayenne water, but there are many avenues for resetting your health. Below are some gentle ideas. Minimizing Exposure One key component of detoxification is minimizing sources of everyday toxic exposures. Set aside a Sunday afternoon to go through the products you use on a regular basis, including skin and hair care, cosmetics, and cleaning products. The Environmental Working Group is an excellent resource for rating the toxicity of various products. For cosmetics and hygiene products, use their Skin Deep database and aim to use products with a score of 3 or lower. Using their Guide to Healthy Cleaning, toss out and replace any cleaning products with a score of C or worse. Consider also revamping your cookware, replacing non-stick pans with well-seasoned cast irons, substituting glass tupperware in place of plastic, and switching out plastic spatulas for wooden and stainless steel implements. Get into the habit of removing your shoes when you get home. This prevents heavy metals, pesticides, and other harmful substances from getting tracked inside by our shoes. Use your low toxicity home cleaning products regularly, removing toxin-carrying dust from surfaces and flooring. Consider investing in an air purifier; IQAir is top of the line. Indoor plants also work as mini-air purifiers, and a 1989 NASA study identified the best species for this purpose (click here for full list). Drink filtered water. If you have particular concerns about water quality in your area or increased sensitivity to exposure, consider investing in a reverse osmosis water filtration system. From a dietary perspective, eat only organic whole foods during a cleanse. Two helpful hints: avoid foods that come in packaging, and stick to foods found along the edges of the grocery store. If finances are tight, aim to purchase organic versions of foods found on the Dirty Dozen list. Supporting Detoxification Pathways The human body has several natural mechanisms for removing waste: bowel movements, urination, breath, sweat, and tears. With a cleanse, it’s important that all these pathways are optimized. When these pathways are sluggish, toxins are allowed to reabsorb into the body. A good goal is 1-3 well-formed bowel movements daily. If you are pooping on a less than daily basis, increase your dietary fiber intake (or consider supplementing), hydrate well, and make sure your having some exercise daily. If you still struggle with regularity, consult a naturopathic doctor. Support regular urination by having a glass or stainless steel water bottle carrying filtered water with...

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Could It Be Perimenopause?

Posted by on Jan 23, 2017

Sometimes I catch patients off guard by mentioning perimenopause as a potential underlying cause of their symptoms. In some cases, this is because the woman didn’t realize the menopause transition could cause more than hot flashes and night sweats. At other times, it’s because the person doesn’t realize that perimenopause can occur at their age. Normal menopause occurs between 45 and 55 (51 on average in the United States), and perimenopause can precede this by up to 7 years (as young as late 30s). We cannot predict when a woman will stop menstruating or how long she will have symptoms related to menopause, but talking to female relatives about their menopause transition and reflecting on personal experience going through puberty can be helpful. Below are some of the lesser known symptoms of perimenopause. You may experience any number of these symptoms or none of them. Provided the underlying hormonal issue is identified, these complaints are all treatable with interventions ranging from lifestyle to nutrient and herbal supplements to pharmaceutical medications. Menstrual Irregularities Counterintuitively, perimenopause often starts with heavier and more frequent periods. The reason being that progesterone declines before estrogen in the menopause transition, and progesterone is the hormone that helps extend our cycles and keep them lighter. There are lots of interventions available to help slow bleeding; consult your naturopathic doctor. Women can also skip periods, sometimes for months at a time. This is usually monitored but not treated if laboratory tests indicate there’s no hidden cause. It’s generally not harmful to skip periods, but it’s possible that the period following will be heavier than normal. Menopause (rather than perimenopause) is when you’ve had no spontaneous periods for 12 consecutive months, and until reaching that threshold, there’s always the possibility for more periods. Prepare accordingly. Mood Changes Irritability, anxiety, and insomnia are all common mood changes in perimenopause. Progesterone binds GABA receptors in the brain, which provides a calming effect; as progesterone drops, anxiety and insomnia can crop up or worsen due to decreased GABA stimulation. Irritability and sleep disruptions can be a result of the hormone fluctuations that occur during perimenopause. Energy & Weight Decline in estrogen can also trigger fatigue and brain fog due to the complex interplay between hormones and whole body functioning. The thought is that it takes time for the mind and body to adjust and adapt to the new hormonal milieu, although in some women these symptoms can persist. Perimenopausal weight gain is a nice illustration of the complex interplay happening in the body when hormone levels shift. Estrogen helps the body be sensitive to insulin. As estrogen declines, women tend to become more insulin resistant. This can lead to an increase...

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Preventing Varicose Veins

Posted by on Oct 13, 2016

Varicose veins are a common concern for women as they age. They range from being an unsightly nuisance to being painful and debilitating. Surgical treatment is becoming increasingly sophisticated, but there are many lifestyle and nutritional steps that can be taken to help prevent them in the first place. Why do varicose veins happen? Veins are low pressure, bringing blood back toward the heart with the help of muscle contractions and valves to prevent backflow. In the case of varicose veins, the veins dilate abnormally and prevent the valves from closing well. As a result, blood can flow backwards into the legs with gravity. Risk factors for varicose veins include obesity and multiple pregnancies (which put pressure on the abdomen, making it harder for blood to flow through), standing for long periods (forcing the valves to work harder against gravity), and family history. Varicose veins themselves are not concerning, but in some cases they can cause pain, swelling, and skin ulceration. Movement The first and simplest step to prevent varicose veins is to get moving. Walk around for a few minutes every hour. The muscle contractions in your legs will help support moving blood back toward the heart. Set reminders on your phone or FitBit so you don’t forget during a busy day. Exercise is also an excellent way to support and maintain weight loss, which will lower your risk for varicose veins and many other conditions. Drainage Dry skin brushing is a nice daily ritual that helps move extra fluid away from the limbs and toward the core where it can be processed. This is helpful for reducing swelling in the limbs and supporting the body’s own detoxification via the lymphatic system. Using a natural bristle brush, gently stroke from the hands and feet toward the heart. Here is a YouTube video showing you how to do it. Compression Recently, a vascular specialist told me she advises women as young as 30 to regularly wear compression stockings if they are at risk for varicose veins. You may be skeptical, envisioning the thick beige compression stockings of yore. Nowadays, there are many fashionable options in light (8-15 mmHg) and medium (20-30 mmHg) support, both of which are appropriate for prevention. Compression socks help promote venous return to the heart and prevent swelling caused by leakage from stagnant veins. They should be worn for most of the day (especially if there’s going to be lots of standing) and removed at bedtime. If you already have varicose veins, compression stockings can be used to reduce swelling2 and prevent skin ulcerations3. Diet A diet rich in flavonoids helps support the structural integrity of the veins. Eat at least 5 servings of brightly...

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