All year round
This is the time of the year when I get calls from people wondering which detox program I recommend, or they come for their annual exam and tell me that they just did "a cleanse." There is something about all that springy, green, juicy stuff coming up out of the ground that makes you just want to inundate your poor sluggish wintry body with Bright! Alive! Enzyme-rich! Juicy! Cleansing foods! (just the ticket when you're emerging from the deep, dark slumber of
a Maine winter).
Eating with the seasons is ALWAYS a good idea, so I recommend you yield to those urges for ramps and fiddleheads and other regional, seasonal delicacies. AND I'd like to offer you some ideas for keeping your detoxification systems (those would be sweat, poop, pee, and breath) working well year-round.
I used to know a woman, a brilliant scientist type and even more eccentric than me, who had this habit of driving her car like a demon, not changing the oil, not rotating the tires, not etc. etc.and something like once a year she'd go crashing in to the mechanic's shop and they would spend a week (and a good bit of her money too) helping the car to recover so she could go do it all over again. Eventually she'd have to replace the carsooner by far than if she'd just
taken care of it along the way. Hope you can see where I'm going here. I'm more of a regular maintenance kind of person when it comes to the body, and I urge you to be that way too.
I am not a big fan of fasts and juice fasts, and encourage you to touch base with me before you do this. Here's the thing: if you undertake an aggressive detoxification program when your excretion systems are operating at sub-par, all you're going to do is stir up a bunch of stuff your body worked hard to tuck away in its version of closets and corners. If you can't get rid of it effectively, that can make you sick. It's kind of like washing a bunch of dirty dishes but
not being able to drain the water, or building a wonderful hearth fire but leaving the chimney closed. Here's how to support your extremely elegant elimination systems, so that when you DO decide to go to another level (like in the spring), you can safely and comfortably mobilize and eliminate what you no longer need.
A little additional background: I worry sometimes when I hear us think of our bodies as uncleanit feels perilously close to "dirty-bad" or "needing punishment" or "out of control." Not to minimize the huge amount of toxins and junk we're all exposed to, even when we live pretty "green," but I would like to support you to approach your biological spring cleaning in a nourishingly gentle and supportive way, rather than within a paradigm of purging and cleansing (which for
some reason is quite popular). You deserve friendliness and gentlenessnot pushing, purging, or pressure.
Certainly you want to start with doing what you can to reduce your exposure to toxins in the first place. This means eating organic food when you can (particularly animal products since they're at the top of the food chain and because toxins bio-accumulate), filtering the water you drink, working to eliminate plastics in your life, and avoiding the use of chemicals inside and outside your home ('nuff said; that's a whole other article!).
Thinking about detox, let your awareness rest first on your fabulous liver. Your liver identifies, processes, and re-packages for elimination everything you consume, and in the 21st century, that's a lot of work! To take pressure off your liver, you'll want to avoid alcohol, nonessential pharmaceuticals (prescribed and over the counter), and refined carbohydrates and sugary foods. Eat enough protein and healthy fat, several servings a day, to keep your blood sugar
stable, and stay away from food additives, preservatives, and colorants. Since there are a lot of micronutrients (vitamins) that are essential cofactors for what your liver does, I'm a believer in the use of a good quality multivitamin in addition to a nutrient-dense food style.
To keep your intestines working effectively, make sure you're getting enough dietary fiber and micronutrients to make you poop every day (at least.) A good quality probiotic supplement (these are the healthy bacteria that populate your gastrointestinal tractperhaps your best friends health-wise) is always a good idea. Lots of fresh fruits and vegetables are on the menu for sure, and emphasize the cruciferous types (broccoli, cabbage, cauliflower, etc) and the alliums
(garlic, onions, shallots, leeks.) Legumes (aka beans) also are good for your guts (that's why they make you toot), so try to get some every day. Did you notice that these foods go together very well?
You get rid of a lot of crud through your skin, tooor you should. If you are troubled by rashes or acne, this step is extra-pertinent for you. Break a sweat every day if you can. Don't put anything on your skin that you wouldn't eatain't no layer of Saran wrap in there. Dry brushing and massage, saunas and steam baths, all help you clear toxins through your skin.
Most of us don't usually think of breathing as part of the detox process, but it is. Certainly you have to blow off carbon dioxide, but your lungs also filter what you breathe in, including allergens and pollutants. Many of my patients don't breathe very deeplywe take these tiny tight shallow breaths that don't really get stuff moving in the chest. You can learn different breathing techniques or ask me for a BREATHE magnet next time you're in, just to remind you. Try it
nowa good big full one, letting your belly get big and your shoulders release and maybe even make an "Ahhh" sound when you exhale. Doesn't that feel good? Hmmm . . . maybe you'd like a bit more of that?
Finally, hydration is the key. I think we each have a different need for fluids, but most of us aren't where we should be. Particularly in the winter, it can be repellent to think about drinking a glass of water. Try herb tea, or hot water with lemon juice. Rather than saying X number of ounces a day, I say, "Just don't get thirsty, and drink enough that your urine is almost clear"bearing in mind that if you're taking B vitamins, it will irredeemably have a greenish,
yellowy cast to it.
I'm inspired to point out how physical activity stimulates all of these mechanisms simultaneously. When you move, you sweat; you increase the blood flow to your liver and kidneys, so you filter and pee; you stimulate bowel peristalsis, which will make you poop; and if you're doing it right, you'll breathe and exhale more deeply and be eager to have some delicious fresh water. Keep these systems working well, and you'll feel a lot less polluted when it comes to next
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GET HEALTHY TO LOSE WEIGHT
(not the other way around!)
I recently had an opportunity to share my thoughts with folks in a small business that is considering a workplace-based weight loss program. I have strong feelings about the science of weight management, so this was a special treat. You know meI love a new soapbox!
Long ago, we in medicine saw that a normal body weight and a lower risk of chronic disease tended to go together, but we made the logical mistake of thinking that if we simply made people lose pounds they would automatically BE healthier. In fact, it could be argued that the way we've historically approached weight management is making Americans, especially female Americans, sick. A growing body of research shows that not only is "weight cycling" or "yo-yo dieting" not
effective for many people scale-wise, it is also profoundly damaging to your health in the long term (let alone that it's just a total psychological drag!).
If you're like many Americans (especially women), you're frustrated and confused by the mismatch between what the nutrition experts say about how to achieve a healthy body weight"eat fewer calories and burn more with exercise"and what actually happens to you when you try it. Guess what? You're not alone, because that approach DOES NOT WORK for most people in the long run (Duh, you say.).
In fact, not only does calorie-restriction-based dieting not work, it actually makes and keeps you fat. Weight loss approaches that primarily emphasize reducing feeding and increasing exercise will indeed often result in your scale weight going downby forcing you to cannibalize your lean body (muscle) mass for essential body nutrients, and converting the calories you DO eat into fat to be used later. You'll be lighter maybe, but it won't last.
Many of the lifestyle habits we engage in, either by accident or in the quest of weight control, actually block the biochemistry that lets you build muscle, and which reassures your body that it doesn't need to store every available calorie on your hips for the next time you experience famine. Then, because your muscles are disappearing, your metabolism is even slower. Doomed to failure, that's what we call it.
You may not be surprised to hear that the hormonal pattern triggered by the stress of all this ALSO contributes to you holding onto your excess weight. The cycle continues until you collapse, exhausted, in front of the TV with a bag of chocolate chips, certain that there must be something really wrong with you and you might as well give up. Until next New Year's . . .
This is the Miracle Business Success Secret of the weight loss industry: they'll have a perpetual stream of customers if we keep buying their flawed approach. Your body is smartit has a four-million-year-old, highly evolved toolkit designed to keep you alive in any food environment that remotely resembles starvation. Bear in mind, your body can be "starving" even while you eat a nutrient-poor diet that includes a wanton excess of calories (this is pretty common in the
US right now). This deep malnutrition makes you hungry, as your body signals to you that it really needs nourishment, and sends you off looking for food.
When your body cells are getting fed properly (right proportion of protein, carbohydrate, and fat; lots of fruits and vegetables, lots of vitamins and minerals, minimal blood sugar highs and lows, and an appropriate number of calories for your body composition and activity level) it alters the efficient fat-accumulating signal cascade that's running on full throttle in most people eating a typical American diet (even a conventionally "super-healthy" one!) into a
muscle-building signal set. Typically, this new environment involves eating a lot of food often (no more starvation!)
Muscle tissue is metabolically active, so when you build muscle, or lean body mass, you will burn more calories and have more energy and powereven while you sleep. Plus, it feels good to be strong! Hence, when folks consult with me to develop a food plan that works for them, I become virtually obsessive (crazed, even) about their muscle mass. We do serial tests, like every month or every 6 weeks, of body composition, to keep track of it. Solid nutrition and regular
movement are the basic ingredients of muscle mass.
This biochemical model is the foundation for the FirstLine Therapy® program I've offered at True North since 2005, which (if you're not doing it already), I've probably suggested that you consider because it is enormously powerful. Lots of people come to FirstLine Therapy® to lose weight, but they end up getting healthier too. Even if you don't have a problem with being overweight, you need to know that the same metabolic signaling that makes us accumulate fat and
consume muscle causes things like high cholesterol, diabetes, bone loss, depression, fatigue, dementia, cancer, and hormonal imbalancesfor starters.
I have become convinced that pretty much everyone should be tending their body using these principles, and I envision a time where there's someone offering a FirstLine Therapy® program in every workplace and primary care doctor's office. Nutrition-and-lifestyle-based clinical interventions are an absolutely essential element of any strategy for getting us out of the disaster that is our medical care system. Plus, it will help a lot of weight-strugglers get out of the
metabolic ditch they've found themselves in. Brings tears to my eyes, it does.
FMI about FirstLine Therapy® click here.
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Twinkie, Deconstructed by Steve Ettlinger
One of my least fond food memories is of the day my friend Sonja and I consumed a box of twelve Twinkies as we walked home from junior high school. I do not know what we were thinking; I do remember feeling pretty crummy the following day, though this was not unusual for me at the time.
So I guess I found myself irresistibly drawn to this well-written and entertaining book, in order to work through a portion of my difficult childhood. (I'm good nowall over it.) Ettlinger systematically investigates each ingredient on a Twinkie wrapper, one chapter at a time: where it comes from, how it's produced and gotten into the Twinkie, and what it contributes to your total Twinkie experience (not that you are having a lot of those anymore, right?) For example,
does the ingredient provide mouth-feel? Aroma? Shelf life? Cakiness? etc. Shelf life is a big one.
This book is not a life-changer, and it's not a nutritional science book. I also disagree with reviewers who think it's an apologia for the food industry. I didn't get that, but maybe I'm just naive. It's fun and interesting, and that works for me! I was really surprised at how many "food" ingredients come out of mining operations out west. (Not that I expected the Twinkie to be a heavy-hitter, earth-y nutrients wise, but still!) Even If you're not a big Twinkies fan,
these things may also appear in other processed foods you might be consumingor that your loved ones consume, or which are fed to little school children across our great nation. Easy to explore and nicely written, so maybe check it out!
The Amazing Mackerel Pudding Plan
by Wendy McClure
I got turned on to this collection of 1970s vintage Weight Watcher's Diet recipe cards several years ago, when an edgy friend sent me this link. These are real cards, and if you have a moment to spare you too will get a chance to experience the real treat of the work, which is McClure's absolutely indescribably wet-your-pants sense of humor. Even if you've never "done" dieting, I urge you to treat yourself to this unique and powerful experience, and when you've had your
fill, and want to find a good gift for someone you know who's been through the Diet Wars, know that The Amazing Mackerel Pudding Plan is widely available in paperback. And seriously, I've read these several times before and just now, clicking on the link to review it, I am having belly laughs all over again.
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You may already be aware of this, but just in case you're not: I recently increased my office hours at True North to include Thursday afternoons as well as Tuesdays and Wednesdays. Help me make it to four full daysthat's my goal! But seriously, if the old schedule was tricky for you, maybe the Thursday thing will help. Plus, I was away a lot in the early part of the year, so I have opened up a scattered bunch of make-up hours even on other days. I'm still seeing people
until fairly late on Wednesday evenings, if you can only make it over after work. Hope to see you!
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PRACTICE UPDATES (cont.)
Hormone Replacement Informed Consent
In perimenopause and menopause, my goal has always been to help you be as healthy as you can, with the most balanced metabolism and hormone profile possible, in order to minimize the use of supplemental hormones. Our track record together is excellent.
There are times when the risk-benefit ratio leans in favor of hormone replacement therapies, and I do sometimes prescribe them. I generally only recommend bioidentical hormones, which are manufactured to be molecularly identical to what your body makes (or would make) itself. These may be from a compounding pharmacy, or they may be the sort of prescription you could pick up at a commercial drugstore.
New research findings and recommendations about the short- and long-term health effects of supplemental hormones are published frequently and can be confusing to a layperson. There are also a growing number of books that pitch hormone replacement as risk free and the greatest thing since sliced bread (hello, Suzanne Somers!) The women's health practitioners at True North decided that we wanted to be as consistent as possible about keeping you apprised of the known and
unknown potential or real risks of using these therapies.
Hence, those of you in my practice who are using hormone replacement by prescription will find that the next time you're in to see me, or the next time we need to refill your hormones, I'll be asking you to review, discuss, and sign an "Informed Consent form for Hormone Replacement Therapy" (HRT.) As a rule, I'll drop a copy of the form to you in the mail so you can review it and identify any questions you might have before we get together.
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Urine Tests of Bone Turnover
Imagine this patient: a fifty-ish woman who's worked hard to be healthy all her life who gets her first DEXA bone density test and it comes back showing osteopenia, a low reading; or her mother gets diagnosed with osteoporosis. She imagines herself a withered, feeble elderly woman with a dowager's hump who has to wear football padding to keep her fragile self from crumbling under the weight of her heavy winter coat. Often there are tears. During our consultation, we talk
about options for improving bone density (these are SO not limited to the use of anti-resorptive drugs like Fosamax!) and then, since the typical interval between DEXA tests is two years and that's a long time to wait for important news), I generally recommend she consider a simple at-home test of which a surprisingly small number of people are aware: a urine test for bone turnover.
Bone loss is a significant health issue for women (for men too, by the way, but they are pretty much off the radar screen.) It can be useful clinically to identify the women who have low-normal but stable bone density (far left side of the bell curve), and who will DEXA-test as osteopenia, but who are not breaking down bone in an accelerated or dangerous fashion, and if possible differentiate them from the ones who are eating up their bones in some way they can
potentially stop doing. Small-framed women can be stable at the low end of the bone-density curve, and that's perfectly normal and healthy for them. It makes no sense for these women to have two years worth of nightmares about their bones if we can help that! That's a long time to wait for feedback!
We are all building and breaking down bone all day, every day. Under correct metabolic circumstances, your body balances the breakdown and buildup rates. When bone is broken down, byproducts of the remodeling are excreted in the urine. Clever laboratory scientists have figured out how to test for these, and a number of labs offer kits for that purpose. We know how much of this stuff there is supposed to be when bone is being remodeled appropriately, and how much suggests
accelerated or abnormal bone loss. This test will never replace formal bone density testing – but it's an excellent adjunct.
You can provide a urine sample in the privacy of your own bathroom, send it off to the lab, and get what I think can be a useful piece of additional information as you're looking at how to help out your skeleton. It's always reassuring to see a normal bone turnover test in a woman with borderline bone densityand if it's high, it can be motivating to figure out why and get cracking on changing that.
Anywayjust so you know about this; I think it's pretty cool. The test is around eighty dollars; depending on your situation and insurance policy, it could quite possibly be a covered test. If this resonates for you, let me know!
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Do You Have a Little to Spare?
Many people don't realize that True North is a 501c3 tax-deductible nonprofit. One aspect of our mission is to provide access to patients with limited means, and a primary vehicle for that is through a fund we've established called the "Reilly Fund" (named after our dear friend and mentor David Reilly, a doctor of homeopathy in Scotland and pioneer researcher about therapeutic encounters and the placebo effect:
www.davidreilly.net ). There are income guidelines for Fund awards. Patients and practitioners apply together to this fund when someone needs services (care, testing, supplements) that they could otherwise not obtain for financial reasons. I have several patients for whom this fund has been critically important.
We are always seeking infusions of money for the Reilly Fund. If you have any amount to spare, consider making a donation by clicking this link to the True North website. Enter your information, and when you get to the checkout, just write "Reilly Fund" in the place where it asks for "Additional Information." Thank you so much!
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I Know What I'm Supposed to Do But I'm Not Doing It! Moving from Frustrated to Fabulous
Karen Fagan, Master Certified Life Coach
Susan Fekety RN, MSN, CNM
Thursday June 18, 2009, 6:30 to 8:30 pm
If these are familiar words to you, or if you've tried repeatedly to eat well for weight control or overall health, but you've had trouble being consistent; or if you're ready to just give up because there must be something wrong with you; or you're just not organized enough; or maybe you just keep getting derailed by the demands of work-relatives-cravings-fatigue; or if you just keep finding yourself at the bottom of your priority list: this class was designed with you
Karen and I are experts in supporting people to nourish themselves on all levelsoptimally, simply, mindfully, and without judgment. You know all about me (I am an advanced practice nurse who coordinates the FirstLine Therapy® program at True North, a 12-week "lifestyle tune-up" using balanced nutrition, activity, and stress management for overall health improvement, including optimal weight) and Karen Fagan is a Master Certified Life Coach dedicated to supporting people to
look clearly at and change their limiting beliefs and patterns, including those involving food and healthful activity. Put us together and you've got an unbeatable combination of talent, passion, and experiencemaybe just the combination you need!
In this program, you'll learn about the new science of true nourishment and explore some common challenge areas around nourishment and self-care, including how to move forward. It will be a memorable evening of insight, information, and laughter. We hope to see you there!
$35 per person or $60 for two people coming together
True North Health Center in Falmouth
Register by phone at 207-781-4488 or online at www.truenorthhealthcenter.org.
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GROCERY STORE SUPPORT (New!)
This issue: Gluten Free options
Many of you are finding that for one reason or another it's time to go gluten-free. There are a variety of reasons for this (see my recent article on gluten) and the shopping opportunities are expanding exponentiallywhich make things a lot easier now than they were 5 or 10 years ago. Many health food stores have a whole section for gluten-free foods, and even some
of the conventional supermarkets are following suit, though I must say, I don't think they really understand the principles. I see lots of things on these shelves that are NOT gluten free (they are usually wheat free, but that's not the same!) and even though Ezekiel bread is a great whole grain sprouted bread with an interesting back story, sprouted wheat, barley, and rye all still contain gluten!
Unfortunately, many commonly available gluten-free foods are just . . . gross. They don't smell right, they fall apart, they stick to your teeth when you chew them. You're not going to position yourself for success eating those! I also see that frequently the transition to a gluten-free diet triggers a different nutritional challenge, since many of the substances used to replace the gluten-containing grains are things like rice flour, tapioca, and potato starchall high
blood-sugar impact fast carbohydrates. Sort of robbing Peter to pay Paul.
Here's the secret secret: most of us need to cut down on grains altogether, not just on the gluten-containing ones. So as you change over please DON'T make the common mistake of thinking that if it doesn't have gluten in it it's okay to have all you want. A typical serving of ANY grain based food is about a slice of bread, a handful of crackers, a half cup of pasta, or a half cup of cooked whole grains.
Over the years, I've discovered a handful of high-quality, nutritious gluten-free items that will help you enjoy your food and stay in balance when you make this transition. Here are some of my favorites:
For bread, the hands-down favorite is Millet Special Bread (gluten-free and yeast-free) by Deland Bakery in Florida. Most of the health food stores around here stock thisyou'll find it in the freezer. Smells right, tastes right, toasts right, and millet is a great whole grain. Don't be put off by the "may contain" disclaimer on the label. Even my super-sensitive celiac patients eat this bread without difficulty.
For crackers, I recommend any of the varieties of Mary's Gone Crackers, which are made with brown rice and a bunch of seeds and things. Moi, I'm fond of the Caraway flavorbut they're all good, super crunchy. A reasonable serving of these is about 13 crackers, which is really plenty. The seeds slow down the digestion of the rice, so it's a lower impact carbohydrate. It's particularly yummy with hummus for a mid-afternoon snack.
Pasta is always a challenge because it's a flour-based food, so by definition it's going to be a pretty fast-digesting carbohydrate. I've tried a bunch of rice and corn pastas over the years and thought they were all pretty lousy, both in consistency and flavor. Tinkyada Brown Rice Pasta is terrific, though; it cooks right and I think it's virtually indistinguishable from the wheat kind of pasta comes in all the right shapes and sizes, too! You can find this in many
conventional supermarkets now and virtually all health food stores. From the name, you'd think this was a Japanese company, but they're in Canada. Go figure.
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Finally, I want to share a wonderful recipe I got from True North's Naturopathic Doctor, Peter Knight. Pete taught an amazing class recently on chickpeas (aka garbanzo beans) (!) and made us this extraordinary Farinata with Chard, Onions, Mushrooms, and Goat Cheese using chickpea/garbanzo flour in a big cast-iron skillet. This recipe is easy and super-versatile, and I urge you to give it a whirl.
This could be an easy dinnerjust plan to mix up the crust/dough batter ahead of time. I just poured mine into a big jar, shook it up, and cooked it the next day, which worked fine. I had no trouble finding the garbanzo flour in the health food store, packaged by Bob's Red Mill. (Serving size is a quarter of the farinata.)
Farinata with Chard, Onions, Mushrooms, and Goat Cheese
(Recipe courtesy of Peter Knight, ND)
1/2 medium onion sliced thin
5 oz crimini mushrooms sliced
4 leaves Swiss chard chopped (stems removed)
1 tbs olive oil
1/2 tsp dried thyme
1/4 tsp salt
1/4 tsp black pepper (ground)
2 oz goat cheese (crumbled)
Freshly grated parmesan cheese (optional)
Whisk together chickpea flour, salt, pepper, and rosemary in a medium bowl. Gradually mix in water until a batter forms (should be the consistency of cream). Allow batter to sit in fridge for at least 1 hour, but up to 12 hours before cooking.
Heat oven to 425F. Place a large, cast iron (or other heavy bottomed) skillet in the oven and allow it to heat for 10 minutes. Remove skillet from the oven. Add the olive oil and swirl to coat the bottom of the pan (add more olive oil if the bottom of the pan is not well coated). Pour batter into pan and swirl to make sure it is even. Return pan to oven and cook for 15 minutes.
While "crust" is cooking, heat olive oil in a medium skillet over medium heat. Add onions and saute until they begin to brown (about 5 minutes). Stir in mushrooms, salt, and thyme, and continue to cook until mushrooms are soft. Stir in chard. Saute for 1 minute. Cover pan, reduce heat to low and cook for 3 to 4 minutes until chard is wilted.
Remove "crust" from oven. Spread chard mixture evenly over the top of the crust. If there is liquid at the bottom of the chard pan, do not put the liquid on the crust. Crumble goat cheese on top of chard mixture. Sprinkle top with parmesan and a little bit more dried thyme. Return to the oven and continue to cook for 15 minutes. Remove pan from the oven. Using a spatula, remove farinata from pan to a cutting board. Cut into 8 wedges.
Download and print this recipe.
(Note: I used a modified version of this recipe to make a yummy gluten-free, pizza-like dish one night, with tomato sauce and onions and mozzarella cheese. If you're not doing dough, there are limited pizza options available and the ones you do find are either expensive orahemwicked chewy or both!
This is a great alternative to try.)
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