by drmiranda | Aug 11, 2016 | dietary supplements, hypothyroid, not losing weight
It’s been said that the road to hell is paved with good intentions, and that certainly applies to the world of dietary supplementation. Many people, through research or recommendation, choose to take a variety of dietary supplements to improve their health, but what many don’t realize is that supplements need to be taken the RIGHT way, or you will impair the absorption of them, or simply end up with very expensive urine.
Taking vitamins and herbal supplements together is usually not a problem but there are a few exceptions to keep in mind.
First, lets cover the basics:
The Best Time to Take Various Vitamins and Supplements
MEAL FRIENDLY
Traditionally, it is recommended that multivitamins formulas and water soluble vitamins – including the B-complex and vitamin C get taken with your meals for optimal absorption but in reality, they can be taken any time. However, fat soluble vitamins, such as vitamins A,D,E,& K – are best taken with a meal containing fats. The dietary fats enhance the absorption of the fat soluble nutrients. One small caveat, some people are sensitive to parts of the B-complex, and that can impair sleep. If this describes you, take your B-complex vitamins before 2 pm. The biggest mistake that people make with taking a multivitamin is taking it once a day. The body can only absorb so many nutrients at a time, so taking nutrients in divided doses will ensure you get the most from the products you buy.
Fatty nutrients, like fish oil, coconut oil, flax seed oil, borage oil, evening primrose oil, and even coQ10 also do best when taken with a meal containing fats. Fats always like fats – any time you take them together, you will get more benefits.
BEST ON EMPTY STOMACH
Certain nutrients require an acidic environment for optimal absorption. This usually means they do best when you haven’t diluted your stomach acid with food prior to taking them. Iron falls into this category. Iron is notorious for not only being difficult to absorb, but it can be highly irritating to your gastrointestinal tract. For this reason, it is commonly suggested that you take iron with vitamin C, which greatly enhances the amount your body can absorb, and take it with the least amount of food your stomach can handle without getting upset. But please keep in mind that iron does not like fiber or vitamin E. Either of these will bind together with the iron and you will negate their benefit. There are forms of iron that are less irritating than others as well – so please experiment with these to find one your body tolerates.
Minerals such as magnesium and calcium* always require strong stomach acid for absorption, therefore taking them on an empty stomach will facilitate absorption as well. I usually direct my patients and clients to take their minerals at bed time, since the transit time is slower, and you can get more out of them. Additionally, minerals like magnesium have a calmative effect – so taking them prior to bed can not only help you sleep better, but they can lubricate your joints and relieve muscle pain, so you wake fresher than you otherwise would. As a general rule, I do not typically recommend routine calcium supplementation unless there is a specific reason why it is indicated. Americans consume more calcium per capita than nearly any other country, yet we have one of the highest osteoporosis rates, so clearly calcium is not the issue. On the other hand, it is estimated that upwards of 80% of the population is deficient in magnesium, and other co-factors for bone health – so I would rather concentrate my efforts there. One thing to keep
Amino acid formulas also prefer acidic environments, so taking these supplements, which are often used in body building formulas, or individually for specific repair processes, on an empty stomach will ensure you get optimal absorption from them.
Joint products like glucosamine and chondroitin also require a highly acidic environment for absorption. While it may be inconvenient that you can’t take them with your meal, you will absorb up to 4X more from them by taking them alone.
Other than calcium, probiotics are perhaps the most controversial supplement on this list. It is my opinion that most recommendations for probiotic dosing are designed to promote probiotic sales, and it not what is required for optimal absorption. I always suggest taking probiotics before bed since most people do not get up in the middle of the night to have a bowel movement. This ensures that the probiotics have the greatest amount of contact time in the intestine, which therefore gives them the greatest chance to grow and colonize. If you were to take them with food, not only are you increasing the amount that would be killed by prolonged exposure to stomach acid, but rapid peristalsis that occurs with physical activity and as your meals progress down your alimentary canal during the day, means that they keep getting pushed along, and are not in contact with the optimal regions of the large intestine to do you much good.
BEFORE MEALS
Most commonly, digestive aids, enzymes, or other products should be taken at the beginning of a meal so that they may be thoroughly mixed with what you eat in your stomach. If you take it too late during your meal, most of your meal may have already passed into the small intestine, and it is simply too late to get the benefit of the product.
SPECIAL CONSIDERATION
If you have been diagnosed as being hypothyroid, you have likely already been directed to take your medication a minimum of 3-4 hours before any foods or supplements. If you have not received this advice, please speak to your doctor or pharmacist to confirm if you should be doing this with your particular brand of medication.
Antacids elicit a quandary. Many people take them (far more than should) so their meals do not upset their stomach, yet, by diminishing your stomach acid, you also diminish your absorption of vitamins and minerals in your diet. This frequently leads to osteopenia or osteoporosis and other health problems. If you are taking your supplements with meals and you take antacids or PPI’s, then you need to speak to your healthcare providers to see what you can do to optimize your absorption of healthy nutrients.
What you wash your supplements down with also makes a difference. Many medications and supplements interact with grapefruit juice, so please don’t use it to take pills of any form. That just plays it on the safe side. Green tea also interacts with a huge list of medications and supplements, so please avoid taking the two together. Milk can interfere with the absorption of a variety of nutrients, and therefore I do not recommend taking supplements with milk either. Even water can be problematic since some people tend to get reflux or their supplements will repeat on them if taken with plain old H20. So what can you take your supplements with — I recommend something lightly flavored, like diluted fruit juice or herbal teas. Even water with lemon.
Herbal supplements all very, so please follow the label instructions on them for optimal results.
So, as you can see, most supplements can be taken safely with your meals, and there are only a few exceptions to the rules. Knowing this, it becomes relative easy for you to divide up your supplements into a few you take with meals, and some on their own. Dietary supplementation need not be complicated. In my opinion, it is better to do something than nothing at all, and hopefully with this little guideline, it simplifies things enough so that you can use timing to get the most out of your health regimen.
by drmiranda | Oct 20, 2015 | chiropractic, diet, dietary supplements, gallbladder, not losing weight, weight loss
THERE IS NO MAGIC BULLET WHEN IT COMES TO WEIGHT LOSS! That is why there is NO SINGLE THING that will work for everyone. There are simply too many factors involved. That said, we can encompass these factors into key categories: Dietary, Hormonal, Chemical, Exercise, and last but not least – Emotional. Dietary factors are the easiest to explain – you have to feed your body real food and provide it with nutritionally sound fuel if you want it to function at a decent level. You wouldn’t put bad gas in your car and expect it to run well, the same can be said for your body. The second imbalance is hormonal – while we have dozens of hormones that readily affect our weight, with women, thyroid, adrenal, or sex hormone imbalances are the most common culprits. Chemical imbalances are both the easiest and the hardest to change. You have control over the chemicals you expose your body to, you may not have as much control over the medications you take. Nearly every drug that is prescribed not only induces specific vitamin and mineral depletions, but many are highly toxic and have a plethora of side effects. There is a long list of medications that not only impair weight loss but can cause weight gain. If you are on prescribed medications which are associated with weight issues- speak to your prescribing physician to see if there are better options (with fewer side effects) available to you. Exercise is the factor which everyone underestimates. Now, I don’t think you need to run marathons or bench press your weight, but most people think they exercise far more than they do. Get a pedometer and keep a record of your physical activity. Walking is one of the best activities you can do. If you can handle more, look into HIIT, yoga, swimming, or even mild weights. Chiropractors are always fond of the saying, “move it or lose it” – if you are not actively moving your joints, you accelerate the aging process, and your strength and flexibility will decrease at a fairly consistent rate. Lastly – lets look at emotional factors. There is a HUGE emotional component to weight loss (and to allergies, but I will save that conversation for another day). Some of us get comfort from food. Some of us were conditioned as children to ‘clean our plates’, some are addicted to fats and sweets. Women that are nurturing and caregivers tend to struggle with weight more than those that are not care givers. Some use fat as an insulation against emotions. Some of us mentally *see* ourselves as a big girl, and can’t even imagine ourselves thinner. Some of us have given up hope.
Let me be very blunt – no one will ever reach and maintain their ‘happy weight’ unless all of these factors are balanced. You might lose and regain the same 15 (or 40) lbs over and over, but you will not be able to maintain it. As a chiropractor, I am trained in balancing the body – that is what we do. We balance it so it works correctly. Moving into the weight loss realm isn’t that much different – you will notice that everything I suggest or recommend isn’t extreme, it is practical & doable. I focus on helping you achieve balance – and I give you simple tools to accomplish that. It could be supplements to balance what your gallbladder should be doing. It could be supplements which balance your body chemistry so you can enhance your metabolism. It may be easy activities like walking to increase your cardiovascular fitness and lymph flow. I may suggest you speak to your physician about certain medications, and I may even suggest other things which impact those emotional factors.
Weight loss is a process, your happy weight is the destination. The road isn’t easy, but it isn’t hard either – it just requires consistent effort. The process doesn’t usually occur at warp speed, but you didn’t accumulate those impairments to your health overnight either. I have dedicated my life to helping people – and if YOU don’t give up on you, I won’t either! Anyone who purchases products from me, whether it is Beta, Vitamin D, – or anything else, becomes my personal client. I send you my personal phone number, my email, and make myself completely accessible to you. I will help you reach your goals, but I want you to know that I can’t do the work for you – only steer you in the right direction. You are always in control of your own destiny.
So, as you’ve read this, and are contemplating your own situation, ask yourself if you are balanced. Are you focusing all of your efforts on one factor and ignoring the rest? If you make a concerted effort to achieve balance in all of these 5 factors, I can absolutely guarantee you that you will achieve your happy weight and never leave it again!
by drmiranda | Jul 15, 2015 | blood supply, diet, dietary supplements, fat breakdown, fatigue, health, insulin resistance, lipolysis, not losing weight, plateau, walking, water retention, weight gain, weight loss
This is an aspect of weight loss that perplexes a lot of people – they start a new diet and notice their clothes getting looser, or their face getting thinner – but their weight is staying the exact same! It is frustrating, because you *think* your diet is working but you step on the scale and feel like a big old failure.
Well, I am here to tell you that you can relax! You are not a failure! You are experiencing the wonders of the fat cell in action (I can hear you saying, “big whoop — skinny thighs are what excites me!”).
Let’s start off with a little physiology lesson. In your body you have 10-30 billion fat cells, and that is if you are of a healthy weight. Overweight people can have 75 billion fat cells or more, and it is not unheard of for morbidly obese people to have 250-300 billion fat cells overwhelming their boney frames! That is a LOT of fat cells (adipocytes). Picture each fat cell like a little deflated balloon. That balloon can be relatively empty or filled to the brim and be stretched over 10x its normal size. Now these fat cells are stubborn creatures – you can always make more, but once you have them, they are yours for good. Up until very recently1, it was thought that the only way to get rid of fat cells was to cut them out, but you can deflate them — and this is the key to losing weight effectively.
You see, fat cells are little storage tanks, and despite your most heartfelt desires to the contrary, they are remarkably efficient at storing fat in the form of triglycerides within the cell. When we want to burn fat – it isn’t an easy matter of having your brain tell your body, “we need more energy – let’s burn that love handle”. It doesn’t work that way! We need two enzymes, hormone sensitive lipase and adipose glyceride lipase to break down the triglyceride within fat cell where it is then released into the bloodstream as FFA’s. The more blood supply an area has, the better it can whisk away those FFA’s that are getting dumped from the fat cells. You can see this on your own body — take a second and poke your facial cheeks. See, the fat there is nice and soft because it has a good blood supply. Now grab the fat on your belly or on your butt. Feel the difference? It is dense and hard. It doesn’t have a good blood supply to whisk fat away. This is why when you start losing weight, it usually leave the ‘soft’ places first – your face, breasts, and arms and leaves you feeling like a saggy humpty dumpty for a while. This blood flow issue also leads us to our key point – when you start a diet and are burning fat, the scale often stays immobile despite you noticing that you are shrinking. This happens because the body abhors a vacuum. When the adipocytes dump out their fatty contents, your body doesn’t like to see an empty cell – so it shuttles water into the cell to fill up the space the fat just occupied. This is also why fat loss can be considered an inflammatory process and why you often feel bad, tired, sick, or swollen when you are dieting (there are other chemical factors, but we will discuss those at another time). Your body is literally replacing the fat with water! This process is more extreme for some people than for others, and some fortunate souls experience very little of this water replacement. This is also why your stomach or thighs can feel mushy or spongy when you are losing weight – you are replacing a dense fat with water.
So, what you can do, especially if you know that you have resilient fat or are a water hoarder? Well, there are a few simple things:
- Stay hydrated. I know, you’re thinking, “Why put more water into a swollen body?”, — Well, you need to flush out the metabolites from breaking down those FFA’s.
- Limit Caffeine and Alcohol. A little of either substance is OK, and small doses of caffeine can even be beneficial because it has a mild diuretic effect. Large amounts of either (and by large I am referring to more than 3 caffeinated beverages or more than 1 glass of wine or beer each day) can cause you to swell up like a balloon at the Macy’s Day Parade AND make your hard-earned weight loss come to a grinding halt.
- Shake your booty. Yes, I said it. The largest lymphatic pump in your body is the quadriceps muscles in your legs, so anything that gets those quads pumping — like walking, dancing, or biking, increases your lymph flow and your blood flow. If you work yourself up to a decent exertion point, then you will really increase systemic blood flow, and breathing (and breathing is the means by which your body excretes the metabolites of burnt fat cells!). Dig out those Richard Simmons’ shorts you’ve been hanging onto for the past 20 years — (they are back in style) and get ‘Sweatin’ to the Oldies!’
So there you have it! Know that you are not hallucinating – your face is thinner, your breasts are shrinking, and those bingo wings are real. Your scale just hasn’t caught up with your body! The more you follow the above steps – the faster you will purge that excess water (and inflammation) and the scale will start moving in the right direction.
1.http://www.nytimes.com/2008/05/05/health/research/05fat.html?_r=0
by drmiranda | Jan 24, 2014 | dietary supplements, network marketing, Plexus Slim Doctor, Uncategorized, weight loss
This isn’t an exciting post but we have to stop throwing the word ‘detox’ around. If you do not define what you mean by it, the term is meaningless, and the vast majority of people are using the term as a symptom catch-all and that is simply not how detoxification works.
DETOX. For such a little word, it is sure used a lot in dietary supplement claims and reports.
Starting a new supplement & you’re feeling bad? You must be detoxing!
How does supplement X work? It detoxes you!
Have a headache? You are detoxing!
Do you have gas & bloating? You are detoxing!
Constipation? Diarrhea? You are detoxing!
You have a rash? You are detoxing!
Not losing weight? Your fat cells need to detox!
Blah, blah, blah.
Let’s start by detoxing the term detox!
I really don’t like the word DETOX. I think it has become highly overused, and most people don’t have a clue what it means or what they are actually referring to when they use the term. So in effect, it has become a vague term that people use when they don’t have anything better to say. In fact, in one British study, a network of 300 career researchers investigating ‘detox supplements and products’ found that no two companies even used the same definition of “detox” and most companies made vague claims without even referencing what “detox means or proof that it actually works.”1
Do I believe that the body accumulates toxins which impair health? Absolutely. Can I think of any science proving or even suggesting that a specific supplement can detox the body of all of these environmental toxins? Absolutely not.
To be clear, this isn’t an exciting blog post. There is nothing exciting about detoxification, especially when so many people have it so spectacularly wrong. First, let’s review some basic physiology. Everything your body ever comes in contact with, and everything you ever breathe in or consume needs to be processed through either your liver, your kidneys, your lungs, your bowels, or through your skin. Water soluble substances don’t pass through the skin readily but are filtered by the kidneys fairly efficiently. Oil-soluble substances can be absorbed readily through the skin and are processed by the liver, and sent through the bowels for elimination. Gaseous substances, like anesthetic, are cleared directly from the lungs. Most of the toxins you are exposed to will be via your mouth in the form of what you eat and drink. Looking at the digestive tract for a moment, consider it a ~30 foot tube connecting your mouth to your anus. Approximately 80% of your immune system is centered in and along that tube, and maintaining its balance is a single, fragile layer of cells only one-cell thick. If this layer of cells is damaged, the selective barrier loses its selectivity, and foods, toxins, and other substances that would normally pass through your system with little consequence, can now be absorbed directly into your system (where your body can mobilize antibodies and inflammation for protection against this onslaught). In addition, there is an intricate balance of over 500 different types of bacteria (about 3 pounds worth all together) that live along is this tube which form part of a collective ecosystem to help you digest food, produce vitamins, make nutrients available, regulate hormones, and excrete toxic byproducts of your metabolism. When this lining or bacterial ecosystem become impaired, then you suffer from a wide variety of health complaints because your organ systems simply cannot operate at full function. Now, your body being the masterpiece of engineering it is, it tries to maintain an equilibrium, or ‘steady state’. So it takes these substances that it recognizes as foreign and it walls them off or stores them in the tissues it deems less critical for survival. As far as your body is concerned, your fat stores are less critical to your immediate survival needs than the health of your ligaments, nerves, and muscles. So initially, your body packs away these metabolites and toxins in fatty tissues and this can lead to cysts, lipomas, or benign tumors. Next in the line of potential storage spots, your body likes the myelin sheath – that fatty layer of insulation that surrounds your nerves and aids with nerve conduction. Connective tissues like ligaments, bones, and blood, and then tissues such as nerve and muscle tissue come next. Areas bathed in fluid, like joints are always prime targets for metabolite deposition (an example would be uric acid crystals depositing in joints in people with gout). If toxic and metabolite exposure goes on long enough, entire organ systems can be affected and thereby become dysfunctional.
Getting back to your gut, many supplement companies do not take into consideration actual human physiology when they talk ‘detox’. I swear that most people think the word detox is synonymous with the word poop. Let me be very clear, just because something makes you have a bowel movement – that doesn’t mean you are detoxing. Every symptom you have is not a sign of detoxing, nor is it a sign you need to detox. Nothing gets me more wound up than all of these ambiguous posts online that blame every negative side effect or symptom on toxins. And please, don’t get me started on all of these posts where people come to a group forum and ask a legitimate health question, only to have their symptoms brushed off or minimized by some well-intentioned but ill-informed individual under the guise that “all is fine, you are just detoxing!” As a health care professional, when I see someone referring to the word ‘detox’, I read their statement as “I don’t know what I’m talking about and have nothing better to say, so I am going to baffle them with BS”.
On a very simplistic level, when we were embryos and our guts formed, one collection of nerves, the ‘neural crest’, forms and divides with one section becoming the central nervous system and the other section becoming the enteric nervous system. These two nervous systems are connected by the longest of your cranial nerves – the vagus nerve. This vagus nerve starts in the brain and terminates in the gut and this is the source of the brain-gut connection that you read about. It is also why you have ‘gut feelings’, why eating certain foods are addictive or simply make you feel good, why you want to eat when you are stressed, why food sensitivities can cause behavioral changes, and why medication such as antidepressants can cause stomach upset or nausea.
When most people refer to detoxification they are referring to liver function, or to Phase 1 and Phase 2 conjugation in the liver specifically. This is truly your major site of detoxification and it is the organ most intimately connected to hormone balance. In Phase 1, blood carrying toxins enters the liver, and the liver prepares these toxins , usually moving them towards being water soluble, and makes them more accessible to Phase 2. In Phase 2, there are a sophisticated set of reactions involving a multitude of things, including Cytochrome P450. In all, there are 6 main types of reactions that occur in the liver – with each one being completely chemically different. That is why there is no magic detoxifying agent that can clean you out entirely. Of these 6 main reactions, 3 (glucuronidation, methylation, and sulfation) are the most likely to be impaired, and the other three are more likely to affect your hormone levels.
- During sulfation, your body adds sulfur groups to certain toxins so they can be removed. Your body requires sulfur-bearing amino acids like cysteine and methionine, and B-vitamins like B12 and B6, and folic acid for these processes.
- During methylation, your body requires methyl donors to facilitate the toxin removal. Up to 40% of the population may carry genetic anomalies which hinder this process.
- During glucuronidation, your body requires glucuronic acid, various B vitamins and a significant amount of specific magnesium ions to work properly.
This all leads to glutathione conjugation, where your body then uses master antioxidants like glutathione, superoxide dismutase, and catalase, along with the antioxidant vitamins A, C, E, and selenium.
OK, so have I bored you to death yet? This is as exciting as watching paint dry, right? But if you have stuck with me this long, you might be asking me what this really means? In a nutshell, it means that there is no single supplement or product that can act as a total detoxing agent. Anyone who suggests otherwise, is steering you wrong and just doesn’t understand basic physiology. CBC Marketplace (click link to watch the video) , Canada’s version of 20/20 style news exposè , recently did a show where they had a group of sorority girls from my alma mater follow Dr. Oz’s popular 48 hour detox or act as a control group. Extensive blind testing was provided by a team of medical specialists before and after the ‘detox’, and would you be surprised by their conclusion that they could discern absolutely no differences between the two groups upon the completion of the detox program? This leads us to a very important point, if you can’t find any biochemical proof that toxin levels are decreasing, then what are you really doing? There is an incredible lack of scientific literature that supports most detoxification claims; not only can people not agree what detoxification is, but they can’t prove that they are causing it.
You can take specific supplements or combinations of supplements to pull, chelate, or adsorb (not absorb) specific toxins from the body, like using chlorella to bind with excess mercury you may have in your body from consuming shellfish or having amalgam fillings; using EDTA to pull lead from environmental exposure; or using N-acetyl-cysteine to detoxify from acetaminophen exposure. But (big BUT) when it comes to detoxification, there is no magic bullet. You can’t go around claiming that every supplement under the sun is ‘detoxing’. They just don’t work that way, and even if a substance supports a step of detoxification, it doesn’t cause detoxification in its own right, and blaming all negative symptoms on detoxification is haphazard and potentially dangerous.
I have kept a running list of the ‘detox’ references I have seen in the online groups I follow over the past few weeks. Here is a list of symptoms that I have seen people blame on supplementation:
- fatigue
- hives and other skin rashes
- weight gain
- gas
- bloating
- nausea, vomiting
- dizziness
- insomnia
- inability to concentrate, mental fog
- headaches/migraines
- diarrhea
- constipation
- heart palpitations
These are not symptoms of supplement-induced detoxification!!! These are symptoms of dehydration and starvation. When many people undertake a detox plan or a new diet, they dramatically cut their caloric intake and unfortunately the do not consume enough water, or consume substances with diuretic properties which therefore increase their odds of becoming dehydrated. On day one of a typical ‘detox ‘/ diet, people often feel bad. They are hungry, may experience dizziness or irritability, and feel fatigued. By day two, their body starts breaking down muscle mass to provide them with energy and they may experience additional mood swings, difficulty sleeping, or overwhelming fatigue. By the third day, they are likely having headaches, muscle pain or stiffness, and even dizziness or nausea. Rolling into the fourth and fifth days (if they have lasted that long), their body has started to adapt to the new situation and slowed down your metabolism so they don’t feel the same degree of hunger, but they still may be dealing with altered mood, headaches, and nausea. Many people who report a 6-8lb weight loss during the initial period of any detox or diet are truly losing water and a small degree of muscle mass. They are not losing fat! You will notice that when you look at symptoms in this light, they are nearly all truly the result of dehydration and lack of calories, they have nothing to do with ‘detoxing’.
Yes, we can take steps to reduce our intake of toxins, and that may be the most practical approach to detoxification, but we can also take supplements which reduce inflammation or support optimal liver functioning so that our livers are best equipped to deal with the chemicals we assault them with. For anyone interested in detoxing, it should be clear that this isn’t a process you undertake in a few days or weeks, it should be a lifestyle change where you eat ‘clean’ and provide your body with a variety of fresh fruits and vegetables, along with vitamins and minerals, and other key nutrients to ensure that our systems are always handling toxins adequately. When someone tells me that they want to ‘detox’, my number one question is what they want to accomplish. Most commercial detox programs are nothing more than fancily packaged bowel stimulants. They make for expensive laxatives, and have no proven, measurable results, and for that reason, I do not recommend them.
While I am at it, I want to tackle ‘gluten sensitivity‘ and ‘candida overgrowth’. As these are two other catch-alls that get as much ill-informed press as detoxification. First, let’s look at gluten. Do I believe that gluten is an issue? Yes. Do I think it is anywhere as prevalent as what people like to say? No. In fact, a recent study2 found that people with self-reported (and to be fair, the gluten sensitivity tests are horribly unreliable) gluten sensitivity actually had no physical reactions from consuming gluten and instead experienced a total elimination of all of their GI symptoms by eliminating FODMAP’s (Fermentable Oligo-Di-Mono-saccharides and Polyphenols, or rather fermentable, poorly absorbed, short-chain carbohydrates) from their diet. FODMAP’s are what we would traditionally consider to be high-residue foods, things that linger in the gut and prove a fertile ground for bacteria to grow and feed off of. When bacteria thrive in disproportionate quantities or in imbalanced ratios, people can experience significant gas, bloating, cramping, constipation, diarrhea, etc. So what are these FODMAPS? The most common ones are fructose containing substances such as fruit, agave, honey, and HFCS. Oligosaccharides such as beans, lentils, wheat, onions, cabbage, and the other cruciferous vegetables. Disaccharides like dairy (particularly in unfermented dairy products), and sugar alcohols like xylitol, malitol, and sorbitol, which are found in many diet products. So looking at this list, you can be eating what you think is a perfectly healthy diet but causing undue havoc with your gastrointestinal tract and immune system. A lot of people are jumping on the gluten-free bandwagon as of late. In fact, I have colleagues who make their living being gluten-free gurus. I have sat down with internationally known scholars in the field and I just don’t see that gluten is the whole answer. Face it, we were all raised on gluten, and while there were a small portion of the population that have celiac disease and cannot metabolize gluten, the majority of us, for hundreds of generations, did just fine with it. It was the advent of genetic modification that heralded the onset of all of this gluten fuss. It countries that do not allow GMO wheat, they do not have the same gluten issues that we face in the United States. I will say that in the allergy blood tests I run on people, I frequently see wheat as an allergic agent but infrequently see gluten, so my personal experience supports the findings of this and other studies.
Lastly, I have received a bunch of questions lately about candida, and specifically the validity of the candida saliva test. I am of the professional opinion that everyone has candida, it is just a matter of whether your immune system keeps it in check or not.
Truthfully, candida is like Epstein-Barr virus; if you go looking for it you are going to find it. It may be more advantageous and easier on your wallet to simply treat for candida if you believe you have symptoms of candida overgrowth. Now, the candida saliva test (where you spit a mouthful of saliva into a glass of distilled water and look for ‘strings’) isn’t overly accurate.3 It can be better said that it is a test of saliva viscosity or thickness, it isn’t reproducible, nor is it specific. Yes, some people have oral candida (also called thrush) and will produce a positive spit test, but many people have candida-free mouths but may have candida over growths on their skin, or in their intestines or vagina’s. Yeast is an equal-opportunity offender. You can spend hundreds of dollars having blood, stool, or skin tests done, but does that really change your course of treatment? If you believe you have it, it may be a lot easier and cheaper just to treat for it, and treat for the appropriate length of time* (*most treatments need to be for a minimum of six weeks to be truly successful). Now I am officially on the record as saying I feel the candida saliva test is a no-harm-no-foul test. You can do it if you want, it doesn’t cost you anything but 10 minutes of your time, and it may or may not help you confirm that you have an issue. I do not think it is fool-proof or diagnostic by any means, but some people need to see things in order for them to believe them, and this is a tangible test that anyone can do but it should not be something you bet the bank on!
1. Detox Dossier. Retrieved 1/24/14 : http://www.senseaboutscience.org/data/files/resources/48/Detox-Dossier-Embargoed-until-0001-5th-jan-2009.pdf
2. No effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Retrieved 1/24/14 from http://www.ncbi.nlm.nih.gov/pubmed/23648697
3. http://www.acneeinstein.com/candida-spit-test-unreliable/
by drmiranda | Jan 11, 2014 | dietary supplements, network marketing, Plexus Slim Doctor, Uncategorized, weight loss
As I mentioned in a previous blog post, My Doctor Doesn’t Recommend Plexus Slim (or supplements in general) , statistics show that the average medical doctor received only 23.9 hours of education in nutrition during their entire medical school career.1 Typically that education centered around fat, protein, and carbohydrate metabolism, and identifying overt signs and symptoms of nutrient deficiency or toxicity because National Boards love to ask questions about things you will virtually never see like beriberi (thiamine deficiency) or pellagra (niacin deficiency). So, in all actuality, most physicians never learn much at all about individual nutritional substances outside of common vitamins and minerals unless they have taken a personal interest in it and searched out more information on their own time.
So when you show up to your doctor’s appointment wanting them to approve you taking a supplement, chances are very high that they will be completely unfamiliar with the ingredients and their knee-jerk reaction will be to tell you not to take it.
So, how do you get your doctor’s consent to take a supplement when they don’t know anything about it?
The single most important thing you can do to aid your doctor in their decision is to provide them with appropriate information. Your doctor doesn’t have the time or the resources to look up 15 separate ingredients while you are at your appointment, so you need to do this for them. If you present to the doctors office prepared with the following, you have dramatically increased your odds of getting appropriate medical advice as to whether that supplement is worth you trying.
- Print off the SUPPLEMENT FACTS box/sheet on the product you wish to take. This is the ‘snapshot’ of the label that lists all ingredients, in order of quantity, and lists product dosing, and any warnings or contraindications. You can get print these off from any supplement company’s website as they are required to make these available to you.
- If your prospective supplement has a study published on their website, print off a copy of that too. Remember though, that many supplement companies do not publish studies on their supplements so they do not run into hot water with the FDA by making a product claim.
- Look up the main ingredients in the product and print off an information sheet about each one. Use reputable websites that your doctor would be inclined to positively receive information from such as MedlinePlus, WebMD Supplement Center, or the Physicians Desk Reference – Herbal Medicines. Please don’t use Wikipedia or other questionable sources! If at all possible, keep the print out on each ingredient to a single page – that way your doctor can quickly skim the information.
- Use Pubmed to print off Abstracts (not the full studies) of any of the ingredients in relation to health conditions you may have. Here is an example I searched for – chlorogenic acid, weight loss and this study pops up. ***Be careful here, because few nutritional journals are indexed at Pubmed, and the nutritional studies posted in medical journals are often AGAINST supplementation, or use rat or other lab animal models and are not based on human trials.
- Lastly, have these all together in a file or envelope that you can present to our doctor and NEVER ask them “I want your approval to take ________”. This type of question opens them up to legal liability . It is far better to word your question the following way, “Is there anything in this supplement that would be contraindicated with my medications or health history?” That way you are not asking for their personal opinion, nor their approval, but you are doing your due diligence that the supplement should be safe for you. Remember, the doctor works for you, and you hire them for their expertise. If they shoot down all supplementation, then they are not working in your best interest. For this reason, I recommend you also print out my blog post My Doctor Doesn’t Recommend Plexus Slim (or Supplements in General) because it covers the exact statistics of risk for dietary supplements and counters any arguments an uninformed doctor may give you.
1. Adams, KM, Lindell, KC, et al. Status of nutritional education in medical schools. 1,2,3,4. Am J Clin Nutrition, April 2006, vol 83. No 4, 941S-944S.
Image courtesy of stockimages at FreeDigitalPhotos.net
by drmiranda | Dec 28, 2013 | dietary supplements, MLM, network marketing, sales, Uncategorized, weight loss
I’m going to let you in on a little secret: Doctors don’t know everything.
Shocking right?
The word doctor itself originated as an agentive noun of the Latin verb docēre, meaning ‘to teach’. That ‘teaching’ part is something that a lot of modern doctors have forgotten. In our haste to get patients in and out of the office in as little time as possible, many of us have bypassed the teaching part all together in order to go directly to that little white prescription pad.
The big losers in all of this is that the lovely little town doctors of yesteryear are a dying breed and insurance companies and actuaries are dictating how doctors treat their patients. This is compounded by the fact that the advent of the internet has turned our patients into armchair researchers who present to our offices with pages of print-outs on what they have self-diagnosed themselves with, or on treatments that they would like to explore with or without our help. And so, in our haste to process patients quickly, we find that it is easier to NOT recommend something that we are unfamiliar with than to look into it further for our patients.
I’m not saying that there are not great doctors out there, because that couldn’t be farther from the truth, but the unfortunate statistic stands that the average doctor received only 23.9 hours of education in nutrition during their entire medical school career.1 Nutrition is a broad term — and typically involves learning about the wonders of fat, protein, and carbohydrate metabolism and recognizing overt signs of individual nutrient deficiency. Very, very few doctors can claim that they learned much, if anything, about specific dietary supplements or herbs.
So when you go to your doctor and consult with them about the safety of a dietary supplement, be prepared that your doctor’s knee-jerk reaction to your question may be to deny, deny, deny. Here is my rundown on the most common arguments you may hear from your doctor on why you shouldn’t take a dietary supplement:
- Argument 1: Dietary supplements are not regulated by the FDA, therefore they are unsafe. This is the same FDA that brought you Raxar, Tequin, Duract, Vioxx, Bextra, sibutramine, dexfenfluramine, Rezulin, Avandia — all drugs they deemed ‘safe’ but had to pull off the market because of overwhelming adverse reactions, including death. The same FDA that approved all of those artificial joints, repair mesh, and surgical hardware that you see mentioned in attorney commercials (and now subject to mass recall and class-action lawsuits) every time you turn on your TV. The same FDA that routinely extorts nutritional supplement companies.2 The same FDA that routinely hires all of its upper level and leadership positions directly from drug companies (or drug companies hire directly out of the ranks of the FDA in a well known, ‘I’ll scratch your back if you will scratch mine’ system). I think I made my point. The fact that the FDA declares something to be safe is more indicative of a multimillion dollar payout than bonafied, objective science. But I digress, the FDA does not regulate dietary supplements per se but they do heavily regulate the manufacturing facilities that dietary supplements are made in and strictly regulate what companies say about dietary supplements. That is why it is illegal for a cherry farmer to post on his website that cherry juice is known to reduce the uric acid crystals associated with gout, but Pfizer can spend millions of dollars a year advertising how Viagra can give you enough wood to build an ark.
- Argument 2: I’ve treated dozens of patients that have _______ [insert health horror story: liver failure, kidney damage, brain cancer, tennis elbow, died, etc.] from taking ‘natural’ supplements. I will be the first to agree that not all supplements are safe. Furthermore, just because something is natural, does not mean that it is without risk, but I will also be the first to point out that 20,500 people died in a given year from FDA approved medicines and zero people died from ‘unapproved by the FDA’ supplements.3 If you look at Adverse Drug Reactions (ADRs) in general, the FDA reports that there are over 2 million ADRs yearly resulting in ~100,000 deaths, making it the 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths.4 Yet according to the Governments own Government Accountability Office (GAO) , between 2008 and 2011, the FDA received 6,307 Adverse Event Reports (AERs) for dietary supplements, this averages just over 1500 per year yet, according to the GAO’s own report, over half of the US population takes dietary supplements. This means that nearly 200 million people are taking dietary supplements in a given year, yet only 1500 people report an adverse reaction. Of those 6307 AERs, only one death was reported and it was “vaguely and probably irrelevantly concurrent with an “unknown dietary supplement or homeopathic agent”—with no deaths reported before 2009. By way of contrast, the same report shows that FDA-approved drugs caused 80% of Poison Control fatalities. More than 100,000 calls to Poison Control Centers, 56,000 emergency room visits, 2,600 hospitalizations, and nearly 500 deaths each year are attributed to Acetaminophen (Tylenol) alone.”5 So, forgive me if I call ‘BS’ on your doctor personally treating dozens of people that had organ damage from the supplements they bought at the health food store. It is statistically impossible.
- Argument 3 : Supplements don’t do anything but give you expensive urine and the manufacturers just want you to spend more and more money with them. Cough, cough, pot calling the kettle black! Hmmm, and big pharma has your best interests at heart? What about those hospitals that bill you $20 for that single aspirin or ibuprofen tablet? No matter how you break it down, supplements do not compete on any level with the drug companies. The top 50 pharmaceutical companies are responsible for $610 billion of annual revenue.6 Compare that to the nutritional industry which had revenues that topped $32 billion for dietary supplements during the same year.7 The simple fact is that most supplements cost a mere fraction of their drug counterparts, and no one makes a lot from individual dietary supplements because they are natural substances and therefore cannot be patented. That is the exact reason why you don’t find dozens of double-blind, placebo-controlled trials on supplements – there is no money in it. A company isn’t going to hire a team of researchers and spend tens of thousands (if not more) to do a trial proving the efficacy of green tea extract, when a) they legally can’t promote any results that prove the supplement did something, b) the margins or mark-up on supplements and raw materials is comparatively very low, and c) all of the other manufacturers that sell green tea extract could use the same data to sell their product (why help your competition?). There is no practical advantage for them to pay for studies. Furthermore, most supplement manufacturers would be required to identify or disclose the exact ratios of ingredients in their proprietary formulas in published data otherwise it would not be reproducible by third parties. Given the low margins and lack of patents, you can see why supplement manufacturers would be reluctant to disclose the only information that protects their trade secrets. Personally, I am more suspect of the doctor writing prescriptions for that expensive new statin drug that just so happens to sponsor their annual continuing education Caribbean cruise.
- Argument 4: Supplement companies pay big money to Google to cover up negative stories about adverse reactions. Please!!! Let.me.repeat: 610 Billion vs. 32 Billion, and 50 big players (companies) vs. tens of thousands. The doctors that would make this asinine statement are the same ones that deny that vaccine manufacturers aren’t in it for the money. The same doctors that figure you must have been born with a metformin deficiency but taking chromium to regulate your insulin levels is ‘crazy’. There isn’t a supplement manufacturer out there that has enough disposable funds to pay off Google or any other search engine. Remember, the mainstream media covers up pharmaceutical negligence all of the time, after all, who is their #1 advertising group? The next time you watch television, grab a pen and a piece of paper and keep a running tally of every supplement commercial for every drug commercial. That alone ought to tell you who controls the media.
- Argument 5: Supplements don’t ‘cure’ you. They are right on that. It is against the law for a supplement manufacturer to ever report or claim that their supplements ‘did’ anything. That is why every supplement advertisement or piece of literature that you will ever see contains the disclaimer :This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease. It is also why supplements rely on anecdotal testimonials of patients to promote them. But I would also hazard to say that the vast majority of drugs don’t cure anything either. They simply address one set of symptoms, often resulting in another set of symptoms, which results in the need to take ever-increasing amounts of medications. This is the real reason why the average American takes 10 prescriptions per year. You are given one medication for one symptom, which results in a drug-induced nutrient depletion, which causes your blood pressure to rise, so you are given a medication for that, which affects your kidneys, so you are given a new medication for that, which constipates you and gives you headaches, so you are given two more medications for that, and before you know it you are taking 10 drugs per day and no one has ever checked for any drug interactions, you end up with liver damage from your 10 medications, but your doctor is more concerned about that weight loss supplement that might help you lose 50 lbs and therefore not need any of those aforementioned medications.
In my 10 years of having a nutritional based practice, I have run into all sorts of doctors. Some are ecstatic that their patients are being proactive and making changes to improve their health. Some deflect nutritional questions under the guise that it isn’t their specialty, so they would rather not comment on it. Others get their ego all tied up in a knot when their patients seek advice from other practitioners. Some are so indoctrinated at the Church of The Mighty Pharmaceutical that they simply cannot rationalize anyone questioning their sacred doctrine. Regardless of what type of doctor you have, you have the right and the obligation to take ownership of your own health. If that means that your doctor isn’t familiar with the ingredients in a supplement that you would like to take, find someone else to help you. That may be another doctor, it may be your pharmacist. You may simply need to reword how you ask your question. Instead of saying, “Hey Doc, Do you approve of this supplement?”, you should ask, “Is there anything in this supplement that would be contraindicated with my medications or health history?” You may not think that there is a big difference between these two questions, but there is a world of difference legally. The first requires their medical opinion and approval, the second only is indicative that there is no overt contraindications and does not require the physicians approval. I have seen some doctors spouting off anti-supplement rhetoric on their blogs and Facebook pages lately, and it saddens me greatly. Reading their posts, they are the ones fear-mongering and creating hysteria instead of offering genuine support or information to the public. The Hippocratic oath centers on the tenet of First, do no harm. In addition, the modern Hippocratic oath contains the statements, “I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure.”8 As a doctor, I find it abhorrent that another physician would be so callous to say that diet and exercise are the ONLY answer to weight loss. There isn’t a doctor out there that has been in practice for more than a day that hasn’t seen patients that were fit and active but over weight. If it were only as easy as diet and exercise no one would be fat. Now, lifestyle modification is crucial to overall health, but some people simply need that added boost that supplements can give them. Completely ignoring drug induced nutrient depletion, or the grossly inadequate nutrient content of modern food, it is virtually impossible to get everything you need from diet alone.
So if your doctor isn’t familiar with supplements, or tells you not to take something, you need to ask them specifically ‘WHY?” If it is one of the cop out arguments mentioned above, you now know how to react. If they simply do not know, feel free to search out a second or even a third opinion. If there is a genuine reason why you shouldn’t take a supplement, such as pregnancy, or a history of kidney or heart disease, then you did your due diligence and got appropriate advice. And always remember, doctors don’t know everything and the really good ones are never afraid to admit that.
1. Adams, KM, Lindell, KC, et al. Status of nutritional education in medical schools. 1,2,3,4. Am J Clin Nutrition, April 2006, vol 83. No 4, 941S-944S.
3. United States Centers for Disease Control (CDC). 2008
Copyright (c) 2013 Miranda Jorgenson. All rights reserved. This material may not be published, broadcast, rewritten or redistributed in whole or part with out the express written permission of the author. You are welcome to share this link or print this page and use in its entirely.
