Nutrition Detective

Blog #41 On Book Tour with the Nutrition Detective

2011-06-25T06:18:00.000-07:00

I am in the middle of a fifteen-city book tour for, “What’s Eating Your Child?” While every city has a different flavor, the problems parents are facing are the same everywhere. In Denver, one news anchor at a local television station talked to me off camera all of sixty seconds. Yet in that small amount of time he volunteered that one of his children suffered terribly from constipation. Glancing at the monitor I knew he would be gone in seconds so I quickly guessed, “I bet she is a heavy consumer of dairy products”.

He stopped short and then replied, “now that you mention it, she loves cheese and yogurt.”

“Unless you want to keep giving her Miralax, you might want to reduce or eliminate the dairy products for awhile,” I speculated further. He looked at me like I was some sort of mind reader but I was simply making assumptions based on the most common scenario. The fact that this information is so surprising is unfortunate.

Everywhere I go parents need help and are living with difficult situations that perhaps nutrition could ameliorate. More than one mother has burst into tears relating her story. Hopefully, the book will help some.

To follow along the book tour check out these links to two of the television appearances:

CNN:
http://amfix.blogs.cnn.com/2011/06/09/whats-eating-your-child-the-link-between-food-and-childhood-ailments/?iref=allsearch

Fox Health Talk:

http://video.foxnews.com/v/1013764998001/misdiagnosed-mood-disorders/

Blog #40 The Finding Real Food Road Show

2011-06-15T21:50:00.001-07:00

I have officially left on the book tour for, “What’s Eating Your Child?” and have already learned a lot of new things about myself. The first shocking revelation is that I like being on TV. The whole TV interview idea had me so shaken that I started wondering if I was developing an anxiety disorder but it turns out there is nothing to worry about. It is just like speaking except with a bigger audience. You can still be an introvert and there are an army of stylists to make your hair look perfect.

What I did not like learning is that I have food snob tendencies. When there is not high quality food around I do not like it one bit and most people in this country have limited access to what I consider decent food. No big news here but one does not appreciate the importance of access to healthy food until it is not easy to get. I am ridiculously lucky that if I am willing to drive up to 25 minutes I have my pick of 6 different places carrying a variety of organic, high quality food. While I usually frequent the place five minutes away, I think nothing about driving 25 minutes to get organic grapes or 15 minutes in the other direction to get the best wild salmon because I can.

Contrast that to the suburb I was stuck in recently when my plane got cancelled. All the hotels close to the airport were already booked, so a $70 cab ride later I alighted in any-town, USA off a busy highway. The hotel offered a continental breakfast consisting of cereal, milk, orange juice and grey bananas. I asked the receptionist if there was any place to get a full breakfast. (I did not want to say, “Is there any place to get real food?” and offend their hospitality.)

The only choice was a diner a mile away. I grabbed a grey banana and started walking. On the way I passed 4 gas stations, a health club, a strip bar, two office buildings, two car repair businesses, and a non-descript strip mall (not related to the strip bar). The food choices were McDonald’s, Subway and Dunkin’ Donuts. Finally, the diner appeared and it was closed.

Now I was starving. There was a BeKind and Odwalla Superfood bar in my suitcase but I had eaten one of each for dinner. Better another bar than McDonald’s I decided and then remembered that Dunkin’ Donuts advertised egg sandwiches. What they actually have is preformed egg patties that they put in a roll just like the other fast food establishments. The place was busy and this is what most people think of as eggs. Not the blue organic ones I eat at home with a chard smoothie chaser.

I could eat the veggie egg white omelet, I thought but then realized that “veggie” was likely a cute euphemism for “vegetable like” as “shake” in fast food lingo really means fake milk-like syrup drink. Next to the menu board was a prominent sign warning consumers to notify the chef if they had a food allergy. Chef was still another euphemism for bored teenager throwing patties (or pucks as my friend Kathy calls them) into a microwave.

Bravely, I placed my order. The girl behind the counter looked at me blankly. “Omelet? What egg white omelet?” After several rounds of negotiation she asked me to just give her a number from the menu. When my number whatever arrived, I scraped off the suspicious cheesy coating, threw away the bread and ate the egg puck with vegetable-like specks. Protein is protein after all.

On the one hand, I could say I am out of touch with most people’s food reality but at the same time, how did most people come to accept this as food? Just last blog I was commenting about the dead feel of the beautiful food at McMillan and Jones but sitting at the Dunkin’ Donuts I would have traded my watch for some of that dead stuff.

Blog #39 What Einstein Knew About Nutrition

2011-06-09T06:53:00.000-07:00

I have been preparing to leave for book tour and so have been somewhat behind in the blogging department. My next few blogs will be about the wonderful world of book touring. This last pre-tour blog is about quantum physics. Since I do not know that much about quantum physics, it will not be overly lengthy. I have always been a fan, however and listen with rapt attention when experts explain why the process of observation changes the outcome of experiments or how atoms are not made up of particles but little bundles of energy.

Once I heard a doctor explain the theory of how physicists could project substance through space like Captain Kirk being beamed up to the starship Enterprise on an old Star Trek episode. He was explaining the military potential for using this technology and I was horrified/fascinated through the entire hour. Unfortunately, I did not understand a single word of the “how” this could be possible. I got that the little bundles of energy formerly known as protons and electrons do not travel in orbits but jump around. Somehow if you blast them with the right kind of energy you can displace them and they show up somewhere else. The details are fuzzy but the important take away is that everything (mind, body and spirit) has an energy configuration. We are just starting to understand what that means and what we can do with it.

Don’t feel bad if this seems mind boggling as apparently even Einstein theorized the quantum physics model but could not prove it mathematically. Despite not understanding the exact details of how Einsteinium physics operates, I ran into a nutrition application recently.

My husband and I offered to take some friends who live in the next state, to dinner. They been through a difficult time and we wanted to be supportive, so we asked them to pick a place they liked. They chose a high end chain I will call McMillan & Jones. The food at this restaurant is famous for being fresh and flavorful.

The company was excellent, the food was indeed fresh and they enjoyed it immensely. My husband and I both had fish dishes and a salad. The fish was flakey and everyone else seemed to like the food. I, on the other hand, chewed my fish and thought it indeed tasty but I did not like it. There was nothing wrong with it but it seemed to lack energy. The meal was beautiful but the food felt dead. (Of course, the fish was dead but that is not what I mean.) If someone told me the chef hated his job and was known for throwing cleavers, I would swear that emotion somehow leaked into the food.

The whole idea was preposterous. The place was packed and everyone else seemed to think the food was superb. Nonetheless, half way through my meal, I pushed the rest of the food aside and could not eat another bite. Truth be told, this is the third meal I have had at the third location of this chain and the experience was the same every time. The experience made me think about the hard to define energetic properties of food.

We know that how a food is grown can change its nutritional value but can the mood or state of mind of the person preparing the food change its ability to nourish? Further, can food mostly grown and processed by machines lack a critical non-nutrient component necessary for health?

From a quantum physics perspective one would have to say , “yes”. If a scientist observing an experiment can affect the outcome just by virtue of watching, then a cook thinking, “I hate people,” while chopping the onions should be able to affect the outcome of the soup. The question is to what extent and how would one notice?

Most people come in contact with many food preparers and handlers in the course of a day so it would be tough to pinpoint long term effect from any one source. But, what if the main food preparer is your spouse and they do not like you or like cooking for you? Would months or years of meals from an emotionally toxic kitchen whittle away at your health?

Studies have shown that toxic relationships are bad for your health but nobody has looked at how that effect is transferred. Could bitterness and resentment experienced by a food preparer alter an otherwise healthy meal so it is not as good for the consumers? I wonder if there would be a way to measure this.

I asked my husband, who is a tax attorney and not a woo woo kind of guy, what he thought about the food at McMillan & Jones. “It was good,” he said neutrally. I countered that I thought it tasted dead. He paused for a few seconds and then replied, “it was somewhat dead now that you mention it.”

Next, I asked him to compare the food to that of a local, inexpensive Italian restaurant near our house. It is a family run operation that pours the same homemade tomato sauce on 90% of its dishes. The fish is clearly not as fresh as McMillan & Jones and the salads are not worth ordering yet we find ourselves there fairly regularly.

“No comparison,” he responded immediately. “The Italian place is better.” This makes no logical or even taste sense yet I bet Einstein would prefer the Italian place, too. It is something to consider next time you eat a perfectly good looking meal that just does not do anything for you.

Me and CNN

2011-06-06T19:09:00.000-07:00

On Thursday, June 9th, I am being interviewed live on the CNN national morning show, "American Morning". The interview will be on sometime between 6 and 9 AM eastern standard time. It is one of the early stops on my 17 city book tour which started here at home, today in Alexandria, Virginia. You can follow the book signings at: www.whatseatingyourchild.com. There will also be local TV appearances in most of the cities. I will let you know how it goes.

Response to Jackie's Question about Allergy Testing- Blog #34

2011-05-31T13:49:00.000-07:00

There are allergies and sensitivities. If you are having a classic allergic reaction (such as hives or swelling), traditional allergy scratch testing or a blood RAST or ImmunoCal test usually works well. Sensitivities and reactions are trickier because the reaction can evolve from a large number of possible causes. Each test looks for a different reaction. For example, there is a specific test for lactose intolerance but it finds no other types of reactions. The best general screening test that I sometimes use is an IgG test from MetaMetrix. It has the least number of false positives and looks for non-allergic reactions to 30 foods. It must be ordered by a practitioner.

Blog #38 Looking for Piracetam

2011-05-26T08:36:00.000-07:00

Recently, my oldest daughter graduated from college (wahoo) and we decided to take a trip to celebrate. I have always wanted to go to Spain and she was willing to go anywhere that had Wi-Fi service so off we went to Barcelona. Barcelona turns out to be a wonderful place to visit and I highly recommend it if this was a travel log. Nor is this a culinary treatise so I will not go on about the intricacies of rabbit stew (not a fan) or chickpeas with black sausage (absolutely delicious). Instead, it is about how even though I left the country, the nutrition detective tagged along.

At first I did not notice her as I experienced the wonders of drinking chocolate and becoming entranced by any architecture designed by Gaudi. Eusebi Gaudi is Barcelona's most famous architect and his presence in the city is impossible to miss. He designed the Sagrada Familia Cathedral using nature as his inspiration. The inside of the cathedral has a forest motif and the outside spires are shaped like stacks of fruit. So, there is something vaguely nutritious about it. There are honeycombs, spirals, plant and animal designs all piled together in an over the top mishmash. You either love or hate the result.

Detectives have curious natures (that is, they experience curiosity, they are not necessarily odd) and as I wondered around, I could not help but notice that in busy areas there are pharmacies on practically every block. You cannot fail to notice them because they have either flashing green or red crosses. And unlike our super pharmacies that carry everything from mops to narcotics, these pharmacies are very small. They have the equivalent of one CVS aisle's worth of items on display and over the counter medicines, like ibuprofen, are all behind the counter. One pharmacy might carry feminine hygiene products and the next not. Maybe that is why they need so many. They must have some type of community pharmacy group where they all agree on who can carry what. Hector's pharmacy gets the face cream but one on 10th and Cambria gets the deodorant.

I could not figure the system out so if we needed something, we just went from one to the next until we ran into it, which never took long. Then I started wondering about locating piracetam. Piracetam is a substance developed in Belgium in the 70's that is the best cognitive enhancer I know. It improves the motor planning and speed of thinking. Nobody knows exactly how it works but taking it with choline enhances its effect. There have been many variants developed since the 70’s but piracetam has a long history of use and so I think it is the most predictable. Piracetam can be found in the US, but the source tends to be China, so I tell people Nootropil (a Spanish brand) from Europe is a more reliable product. And here I was in Spain!

So one morning I walked into a tiny pharmacy three streets behind our apartment and requested in my best high school Spanish a box of Nootropil. They speak a Catalan version of Spanish in Barcelona so nobody ever seemed to understand anything I said. Either that or my Spanish is dreadful which was my daughter's explanation. The clerk looked at me blankly. After repeating several versions of my request she handed me a slip of paper and instructed me to write down the name. "Ahhhhh," she responded with understanding after reading the name. That was easy, I thought until she started shaking her head and waving her hands. I needed to try the pharmacy next door or three doors down that carried piracetam and hair spray.

Armed with my paper I made faster progress until finally at the third pharmacy, I hit pay dirt. There for a measly 3.5 Euros (less than $6), I was able to purchase a box of Nootropil in my choice of potencies (800 or 1,200 mg). When I asked in my cringe inducing Spanish if a prescription was needed, the pharmacist appeared puzzled that I asked. I had asked because piracetam inexplicably sometimes seems to require a prescription and other times does not. I have a client in Ireland who needed a prescription while one from Italy, did not. You can order it from England without a prescription but I think you need one if you are actually in England.

To further thicken the plot, getting piracetam in Spain was no harder than tracking down a nail clipper and about the same cost while getting piracetam in the US can take weeks and costs many times more. It made me realize again how little medicine is about what works and how much it is about health care politics and just how things are done in a particular place at a particular time.

Last year, I saw a child who had severe, global developmental delays. Dmitri had been getting occupational, speech and physical therapies but was making very slow progress. After creating a good nutritional base for learning, I asked his mom if she had ever thought about trying piracetam. In these complicated cases, piracetam can speed up progress by building neuroconnections across the corpus callosum to help with processing. I pointed her to some resources and information about it so she could consult with her doctor.

Several weeks later she reported her doctor advised her against using piracetam. It cannot be that good, the specialist had said, or he would know about it. He could not assure her it was safe and there was no evidence (according to the expert), that it worked. What was his alternate suggestion? There wasn’t one. She would have to learn to live with his disabilities. Dmitri’s mom was discouraged but listened to her doctor. Dmitri progressed very slowly until the summer. His mom decided to take Dmitri home to Poland and spend time with her family.

While there she made an appointment with a neurologist her family liked and asked him about piracetam. He told her Dmitri should have been put on piracetam a long time ago. Of course, it was safe and if she were there, he would have been put on it a long time ago. She started it right away and Dmitri’s speed of progress increased.

So either piracetam only works in Europe or if someone tells you they have never heard of something, you should not trust their opinion on it. The US doctor did not realize how much of what he thought he knew was colored by limited medical cultural experiences. Maybe he should travel more.

#35 Nutrition Fatigue and Cholesterol

2011-05-11T11:29:00.000-07:00

Lipitor, a cholesterol lowering statin drug, is the best selling medication of all time. One year 9 billion dollar’s worth was sold in the US alone. Now it is more like 7 billion per year (source: Los Angeles Times May 4, 2011) because a bunch of copy cat drugs were rolled out to hone in on such financial largesse. (Crestor, Zetia and Zocor to mention the brand names of 3 of the 6 other statins.) The point is, there is a lot of money involved in anything having to do with statins.

All the statin drugs lower cholesterol but in slightly different ways. The key to their success is buying into the theory that lowering cholesterol reduces heart disease.
Recently my friend, Basil sent me an e-mail, “There is a small but growing school of thought that rejects the high cholesterol-heart disease hypothesis. High cholesterol may not cause CVD (cardiovascular disease),” he wrote. “They were talking about it on that silly Dr. Oz show. You should write about that.”

Okay. I will though I will disclose that my temporarily crippled assistant, Tania, has been spending a lot of time recently deepening her relationship with Dr. Oz and she describes him more as “almost cute”.

An interesting study completed in 2006 on two popular statins, Vytorin (Simvastatin) and Zetia (Ezetimibe) changed the conversation about cholesterol lowering. Both drugs successfully lowered cholesterol however, the study (sponsored by the drugs’ manufacturers Merck and Schering-Plough) found the medications did not prevent heart attacks or other life-threatening events. There was actually no benefit from taking them. (See: The New York Times, Jan 14, 2008, “Drug has no benefit in trial, makers say”.) This four year long, multicenter trial of Simvastatin and Ezetimibe in Aortic Stenosis (SEAS), found the rate of congestive heart failure, stroke and cancer actually went UP when people took these two drugs together though in people who already had symptomatic aortic stenosis, ischemic events decreased (“Intensive Lipid Lowering with Simvastatin and Ezetimibe in Aortic Stenosis,” A.B. Rossebo, et al, NEJM, 2008, 359.)

Dr. Terje R. Pedersen, chairman of the SEAS trial summarized the findings by calling the drug combination “safe and well tolerated”. (http://www.internalmedicinenews.com/specialty-focus/cardiovascular-disease/single-article-page/major-cv-events-not-decreased-with-vytorin/033eb84c9a.html). Yeah, but they do not do help prevent disease and may, in point of fact, increase one’s chance of having a stroke or heart attack. Nobody will be surprised to hear that the study was misplaced for a couple of years. There is an ongoing investigation on how that could have happened. Do not expect results any time before hell freezes over.

Confusion and debate commenced and nothing changed. Both drugs still enjoy robust sales because the important point the manufacturers want doctors to remember is that the drugs lower cholesterol. Which brings us to Basil’s point. Maybe high cholesterol levels are not the risk factor for heart disease that they are believed to be.

The quiet truth is that the big difference between Zetia and the other statin drugs is that Zetia lacks anti-inflammation properties. All it does is lower blood cholesterol levels. Most of the other statins have mild anti-inflammatory properties. Mounting evidence suggests that high inflammation not high cholesterol may be what is increasing heart attack risk. It just happens that inflammation goes down as a secondary side effect of the cholesterol lowering process.

When you think about it, lowering inflammation as the mode of action makes much more sense than lowering cholesterol. For one thing, if lowering cholesterol is so important, why have heart attack rates barely dropped even though practically everyone you know over 50 takes a statin drug? Heart attacks and heart disease statistics have changed little since the massive and pervasive use of cholesterol lowering therapies.

The cover story for the May 2011 Harvard Heart Letter announced, “Gloomy forecast on heart disease”. The article goes on to say the American Heart Association predicts heart disease will increase 17% and heart failure and stroke will go up by 25% each over the next 20 years. They recommend avoiding tobacco, exercising, maintaining an ideal weight, managing stress and eating better. These are all life style choices that lower inflammation. Only one (healthy eating) might lower cholesterol.

Of course, lowering inflammation requires lots of work on your part while taking a statin drug only gives your wallet a work-out. I predict you will not hear much about the doubts surrounding the effectiveness of statin drugs until October. Actually, you do not need a Nostradamus level of psychic ability to predict that sometime this fall there will suddenly be many reports on how researchers now know it was not the cholesterol lowering properties of Lipitor that helped the heart but its mild anti-inflammatory properties. (We actually already know this.)

Why will this hot news story break in the fall? Because Lipitor goes off patent in November and the 7 billion dollar a year cash cow is about to become hamburger. Generic drug manufacturers will be able to crank out the thing at a tenth of the cost. Seniors on restricted incomes will finally be able to save lots of money on medication but what’s this? They no longer need their statins?

That’s right. I can see the headlines now, “New anti-inflammatory drug slashes heart attack rates.” I think they should call it, Inflamator.

#34 Nutrition Fatigue

2011-05-01T19:31:00.000-07:00

“There was an article in the paper that women who take calcium are more likely to get heart attacks,” my loyal assistant, Tania reported to me one morning. “Should I stop taking my calcium?” she asks ominously.

“E Tu, Tania, E Tu?” I lament dramatically.

“As usual, I have no idea what you are talking about,” she snapped, uncharacteristically irritable.

I hate to say it but Tania has been a tad bit cranky lately. Her mood seemed to shift slightly last month after a freak accident and subsequent major surgery to insert a foot long titanium rod into her leg. The only good thing that seemed to come out of this horrible ordeal is that after years of failed badgering on my part, she finally started taking her supplements regularly. Now it seemed even this small benefit was in danger of being lost under the constant onslaught of negative media reports on supplements.

There is a condition called, compassion fatigue that happens to people when they are so overwhelmed by hearing horrible stories of suffering that they just cannot feel anymore. A general numbness descends. The news media has managed to create this in most of us regarding every major disaster in the last few decades with relentless, non-stop reporting of every tragic, pain ridden moment.

A similar condition happens with “health” reports regarding nutrition which I call nutrition fatigue. Much of the information is negative. Some of the more recent sound bites (insert ten exclamation points to mimic intensity of reporting) claim fish oil does not lower cholesterol, choline causes heart disease, calcium does not protect the bones and melatonin causes precocious puberty, scratch that, now it delays puberty.

No wonder everyone is confused, scared or discouraged because nothing works and the world is going to pot anyway. The solution is to take a deep breath, check into the situation more thoroughly by reading the actual research and think it through. Who has time for all that? Exactly.

I do take the time to do this because people tend to stop taking their supplements in response to these irresponsible reports and I get a lot of panic laced questions. There are so many reported health news disaster stories to pick from but let’s start with calcium because I have already gotten several questions about the study Tania mentioned. Calcium use to be an uncomplicated nutrient until sound bite reporting got to it.

You may recall the beginning of the made-up calcium debate. It involved the huge Women’s Health Initiative study published in the New England Journal of Medicine a number of years ago. The initial headlines screamed that taking calcium does not help bones!!!!!! The comprehensive study had over 36,000 women in it and the ones taking calcium did not have any less fractures than the other group, the reports trilled. Women all over the country viewed their calcium supplements with suspicion. My phone started ringing.

Upon careful review of the study, it turned out that half the women in the calcium supplement group did not actual take their calcium. They were naughty. Unfortunately, there were so many naughty women that removing their data from the study would have invalidated it, so the researcher left the non-compliant ladies in. Garbage science. The study really proved that if you do not take your supplements, they do not work. No big news item there.

In this case as the study was scrutinized, new amended reports started to surface. One from ABC News asked the question, “Does calcium help bones?” Then it answered that in a big study (the same one), women who took calcium had significantly less breaks but they had to take calcium for a long time. So, it was not a quick fix and by the way, maybe it increases kidney stone risk. I guess just saying, “yeah, it does”, would have been boring because everyone already knew that anyway.

The study Tania heard about was a new unexciting study about bone health published in the British Medical Journal. To spice it up, the results were reported with the byline, “Calcium builds bones but may weaken the heart. “ However, there was insufficient evidence in the study to prove or refute an association between taking calcium and heart disease. The researchers were not even looking for a calcium and heart disease link but after the study was done were picking through the data to see what else they could put together to report.

People taking calcium before the study started had no increase in cardiovascular incidents but in the group given calcium for their study there might have been slightly more heart incidents but the association was murky because of many other variables. No problem. Maybe someone else had found an association they could apply, after the fact, to their study. They looked through the literature for other studies to boost the possibility and start a debate.

Researchers from the Women’s Health Initiative (WHI) study weighed in that they did not find any increased cardiovascular risk in the 36,000 women in their study. The new investigators had to be looking very hard to come up with this vague association, one WHI researcher pointed out. (Of course, it is hard to say if one can trust the WHI based on what their researchers initially reported about their study.) There may be science here somewhere but it sounds more like a reality TV script for The Real Biology PhDs of Cambridge. This kind of “I wonder if”,” chitchat should be limited to conversation between researchers over a few beers on a Friday afternoon and not reported as science news.

The result of this sensationalized reporting is some people worried about heart disease, stopped taking their calcium. A larger number of people already forgot the details of the latest report but are building a sense that nutrition is confusing or there is always something wrong with supplements. While annoying and destructive, the results are mild compared to what happens when the financial stakes go up. Then the marketing people get involved and start spinning the results to be sure you take away what they want you to believe which can be very distant from the real findings.

To be continued….

A Visit to Barnes & Noble

2011-04-23T17:29:00.000-07:00

"What's Eating Your Child? was not officially scheduled to come out until June but my friend Lynn reported it was at Barnes & Nobel's already so I had to go take a picture.

Blog #33 The Case of the Passing Wind

2011-04-18T07:17:00.000-07:00

Forty three year old Carrie sat down and frowned with concentration. “How can I help?” I asked.

“I am a little uncomfortable talking about this,” she hedged looking down at her lap.

“Take your time and start with what you are comfortable with,” I suggested.

Slowly, her story unfolded. Her health was excellent, in general and she did her best to “stay away from doctors”. Her main strategies for avoiding the medical profession were to eat well, exercise and generally take care of herself.

“I am pretty boring,” she confessed. “I don’t drink or smoke. Not even coffee.”

“Sounds good,” I said encouragingly.

Carrie fidgeted but continued her story. She was not one of those people who liked to complain about the little physical quirks of life, she explained. Her mother-in-law talked about her bowels like she was reporting on the weather, which Carrie thought was disgusting. Where she grew up, this was considered uncouth.

Now Carrie found herself in the embarrassing situation of having developed a sudden problem with her bowels. “Maybe I have no patience for the bowel report because mine have always been perfect,” she says with self-depreciation.

She had not changed her diet or habits but for the last month or so she had developed horrific flatulence. “I could burn a hole in the upholstery,” she laughed nervously, her face turning red.

I laughed with her and agreed that would be cause for concern then asked some questions.

Had she been traveling?
Yes, but only a short business trip. She took these several times a year.

Had she been sick? No.

Any history of bowel issues? None. Her bowels had always been reliable.

Had her bowel movements changed, too? Absolutely. They were now more frequent, mostly loose and “clear the room” stinky. Before they were well formed and regular.

I looked at her diet and was happily surprised to find lots of fresh fruits and vegetables. “As much organic as I can get,” she insisted. She avoided dairy products because they did not agree with her. There was little processed food and her weight was good.

Gas is the product of fermentation. The bowels have plenty of partially digested food slug to ferment and the bacteria to do the job. If there are enough of the right kind of good bacteria, there is clean processing and minimum bad gas production. But, if the wrong bacteria and/or excessive yeast get to the food they form all types of gas. One species of bad bacteria, for example, thrives on sulfur and produces methane gas. High levels of methane gas produced by people (and more famously, cows) are thought to be a contributing factor to global climate change. So, reducing personal emissions is another way to go “green”.

Clearly, Carrie had picked up or for other reasons was growing too many unhelpful bacteria. The questions were, which one and why were they growing so well? The most accurate way to measure what is growing in the gut is to have a good lab culture the stool. The test I like also looks at other factors such as digestive enzyme activity and has a marker for general gut immune function. This costs about $200.

After hearing my explanation Carrie was quiet for a minute. “My husband is about to change jobs,” she started hesitantly. “Is there any cheaper way to deal with this?”

I told her we could try to overrun the bad bacteria with good bacteria and then to be sure, we could give her some gut immune support. If the problem was a simple imbalance in an otherwise healthy system a few ecological shifts should make her right as rain. But if she was not better in 2 weeks, we could run the stool test. “That would be great,” she enthused.

The plan was laid out. She would take probiotics (good bacteria) twice per day. I recommended a brand containing 20 billion bugs per capsule that required refrigeration. Then I suggested a gut immune support supplement called Probioplex (2 twice per day).

“The gas may get a little worse for a few days, due to ‘die off’,” I explained. As the bad bacteria “die off” they release toxins which can smell bad and be absorbed into the blood. “But, if it is a simple problem, the system should settle down within a week. If not give me a buzz.”

“Either that or I will have to invest in an industrial grade air purifier and carry it with me everywhere,” Carrie quipped.

Carrie agreed to leave me a message in two weeks. She would report that all was well or request I send her a stool test kit. Two weeks passed and I was going through my e-mails when I saw her name. I clicked on.

“Furniture upholstery is safe and my husband loves you,” it read.

I guess the plan worked.

Blog #32 The Other War on Drugs

2011-04-08T07:21:00.000-07:00

I think we might be losing the other war on drugs. More and more kids are being diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and put on stimulants to tolerate an increasing crazy education system and I have become less and less effective at talking parents out of it.

“It is normal for little boys to explore the world through motion,” I will insist.

“But the psychologist said his self esteem will suffer if I don’t help him with medicine,” the parents will counter.

Calling this situation the other war on drugs is not strictly accurate as it is more of a siege with growing numbers of parents ignoring their instincts and succumbing to the pressure to medicate.

The problem is that nutrition, cognitive and other approaches to support brain function work over a long time while stimulants or ‘speed’ work right away. Work how? That is not entirely clear, but stimulants do increase the speed of brain waves and distractibility is linked to excessive slow wave activity.

The brain has different types of electrical wave activity depending on what you are doing. When you are sleeping, for example, there is mostly slow delta wave activity. Concentrate on a calculus problem and there is more alpha activity. Theta waves are associated with semi-conscious, dreamy states such as when you first wake up. They are the next level of activity above delta sleep waves.

Drugs like cocaine and stimulates “speed” up wave activity shifting theta waves to an alpha or beta level. How can kids who are hyperactive have more dreamy waves? One theory is that they have to keep moving to compensate and concentrate. Here is the sticky point- all children have mostly theta wave activity until they are 6 or 7. This dreamy, unfocused state is normal developmentally. So when Molly or Erin or Stacey are pulling their hair out trying to decide if their 5, 6 or 7 year olds should take stimulant medicine because the school is saying their children might have ADHD, I know something is wrong with this picture.

No single human being should be asked to teach a class of twenty seven 6 year olds. It is not possible to do this successfully unless you drug into submission a big hunk of them. They developmentally are not ready to focus.

And it gets even kookier. One of the main diagnostic criteria for ADHD is the ability to concentrate on things that are not interesting to you. The part of the brain thought to be responsible for this function is the prefrontal cortex. Prefrontal cortex (PFC) dysfunction is blamed for ADHD symptoms but the PFC is the last part of the brain to develop. It is not fully operational until age 18 to 22. (Earlier for girls but on the later side for boys.)

The PFC gives you perspective and allows you to do the hard things. A well functioning PFC allows you to wait your turn when you would rather not and recognize the last time you ate two donuts for breakfast you felt lousy all day so you better not do that again. Heck, it is why adults can do their taxes even though they are extremely boring.

It is not suppose to be working very well at age nine or fourteen. Part of the cause of teenage impulse control problems is that their immature PFC does not allow them to truly calculate the results of their actions ahead of time. Kids are not supposed to be little adults.

But who has time to respect or wait for development? We need kids to behave in overcrowded, movement restrictive classrooms now. And the studies show this is exactly what stimulants can do for us.

Most parents think giving their children stimulates will help with academic success and improve self esteem but what they really do is work as a classroom management tool. The few studies done looking at long term use of stimulates found they do not improve standardized test scores but they help kids sit better, at least temporarily. Over many months any perceived changes appear to level off.

Teachers cannot be blamed because they are trying to help kids in a system that does not respect learning differences or even child development. Parents are told that if only their child could concentrate, they would learn. I contend that if only they could learn, they would concentrate. Unfortunately, the education system is broken and we are not going to medicate it into health. But, don’t take my word for it. Before making any decisions, check out this spectacular video by Sir Ken Robinson: http://www.youtube.com/watch?v=zDZFcDGpL4U
His explanation is spot on and his accent makes everything sound better.

It's Coming!!!!!!

2011-04-05T06:50:00.000-07:00

My book is printed and sitting in the warehouse ready to ship! Wahoo. I am so excited.
Here it is:

It can be preordered at a discount from Amazon or Barnes & Noble.

Blog #31 The Flu Cometh

2011-03-21T10:54:00.000-07:00

Recently, I was congratulating myself on not getting sick for 3 or 4 years. Yes, nutrition and lifestyle really works, I told myself smugly. So when clients brought their sick children to my office, I did not think much about it. Half the people I have run into over the last month had one contagious illness or another. Many had the flu, despite the fact that they had gotten a flu shot. Funny how 40% of Americans get the flu shot, yet the number of people getting the flu does not seem to go down.

This was a particularly tough year for those who “believe” in the flu shot as the one offered did not actually contain the virus responsible for this year’s stomach flu. Personally, I would sooner believe in the Easter Bunny- there is more supporting evidence plus the chance of getting chocolate. But, it is just this type of bold, maybe even obnoxious statement that may make people wonder if I would reconsider my position if I actually got the flu.

Someone asked me a related question at a recent workshop. “What if you had immune deficiency, wouldn’t you get the shot then?” she wanted to know. Viewed logically, having immune deficiency does not make an ineffective shot work better, it only makes the recipient more desperate and willing to consider unproven technology. An understandable case of fear overriding logic.

I responded that I would be even less likely to get the shot because it can contain aluminum and mercury, both of which are immune suppressants. Plus, there are several viruses in the shot which elicit an immune response. Why use up immune resources mounting a response to viruses you are not going to run into that year anyway? Easy words to say when one is healthy. What a scary minefield life is when you pick up everything.

A few busy weeks passed. I took several trips involving cancelled planes, broken down trains and taxicabs with an inch of water on the floor. I was once again feeling thankful for handling it all when I woke up one day feeling extremely tired and crabby. Such is life, I told myself. Though I am fairly even tempered, everyone gets cranky and being tired makes sense given my schedule, so no big deal. As the day wore on and I found myself muttering and cursing over very minor issues, like a stuck drawer, I started to get suspicious.

There is a messenger molecule in the body called IL10. It is in a class of compounds called cytokines. Cytokines deliver all sorts of messages that modulate immune function and IL10’s message makes people feel tired and depressed. It is basically a shut down message telling your body to slow down and rest because the immune system is trying to fight off something. In other words, man the hatches, a storm is acomin’.

By early afternoon, I started thinking that I hated my life and work and need to find something else to do. While anyone can have a similar passing thought, the ferocity of my discontent finally registered. I am getting sick, I realized. As soon as I recognized the early signs provided by IL10 and probably a number of other cytokines, I took action. My acute prevention cocktail is 20,000IUs of vitamin D3, 1000mg of vitamin C, a probiotics, 30mg of zinc, 2 My Community (Host Defense) and 2 Transfer Factor Plus (4 Life). This group of nutrients has warded off any number of illnesses but the key is catching the virus before it has invaded the system too far.

Viruses cannot replicate themselves so they take over your cells and use them as incubators. They are little pieces of DNA or RNA (depending on the virus) and they inject themselves into the nucleus of a cell. Now their DNA or RNA is telling the cell what to do, not yours. Just like the movie, “Alien” but at a teeny tiny cellular level.

Once a virus has taken over a cell, the cell stops being useful to you and does nothing but churn out viruses. The immune system’s job is to identify rogue cells, destroy and discard them. The cold or flu symptoms are the result of the immune system coming in to clean up and heave ho the dead cells. (Think runny nose or diarrhea.) If enough cells have been infected, the symptoms are pretty ugly. The virus is trying to stay ahead of the immune system by infecting as many cells as fast as it can while the immune system is targeting and blowing up viral replicating factories as fast as IT can. The battle is on. No wonder you feel terrible.

The reason a cure for the common cold is evasive is that the cold itself partially reflects necessary clean up. The immune system has identified the interloper and is in the process of tossing it out. At that point you can only reduce the severity and length of the symptoms. By strengthening the immune system response, the viruses can tossed out before they invade more cells and cause more of a mess. The big opportunity is prevention. Was I too late?

By late afternoon, I was desperate for a nap but still had 2 more clients to see. Finally, the work day ended. I stood up feeling a little dizzy and crankier than ever. My stomach cramped and rumbled. It was not happy. I suspected I was fighting the stomach flu which appears to be this year’s flu. After an uncomfortable interlude in the bathroom, I was sure. I felt off but not terrible yet. Time to rethink immune support.

The best strategy for fighting stomach bugs is good bugs. I had three different probiotics in the refrigerator and took an aggressive 200 billion bugs. This was two capsules as I had VSL3 on hand (www.VSL3.com). Before bed I took another probiotics and 2 more Transfer Factor.

The next few days I felt a little wobbly and tired. But all and all, I would say nutrition helps.

Here are my flu statistics:

Number of hours feeling crabby and depressed 36
Number of nights of restless sleep 1
Days feeling shaky and tired 2
Extra trips to the bathroom 3
Weight lost Half pound (It's back)
Percent of regular vitamins taken during flu period 50%
Extra Vitamin D3 (taken as a single dose) 20,000 IUs
Number of good bugs taken per day for 3 days 200 billion
Amount of Transfer Factor taken per day for 3 days 4
Amount of My Community taken per day for 3 days 4
Diet changes Bananas In Green Juice Out
Missed days of work 0
Cost of avoiding possible neurological and immune damage by skipping the flu shot Priceless

Blog #30 The Trouble with Traveling

2011-03-13T14:00:00.000-07:00

Having a detective mindset means having an inquisitive nature and asking a lot of questions. “Why should I care if the IRS clarifies the sub part F regulations?” I asked my husband the tax attorney recently. Or, “why does it cost $1,400 to join a sorority?” this to my daughter, the college sophomore.

So, it is not surprising that when I was at the airport this week-end on my way to teach a course in New York, I found myself asking, why, oh why, oh why? I watched with utter perplexity as a line of people allowed themselves to be lead into a milliwave machine and radiated.

According to Dr. Russell Blaylock, a physician and writer, TSA naked body scanners can cause sperm mutations and increase the risk of breast cancer. The Pilot’s Association has reportedly sent a letter to its members urging them to opt out of the Advanced Imaging Technology (AIT). Other sources report that the ionizing radiation by the machines concentrate on the skin increasing the risk of skin cancer.

This all sounds ominous to me and I figure I should at least wait for some good long term safety data before getting ready for my milliwave close up. So, I was dismayed to watch one person after another dutifully and passively walk in to the mystery machine and get zapped. Not a single person opted out.

I was bracing for a body cavity search or whatever other indignity I was going to be subject to for opting out when I noticed there were two lanes and you could just avoid the X-ray machine. So, I did.

Why are people not objecting? The acceptance by so many of the invasive and unsafe is distressing to me. Ask questions. Object when things don’t make sense. Get patted down but do not add to your chances of getting cancer which are already 1 in 3 over a lifetime.

Depressed by this full scale display of submissiveness, I trudged to my gate. On the way, I saw a man drinking a tall beer at one of the many generic bars. The scene would not have been notable except for the fact that it was 11:00 in the morning. Yes, traveling has gotten to the point that a beer with breakfast is about what you need to get through a typical airport experience.

I realized I was hungry and went searching for food. The places I can most reliably depend on finding edible food at airports is Cibo and Starbucks. Cibo has small salads, mini chicken Cesear chicken wraps, tiny hummus containers, veggies with dip and Be Kind bars. They have reasonable portions. Most of the other places that have single salads that could feed a family of four or lunchmeat sandwiches. What can I say? Lunchmeat is gross. Sadly, this terminal did not have a Cibo, which meant looking for a Starbucks.

Of the chains usually represented at the airport, I have been surprised to find myself sometimes looking for Starbucks, even though I do not drink coffee. This morning, I stood in a long line to order their very tasty oatmeal. I threw away the brown sugar packet but added the nuts and dried fruit. It was made with water and was delicious.

I walked back to my gate and enjoyed every bite. But, I still needed something. Maybe a beer.

Blog #29 Secrets of People Who Never Get Sick: The Bonus Material

2011-03-02T07:20:00.000-08:00

After writing a book there is a big hunk of empty time while waiting for it to be printed and released. That time for me is happening right now. The down time should be welcomed because of the exhaustive push of deadlines along with my regular work schedule. But, of course, I am too excited to be sitting around waiting so I had to come up with a productive way to fill the time.

My kids are all in college so I can only call and annoy them so much. I took a few baths, trimmed back the liriope (a fast spreading ornamental grass used in landscaping) and sold stuff of my husbands that he almost never uses on Ebay. That took a week and I still have four months left until the June 6th release.

My publisher (Workman) puts out some interesting books and while I had read some before signing with them, I had not had a chance to read any since. I decided to look at books that were in the same health genre as mine. The title, “Secrets of People Who Never Get Sick,” by Gene Stone caught my attention immediately. At least half of the people I have talked to over the last few weeks have been sick so I decided to see what he had to say on the subject.

Most of the hardly-ever-get-sick people I know do what you would expect, they exercise, think bright and happy thoughts, eat a diet full of whole foods (some vegans, others animal eaters) and take a handful of supplements everyday. Stone chose to reveal the secrets of 25 people who concentrated on one main area to maintain their health and avoided those with complex regimens.

I am not going to be a book spoiler though if you are the health conscious type you can probably guess ½ of them. (That could be a fun game to play at your next party if charades is not going well.) Reading it made me think about my own personal keep healthy tricks. Consequently, I am adding my very own bonus secret: mushrooms.

Naturopaths and herbalists have long recommended certain mushrooms for immune enhancement but the exact reason they worked was not discovered until recently. Dr. Ikekawa, arguably the father of mushroom science, discovered that the cancer rates of families of Enoki mushroom growers had remarkably low cancer rates compared to the rest of the population. The cancer rate in the men from mushroom growing families was 1/3 (or 2/3rds less) than other men in the same area. Women had ½ the predicted cancer incidence. If there was a drug that could claim this near miraculous cancer reducing capability, it would be the best selling medicine in the country. Ikekawa isolated the chemical responsible for the immune protecting properties of this little fungi and the science mushroomed from there.

We now know different mushrooms have different immune enhancing compounds. Some prevent cancer, others fight tumors, still others increase first line defense against illness or decrease inflammation. There are species that produce antibiotic compounds and one even helps nerve regeneration. This last one is called Lion’s Mane and it is a white mushroom that grows on trees and logs.

In Blog # 18- What to do to prevent the flu, I mention three great immune enhancers. One, Immpower (American BioSciences) is extracted from specially cultivated mushrooms and has been studied in cancer and AIDS treatment as a natural killer cell enhancer. Natural killer cells are part of the immune system that respond first when an illness threatens. I have used this product for years and it is very effective as a first line defense against colds and flus. I take two twice per day for a few days if I feel run down or am being exposed to a particularly high amount of germs in a stressful environment such as traveling. Whenever I fly, inevitably I am sitting right next to someone who is copiously sneezing and snorting. Then I think about the one cubic feet of air being filtered for the 280 people on the plane and I take out a bottle of mushroom extract and pop a few for peace of mind.

Last year, I discovered Paul Stamets and his company Host Defense. Stamets is a mushroom nerd. There is probably a more technical term for his avocation like fungologist. All I know is if you ever read anything he has written it makes you want to go out and eat mushrooms by the handfuls. After reading one of his treatises last week, I ran out and bought a half pound of shitake mushrooms to sauté. He talks about mushrooms like they are the most luminous and magical plants in the world.

His classic mushroom mixture product for general immune enhancement is called My Community. Host Defense has a line of mushrooms but My Community is the place to start for beginners. If you are having a hard winter, immune-wise, consider taking two per day. If you are having an awful winter, double that dose. If you are still having trouble, you might have to take a deeper look at your sleep, eating and exercise habits and brush up on those happy thoughts.

Blog #28 What the Dog Ate

2011-02-18T19:32:00.000-08:00

“I am so disappointed in Best Foods,” my daughter Isabel fumed throwing down her gloves on the kitchen table.

“How so?” I asked neutrally.

“Their brand of dog food contains animal BY PRODUCTS as its first ingredient. Can you believe it?” she ranted. “Do you know how bad animal by-products are?” she continued. I did. Animal by-products can range from 4-D meat (animals that are dead, dying, diseased or disabled) to road kill to just about anything associated with any type of animal. (Try not to think too carefully about that last one.)

“How can they call themselves Best Foods and sell such crappy dog food?” she asked rhetorically. (Full disclosure statement: Best Foods is a pseudonym because I still want to be able to shop there despite its lamentable dog food.)

“They probably have not taken on dog food yet, honey, “ I soothed. “They may still be dealing with the ruckus from labeling untested food from China ‘organic’.”
Though a smarty pants remark designed to lighten her mood, it may not be far from the truth. Creating a healthy dog food is not only a commitment; it is a whole specialty onto itself. Interestingly, some of the issues about doggy eating are the same as they are for people.

The most important concern is that dogs are increasingly suffering from the same chronic illnesses as people. Could this be related to their diets having some of the same pitfalls as people's diets? Dogs, like people, do best eating a balanced diet of fresh meat, whole vegetables, fruits and grains. For dogs, the heaviest emphasis should be on meat as this is the basis of their natural diet while people arguably should concentrate on vegetables, fruits and grains.

Some of us (I am guilty here) actually make their dogs a diet of whole foods. My dogs eat better than most of the people I know and it requires extra work. My efforts in this regard are a source of laughter and conversation in my neighborhood. A conversation that usually starts with, “What in the world are you making for those dogs?” Yes, steaming up vegetables may seem a little over the top but I had three dogs with touchy stomachs and skin problems so I had to figure out what they could eat, just like I did for the people in my practice. When I took them all off chicken, all of their stomach and skin conditions completely cleared up. Just like removing food irritants can help people symptoms.

Isabel watched this growing up so when she got her own dog she expected to be making her food. But, unlike some children who outgrow a total absorption with animals, she did not. Through college she worked at pet stores ending up at a serious holistic establishment that does not sell any dog food that contains animal by-products, soy or corn. Now she educates me on dog nutrition. Last year, she told me the grains had to go and I should stick to vegetables, fruits and meat. One of our dogs had a bad breathe problem and it made sense to me that getting rid of grains might help as getting rid of gluten sometimes helps people with sour stomachs.

“What else do you tell people?” I asked her, curious.

“Many dogs are overweight,” she explained, “because they eat bagged kibble that contains grains. The best way for them to lose weight is to get off of dry food and starch and eat meat, fruit and vegetables.” Just like people!

Most dogs eat dry dog food out of a bag that contains low quality meat by-products, grains and sweeteners. The sweeteners are added to entice the dogs to eat food that is mainly cheap starch vs. more healthy animal protein. That sounds familiar. This is exactly what fast food restaurants like McDonald's and Taco Bell have been accused of doing with meat entrees. Allegedly Taco Bell taco “beef” filling and McDonald Chicken nuggets contain far less than 50% meat. Instead cheap starch fillers, taste enhancing chemicals and sweeteners are used to entice people to choose an inferior food. (See: http://www.csmonitor.com/Business/new-economy/2011/0126/Taco-Bell-meat-Beef-says-firm.-Filling-says-suit concerning the lawsuit against Taco Bell for low meat content in their “beef” taco filling or Michael Pollan’s excellent discussion on McNuggets in The Omnivore’s Dilemma.)

The first veterinarian I ever saw informed me he had extra training in dog nutrition because he knew I was a nutritionist and this would be impress me. He then went on to say that the most balanced way to feed a dog was to use only prepared, expertly fortified dry dog food. “Very funny,” I said thinking he was making a joke at my expense. “And you should only feed your kids fortified dry cereal,” I cracked. He was not joking and I never went back. I had to assume his nutrition “education” was provided courtesy of the Fido Dog Chow company.

“What do you tell people who say their vets only recommend prescription diet food that they sell?” I asked Isabel knowing this situation had to come up frequently.

“Most of those prescription kibbles are the same old junky dog food at premium prices,” she opines. “ but you have to be very careful. People think their vets are experts on dog feeding when they mostly know what the dog food companies want them to know. I try to explain without being offensive that most veterinarians are not properly trained in nutrition and that they have to be informed consumers.”

Just like people.

For more information on how to choose a healthy dog food, see, “Choices, Choices: On what criteria do you base your dog’s food selection?” The Whole Dog Journal, Feb. 2011. (www.whole-dog-journal.com).

#27 The Clues in the Conversation

2011-02-10T20:10:00.000-08:00

“No, that is not right,” Rudy said in response to my third attempt to ascertain his reason for coming to see me.

I am in trouble now I thought glancing at the clock. Twenty minutes had passed and I still had not even pinpointed the problem. What I did have was fifty pages of medical reports and test results with symptoms and complaints that Rudy insisted were not accurate.

“How can I help?” I had asked directly fifteen minutes before. Leaning across my desk he passionately described a number of vague aches and pains that appeared to come and go. I listened intently and finally at one point repeated back to him word for word his latest description starting with, “So you are concerned about……”

“No, no,” Rudy shook his head rigorously. He was not concerned about that symptom. In addition, he was upset that his doctor, who had ordered many of the tests whose results were piled up in front of me, did not seem to understand him.

As easy as it is to criticize doctors given the present state of the health care system, I could find not a single fault with the thorough way his physician had analyzed the situation. If Rudy had not been understood, it was not from lack of trying on his doctor’s part. I empathized with the maligned internist.

I had been trying to listen so hard that my eyes were watering and I still was not getting it. Talking with Rudy was not improving my understanding so I reviewed in my mind what I did know. Rudy was prosperous and productive. This I knew because I recognized his name and Daisy, the woman who referred him to me called him “a business genius”. His medical records indicated he was in his early forties and his lean and toned physique were a testament to many hours at the gym. According to the extensive test and procedure results in front of me, there was nothing notably wrong with him.

Could he just be anxious? I wondered. I hated going down this road as so many patients are dismissed as anxious when practitioners cannot figure out what is really wrong. I flipped through the paperwork again and spied his diet diary. It was a mass of scribbles squished chaotically on to the page. I had seen papers written by 3rd graders that were neater. Then, I remembered a conversation I had with my attention-to-details assistant, Tania. She had mentioned that she was having a tough time scheduling Rudy because he was hard to reach by phone and did not use e-mail. I remember wondering how such a successful business owner could function without e-mail and as I was recalling that conversation I suddenly an idea occurred to me.

Rudy was still talking and leaning against the front of my desk when I looked up and interrupted him. “Ah ha, I’ve got it,” I said pulling his papers together and talking with more authority and confidence than I felt.

He looked at me wearily. After all, I was not impressing him up to this point with my stellar detective skills.

“You obviously would like to feel better,” I stated without waiting for agreement. “And I have identified three things that you are going to have to do that will help.” I glanced up to gauge his reaction. He took a breathe, stopped talking and slumped back into the chair. We were in agreement at last. Coming up with three healthy interventions for an overly busy person was not going to be difficult.

Rudy was a fit 40 some year old guy who was experiencing some of the annoying symptoms of middle age. He needed to make a few life style adjustments to optimize his energy. He was not 23 any more but he still had some long standing bad habits that he could get away with then but were not working so well now. This is what I think he had come for but in my view, this was not the most pressing problem. The more interesting issue was what appeared to be a significant learning disability in an otherwise wildly successful person. I wondered how much of his life had been spent covering up or compensating for his learning quirks.

I was having trouble communicating with him because he could not prioritize or organize his thinking. This is why when I repeated exactly what he said he did not agree with himself. It is also why he had thousands of dollars worth of tests looking for the cause of symptoms he claimed he really did not have. The thoughts he said out loud were not necessarily the most relevant ones. His communication was a jumble of important and insignificant information all mixed together. He needed help sorting his chaotic thoughts and a plan with a clear structure.

If organizing his thoughts was this difficult, no wonder he avoided e-mail. Writing must be a nightmare for him. Yet, there were significant areas of his life around his business where he was organized and brilliant. I would bet good money that getting through high school had been pure hell. Luckily, a horrible high school experience is not necessarily a harbinger of future failure because learning differences do not have to be crippling. If a person plays to their strengths and works with or hires people to handle their weak areas, they can succeed spectacularly as Rudy had.

But heavy compensation exacts a toll, especially when people do not understand the nature of their learning differences. Every activity that requires skills in their weak area will be more stressful. They may feel overwhelmed more easily and can get frequently frustrated. To avoid failure some procrastinate while others bully those around them to divert attention from themselves, depending on their nature. The behaviors that result from poor compensation could fill a psychology textbook. I have seen people unwittingly destroy marriages and relationships, lose jobs, fall into depression, suffer from chronic anxiety and become violent.

Rudy had an intense personality and I could not help but wonder how much of that was due to the stress of working around cognitive obstacles. Did he realize how tiring it could be to communicate with him in some areas? Was it equally exhausting for him? I wondered what he knew and how open he would be to discussing his cognitive quirks Exploring and perhaps coming up with some strategies to improve some of the ways his brain worked was how I wanted to help but decided he might not see that as help.

I decided I would have to build some trust and a connection before broaching this potentially touchy subject. And my analysis could be dead wrong leaving him to wonder about what kind of learning disability I had. Consequently, I decided to address what he wanted first and then see if there is an opening next time. Assuming that is, there is a next time.

#26 The Case of the Dirty Dishes

2011-02-01T06:28:00.000-08:00

I reached for a clean glass to hold my freshly pureed green sludge and there it was. Trailing along the lip were the unmistakable remnants of yesterday’s drink.

“EEEEow,” I squeaked.

“Stinkbug?” my husband called out from the other room.

Like many households in our area we had a mild stinkbug infestation. Occasionally one would fall on our heads from the ceiling or show up unexpectedly looking gross. Hilarity or screaming would ensue depending on the situation.

“No,” I called back. “Just dirty dishes. I think something is wrong with the dishwasher.”

He agreed that he was seeing too much of yesterday’s food on the silverware and suggested calling Mr. Kenny. Mr. Kenny is our personal version of the Maytag repairman that was a TV icon about a decade ago. He is pleasant, efficient and reliable. We love him.

The next day the dishwasher was dismantled with various parts strewn on the kitchen floor. Mr. Kenny looked up and commented conversationally, “that’s what I thought.” There on the floor of the machine was either a million dollars worth of cocaine or all the soap crystals I had poured into the noisy contraption over the last 6 weeks. Mr. Kenny was going with the soap crystal theory.

“A few weeks ago new Maryland EPA regulations regarding the composition of dishwasher detergent took effect, “ he explained.

I stared at him blankly.

“The manufacturers are not allowed to use phosphates any more and that is the chemical that allows the soap to dissolve and get your dishes clean,” he clarified.
It is also the chemical, I thought to myself, responsible for the death of untold numbers of innocent fish.

High levels of phosphates from domestic and municipal wastewater end up in local streams, lakes and rivers. Phosphorus is a growth enhancing nutrient for plants. A little is good but too much and you are looking at Little Shop of Horrors, the water version. As the phosphorus levels go up and up, the algae grow to cancerous proportions literally sucking the streams and rivers dry. Some regulators have recognized the utter destruction of lakes as a bad thing and sixteen states, apparently including Maryland where I live, have enacted laws restricting or removing phosphates from dish washing detergent.

Mr. Kenny informed me that the dishwasher manufactures recommended Cascade Complete with the addition of a water softening product called Lemi Fresh. He admitted the soap manufacturers had not perfected the new formulations yet and they did not work very well. I hate it when choices are reduced down to clean dishes or destroying the environment. As the dishes were getting increasingly dirtier, I had tried Cascade among several other products and was unimpressed. Now I was feeling guilty for inadvertently contributing to massive fish kill all these years when I was not paying attention to which dish washing detergent I was using.

I try to be as ecological conscious as possible by buying organically raised food in part to reduce pesticide run off that also ruins waterways. Except for dish washing detergent, most of the cleaning products in my house are practically edible. For laundry, I stopped using detergent altogether and bought Super Washer Balls (www.superwashball.com). They are plastic balls filled with ionically charged beads that clean your clothes without soap. I have no idea why messing with ionic particles gets clothes clean but my friend, Bill highly recommended them. I even wash and reuse plastic bags, much to the horror of my husband and children. Yet I never thought twice about the dishwasher. It was a dishwashing detergent blind spot.

I wondered if my clever virtual assistant, Tania, was having similar problems.

“Nope,” she insisted. “I don’t like my dishwasher so the last time I bought detergent was 1996. It was full of phosphates then, so I am good. Do you want me to send it to you?” Some people are ordering dishwashing detergent from non-phosphate restricting states to get around the dirty dish situation.

“And destroy rivers!” I countered. “Absolutely, not. I just have to figure out what will work that is environmentally friendly.” Treehugger.com claimed 7th Generation detergent worked best while another site suggested adding a cup of vinegar to the wash cycle. I cannot figure out how or where to add vinegar so it doesn’t just rinse down the drain. There is not a “Vinegar” dispenser on my model. Besides that could get expensive. Seventh Generation has only ever made phosphate free detergent and so that is what I am using now.

“It is even cheaper and more environmentally friendly if you just wash your dishes by hand, like me,” Tania observed smugly. As much as I hate to admit it, she might have a point though I might end up using more water than my dishwasher. I can’t help but think of Kermit the Frog when he lamented, “It is hard to be green”.

Index to the First 25 Blogs:

2011-01-24T17:02:00.001-08:00

# 1 Nausea 911 – The case of the woman who woke up nauseous

# 2 A Bear by any other name - Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep

# 3 PANDAS continued

#4 Looking for Mr. Rightcheese - Cheese substitutes for the dairy free

#5 Me and The GI Guy – The case of the sick apartment

#6 The Secret Life of A Nutritionist

#7 Two Salads to Go: Hold the Receipts – Hidden toxins

#8 And You Thought Your Teenager Was Tough

#9 Me and The GI Guy continued (Blog #5 Follow-up)

#10 I Want To Thank Jim Carrey - The story of how I got to write a book

#11 The Subtle Bouquet of Pear Juice - How to write a food endorsement

#12 How To Have a Difficult Conversation

#13 Vitamin M- The relationship between movement and learning

#14 Coming to a Store Near You- New products from the health food expo

#15 One Afternoon at the Conference- What you need to know about infections

#16 Vitamin M Continued

#17 The Most Hysterical Time of the Year- Getting geared up for the flu

#18 What to Do to Prevent the Flu

#19 Topsy Turnips- Getting ready for Thanksgiving

#20 Toddler Crack- Preventing picky eating in your toddler

#21 Men with Rashes- The case of the man with complex rashes

#22 An Afternoon at a Different Conference- Take aways from the American Academy of AntiAging Medicine Conference

#23 Men with Rashes Continued

#24 What You Got from Grandma that Wasn’t in the Will- What you need to know about epigenetics

#25 The Real Reason Some People Can’t Lose Weight- Epigenetics continued

Epigenetics Discussion

2011-01-15T17:40:00.000-08:00

In response to the thoughtful comments by the authors of the DNA article quoted in blog #23. Your points remind me of the Mark Twain quote about how the problem is not what we think we know but what we think we know that just ain’t so. I loved your article but still hold on to some hope that epigenetics will change our narrow understanding/definition of genetics. Perhaps the non-DNA regulatory material will be more reveal some of the answers. The clinical effects are certainly there and we have to come up with some way to deal with them. With a lack of useful research the clinician, as usual is left having to make it up.

Blog 25- The Real Reason Some People Cannot Lose Weight (Blog 23 continued)

2011-01-15T15:04:00.000-08:00

Danika was of a young woman of African American descent who had been adopted by a Caucasian couple shortly after birth. She was a happy, bright child who was healthy overall except when it came to eating. "We are concerned about her appetite," her mother reported obviously uncomfortable. "We don't want to make a big deal out of it, but we are worried she might be getting rather too large," she tentatively concluded. She was going for tact but Danika was having none of it.

"I'm huge," she stated matter of factly.

I generally appreciate when people are blunt because it saves a lot of time and trouble figuring out how to approach a situation. So I liked Danika immediately. She was a big girl heightwise, too, making her look more like a fourteen year old. I would have to remind myself not to expect behavior beyond her actual years especially because she was so articulate.

"Don't say that about yourself," her mother protested, cutting her off and fidgeting in her seat. I stopped for a second and took in the situation. Here sat two thin Caucasian parents raising a non-thin child of African decent. They were trying so hard not to let any cultural preconceived notions prejudice them that they were practically sweating from the stress of not being judgmental. This could get dicey.

"What do you think is going on?" I inquired.

"I try to eat healthy," she explained, "but I am hungry a lot."

Looking at her food diary it was clear she had a good appetite but was not eating the quantity of food I would have expected given her size. Her thyroid had been checked and she was in otherwise perfect health. She was partial to pasta and bread so I suggested a gluten free diet for 6 weeks to see if that helped her feel less hungry. If a reaction to a food is causing excessive hunger, that food usually contains gluten or sugar. It is almost impossible to help someone lose weight if they feel hungry all the time so I thought it was a good place to start. Danika groaned. Her parents groaned but the deal was struck. Six weeks: no gluten.

What does this all have to do with genetics? I could pretend I am trying to build up some suspense, but in truth, it is just complicated so the answer will take a little while. The six weeks passed and Danika’s parents checked in. They were pleased to report her appetite had calmed down and she was eating less. Nonetheless, they were very unhappy because despite her food reduction she had gained of three pounds. It was that old medical joke where the doctor announces the treatment was successful but the patient died.

The laws of physics states this is not possible. In my profession, this phenomenon has only one accepted explanation: the client is fibbing. Nobody wants to blame the client because of course, they do not mean to fib but if there is weight gain, there must be a cookie somewhere nobody is copping to. But after much poking around and having run into this situation before, I concluded Danika was not eating in secret but is likely suffering the results of unfavorable epigenetics.

Recall that epigenetics is how the genes change in response to the environment. When big adaptations occur during pregnancy, the child’s gene expression changes and that child passes that adjustment on to their child and so on for many generations. What may have been useful and adaptive given your grandmother’s environment when she was pregnant, may not be so useful for you now. One of the strongest epigenetic trends has been high rates of obesity in the offspring of pregnant women suffering from starvation. This tendency has been documented to continue through four generations.

Danika’s birth mother’s history was murky. In adoption where the health history is not clear, there is a good chance it involves poverty or other social issues where food is not plentiful or eating is restricted (to hide weight gain, for example). I have also noticed through the years that Africian American women can have a particularly hard time losing weight even on severely restricted diets. I ran into this situation so many times that I developed a theory about it.

From an epigenetic perspective, the best body type for surviving in Africa would be one that conserves calories well. The growing conditions are harsh in many areas and there can be long periods of drought when food is scarce. While in the womb, the smart, adaptive baby would naturally shift its metabolism so it could survive on very little food. And as long as the person lived in Africa, all would be well. But transplant that same metabolism here where most people can get all the food they want, drought or no drought and that same baby will put on weight.

A full figured woman once consulted with me because she had been on a 1,200 calorie diet and had not lost an ounce. She was understandably very discouraged. She insisted that calorie restriction never helped her lose weight and wanted some new ideas. We tried a low carbohydrate version of the low calorie diet with no success. On the plus side, she was an amazingly vibrant woman. She was strong and healthy and probably could survive well on a few turnips a week but her epigenetics was not geared for a plentiful food environment. I could not bring myself to reduce her calories further so I asked her to make a difficult decision. I explained epigenetics. Then I told her she would either have to accept the fact that she needed very little food compared to others to maintain weight or she would have to accept herself as a bigger woman. She chose the later.

I often wonder if this is the situation Oprah faces. Even with a trainer, a chef and 42 personal assistants, does she have an epigenetic situation where she can only lose weight eating ridiculously few calories? It is hard to live in this country on a severely calorie restricted diet and it would make sense that she would hang in there for awhile but periodically eat an extra cracker and gain 3 pounds. That sounds like an exaggeration but the small amount of food people with this epigenetic profile can eat is no joke.

Danika was another strong individual who needed very little food to maintain weight. In fact, when she reduced her calories by going on a gluten free diet, her body immediately interpreted this as starvation. Applying epigenetic theory, Danika’s body was highly adaptive for dealing with starvation and so it went immediately into conservation mode. She was not going to need much food to maintain weight. A tough reality at any age but I thought it might be a good thing for her and her parents to know.

“So, what are we suppose to do?” her mother asked.

“Well, here is the situation…….” I started.

Blog #24 What You Got from Grandma that Wasn't in the Will

2011-01-02T13:06:00.001-08:00

There has been a lot of talk in the medical media lately about genetics. After reading and listening to a number of interesting pieces there seems to be two main points….

1. Genes are not nearly as important/predictive as we have been told
2. Genes are significant in more subtle and profound ways then previously thought.

Media messages are nothing if not abundantly clear.

According to one article (The Great DNA Data Deficit: Are genes for disease a mirage? By Jonathan Latham and Allison Wilson in The Bioscience Resource Project, Dec. 8, 2010), knowing the make-up of your genes helps you predict your chances of getting an illness at about the same accuracy rate as reading an insurance company chart with population statistics of getting a disease and finding your demographic. Forty year old, normal weight black female who does not smoke? You can look up your group on a disease risk chart and find your chances of getting dementia and save yourself the trouble of cracking your personal genetic code.

Francis Collins, renowned geneticist and the head of US National Institutes of Health (NIH) encourages everyone to have their genetic disease susceptibility tested anyway. He had his own mapped and it was such a profound experience that he wrote a book. His most significant personal discovery was that instead of the average risk of developing diabetes given that he was a white male (23%), he had a 29% chance of getting the disease. Otherwise his likelihood of getting cancer, heart disease and dementia was like everyone else. The book must be very short.

Consequently, the gene mapping industry is in trouble. Most people who have done disease risk gene testing discover the same shocking fact: they are average. The exception is those with rare genetic disorders like cystic fibrosis. Of course these individuals by definition are “rare”. With consistently underwhelming findings, the monetary returns that were supposed to be generated from personalized gene mapping technology are looking bleak. At the moment, it looks like you would be better off investing in soap futures or uranium mining.

Genes are not as important and predictive as we have been told because one of the unexpected results of the human genome project was the discovery that DNA is not the most important part of the chromosome. DNA represents half of what is in the chromosome and the only material scientists were interested in until they realized how inert DNA is. Every cell has all the DNA needed for making everything in the body. In addition, there is enormous similarity between the DNA of human and all other animals. We have many fewer genes than scientists expected to explain human diversity let alone the bigger variation between people and fruit flies. DNA turns out to be mostly generic blueprint material. In other words, most of the DNA we carry looks like everyone else’s including monkeys and I don’t mean your brother-in-law.

What regulates and individualizes the DNA? The other half of the material that scientists thought was not important. Yes. It turns out that regulation is where all the action is and few scientists realized this until all the DNA was mapped and turned out to be stunningly generic. (For more on this topic see Dr. Bruce Lipton’s, The Biology of Belief.)

Which leads to point two about the ways genes may be more important than we thought. The DNA might be similar but the controlling proteins and regulation is wildly diverse. Regulation can be affected by your environment, stress, thoughts and your diet. The results are profound and can be so long lasting that what your grandmother or great grandmother ate or experienced while she was pregnant might be effecting how you are expressing your genes today. There is even emerging evidence that your grandfather’s health at the time of conception (try not to think about that part) could shift your disease risk today. This emerging field is called epigenetics and it is mind blogging.

Imagine the implications of this study. Scientists took some male rats and made them fat by feeding them a high fat diet similar to what we Americans eat today. The fat rats, who had symptoms of type 2 diabetes, were bred with non-overweight females. The pups did not become overweight (because of how they were fed) but a lot of them developed type 2 diabetes anyway! Ditto for the next generation.

We already know that pregnant women on starvation diets (due to famine or war) have children and grandchildren with much higher rates of obesity. The fetus makes decisions about gene expression in utero based on the kind of world it thinks it is coming in to. This early gene regulation has life long (and after) ramifications.

So, what practical application can this information have? The results of epigenetics walked into my office in the form of eleven year old, Danika. To be continued…….

Blog #23 Men with Rashes Continues....

2010-12-22T18:35:00.001-08:00

Returning to Alan’s skin of many irritations, I thought briefly about all the possible causes of rashes. In the almost 30 years I have been a nutrition detective, I have seen rashes caused by all manner of substances.

Here is a list of the ones I can remember:

• Food reactions to chicken, eggs, olive oil, nuts, fish, grains (especially wheat and sometimes rice), potatoes, seeds, most fruits, a few vegetables….any food can do it but vegetables and lamb react the least.

• Medicines especially anti-depressants, mood stabilizers, anti-seizure meds and antibiotics.

• Bad stuff added to foods including preservatives, additives, colors, pesticides and genetically modified organisms (GMOs) which is actually bacteria DNA spliced in to food.

• Contact rashes from creams, sun screen, soap, bubble bath, shampoo, dryer sheets, laundry detergent, pollen, swimming pool water, leaves, wool, animals (all sorts including a guinea pig).

• Molds (either outdoor varieties or from a sick house).

• Yeast problems.

• Touching water (true story). This was probably from the chlorine in tap water.

• Mites and other bug bite reactions.

• Essential fatty deficiency.

The list is long and basically includes almost anything you can think of but I had ten minutes to make a good guess. Most people can figure out topical contact irritants on their own unless it is something in the environment like pollen or mold. Once I saw a child with extensive eczema. The referring doctor and I tried all sorts of elimination diets and environmental changes but nothing helped. Finally, the family went to Italy for a month and the child’s skin completely cleared up. We then realized (through an additional process of elimination) that the problem was likely an environmental mold though we never knew exactly which one. Allergy testing also could not pinpoint it. Wouldn’t it be nice if your doctor recommended an extended European vacation for unresponsive eczema? Besides his wife had worked that angle pretty hard by eliminating the usual suspects without success. So, I ruled out topical culprits and circled in on the diet and family history.

If a food is causing such a complex ongoing rash it would have to be one that is commonly consumed. It cannot be mangos or pork chops because people do not eat enough of them through out the year to cause this much skin trouble. The number one frequently eaten food irritant responsible for bizarre, extensive rashes is gluten. I already knew his son was doing better off gluten. That made it very easy to ask the father to go on the same diet. For good measure, I added some supplemental fish oils to deal with the papules (or chicken skin) which are often a sign of essential fat deficiency. Those two steps are straight forward and will probably help. He readily agreed because he confessed after I suggested a gluten-free diet that eating too much bread gave him gas anyway.

You may be thinking, “oh come on!” After you go through all of this he admits that he thinks gluten bothers him. The answer was sooooo obvious all along. Why didn’t he figure out gluten was bothering him if his son could not tolerate it and he got gas when he ate it? Why most of us miss the obvious things about ourselves is one mystery I cannot figure out.

Blog #22 An Afternoon at a Different Conference

2010-12-14T19:35:00.000-08:00

I decided I needed to understand hormones better, being menopausal and all. Getting good information on natural hormone replacement is much harder than you would think and as a result, I found myself on a plane to Las Vegas heading for the American Academy of Anti-Aging Medicine (A4M) conference.

Las Vegas, I discovered is not for anyone suffering from sensory processing disorder or a low tolerance to cigarette smoke. The hotels are designed so you have to walk through miles of underground casinos to get anywhere, including the registration desk or conference center. Casinos appear to be the only indoor facilities left in the country where cigarette smoking is not only allowed but possibly necessary so the calming effect of nicotine can help people deal with the stress of losing their nest eggs to computerized slot machines. “Gee, what are the chances of winning against a computer that sets the odds and makes up the rules?” I commented to my roommate, Victoria.

She informed me that I was missing the point and that it was all about the dopamine rush. Given the crowds, I would have to say she was right and I should probably learn more about dopamine since it is clearly popular. I made some mental adjustments to accommodate the environment and enjoy the conference.

For the next three days I immersed myself along with 4000 other physicians and practitioners in the latest research on maintaining/regaining vitality with aging. One speaker summed up the challenges of getting older with the Phillip Roth quote, “Aging isn’t a battle, it’s a massacre”. While it can certainly feel and look like that, there are many strategies people can use to manage the ravishes of time more effectively.

The hardest thing about an intensive conference, beyond the sitting, is information overload. Luckily, for me, I have a solid background and very specific questions I wanted answered which made the potential overwhelm manageable. There was so much generally interesting information that I compiled a list of the more fascinating little pearls.

So, here are:
The Top Ten Fascinating Facts and Observations Gleaned from the Anti-Aging Conference

1. Low testosterone is a common problem in aging men and reduces quality of life. The symptoms are low vitality (fatigue), passivity, low sex drive, weak erections, declining muscle tone and general grumpiness. It is also associated with increased mortality, cancer levels and heart disease. This condition is easy to diagnose and correct though it is generally considered to be vague and hard to treat.

2. Giving testosterone to men with low testosterone levels has never been proven to increase prostate cancer risk. The only time giving testosterone appears to feed prostate tumors is when a man’s testosterone level is extremely low (that is, at castration level which is very, very low).

Harvard urologist Abraham Morgentaler addressed this in great detail and prescribes testosterone even to men who have/had prostate cancer. In general, their PSA levels go down and their cancer growth is generally slower! He presented gobs of research. It took him 45 minutes to explain why there has been such general misunderstanding of the relationship between testosterone and cancer. For more info see his popular book: Testosterone for Life.

3. If you want to slow the aging and deterioration process, balance your hormones. Balanced hormones reduce the inflammation process and inflammation is associated with deterioration and most diseases.

4. Maintaining ideal weight is the best way to reduce inflammation, assuming you are doing this with a balanced diet. The short explanation is that gaining weight increases inflammation. Something about adiponectin inhibiting TNF-alpha (an inflammation marker that can now be measured in the blood) and dozens of other pathways that get thrown off as you put on the extra pounds. There were at least ten sessions on obesity and why it is bad for you. One presenter claimed Type 2 diabetes (usually from obesity) is now being called type 3 Alzheimer’s Disease.

5. Vitamin B-12 shots tied with correcting stomach issues can significantly reduce asthma attacks in adults and children. The theory is that most people with asthma have low stomach acid and absorption issues. When you think about it, the stomach and lungs and sinuses are all connected through a series of tubes. Something that affects one of them can bother the rest.

In children who are allergic or reactive to dairy products, a single exposure to milk can measurably reduce nutrient absorption capacity leading to low hydrochloric acid which causes vitamin B12 deficiency. Giving B-12 in a way that bypasses the stomach may help.

6. Synthetic progesterone (called progestins) does not have the diuretic and other beneficial properties of natural progesterone. Progestins also have more androgenic (testosterone) and pro-inflammation properties though they still appear to protect against uterine cancer. Increased inflammation leads to increased crankiness and headaches both of which are common side effects of the progestins.

7. Bioindentical hormones are well studied, especially in Europe. They are chemically and functionally completely different from the horse estrogen (Premarin) and synthetic estrogens given to most women seeking hormone replacement therapy. Studies have found the risk to breast cancer is significantly different depending on the estrogen being used. Estriol (found in bioidentical hormones) reduces breast cancer risk while high levels of estrones (found in synthetic estrogens) increase it.

8. Growth hormone treatment does not increase cancer risk. One study followed children treated for brain cancer who were later given growth hormone. The recurrence rate of cancer actually went down! This research was a pleasant surprise to hear and there was a lot of it. Once the presenter explained the biological link between growth hormone and immune function it made me wonder why so many people have been worried about growth hormone and cancer. (Probably because many of the early studies involved pouring growth hormone on a tumor in a dish and watching what happened.)

9. Hormone imbalances of all sorts contribute to the susceptibility to cancer. Higher cancer risk (in separate research presented over the course of the conference) was associated with low estriol, low testosterone, low oxytocin, low melatonin, low progesterone, low thyroid and low growth hormone. It does not take a rocket scientist to see the pattern there.

10. Information backed up with research is always sited as the thing practitioners most desire but nonetheless, the most popular speaker was Suzanne Somers. She was described as the most exciting event of the conference. She spoke about her personal experiences and quite the inspirational speaker. I developed a deeper appreciation for how much she has contributed to increasing awareness about alternative medicine. At 64, Somers is a walking testimonial to the wonders of bioidentical hormone replacement, alternative cancer treatment and plastic surgery though that last one was discreetly unmentioned.

In truth, there was nothing alternative about the research presented at this conference with the possible exception of the “aesthetic” courses. There was a whole tract, which I did not attend involving a bunch of frightening looking laser machines and Star Trek inspired apparatus for filing, zapping, exfoliating and otherwise revitalizing the skin and muscles. I did get a sample of the $250 a jar resveratrol rejuvenation cream. While I admit the claims are hard to swallow, wouldn’t it be nice if looking younger was as easy as putting on some really expensive cream?

Blog #21 Men with Rashes

2010-12-06T10:47:00.000-08:00

If statistics are to be believed, men as a group, prefer to avoid doctors and perhaps more generally all of us in medically related fields. This has certainly also been my experience. A few times a year a man (or if the truth be told, a woman) will come in to see me just so I can look over what he is eating and taking to be sure he is up to date and doing the best for himself. I often catch myself looking at these people adoringly thinking this is so wonderful. They are taking care of themselves and being proactive. How rare. How inspirational. Prevention is so much more fun then disaster relief.

Sadly, most of us do not operate this way, especially those of the male persuasion. There was a book about this written a number of years ago by a physician’s wife. She relayed the story of how she had to force her husband, who was a cardiologist to go to the hospital because it was clear to her that he was having a heart attack. “I am fine,” he argued. But she was correct.

According to my husband, a self appointed expert on all guy things, being male and all, this attitude is completely understandable. “Men do not like to be seen as weak,” he explained as if it was patently obvious. “They will put up with a lot to keep up the appearance of strength.”

“How do they feel about dead?” I asked innocently at which point he suddenly developed an acute hearing problem.

Over the years I have noticed that most men come to see me for one of three reasons. First, and most popular, they are dragged kicking and screaming by a concerned loved one. Second, they have big complicated situations that have gotten so out of hand even they realize they have to do something. And my personal favorite, they come in with someone else and three minutes before the end of the session they want to know if they ask a “quick” question, really it is just a little thing they assure me. Is there anything they can do about the diarrhea they have had for the last ten years or this rash that covers their whole body and has confounded a gaggle of dermatologists?

You think I am exaggerating but this last situation happened recently. Alan came in with his wife who was the designated patient. I thought I was being clever and a full ten minutes before the end of the session, I anticipated there might be an issue and inquired if I could ask the gentleman a question. “Sure,” Alan replied.

“What are you doing about that rash?” I asked.

“Which one?” his wife cut in. “Lift up your shirt and show her, honey,” she cajoled apparently very happy that I had opened the subject.

I am not a dermatologist, but could see at least three different types of rashes. “If this was not so clearly irritating to you, “ I commented, “this would be fascinating. Look there is a ring worm,” I said pointing to a perfectly round red circle with a clear center. And there were hundreds, possibly thousands of little papules. “I wonder what they are from?” I mumbled thinking out loud. “These rough spots look like essential fatty acid deficiency,” I remarked pointing to several sand paper areas. “Though I bet that was diagnosed as keratosis pilaris.”

Keratosis pilaris (“chicken skin”) was indeed one of many diagnoses he had received over the years. Apparently, the numerous dermatologists and specialists he had consulted through the years were no longer fascinated and had given up on trying to unravel the situation, as had he.

Luckily, I am not a doctor and this allows me the freedom to take chances and say things that otherwise I would have to keep to myself to maintain decorum. “You must be miserable,” I blurted out. Alan responded with a shrug. “We have to do something about this,” I continued as if he had not been trying to fix the situation for years.

I assumed he had been tested for allergies. Alan confirmed he had and nothing significant had been found. I next asked if he ever found anything that had made it better or worse. His skin was obviously sensitive and his wife was careful with soaps and detergents she bought. Unfortunately, while some products used topically could make him worse, nothing he avoided in particular made him better. He had tried great numbers of ointments and salves through the years but nothing corrected the problem. Presently, he used moisturizers when he remembered or was particularly dry.

Since there were no clues in his dermatology history, I started asking about other symptoms (that might be related) and reviewed his children's medical histories. The original person I saw in his family was his son and he turned out to hold the answer to the mystery. To be continued……

Blog #20 Toddler Crack

2010-11-28T18:49:00.001-08:00

This week three parents asked me how to stop their second child from becoming a picky eater. In two of the cases, I am helping deal with said picky eating older child and the third was the mother of a baby with other red flags for developmental issues. Is there anything they could do to prevent the picky eating debacle?

The best suggestion I have is to not introduce the three C’s or what I call toddler crack. Everybody knows these three oh-so-friendly kid foods. One of them is in a container in practically every diaper bag/mommy purse in the country because they are universally adored. They are crackers, cookies and cereal and once kids discover them, they are as addicting as crack.

And why shouldn’t they prefer salty or sweet crunchy foods they can pick up with their own hands verses a non-descript mush mix spooned in by daddy? At two, the toddler has just discovered there is a connection between action and consequences and he wants to see what he controls. Eating looks promising so he wants to feed himself when possible. Utensils can be challenging so finger foods are better. Crackers, cereal and cookies fit the bill perfectly.

Once in the mouth, baby mouths can find the crackers because they are crunchy but as soon as the saliva hits them, they dissolve without much chewing. In the feeding world, these foods are called meltables. They are extremely convenient because the little ones do not have a full component of teeth yet but want eating independence.

The final attribute sealing the addictive quality of toddler crack is the taste. Face it. Chicken and peas cannot compete with highly flavored crackers and cookies. David Kessler has written extensively about how food companies use these ingredients heavily to encourage people to prefer and overeat empty calorie food. (See, The End of Overeating.)

This is how kids get hooked right from the cradle. You are out at the park in the afternoon and two and a half year old Seth is starting to get cranky. It has been several hours since lunch so clearly he is hungry. Carrying around a bean burrito for such occasions is impractical and tough for him to eat so you hand him a container of dry cereal that is perfectly fine after a month laying at the bottom of your diaper bag. Seth calms down immediately because he can pick up the little pieces and feed himself. (“He is building self esteem and self care skills,” you tell yourself.) There is an additional bonus of keeping him occupied for a full five minutes so you can get him in the car/stroller without screaming.

Once home, you make a lovely dinner which he does not want to eat because his tiny toddler tummy is full. Twenty minutes of coercion and three bites later, you give up only to have him tell you he is hungry right before bed. You already put away the salmon and green beans so you hand him, just this once, a few fish crackers which he eats happily. It is straight downhill from here.

It all sounds so innocent but crackers and dry cereal are like crack to babies. Most toddlers love them to the exclusion of anything else given the choice. If you want to raise a child who will eat fruits, vegetables and a variety of healthy foods, DO NOT BUY CRACKERS, LITTLE COOKIES OR DRY CEREAL, period. They have little if any nutritional value.

What to do instead? You have to think ahead a little but pack up cold cooked peas and carrots, bananas, grapes cut in half, ¼ of a sandwich or little pieces of cheese. In the heat of the summer you may have to throw in an ice pack. Eating pieces of fruit and vegetables also require more supervision, as they are not meltables. Small children can choke more easily as developmentally they have not completely mastered eating skills. When planning for snacks, think real food instead of empty calorie treats.

A recent October 2010 study found that 40% of the calories in children’s diets now come from empty calorie foods. The most common was grain desserts or cookies and granola bars. According to several articles reporting on the study, despite the horrifying state of children’s diets in this country, nobody seemed surprised by the findings.

Blog #19 Topsy Turnips

2010-11-22T19:24:00.000-08:00

My husband, Jeff, and I would not survive well as farmers. Despite having a nice organic garden, we have poor crop planning skills. Left to his own devices, Jeff plants mostly tomatoes that he loves but I cannot eat. When they failed this year, I stepped in and we attempted a second cold crop of peas, lettuce, carrots, radishes and turnips. It was too late for the peas which climbed about half way up the trellis before the cold set and arrested their development at mid adolescence. The carrots were delicious but the size and width of a fountain pen. I ate a head of lettuce a day for several weeks and Jeff had plenty of radishes but the turnips…… The turnips went wild.

They grew in crowded clumps because we did not thin them properly. Ignorant suburban farmers that we are we thought how many turnips can a few seeds produce? It turned out to be enough for an army of underfed groundhogs. There were so many that they pushed each other out of the ground where we could just scoop them up rather than pull them out. Some were the size of soft balls.

Jeff gamely ate one or two every day and I gave them away to all of our friends/neighbors who liked them which was a grand total of one person. Nobody seemed to know what to do with them and they were starting to pile up. Finally, I decided to make a big turnip dish for Thanksgiving and invite a lot of people. The first challenge was finding a decent dish. After some experimentation, I decided on pureed turnips because I had them once at a fancy restaurant and deemed them to be a potential crowd pleaser.

Playing around with several recipes, I came up with this one. It would probably taste better with a half cup of heavy cream added but too many people in my family do not eat dairy. Besides, without the cream, it has the advantage of being extremely healthy.

Cut and peel turnips and carrots and put them in a greased roasting pan. I use two parts turnips to one part carrot. The farmer’s market had yellow carrots and they worked great because the puree is yellow rather than orange like sweet potatoes and they are sweeter. Roast them for 20 minutes or until tender. Next dump them into a food processor or better yet, a Vitamixer. Then add salt (to taste), chicken broth (to get it to the thickness you like) and a tablespoon of maple syrup. The maple syrup was important because the baseball size turnip was pretty strong tasting though the little ones were not. A couple of spins around the Vitamixer and the result was creamy and tasty. Now to find more people to eat it.

I called my virtual assistant, Tania who lives a few hours away. “So, do you want to come for Thanksgiving?” I asked.

“What are you serving?” she asked warily.

“Pureed organic turnips with a hint of maple syrup,” I said in my most seductive voice.

“Gee, it looks like we will be awfully busy that day,” she retorted.

“Well, I also got a delicious turkey from the Amish farmers,” I tried again. “After which, I signed up for their e-mail list.”

“You are making that up,” she gasped appalled.

“Am not. The Amish have e-mail now. I wonder what kind of horse powered generator they use to run their computers?” I mused.

“They do not have computers,” she corrected. “They probably hire outsiders like they do for driving and things.”

“Well, they are famously adaptive business people, “ I agreed. “But I still think there might be a poor horse walking around in circles somewhere long into the night so Amish teenagers can be on Facebook.”

“I think you better cut down on your turnip consumption, it is affecting your mind,” she countered.

I would love to cut down as I do not like plain turnips very much but what am I going to do with all of them? They are such an underdog vegetable that I am afraid if I donate them to the Manna Food Bank, they will wish it was carrots or green beans instead. One of the vendors selling them at the farmer’s market said he had no clue what to do with them but I bet the Amish farmers have some ideas. Maybe I will send them an e-mail.

Blog #18 What to do to prevent the flu

2010-11-16T19:24:00.000-08:00

To read a detailed, technical chronicle of the foils of the flu shot, see my last blog. To summarize, the flu shot does not work but contains harmful toxins and preservatives like aluminum and mercury so thoughtful people avoid it. The pressing question is what really does prevent the flu? I will start with the boring stuff that everyone knows but does not want to do.

• Exercise
• Healthy Diet
• Getting enough sleep

These three basic steps are enormously effective at improving immune function but most people prefer the myth of a magic shot instead. Exercise is hard to squeeze in anytime but in the winter there are so many better weather excuses to avoid it. The truth is you do not have to train for the Boston marathon, just walk 25 minutes 4 or 5 days per week. My solution for this was to purchase some very comfortable ski pants. Now no matter how cold it is, I can walk comfortably with my dogs who never complain about the weather.

A healthier diet does not have to be intimidating either. Added sugar is the major immune suppressor in the diet. If you just cut that way down your immune function will pick up significantly. Eat fruit (fresh or dried) or put some raw honey (which has immune enhancing properties) in your tea to soothe your sweet tooth. This is the hardest step for me.

If you don’t build enough sleep into your schedule, your body will eventually correct that by making you sick so you have to sleep. By biggest problem with this is the &%$#%^ computer and e-mail. If I stay on too long, the e-mails run through my head when I’d rather be sleeping. In my practice I have noticed that turning off the computer is a particularly difficult problem for men.

Now for the more exciting, easier supplement strategies:
• Get your blood vitamin D level up to at least 60.
• Take vitamin C, probiotics and at least 15 mg of zinc daily.
• Keep a strong natural killer cell enhancer on hand in case you feel an illness coming on.

Robust vitamin D levels are highly associated with lower illness rates (including cancer). Blood levels over 30 or 32 ng/ml are considered “normal” but higher levels can protect against illness. Of course, the only way to know for sure if you have a decent vitamin D level is to have your doctor order a blood vitamin D test. Since about 70% of women and children are low, most doctors agree to this request and it is probably worth doing.

Vitamin D-3 (the natural version) is easily available in drops and pills. Several doctors I know recommend taking one large dose (25,000-30,000 IUs) immediately if you start feeling under the weather. For dosage recommendations for children, consult your pediatrician. Note that nutritional interventions to prevent illness do not work once the illness sets in. You must strike early when the immune system first notices a problem.

Consistently taking the immune trio of probiotics, vitamin C and zinc can keep up your defenses during the flu season. Keep probiotics in the refrigerator and find one that has at least 10 billion bugs. Take 500-2000 mg of vitamin C depending on age of the person and level of vulnerability to illness. You cannot overdose on vitamin C because when the body cannot absorb anymore, it causes diarrhea and out it goes. A good multiple vitamin/mineral may already contain the basic zinc most people need but you can take an extra 15 or 20mg daily during periods where you need an extra boost.

Keeping a strong immune enhancer on hand is a must because you know you are going to need it at 11:00 PM on a Tuesday night. Waiting 12 hours to get to the store (or days until it comes by mail) will be too late as the illness will have enough time to take hold. Viruses replicate very quickly and the more cells they have time to infect, the more serious the illness. Natural killer cells are the first line defense against viruses. Several products enhance these fighters and people have individualized responses to them. Some find one product works better for them than another. I will take one of these for a few days (or sometimes just one or two doses) if I feel like I am run down or fighting something.

My three favorite are:

• ProBoost Packets (http://www.proboostmed.com/faq.html)
• 4 Life Transfer Factor – Trifactor formula (http://www.amazon.com/4Life-Transfer-Factor-Classic-capsules/dp/B000OUY84U)
• American BioSciences ImmPower (http://www.vitacost.com/American-BioSciences-Immpower-AHCC).

The price of these products vary greatly but they all work great. Follow the directions on the bottle. This is a blog and should not be used as a substitute for medical advice. If you have questions, contact a knowledgeable medical professional.

Finally, use hand sanitizers frequently. Just kidding. These products have been found in studies to be as useless as the flu shot. You may as well rub your hands in the grass or on your pants. Better to wash your hands with plain old soap and water every once in awhile.

Just to let you know how long you need to wash your hands to significantly get the germ level down, imagine singing through a verse of “All the Single Ladies” or about 30 seconds. That is what it takes and unless you are preparing for surgery, you probably are not doing this.

Not to worry, while germs cause colds and flus, they are less responsible for illness then most people believe: Mainly because they are everywhere so one cannot avoid them. In one study, healthy volunteers were asked to play cards with other volunteers who had colds. (Warning: this is a gross study.) No tissues were provided so after awhile the cards were literally damp with the viral laden nasal discharge from the sick participants. The high virus exposure did not result in significantly more colds among the healthy volunteers.

As Pasteur said at the end of his life, “It is the environment”. It probably sounded better in French but after years of proving germs caused disease, in the end, he realized it was the environment the germs were introduced in to that often counted more than the bugs themselves. So, strengthen your environment and the germs will find somebody weaker to attack.

Blog #17 The Most Hysterical TIme of the Year

2010-11-08T12:07:00.000-08:00

Bundled in my overcoat and out walking my dogs, I cannot help but appreciate the crisp air and beautiful foliage. The joggers are out and the left over Halloween pumpkins seem to wink as you pass by or perhaps they are just spoiling and sagging some. Still, fall would be absolutely perfect except for one sour note. Yes, it is time for the annual drug company induced flu hysteria.

“The flu is coming, the flu is coming,” is the battle cry. “Experts advise the best way to prevent the flu is to get the flu shot or flu mist,” shout the television commercials. I ran into flu shot "clinics" at the airport. And then, while looking for an elusive shower cap, at several pharmacies. All utilized cleverly worded signs to entice or frighten the consumer into submitting to unproven technologies. You cannot avoid being affected by the deluge or the very seductive word, “free”. Everyone likes getting stuff for free.

For me, the result is many phone calls and e-mails. The first came from my friend, Lizzy. Lizzy evaluates children for sensory processing issues. She sounded awful on the answering machine. “What should I do?” she wanted to know. She had been testing a child who had come directly to her office after getting a dose of the flu mist. He had been sneezing throughout the session and now, several hours later she was feeling heavy headed and achy.

You may recall from several years ago when experts unequivocally stated the flu mist did not work. Part of the problem was it contains a live virus so it had a tendency to cause the flu. That was the year that Walmart was naively squirting the viral mist up the noses of its shoppers only to find that they would wander over to the deodorant aisle and sneeze. Viral clean-up needed on aisle 7. It did not take them long to figure out they were potentially spreading more flu than they were preventing.

Now Lizzy was worried she was coming down with the flu. It was still early enough for her immune system to fight it off. She upped her vitamin C, probiotics and immediately took a packet of a powerful natural killer cell enhancer called ProBoost. I had introduced her to ProBoost several years ago and she has not been sick since. I told her to take a second packet the next morning and to take one large (25,000 IU) one time dose of vitamin D. When I talked to her a few days later, she was doing fine, disaster averted.

The calls and e-mails, however, were just beginning. Tania, my loyal assistant called soon after. “They are offering the flu shot and flu mist at my son’s school,” she reported. “I was wondering if I should keep him home that day.”

Good question. “If they were sprinkling virus around the Nordstrom Rack, what would you do?” I asked.

“Show up early to avoid the crowds?” she retorted smarty pants that she is.

Very funny,

“Go to TJ Maxx instead?” she continued on a roll. “I never really liked Nordstrom Rack anyway.”

It is a start, I agreed.

What about the flu shot? That does not contain live virus. Putting aside the questions about the mercury content and other potentially dangerous preservatives for the moment, does it work? Apparently not as the number of people getting the flu is not decreasing despite dramatically higher vaccination levels.

The research, what little there is, has never proven the efficacy of the flu shot. In fact, there have never been the basic studies done on the flu shot that are required of other FDA approved medication. Not a single double blind study.

What a review of 15 studies found was that influenza vaccines were ineffective against influenza-like illnesses, influenza and pneumonia. (The Cochrane Database of Systematic Reviews 2006.) It also works equivalent to placebo in children under 2. (The Cochrane Database of Systematic Reviews 2008.) In other words, it does not work.

One study found the flu vaccine may triple the risk for flu-related hospitalization in children with asthma. (May 25, 2009, www.medscape.com/viewarticle/703235). There are a shocking number of negative studies yet the shot is consistently recommended. (For more flu shot info see: www.drtenpenny.com.)

The best explanation for this incomprehensible disconnect was offered in a brilliant article in the Atlantic Magazine (November 2009), “Does the Vaccine Matter?” According to the article, the research often quoted to promote the shot does not prove the vaccine works but uses conclusions from cohort studies. These studies look at death rates associated with various factors. It is often observed that people who get the flu shot die at a much lower rate than those who do not. So, therefore, the flu shot saves lives, right?

Nope. It turns out that people who get the flu shot die much less often than other people summer, winter, spring and fall. In fact, they die less from all causes all the time because they tend to be healthier to begin with. It is called a “healthy user effect” and completely accounts for the lower death rate in flu shot receivers. When Dr. Lisa Jackson, a brave Seattle based researcher and physician studied the association more closely, she found the shot did not reduce death whatsoever.

But the November 2009 Atlantic Magazine article said it better than I can:

“…. in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the “healthy user effect.” They hypothesized that on average, people who get vaccinated are simply healthier than those who don’t, and thus less liable to die over the short term. People who don’t get vaccinated may be bedridden or otherwise too sick to go get a shot. They may also be more likely to succumb to flu or any other illness, because they are generally older and sicker. To test their thesis, Jackson and her colleagues combed through eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didn’t. Then they examined which group’s members were more likely to die of any cause when it was not flu season.

Jackson’s findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson’s papers “are beautiful,” says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. “They are classic studies in epidemiology, they are so carefully done.”

The results were also so unexpected that many experts simply refused to believe them. Jackson’s papers were turned down for publication in the top-ranked medical journals. One flu expert who reviewed her studies for the Journal of the American Medical Association wrote, “To accept these results would be to say that the earth is flat!” When the papers were finally published in 2006, in the less prominent International Journal of Epidemiology, they were largely ignored by doctors and public-health officials. “The answer I got,” says Jackson, “was not the right answer.”

The entire article is available online.

So, the flu shot and the flu mist do not work. So what does work? To be continued………

Blog #16 Vitamin M Continued......

2010-11-01T18:42:00.000-07:00

“You were soooooo right,” Ellen enthused. Oh goodie, I thought. I love being right. Then it occurred to me that I had no idea to what she was referring.

“About what?” I queried.

“You know,” she continued. “About movement and speech. Remember that story you told me?”

I did. It was currently my favorite story about movement involving a 5-year-old boy on the autism spectrum. I will call him, Kirk. Kirk hopped from one thing to the next with limited attention or engagement. His language consisted of demands and basic observations with little conversation. If you work with or have a child with autism, you may know about the concept of closing circles of communication. Basically, you say something, the child acknowledges your opening and responds with something related to what you said and sends the conversation back to you. That is one circle.

The late Dr. Stanley Greenspan stressed the importance of closing circles of communication and developed many techniques to help improve conversational skills. The child needs to be interested enough in another person to engage and then respond appropriately to unexpected conversational gambits. An autistic conversation is more like a political debate on TV when one question is asked and another is answered. This “conversation” tends to be one-sided. Something like this:

“What did you do at school today?”

“Thomas”

“Oh, you played with Thomas?”

“No, want to play with Thomas.”

“You want to play with Thomas the tank engine. Okay, but did you have music today?

“Eat cookies.”

Etcetera.

Kirk communicated at this level with much prompting and redirection needed to have any level of conversation. The parents and speech therapist were working hard to improve the quality and complexity of the interactions. I explained to the mother that the language centers were right next to the movement centers. Parents so often concentrate directly on speech rather than working on motor skills and/or sensory function. When language is not improving, improving sensory and motor function can create a neurological foundation for better speech. It is the reason children usually walk before they talk and why boys, in particular, use movement to help them think straight.

With this little developmental tidbit in mind, the Kirk’s family headed off to Disney World. It had been a tough year and the parents decided for one day to allow Kirk to do whatever he wanted. What Kirk wanted was to go on the Disney equivalent of the roller coaster “20 times”. So, they let him.

At the end of the day, Kirk was communicating better than he ever had. He was answering questions and initiating more conversation. His parents were so excited but did not know how to sustain the gains.

Since they did not have room for a roller coaster in their living room and they could not move to Disney World, the question was what to do to get Kirk’s level of movement and sensory input way up. We talked about using Wii fit and checking in with their occupational therapist about what equipment could be installed and used at home. This was the story I told Ellen.

Ellen took her son with speech delays to a local amusement park and used the same strategy with similar results. “You should have heard him talk,” she reported. “It was unbelievable”.

Once again, I had a conversation about increasing the levels of vitamin M in a little boy. “Sometimes I think there is not enough movement in the world for him,” his mother cracked.

The difference between these two children and Colin, discussed in the previous vitamin M blog is in the type of movement. For Colin, it was direct heavy exercise while in Kirk and this young boy it was machinery moving them. While the child moving himself is generally preferable, the intense movement of a roller coaster is very stimulating to the nervous system and can also do the trick. The key is finding a way to get lots of movement into everyday life.

One afternoon at the conference (#15)

2010-10-25T14:44:00.000-07:00

Recently, I was at a large medical conference. After my talk, I thought I would sit in on an open discussion of a case being presented by a well known doctor. When I arrived there were about 40 other physicians/practitioners as well as the mother of the child, whose history was laid out in front of us. She sat calm and poised on the platform next to the doctor.

The mother and doctor went back and forth filling in the details of her son’s history. The blood and other medical test results were flashed on to a large screen and the presentation was going as these things generally do.

Somebody asked a question which I did not hear. The mother responded that the most important factor in a successful patient-doctor relationship was utter and complete confidence in the doctor, which she had. Many of the attendees nodded their heads in solemn agreement but this type of comment to me, usually means bad things are a comin’.

I am all for complete confidence in the medical professional one works with but draw the line at utter. In any relationship, there has to be one finger of yourself left to raise questions and consider other possibilities in case the practitioner is human and prone to mistakes or has a few gigantic blind spots, like everyone in the world. “Don’t give all your power away,” I wanted to shout. “Retain your right to question authority.” Alas, it was too late. Not only had she given all of her power away, most of the practitioners in the room seemed only too happy to take it.

Yet, she seemed peaceful and satisfied with her care and she had a right to her own views so I got off my little mental soapbox and decided to get what information I could from the session. With all of these highly educated people in the room, there should be some good clinical pearls, I reasoned optimistically.

The doctor finished showing the blood tests and explained what he had done in response and a lively back and forth with the audience ensued. Most of comments were started with, “I spent 20 years as head researcher on this topic….” or “I used to be clinical director of….” These were followed by an observation or advice wrapped in a question. “In the hundreds of similar cases I have seen,” went one, “I found such and such worked best. Why didn’t you use that?”

The presenter took these Monday morning quarterbacking comments equitably, explaining his thinking about this or throwing questions back to the audience when an unfamiliar concept was broached. The audience jumped on these like bears at a salmon convention. And they were so smart. Obscure and fascinating research was quoted. The usual wind up for these tidbits was,” You are no doubt familiar with Dopplehoffer’s seminal work on blah, blah, blah.” I wasn’t! I furiously took notes.

As the presentation went along, I waited to hear what the doctor did to figure out what type of infection this child had. There was a significant infection marker in the blood work that he had skipped but surely would come up in his treatment protocol. It did not. I tentatively raised my hand and asked. He looked at me blankly. “Nothing,” he said and moved on to the next comment.

I eyed the audience suspiciously and stopped writing. This could not be good. Why aren’t these doctors concerned about a possible infection? Instead, he highlighted a low iron level which he explained needed to be corrected. Many heads nodded in agreement once again and there was a brisk discussion about how everyone is afraid of iron but how important it is. One former clinical director claimed he even prescribed iron injections. The consensus was, iron: excellent choice.

MayDay! MayDay! Iron goes low when there is an infection. The body has a protein called lactoferrin that eats it up so the bacteria don’t get it because bacteria need iron to thrive. The case went straight downhill from there. A secondary gastrointestinal infection was uncovered which was treated with antibiotics. Iron stops antibiotics from working so I was not surprised to hear that the child had the same recurring GI infection. The doctor treated the problem with antibiotics but sighed with frustration when reporting it just was not going away.

Here I thought I was in an educational seminar but I had forgotten about how myopic the culture of medicine can be. Everyone was more interested in quoting medical literature and looking brilliant than considering new perspectives or asking real questions. I tried to raise a few delicate points without being insulting but nobody was listening.

Afterwards, I realized my failure was in being polite and not coldly explaining the forgotten basic principles of infections and iron. I was not speaking their language. The most important criteria for being heard is thrusting forth with unassailable confidence. “To anyone familiar, as I am sure you all are, with the studies by Smurf that found that iron deactivates antibiotics,” is what I should have said. I have done this many times one on one with other medical professionals to help clients. The trouble is that Smurf did not do those studies and I would have to look up who did in order to posture effectively. And though I can be an intellectual bully when arguing for proper patient care, it always leaves a bad taste in my mouth.

When I left, I was downtrodden. Intellectual arrogance and jockeying is usually bad for patient care. That poor kid. He has some kind of primary infection nobody is looking for, he is being treated for a secondary infection with antibiotics which might even accidentally help the primary infection but are being deactivated by supplemental iron and everybody just thinks this is an unusually tough case.

I took a breath. There are many ways to do things and mine may not be the only or dare I say, the best. I should take my own advice to question my own thinking. Iron is an important nutrient so perhaps I am not using it effectively and often enough. Perhaps this child will get better because of other unknown factors. Maybe the mother’s unquestioning faith in her doctor will overcome the biochemical factors. Question everything, I told myself. Try not to be attached to what you think you know.

The truth is the price for good health care is eternal vigilance. Ask more questions if the advice you are getting does not feel right. Get a second or third opinion. Like your doctor or nutritionist but do not adore them unconditionally because they are human and therefore, will screw up sometimes.

But don’t take my word for it.

Blog #14 Coming soon to a store new you

2010-10-17T20:01:00.000-07:00

A good detective keeps up to date with what’s new in her field and to that end every year my husband and I spend a day at the Natural Products Expo. This is an enormous natural foods convention where new products are trotted out and old standards search for new vendors. The fun part is getting to taste everything.

Through the years we have noticed the health food industry, like everything else is subject to trends. One year there was a whole aisle of soy enhanced foods including soy meats, drinks and puddings. Another time it was the year of the obscure berries and exotic fruit like acai, goji berries and mangosteen. Goji berries tasted like red lint no matter what they mix with them including chocolate. But we try everything.

Once we ran into our friend, Enrique, who works for the FDA. Last we had heard he was hot on the trail of a dangerous man parts enhancer that was heavily advertised on the internet. “You should see what happens to the poor slubs when this goes wrong,” he confided, shuttering. The whole project was depressing him. We were glad to see him out doing some fun field work but though we love Enrique, we could not bring ourselves to invite him to walk around with us.

“Being with you is like wearing a “cooties” badge,” I apologized lamely. “Nobody will tell us anything interesting when they see you are from the FDA.” He understood and was not offended. To make amends, we told him where all the good organic ice cream samples were.

This year was all about gluten free foods. Coming to a store near you soon is gluten free….everything. The best was a line of naturally gluten free frozen soups by Kettle Cuisine. Their yet-to-be released Thai chicken with a coconut milk base was particularly yummy. The cookies and cakes on the other hand were consistently too sweet. After trying a half dozen, I could not stomach them any more. For gluten free treats stick to chocolate, ice cream, macaroons or Pamela’s cookies is my advice.

As for new cool discoveries, my husband’s favorite was a naturally fermented “soda”. Technically, it was a type of water kefir made with probiotics. They make it using a process similar to the one used to make kombucha. It is sweeter than kombucha however and only has 40 calories. His favorite flavor was tarragon. Check out: www.eatcavemanfood.com.

My fun new find was Sea Buckthorn. It only grows in the harshest environments like salty marshes and the Himalayas. To survive these inhospitable environments the plant has developed some unique bio-defense mechanisms. These chemical mechanisms are often anti-oxidants and nutrients to the plant consumer.

“Sea Buckthorn is the world’s only source of essential omega 7 fatty acids,” the enthusiastic sales rep informed me.

“I was not aware that omega 7 fats were essential,’” I replied.

“Oh, they are for the skin,” he assured me. “In fact, my girlfriend complains my skin is too soft because I work with them so much.”

“That seems like an unusual complaint,” I retorted eyeing him suspiciously. “Let me see your hands.”

His hands were spookily soft for a man; it was like touching Gumby. “Very impressive,” I commented. “What else is it good for?”

“Acne,” he said with confidence. “Clears it right up.”

Luckily, Enrique was not here to witness such a claim but I wanted to know more. “I wonder how it works,” I mused while trying to read the bottle. “You know omega 7 fats have to be made from something else, so are they long chain polyunsaturated fats?” I asked.

He looked at me blankly and then recovered. “I am not sure but they are essential.”

No, they are not, I explained. There are two essential fats and omega 7 is not one of them. Every other fat is made from these two though it is sometimes useful to get non-essential long chain fats like DHA and EPA directly. Now, he was stepping back from me.

“Think about it,” I challenged, “how could this fat for which there is only one direct food source in the world, be essential? Ninety nine point nine percent of the people in the world would not have access to it. The question is, what is the structure of it and why is this form particularly good for the skin?”

“You need to talk to Dr. Liu,” he decided and scribbled a name and number on a card. In the meantime, I ordered a few bottles. I thought about someone who might be willing to be a guinea pig to test it out.

But all this talk about chemistry was making me hungry. “Look,” called my husband, “I found some high antioxidant chocolate.” Now that sounded essential.

About the book.....

2010-10-13T19:37:00.000-07:00

Dear Rosa Maria....

Thank you for asking about the book. "What's Eating Your Child? The Hidden Connections Between Food and Your Child’s Well-Being — and What Every Parent Can Do," is deep in the process of editing which takes a long, long time. In fact, it feels like I produced three children in less time. The good news is that this paperback baby is expected from Workman Press in April 2011. Hopefully, Jim Carey will be between movies and will be available to star in the movie version. Just kidding. I want Diane Lane.

Blog #13 Vitamin M

2010-10-08T15:36:00.000-07:00

Julia dropped by to discuss her son, Colin. I had seen him many years ago but now he was attending a famous military college that starts with “The”. I will call it, “The Academy” though it is not really THE Academy but a different equally famous The something. Anyway, she was worried because Colin was diagnosed with ADHD and she wanted him to be successful at The Academy. Colin had discovered the reported wonders of Ritalin by scoring it from some buddies and believed he was not nearly as focused without it. The Academy, like all military institutions, did not allow its cadets to take stimulants, prescription or otherwise. In fact, they randomly and frequently drug test the students.

I love this place! I wish all universities did the same thing though for all I know one of my own children might have been kicked out which such a policy. I have talked to many college students and most of them have admitted to me (usually without their parents) that they have tried stimulants for studying and/or test taking. They are the most abused drugs on college campuses. The military thinking is you cannot have a soldier running out of medicine while under fire somewhere, especially a narcotic. (Technically, stimulants are narcotics.) Who knows who you would be dealing with? They certainly do not want to find out.

Colin had survived freshman year with a “B” average. It was rough physically with many hours of intense physical training every day plus academics. There was little we could do about his diet. He had to eat at the dining hall and he was already making good choices eating salads and vegetables whenever they did not look too soggy.. And, he was doing the best he had ever done academically I think I know why.

He was getting a gigantic dose of vitamin M: Movement. For a certain type of attention issue, the best strategy in the entire world is loading up with vitamin M. Colin was getting 4 or 5 hours a day of motion and physical activity. The Academy was doing for him what no other university and a fistful of medication would ever match.

The movement centers are right next to the language centers in the brain. All that running around was organizing Colin’s thinking and putting his frenetic energy to productive use. His mother admitted he was calm and happy. The biggest problem was he was comparing his present performance to how he felt taking stimulants. The stimulants gave him a false sense of confidence because his thinking was so remarkably sharp. What can I say? This is why people like cocaine and stimulants are similar.

I assured Colin’s mom he was thriving and that the magic of vitamin M would keep him in balance. I also explained the concept of neurodiversity. That is, there is a wide range of ways that brains function and process and there was not anything particularly wrong with Colin’s. I call people like Colin who have been diagnosed with ADHD, Warriors. Until recently, Warriors were highly prized in society. They were the knights and warriors you called (and paid) when the village needed to be cleared of marauders. They were athletic types who had no trouble riding their horses all day and were what we would now call, “risk takers”. They would shoot first and ask questions later. It makes you wonder if Clint Eastwoods’s Dirty Harry would be classified as ADHD if he had to get through the police academy today. You can imagine the report. “Has trouble following directions. Cannot sit still. Tends to shoot first and ask questions later suggesting impulsive tendencies. “

Today, the valued jobs go to people with brains that can concentrate for long periods of time while sitting at a desk. The physical warrior has been replaced with the computer warrior. Not a better brain, just a different, presently in more style brain. (For more on this fascinating subject see one of Thom Hartmann’s 8 books on neurodiversity at www.neurodiversity.com )

Along with many assurances, I suggested some nutrients that help with cognition and would not trip any drug tests…..just for insurance. Besides, it can never hurt to be a little smarter. But this is not all vitamin M can do……(To be continued.)

# 12 How to Have a Difficult Conversation

2010-09-28T09:56:00.000-07:00

I first started seeing Helen three years ago when she was nine. She had a terrible memory problem, could not understand the simplest math concepts (especially when it came to using money), was socially immature and melted down a lot at home. Of course, she was the epitome of sweetness at school which made her mother, Debbie wonder what was going on with her little Dr. Jekyll and Mr. Hyde.

The diagnosis, as expected, was learning disabilities but her adoption from the former Soviet Union made me uncertain. This pattern of learning disability connected to a Russian adoption always makes me wonder about Fetal Alcohol Syndrome (FAS). It’s true that children with full blown FAS are rarely released for adoption anymore. They have physical characteristics that mark the condition and I shutter to contemplate where they all end up. But Fetal Alcohol Syndrome Effect (FASE) has no physical markings. It is FAS light and all the damage is inside. In my experience it is horrifyingly common in adoptions from that particular area of the world and looks just like this.

FASE was not mentioned so I asked if the possibility had been explored. “We consulted an expert,” Debbie replied defensively, “ and she doesn’t have it. She is beautiful and has none of the traits,” she concluded, case closed.

Uh oh. Either this “expert” was not the sharpest stiletto at the shoe store or more likely did not want to open up an uncomfortable or unproductive conversation. Some people believe there is nothing that can be done about FAS(E) anyway, so why make parents feel bad?

I don’t like having these conversations any more than the next person. They are hard and don’t always go well. But who am I to decide what is or is not possible? I am committed to being honest but I don’t want to be cruel. I grew up in a culture where you could walk around with a worm coming out of your head and nobody over the age of 16 would be “rude” enough to mention it. They might call you worm ear behind your back- but would politely avert their eyes and pretend not to notice.

Today, you would get your own reality show, “Keeping up with the Worm” or Dr. Phil would boom at you to “ lose the worm”. None of these extremes helps people or involves conversation.

So, I took a breathe and explained to Helen’s mother how you could not see FASE but that there might be some strategies we could try if we know what we were dealing with. There is some theory, for example, that high doses of folic acid might help brain development in FASE. She asked questions but objected to everything I suggested.

I mentioned specific bonding therapies and supplements that might improve cognitive function. “I am not comfortable with all of these supplements, “ she asserted but continued to talk with me. During the whole conversation I neither got defensive nor offensive but just hung in there with her.

A few months later Debbie returned. Surprisingly, she had purchased and had started giving Helen the nutritional supplements. “But, I don’t see any difference,” she insisted.

I again explained how the brain injury from prenatal alcohol exposure is persistent and pernicious. “This is a long haul operation,” I told her. “Looking back we hope she will have made more progress than expected or be functioning better than she might have otherwise.”

Debbie remained dubious.

Over two years passed and I did not hear from Helen’s mom. Last week she reappeared. “Remember, Helen?” she asked. “She is a 12 year old girl with FAS.”

Clearly something had changed. Debbie and Helen had been busy the last two years. Debbie had enrolled her in a special therapy program for children with FAS(E). She had been evaluated by one of the world’s experts on the condition who opined that Helen was progressing unusually well to therapy and supplements. Finally, Debbie had started a blog about raising a child with FAS to help other families.

“I don’t think the supplements are helping,” Debbie reported though Helen was actually doing better in many ways. The meltdowns were mostly gone, her memory was better and she was doing well at school, though still behind her peers. Math remained her big area of academic weakness and she was still significantly immature for her age.

I decided to change the cognitive program away from motor planning and memory. Helen had been taking everything for 2 years and had probably gotten all the benefit she was going to get from the old compounds. We kept the folic acid and fish oil but decided to try something new I had discovered. It is a unique supplement that helps regenerate the proteins used to send signals in the brain. I was not sure it would work because nobody knows exactly what will work in FAS(E) and said so.

Debbie was not enthusiastic but is considering the suggestion. She also mentioned that Helen had gone through puberty and now had the body of a lovely young woman, “with the emotional development of a 7 year old”.

I froze. That is a bigger gap than I had expected given our conversation so far. “How social is she?”

“Oh, she is so friendly and is very eager to please these days,” was the response.

I asked several more questions about Helen’s life, took a deep breath and started the new difficult conversation. “So, what are you going to do about birth control?” I ventured.

Helen’s mother sighed.

Blog #11 The Subtle Bouquet of Pear Juice

2010-09-19T18:42:00.000-07:00

“Dear Mrs. Dorfman,” the ordinary sounding e-mail started. I knew immediately it was from a stranger as nobody that knows me calls me, Mrs. Dorfman because I don’t like being called Mrs. Dorfman. Maybe if I had a cool last name like Starfish or Ravenhurst: but it was not to be. I digress. The e-mail continued.

The writer went on to compliment me on my work with children, etc. etc. and as a result of my interest in the well being of children, she thought I would want to know about her new very yummy organic pear juice. Perhaps, she continued, I would even be willing to taste and comment on it.

It was a request for a product endorsement! This will be so much fun, I thought. The product is certified organic, which is particularly important for products utilizing pears and apples. Both are on the dirty dozen list of produce with the most pesticides (See: www.ewg.org.) Pears are also low in salicylates, which makes this juice a better choice for children with hyperactivity. Finally, pears juice is less sweet than apple juice. Apple juice has about 28 grams of sugar per 8 oz. serving while pear juice has 20 grams. The only problem is that I am not much of a juice fan unless it is green or purple and comes out of my Vitamixer. Still, I recognize the need for healthier drinks for kids and in small amounts, it could be a good choice.

“Absolutely, send some,” I enthusiastically replied.

A few weeks later, the juice arrived. It was in a plastic bottle which is not optimal but is admittedly more practical when small children are involved. I opened it up and took a sip. It tasted just like…..pear juice. It was good, as promised, and sufficiently, peary. I detected no subtle undercurrent of wildflowers or hints of honeybee pollen, not that I could if they were present.

What is there to say about pear juice? “Not too sweet,” would not fly as an endorsement. Maybe, “If you like pears, this is just like them.” Or, “For busy moms who do not have time to juice their own pears….”

Maybe the lady will not get back to me, I hoped fervently. Within days she did and wanted to know if I could comment on her product for her website.

“What am I going to say?” I asked my ever helpful assistant, Tania.

“Maybe if you mixed it with tequila, that would spruce it up,” she offered. “You could call it a Peargarita.”

It probably would make a good Peargarita and would still be low in salicylates. However, the target audience is a different age group.

I was determined to come up with something useful. I like the idea of helping a small independent food entrepreneur. Producing high quality food is a lot of work and there is not enough of it. My husband is the juice drinker in the house, so I asked him to taste it.

“This is really tasty,” he remarked taking a large swig. I leaned forward excitedly.

“What’s so good about it?” I asked nonchalantly.

“Well, it is not too sweet,” he said drinking some more, “and it is very flavorful. I like it.”

I ran back to my computer and started typing. “GoGo Juice is a good choice if you are looking for a pure, flavorful lower sugar juice,” I wrote. It is short, to the point and true. I think it is a GoGo.

Blog #10 I want to thank Jim Carrey.....

2010-09-13T06:44:00.000-07:00

I spent an enormous amount of time last year writing a book. It is about how many common childhood ailments can be caused by nutritional problems and how to fix them. Anyway, we are in the edit phase, an extremely painful process. It is akin to walking to your car after running a marathon: necessary but agonizing. As I am reading the comments to “clarify this” and “take out” that, I feel a little like a three year old. I don’t want to take out that and I think this is clear enough! But when it comes to editing a book, I am a three year old. Consequently, the editor is usually right.

To calm myself down, I have to remind myself how lucky I am to be writing a book at all. For this privilege, I have to thank the actor, Jim Carrey. Really. It is all because of him that I am in the editing process now even though I have never met him.

My unlikely story started with a con man named, Steven Russell. He was a swindler, imposter and multiple prison escapee who was born in the mid-west but now resides permanently in a Texas Prison. With nothing else to do in solitary confinement, he decides to write his memoirs. His escapades are so outlandish that nobody would believe him if he had not gotten a 25 years to life sentence to prove it.

The memoirs landed on the desk of a book agent working for a large literary agency. Russell is clearly crazy but many of his more outrageous antics such as escaping from prison numerous times, he does for love: specifically the love of another inmate named Phillip Morris. Phillip Morris has the misfortune of being named after a controversial cigarette company but that is small potatoes compared to the misfortune of falling in love with Steven Russell.

Peter, the agent, loved the manuscript and options it under the title, “I Love You, Phillip Morris”. He figures, it will be one of those little gem, specialty audience quirky books. And it is. What he does not predict is that one of the specialty audience members will be Jim Carrey. Carrey sees himself playing Russell and buys the movie rights to the book.

Peter’s talent for spotting a great story pays and he makes enough money from the movie rights to start his own literary agency. About that time I was giving a talk in New York City, which is attended by Peter’s wife. She identifies me as a potentially interesting project for her newly minted independent literary agent husband. Peter has the time and inclination to help me along and voila′, a book is born.

You are probably wondering what happened to Jim Carrey’s movie. Carrey got Ewan McGregor to play Phillip Morris and the love story is released in 2009…..in Europe. Even fans of Brokeback Mountain might find the movie a bit racy. I know this because my daughter’s convenient computer nerd boyfriend located a copy of the DVD. I didn’t ask questions; just watched it. It will be interesting to see what happens to Carrey’s career when it is released here in November. He is perfectly cast but perhaps he should not plan a trip to the mid-west anytime soon. Or, maybe they will edit it for American audiences.

So, that is how I came to be rewriting chapter 6 for the third time and daydreaming about who might star in the highly unlikely event that a nutrition detective book would be turned into a movie. Maybe they could call it, “Nutrition, CSI Unit” or “I Love You, Peas and Carrots.” I had better get back to work.

Blog #9 Me and the GI Continued......(Blog #5 follow-up)

2010-09-08T15:44:00.000-07:00

Remember my neighbor who was throwing up every time she went to visit her apartment in New York? After several weeks, she returned. The doorbell rang and there she was. “Some of your mail ended up at our house,” she said by way of greeting.

She handed me the errant envelop but underneath it I spied a lab report. “So, you got back the mold test results?” I ventured.

“Yes, and they were very bad,” she frowned handing me them to me. “Apparently, the counts are high enough to make the occupants sick. That would be me.”

Glancing over the results, l saw the level of aspergillus was moderately high in the kitchen but off the charts in the bedroom. Aspergillus is the genus name for a group of 200 some species of mold. Most of them are harmless or even useful. For example, one species is used to turn soybeans into soy sauce. Others can decompose plastic. I can think of a few landfills that might be able to benefit from an Aspergillus invasion rather than waiting 10,000 years for the mountains of plastic bottles to breakdown on their own.

Around 20 or so of Aspergillus species cause illness. The most common symptoms of exposure are chest pain, fever, cough and trouble breathing but vomiting is also a less frequent but known symptom. My neighbor had the sudden vomiting episodes whenever she visited the apartment.

“So, what are you going to do?” I asked tentatively. Correcting mold in apartment buildings can be tricky. Often the problem extends beyond one unit and getting a condominium association involved can get messy. In addition, once discovered, mold issues may have to be disclosed before selling a house or remediation proof provided.

“Well, it turns out there is a problem with the air conditioning system and they are replacing all of the units. They have not gotten to ours yet.” She explained. “ I am hoping that will take care of it.”

An old air conditioning unit could be the problem. Aspergillus mold can be found literally wherever there is water or dampness. An old, malfunctioning air conditioning system would certainly qualify as a mold breeder. I would have been tempted to avoid the apartment until the work was done and then retest. My neighbor seemed content just knowing the source of the problem and addressing it over time. She was tied up with other family issues and her husband was unaffected by the problem.

This is a common and fascinating phenomena; several people living in an infected home but only some of them getting sick. I always wonder if the injury being done to the person without symptoms is just attributed to something else later and/or they are truly unaffected. Maybe they have a super mold resistant gene. Since the most adaptive people survive best, in the future, the ability to withstand mold will be the gene to have.

People always think of cockroaches as being the ultimate survival organism but molds are far more resilient. I remarked to Tania, my assistant, that if molds were competing with cockroaches for adaptability, the molds would win hands down. They have already adapted to global temperature shifts and as a result are more virulent and toxic to people. “I think the cockroaches would win,” Tania remarked, “unless aliens were involved. Then they would win, “ she snickered. Sometimes, I don’t think she takes my work very seriously.

#8 And you thought your teenager was tough.....

2010-08-30T10:43:00.000-07:00

I was asked to write an article for an online site about food reactions and performance. I decided to tell the story of a teenager I saw this week. Here is the grittier blog version…..

When I looked at my schedule at the beginning of the summer and saw Sam’s name, I sighed. Sam is a thirteen year old boy that defines the concept of a child “only his mother could love”. I have known him since he was seven. Being kind one might say he had a tendency to be negative but defiant, belligerent, argumentative and angry were more accurate.

I always use to think there is not enough money in the world for someone to want to deal with young teenage boys. They are sullen, mouthy and generally smelly. One had to admire middle and high school teachers for their commitment to this age group and I thought their work was a kind of calling, like the priesthood. (It pays about as well, too.) So, inexplicably I have found I love dealing with the these little hormone bombs professionally. Most of them are fun and interesting if you can get them talking and I do not take the sullenness too seriously because I understand the chemistry of it. They rarely get to me.

Sam, unfortunately, is the exception.

He was so difficult at age seven that his parents gave up before they were able to put into practice any of the dietary changes I had suggested. Sam was a rigid, fussy eater and refused to eat at all if mom did not make exactly what he wanted. His parents worried about his size (extra small) and his temperament (extra prickly) but decided medication was the way to go. It was an ongoing disaster.

His mother dragged him to see me every few years between medication trials with the same results. We would develop a plan which he would dig in his heals and refuse to do. At one visit when he was ten, he glared at me and then yelled at his mother, “I like being small.” When concerns about academic performance were raised he declared that he “hated school” and his teachers “sucked”.

I could only imagine how much more impossible he was going to be as a fullblown teenager. It was a spiritual practice staying calm under his provocative attacks. Change can take a long time, however and I had to give his mother points for tenaciousness. Maybe this would be the year.

Gloomy as ever, Sam plopped himself into a chair and narrowed his eyes, ready to rumble. What it must have taken his mother to get him here! He was still peanut size and his diet remained mostly pizza, cereal, pasta and sugar with a little meat thrown in from time to time. There was a new development however; he now had chronic stomach pain. His doctor had prescribed a reflux medicine which helped a little.

Food reactions do not always affect behavior and performance. When they do, the substance most likely to cause stomach pain and make a child chronically angry is gluten. Throw in poor growth as a symptom and the result is practically a textbook case of gluten sensitivity (and maybe even celiac disease). Gluten is a protein found in many grains like wheat, rye and spelt. There are gluten like substances in all grains and many families of gluten. Consequently, what contains gluten and what does not can be arguable.

To simplify matters for an initial trial, I often recommend just removing anything made with wheat or rye flour. Foods like quiche, pasta, bread, croutons, bagels, pizza and cereal are eliminated or a gluten free alternative chosen. Minor gluten ingredients are present/hidden in many processed foods such as salad dressings, soy and other sauces. If celiac disease (an autoimmune condition associated with gluten intolerance) is suspected, all gluten sources must be strictly avoided. With gluten sensitivity, sometimes small amounts can be tolerated and allowing more flexibility in the beginning is less intimidating. Highly sensitive children are discovered quickly when reactive foods are removed but by then, the parents are more comfortable with elimination and can tighten up.

I had been trying to get Sam’s parents to remove all gluten based foods from his diet for six years because of he was so difficult and not growing. Now there was chronic tummy pain to add to the list. During one of our aborted trials, his mother had stopped eating gluten herself as a gesture of support and felt so much better that she had stayed off.

Getting a few fruits and vegetables in would also have been nice, but my first concern was getting the gluten out. Occasionally, that will miraculously open the rest of the diet. Besides, I was getting nowhere, so I was down to one change.

I have found with angry teenage boys, truthful and straightforward work best. Luckily, I can be straightforward to the point of bluntness. “How is the small thing working for you these days?” I asked looking straight at him. Apparently: not so well. Sam was an excellent athlete despite (and possibly because of, if you watch professional sports) his temper. I don’t know how he lasted through a game with his diet, but he had until his stomach started acting up. Now, he was trying out for the high school team and was nervous.

I pounced. “You have a month before try-outs start to straighten out your stomach and get growing. This is the perfect time, “ I shamelessly enthused. “Just say you’ll try it.”

He glared at me.

“Come on, Sam. Just say, ‘yes’,” I coaxed. I shamelessly use the used car salesman just-say-yes-to something trick often and successfully. Research on persuasion has found that once a person says, “yes” to one thing, they are more likely to be open to a bigger commitment. This is why a common first question asked when you walk into a car showroom is, “you want to save money don’t you?” Of course you do, so you say, “yes”. Then before you know it, you have bought a previously owned Hummer.

I cajoled and prompted; bullied and soothed and he folded.

“Fine,” he muttered and the no gluten diet trial was in place.

The half smile when he returned a month later was thus significant. A month is not enough time to evaluate growth but the stomach pains were gone and he was pleasant. Reluctantly, he agreed to continue if he could cheat once a month. “Absolutely, try,” I explained. Some people can have small amounts of the problem food without symptoms and others cannot. It is all trial and terror to find out who belongs in what group.

In the meantime, this school year is looking a whole lot better and in a few months we will see if he is growing. I am sending him to an endocrinologist, just in case we are too late with the dietary changes and he needs growth hormone. Shockingly, he agreed to go even when I told him there would be a blood test.

I actually think he has felt bad all of his life and for the first time is feeling, dare I say, pleasant. All I know is there will be a lot less groaning on my end next time I see he is coming in. That has got to be a good thing.

#7 Two Salads to Go: Hold the receipts

2010-08-23T10:50:00.000-07:00

“You should read this,” my husband declared while sliding an article in front of me.

“What is it about?” I asked suspiciously. Jeff is very thoughtful about digging up interesting items for me to read but has been known to occasionally slip in something about global transfer pricing or taxation of international financial instruments. As a result, I know more about Subpart F of the Internal Revenue Code than the average nutritionist, the only purpose of which is to make me a better conversational partner when he wants to talk about work.

“You won’t believe it,” he says cryptically and dashes off to work.

The article was written by Dr. David Williams, a clever, holistically oriented physician who produces a subscription newsletter and sells his own line of supplements. The subject was a nasty chemical called bisphenol A (BPA). BPA is used in the manufacture of polycarbonate plastics, such as water and baby bottles. It is one reason we have been warned to minimize drinking out of plastic bottles.

I have dutifully informed my clients not to microwave in plastic and encourage the use of glass storage containers to reduce BPA exposure. While scientists continue to debate exactly how dangerous BPA (a known hormone disruptor/synthetic estrogen) is, I figure it is better to be safe while the industry subsidized “experts” duke it out.

Williams’ report claimed a new study suggested all this fuss about BPA in plastic bottles is misplaced. The major danger from BPA actually comes from store receipts. Huh?

You could chew plastic bottles all day, he asserts and only accumulate a small percentage of the BPA you could get from TOUCHING grocery store and post office receipts. The culprit is the thermal ink-less paper used to print receipts at big retailers, restaurants, gas stations and practically any place else one shops. They are coated with tons of the toxin which absorbs right through your skin.

All this time I have been trying to figure out which number plastic bottle is safest and the real health danger is shopping!

Further research on my part discovered an Environmental Working Group (www.EWG.org) report which found BPA in 40% of the receipts they collected from stores. Another study found 80%. In 2006, the nation’s largest manufacture of this poison paper dropped BPA from its formulation because of “growing concerns” about its safety.

The US Postal Service stopped buying BPA coated paper in Sept. 2009 but samples taken in March 2010 were still all positive for BPA. I go to the post office all the time! Perhaps I should collect hazard pay for mailing boxes. I try not to be a nut about my living habits but these findings call for action.

My action plan is to only accept the receipts I need for tax or record keeping purposes. Good thing all my reading on obscure parts of the tax code allows me to immediately identify the important receipts. I now wash my hands as soon as possible after handling receipts and no longer throw them on top of my food or newly purchased underwear.

Unfortunately, these behavioral changes move me one step closer to the “out there” level of healthy/environmentally sound living. I already take my own bags, even to the mall, much to the distress of my teenage daughter. Imagine her mortifications when I whip out my cotton gloves before taking the receipt. I am not sure I am ready for that step.

She is also about to start a job in retail sales. Are the potential long term dangers of exposure to BPA for such a benign occupation now to be compared to working in a coal mine? If she can’t have children one day, will we be blaming all that receipt handling?

This scenario sounds ridiculous yet that is exactly the kind of detective work I employed this week with one of my 60 year old clients with complex medical problems. Some of her symptoms harken back to her employment in a perfume factory while in college. Who knows what class of possible poisons were used to create scents in the 70’s and what effect it could be having on her present health. Perfume may sound innocent, pleasant even but we suspect the effect of the chemical exposure is still significant today.

Now consider the innocent receipt…….

#6 The Secret Life of a Nutritionist

2010-08-15T16:53:00.000-07:00

Because I am a nutritionist, people think I eat nothing but braised bean sprouts or that I spend an inordinate amount of time taking the personal eating inventory of all those around me. Sometimes if I am eating out with new acquaintances they will eye the menu nervously and then ask what I am ordering, imagining that I am carefully cataloging their every nutritional move for later dissection and harsh judgment. Mothers of my daughter’s friends regularly ask her what I eat and what it is like to live with a nutritionist.

“She has a huge sweet tooth, “ my 19 year old daughter, Tory will divulge conspiratorially. Then she will come home and lament the fact that her friends and their mothers are all obsessed with food. “It’s annoying,” she complains while rummaging through the refrigerator. “Do we have any sushi?”

“Did you tell them that we drink a pureed chard drink for breakfast?” I asked once, figuring it is always good to keep the mystique going though this is true.

“No, I told them you sometimes hide candy in your office drawer,” she says as she eyes the refrigerator contents critically. This is also true. “Did you make any salsa?”

I had.

The next morning, Miriam came to the office. She is 83 and a real firecracker but I had not seen her for over 8 months. Most of my clients drop by or call if there is a problem so while I was happy to see her, I was concerned something might have happened. “I spent Saturday at the emergency room,” she said without much preamble. “ I am dehydrated and look awful,” she continued. “What in the world are you drinking?”

It was chard, spinach, parsley, apples, blueberries and grapes Vitamixed into my morning drink.

“It looks awful,” she opined distracted for the moment. “I would never drink that.”

I assured her it was very tasty and asked if she wanted to try it.

“You would have to blindfold me first,” she replied. “It looks like pond scum.”

I started to laugh. “Well, it does,” she insisted unfazed. “So explain to me what these tests mean,” she demanded pulling out a stack of papers from her hospital visit. “My doctor won’t tell me anything.”

So, not everyone cares about what I eat and my personal consumption is not necessarily relevant to anyone else. Like most nutritionists, I have played extensively with my diet because it is interesting to me and I want to experience what I recommend. Through the years I have toyed with macrobiotic, raw, vegetarian and vegan diets. I have tried dairy free, gluten free and sugar free elimination routines. Most nutritionists I know are also diet dabblers.

In the end, we figure out what works for us, personally and develop a bag of tools for everyone else. For example, I consume almost no alcohol because it makes me tired but realize this experience has limited application to most people in my practice. On the other hand, I avoid artificial colors, sweeteners and flavors and eat plenty of fruits/ vegetables and believe these principles have general application. Most other factors, especially when it comes to food avoidance, applies to some people but not others. Other nutritionists I know imbibe with abandon, are vegetarians or are not, smoke pot, avoid hemp, eat cheese, don’t eat cheese; We are pretty much all over the place in diet and personality.

The one consistent factor is a vast majority of us are not obese. We are an intimidating group of thin-ish women in a society rift with distorted body images and unhealthy relationships to food. I believe this is the real source of questions from the mothers of Tory’s friends. They do not ask me directly what I eat because I might ask them back. Better to secretly compare what they are eating to someone who, in theory, knows what they are doing and is thin. The question they are really asking is the dietary equivalent of, “does this skirt make me look fat?” That is, does my diet look like it is making me fat?

As any husband knows, answering THAT question is a minefield.

#5 Me and the GI Guy

2010-08-09T17:42:00.000-07:00

“The GI (gastrointestinal specialist) agrees with you,” my neighbor announced triumphantly when I opened the door.

“Then it must be right,” I drawled dryly.

Undaunted, she walked in and happily relayed the details. Several weeks ago, she had approached me with the seductive come on…”I know how much you like medical mysteries…..”

She then went on to explain a strange vomiting illness that she developed every time she went to visit her husband who worked and lived in another city. After 24 hours, she would be overcome with a flu-like illness and have to spend a day or two in bed. She and her husband traveled extensively but this situation only occurred and it occurred every time, she went to their apartment in New York. China, Rome and Chicago: No problem. New York: Two days in the bathroom.

She had already talked to several doctors and specialists when she approached me and they were all “baffled”, in her words. She had been given a clean bill of health and sent from one specialist to the next.

I started with the kind of questions that come to mind when the unusual occurs….
Did it ever happen, even once, somewhere else?

No.

Are the symptoms always the same?

Yes. I am fine for the first 24 hours and then get the same vomiting illness.

Are there any other symptoms? Itching? Fever? Tingling of the hands?

No.

Do you have any other medical problems or are you taking any medication that could sometimes cause these symptoms?

My internist says, “no”.

Does it happen if you stay other places in New York?

Not sure because I always stay at the apartment.

Is the apartment in an old building?

Yes, but we renovated it.

The insides are new?

Yes.

I told her I was suspicious about the building and suspected a reaction to mold. I had run into several cases of building mold causing strange symptoms and too many were linked to pre-war buildings in New York City. Nonetheless, I asked her if I could present her case to a medical study group I belong to, to see if any of the doctors or therapists in it had any additional ideas. She agreed and until she rang my doorbell, I had not seen her for several weeks.

The study group had two alternate lines of consideration. One line was psychological and the other biochemical. Was she emotionally reacting to moving between two very different lives: one here and the other in the big city? Interestingly, the doctors in the group were curious about psychological causes. The other idea was solvents from sealing floors or other chemicals used to renovate.

I presented both these possibilities to her. She balked at the psychological suggestion claiming it was more relaxing in New York than being here where she was on frequent grandmother duty (which she loved but was exhausting). The floors were installed pre-finished, so there was no off-gasing, there. The paint had dried and aired out long ago.

So, we were back to GI guy agreeing it was something in the apartment and reconsidering mold. I gave her the number of a great company that sells mold test plates and she said she would run the tests. (FYI…the company is called Tennessee Mold Consultants and not only do they run a mean test, the results provide specific counts and mold type.)

Will let you know what happens.

# 4 Looking for Mr. Rightcheese

2010-08-01T16:12:00.000-07:00

Cheese substitutes for the dairy-free have traditionally been pitiful. Without casein, the most abundant protein in milk products, the darn things won’t melt. Like a wad of rubber cement, they lay on your faux pizza defying any amount of heat a conventional oven can muster. I often wondered if an acetylene torch could do the job but my husband will not let me near one. Besides, there would still be the unappealing taste to contend with.

Through the years I would watch one digestion disturbing contender after another appear then disappear from the shelves of the nearby health food markets. I would imagine the dairy free newbie demanding their local establishment stock these alternatives and then buy exactly one package. I know I did. However, one taste and the verdict was inevitably, “blech”. The remaining packages would sit in the dairy case until the expiration date arrived. Then the unsold items would be tossed away and the product unavailable until the next unsuspecting consumer approached the store buyer and the whole cycle started again.

Every year I went to the National Health Expo, where new products for the health food industry are rolled out and dutifully tasted any new cheese substitute offering. About 10 years ago, a melting soy based product was introduced. It was soy-y tasting but acceptable and it melted without the addition of casein. I was hopeful, but the company was not viable and the product died a quiet death before anyone even heard of it.

A few months ago, a client reported they had found a great cheese substitute. Since we were speaking by phone, I could roll my eyes with abandon. I asked the critical questions:

Does it melt?

“It does,” she swore.

Does it taste like old socks?

“Not a bit,” she claimed.

I dutifully wrote the name down in case I ever ran into it. (A good detective checks things out.)

The product is called, Daiya and within a week, I spotted a package at Whole Foods. It comes shredded in two flavors, cheddar and mozzarella. I bought the mozzarella version and for the first time in many years, I made a pizza.

The good news is that it is tasty though Wisconsin does not have to worry about losing its share of the cheese market to it. Nobody who eats cheese would willingly choose Daiya. It does indeed melt and within a few weeks, Whole Foods was using it to make a vegan pizza alternative.

Now, the bad news: it is not health food. The main component is tapioca. The result is 6 grams of carbohydrate and one gram of protein per serving, it is about the nutritional equivalent of putting white rice on your pizza. Still, if you load your pizza shell with tomato sauce and vegetables, a sprinkling of Daiya makes it much more like regular pizza. Or if you use a little to melt on top of a turkey sandwich or vegetables rather than trying to make a plain “cheese” sandwich with it, there should not be too many nutritional concerns.

Bottom line: Daiya is a useful condiment.

#3 PANDAS continued.…….

2010-07-23T06:14:00.000-07:00

“Alex’s doctor wants to talk to you today,” Tania, my stalwart assistant informs me.

“Which one?” I ask. This clarification was important as Alex’s mother had now consulted at least four physicians/specialists plus the ever present Dr. Internet.

“Well, let’s have a look see, shall we?” Tania chirps.

I hear the unmistakable click click tap tap of computer keys.

“That would be Dr. W.” she clarifies. “Do you have her number?”

I did but I could not help but have an uneasy feeling. Mrs. P had taken Alex to a well known PANDAS expert for diagnosis confirmation plus the most up to date treatment protocol. Alex had been on antibiotics for a week and from all accounts was making remarkable progress. Her repetitive behavior had reduced significantly and I was hoping for a quick and full resolution. Mrs. P had been aggressive and rapid in her response. She had latched on to the PANDAS idea and had become a lay expert in an incredibly short period of time. Consequently, she had been in almost daily contact with questions and reports. She was a bit of a nervous Nelly but who wouldn’t be after witnessing such dramatic behavior changes in their child?

“Mrs. P is going too far,” Dr. W blurted with little preamble.

I suspected she was referring to the daily e-mails and blow by blow tic reports that were cc’d to the group of professionals Mrs. P had assembled.

“Every small flick or head toss the mother is attributing to PANDAS and is pursuing more and more involved treatment. I saw Alex this week and she is perfectly fine,” the doctor continued.

“Well, it is still pretty early in the treatment,” I countered. “Mrs. P does not understand the long range view and is trying to calm her anxiety by having a back up plan.”

“ No way,” the physician argued. “Something has to be done. I think we are dealing with a case of Münchausen syndrome by proxy.”

Oh boy. Münchausen syndrome by proxy (MSP) is a condition where someone, usually a caretaker or parent, invents or exaggerates medical symptoms leading to excessive medical procedures or unnecessary treatment of their charge. It is a particularly twisted form of child abuse but I am reluctant to jump on the MSP bandwagon. Not because I want to ignore potential child abuse but because the label is thrown around way too often when a parent is a little overbearing or if the mother (in particular) is persistent about a course of treatment her physician does not support. The more mysterious the illness, the more often one hears about suspicions of MSP.

I wish the doctor had just said she couldn’t stand Mrs. P and had blown off steam the old fashioned way by calling her a witch or a pain in the butt but that would have been unprofessional. So, instead, she had to hide behind this devastating charge of serious mental illness.

Mrs. P did not have MSP and Dr. W was not a bad doctor, they were both just wielding the tools they had but the result was about to get ugly. I spent the next few weeks bouncing between the two of them (usually via e-mail) emphasizing common goals and places of agreement. Mrs. P started relaxing as Alex’s tics continued to diminish. She dropped the idea of pursuing further experimental treatments and agreed to a monitoring program instead. Dr. W. with further input from the PANDAS expert, developed a deeper understanding of the condition and was able to help Mrs. P evaluate neurological symptoms that could signal a recurrence of strep.

Alex finished a long round of antibiotics and recovered completely. Ironically, Mrs. P calmed down enough to realize she did not need so many doctors and got rid of Dr. W. first.

2010-07-18T11:57:00.000-07:00

#2 A bear by any other name…..

“ Alex has OCD (Obsessive Compulsive Disorder)! She was fine until a few weeks ago and now she gets stuck on everything. She was fine and so normal. Now she has completely regressed. It is horrifying to watch, “ Mrs. P relayed without pausing to breathe.

I had not heard from Mrs. P for over a year. Alex, who had a history of developmental delays had completely recovered with some miraculous combination of nutrition support, solid therapy and persistent parenting.

“Can you give me some examples of what she is doing now?” I asked.

“She opens and closes doors over and over or she repeats the same thing a half dozen times, “ Mrs. P supplied readily and then lamented, “All of the gains she has made are gone.”

After several more minutes of clarification it appeared that while Alex’s behavior as off, her cognitive development was unaffected. Having honed in on the symptoms, we threaded through the recent history.

Had she been sick around the time of the change?

No.

Had she changed her eating or sleeping patterns?

Negative.

Had the doctor checker her over?

Yes.

Her conclusion?

Everything was fine and it was a minor quirk that would pass.

Trips, school changes, life changes?

No, no and no.

Were there indications that the repetitive behavior was diminishing or possibly getting better?

No. Mrs. P thought the symptoms were getting worse.

Has strep been going around the school?

Yes. There was a notice sent home several weeks ago but Alex was fine.

Now we were getting somewhere. Strep can often be asymptomatic that is, without symptoms. A lovely researcher I know from NIMH named Susan Swedo, discovered that strep infections can cause the sudden onset of OCD. She called this condition PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Strep).

I explained the emerging link between strep and sudden development of obsessive and/or repetitive (including tics) behaviors to Mrs. P. and suggested she call her pediatrician and request a strep test. The least invasive way to do this is with a throat culture but if the throat culture is negative a blood test is needed to completely rule out PANDAS as a possibility. The basic blood test measures DNAase and ASO titers for strep.

Mrs. P wanted the problem solved yesterday so she hung up and called her doctor immediately demanding a blood test. The doctor balked and suggested a throat culture. Mrs. P refused to budge and I am sure would make an excellent district attorney if she ever put her mind to it. It was a good thing she was stubborn because the blood test was run and came up strongly positive.

It was PANDAS alright so you would think that would be the end of this story…..
(To be continued……)

#1 Nausea 911

2010-07-11T17:35:00.000-07:00

“Emergency call!” my trusty virtual assistant Tania informed me on during our daily check-in. “I told her you would call her back when you get a break.”

“But that is the only break I have all day,” I whined.

“Yeah, yeah, yeah, just call her,” Tania sympathized unfazed and hung up.

You would be surprised how many urgent calls I get. Some days it feels like I work in a nutrition emergency room. No, people are not calling to find out what to substitute because they ran out of sorghum gum and they need to make those gluten free birthday cupcakes before 2:00!

The sad truth is I get so many MAYDAY calls because of the tremendous gaps in health care delivery. Many doctors don’t have time for the minor-to-them, major- to-the -patient kind of concerns that come up. The overwrought patient is told to make an appointment or go to the emergency room-if they get a call back at all. For those who do not have insurance, a few questions can get expensive quickly.

One specialist, who I really like because he is thoughtful, open minded and thorough, wont’ return a call even if the patient is bleeding from the mouth. (This actually happened once to one of our mutual clients and I spent a week begging his assistant to call the patient. Shockingly, he did not and other arrangements had to be made. Still, the specialist has a long waiting list.)

But I digress. This emergency involved a woman who had been waking up dizzy and nauseous for the last few days. She put a call into her doctor but was terrified her symptoms could mean expensive tests and visits and money was tight. She was scared but wanted to talk to me first, in case the problem was nutritional.

People really do have good instincts. Personally, I would be worried about having cancer or an ulcer or something but since she asked about nutrition…….

She was waking up with the symptoms, so I asked her what she was eating for dinner the last few nights when the symptoms started. Specifically, was she skipping dinner, eating a very light or early dinner?

“Now that I think about it, I have not eaten much for dinner the last several nights”, she remembered.

“Aren’t you a little prone to low blood sugar?” I fished. She was but did not realize the symptoms of low blood sugar could get so bad, they never had before. She quickly admitted to not eating much dinner but my spidey sense suspected she may have been skipping some of those dinners.

The fast between dinner and breakfast can be 12-15 hours which is too long for some people to go without eating. I explained to her that the symptoms of low blood sugar can include both dizziness and nausea. We talked for a minute about eating enough dinner or a protein rich snack before bed if she retires late or eats very early.

She quickly calmed down, agreed to see her doctor if correcting her diet did not immediately fix the symptoms, thanked me and said good-bye.

Emergency averted.
Break over.