In this episode of The Dr. Hedberg Show, I interview DUTCH test founder Mark Newman.  We covered a lot of detailed information about hormone testing and why the DUTCH test is superior in many ways to other forms of hormone testing.

Here is a transcript of my interview with Mark Newman on the DUTCH Test

Dr. Hedberg: Okay, well, welcome, everyone. This is Dr. Hedberg and welcome to "The Dr. Hedberg Show." I'm excited today to have Mark Newman on the show, and Mark is the founder of Precision Analytical. This is a lab that I've been using, I think, pretty much since the beginning, but Mark is a recognized expert and international speaker in the field of hormone testing. He has assisted many labs in developing novel tests to create world-class laboratory testing. He's also educated thousands of providers about hormone monitoring best practices. Welcome to the show, Mark, thanks for coming on.

Mark: Yeah, glad to be here. It's good to chat with you.

Dr. Hedberg: Why don't we start with you just filling everybody in on what you've been doing and what you've been working on with your testing?

Mark: Sure. The tests that we do and most people know it by its acronym, which is DUTCH, so it's a Dried Urine Test for Comprehensive Hormones. It's kind of a culmination of everything I've done career-wise vocationally in this world of hormone testing, starting off developing and working on 24-hour urine testing and kind of taking a good look at that in terms of the pros and cons. And then moving on to blood testing and saliva testing and governed over about a million of those tests over a five or six-year period. And what we've been doing the last five or six years is trying to piece together a little bit of a better model for people to get more information when it comes to reproductive and adrenal hormones.

You know, saliva testing has its advantages and blood testing has its advantages, and we've tried to combine all of that into one model that people can use to get a lot of information. So, we've got a uniquely comprehensive look at your adrenal hormones and your reproductive hormones and that's what we did and launched in about 2000, early 2013. I think you were kind of one of the first to jump on with us, which we've, of course, appreciated. And since then, we've been looking at this puzzle and saying "Okay, what else can we add to this to add into the picture?" So, we added a melatonin marker, we added 8-Hydroxydeoxyguanosine for an oxidative stress marker.

And then we've recently added a handful of organic acids so that we can see B12 deficiency, B6 deficiency, glutathione deficiency, a window into the neurotransmitter world. Because those all have a lot of crossover with the hormones and our goal and my goal is really just to give people the best most cost-effective tool they can for when you're dealing with functional medicine, integrative medicine and just some of these tough cases where you've got multiple things going on and we're trying to figure out as much as we can about those patients so that we can treat them well.

Dr. Hedberg: Yeah, I was really looking forward to this interview so we can really delve deep into some of these areas. So, like you said, I think I was one of the first to start using the DUTCH Test and like a lot of practitioners out there, I started with saliva and blood. And then I had done some 24-hour urine, but that always was a little bit difficult to get the patient to do all 24 hours of collection. And then with that, we didn't have the cortisol rhythm that we have with the DUTCH Test. So there were a few disadvantages there, but why don't you give us a general breakdown of the advantages of urine compared to saliva and blood testing?

Mark: Sure. Yeah, I mean, I think historically, if you're trying to use something for its biggest advantage, then you're really better off, if saliva and blood are your options, you're really better off going to saliva to look at cortisol. Because you want to look at not just free cortisol, which you're not typically getting in blood, but you want to look at free cortisol at multiple points throughout the day, right? Blood cortisol is not a useless test, but it really tells you so very little, and we could go into the specifics of that, but it's just well-documented that going to saliva to get free cortisol over time is better. But then when you look at the reproductive hormones, there are very significant advantages to testing the blood over saliva, and I would point mostly to the problems in testing estradiol.

And that is, you know, with no disrespect to the labs that are doing the test, there's just so little hormone in saliva that your ability to differentiate between "sufficient" and "deficient" is really just not done well enough for us to make decisions. So just as an example, I can think of a very prominent lab that does a good job with lab testing, but if you look at their saliva assay, the estradiol range for postmenopausal women and premenopausal women is essentially the same. So what I'm saying is when we test otherwise healthy people who are estrogen-deficient and estrogen-sufficient, we get essentially the same values.

And when you look at those in blood, there's a full tenfold difference between those two groups, so blood is a much more accurate way to test reproductive hormones, typically. So what you're gonna do, you use both, you got to kinda pick and choose. And what we've shown is that our pattern of free cortisol in urine parallels saliva very well, and we just about got in print our correlation data for reproductive hormones, particularly the female ones, between our urine testing and blood testing.

And one of the other things about blood testing is, well, the numbers, I think, are better than what you're gonna get in saliva, I was just reading a paper actually last week where they tracked a woman throughout a day, and her progesterone varied from 5, which is really on the lower end of, you know, in ovulatory number, all the way up to 35 throughout the day, so it's bouncing all over the place throughout the day. With a urine test, you can average that out and get a truer picture of what their production is.

So, our goal is to give you a viable alternative for those reproductive hormones and the cortisol pattern and the reason that that was my angle when we started working on the DUTCH Test is because once you've established that, now you can open up your panel to everything else that you can do in urine, which includes your estrogen metabolites. So not just estradiol, but, you know, phase 1 metabolites, 2-hydroxy, 4-hydroxy, 16-hydroxy, then you can look at methylation, which is a part of phase 2. And the same story for the androgens, you can look at the hormones, but also the metabolites to see if they're pushing down that highly androgenic 5-alpha pathway like you see in PCOS patients and other situations.

And this story continues to unfold for cortisol and other things. As looking at the metabolites, just adds a lot of value to try to figure out what, really, someone's story is as it relates to that hormone and then when you continue on melatonin, 8-hydroxydeoxyguanosine, organic acids, you just got a really, a comprehensive look that just isn't there with those other tests. Although, having said that, you know, if I've got a testosterone injection and my only goal is to get a good testosterone value on a guy, a blood test is a great way to do that. To get a total in a free testosterone, you know, that works well. If you just want to look at that free cortisol pattern, you know, saliva can do that quite effectively. But when you want to get comprehensive and really see what's going on, that's where, for me, urine brings a lot of value because you're getting everything that you had in those other tests, but you just add, you know, so much more.

Dr. Hedberg: Yeah. I always felt the least comfortable with saliva, the most comfortable with blood and urine, blood especially with testosterone and then urine with the adrenal hormones. But like you said, for me, there was, all was...there just always seemed like there was a lot more to look at and then when the estrogen metabolism markers came out and that became an individual test that was available, I started getting interested more and more into that. And that's something that the DUTCH does test for, so can you talk a little bit more about estrogen metabolism and if there's any advantage to adding those metabolites?

Mark: Sure. Yeah, the metabolites, to me, have kind of two or three different angles. One is, and this is another benefit of urine testing, is if I'm gonna call you estrogen-deficient or estrogen-sufficient or whatever, it's sure nice to have more than one marker, right? So, if I'm looking at, now we have 10 estrogen metabolites, right, when they're all tanked in that postmenopausal range, like, I know who you are as it relates to estrogen. And if there are high, like, that's clear, too, but when you get some of these weird cases where they've got some unique patterns, it's sure nice to see a lot more to just confirm where that patient may be as it relates to just not enough or enough or too much.

But then there's another story that we often see and that is what if your, the reason that you have too much estradiol is not because you're making too much, but because you're not getting rid of it properly. I've had a number of friends who, you know, have come to me and they're just not feeling right and it sounds like estrogen dominance. "Okay, we could just put you on a treatment of, you know, calcium-D-glucarate and high fiber diet and try to get rid of inflammation and maybe some DIM and some of those things." But then we test them and we see is, "Okay, your estradiol is high, but all of your phase 1 metabolites are low."

So, here is a picture of a woman who is making just a decent amount of estrogen,

In this episode of The Dr. Hedberg Show, I interviewed writer and thyroid advocate Rachel Hill of The Invisible Hypothyroidism.  We discussed Hashimoto's disease, hypothyroidism, and many connections to these illnesses.

Rachel suffers from thyroid issues herself so we can learn a lot from her about her personal experiences.  I urge everyone to listen or read and connect with her through her website and social media which I have linked to at the end of the transcript.

Here is a transcript of the recording with Rachel Hill for those who prefer to read rather than listen:

Dr. Hedberg: Okay. Well, welcome, everyone. This is Dr. Hedberg and today, I'm gonna be talking to Rachel Hill. And Rachel Hill is the founder of Invisible Thyroid and just some background on Rachel. She was diagnosed with hypothyroidism, Hashimoto's disease, as well as chronic fatigue syndrome, as well as having adrenal fatigue, and experience with depression and anxiety disorder. Rachel created The Invisible Hyperthyroidism. This is an award-winning patient advocacy blog that focuses on helping others by advocating for better thyroid disease diagnosis and treatment. So, I'm excited to have you on. Welcome to the show, Rachel.

Rachel: Thank you for having me. I'm excited to talk to you today.

Dr. Hedberg: Excellent. Why don't we start with you talking about The Invisible Hypothyroidism, exactly what that is and why you started it?

Rachel: Yes. So, The Invisible Hypothyroidism is the name of my thyroid patient advocacy blogging website that you've just touched on. Under that name, I also get involved in other things such as doing interviews, podcasts like this, fundraising for thyroid charities, and I run a couple of forums in Facebook groups as well to reach for the thyroid patients and other halves, to provide some support and advice, really. The Invisible Hypothyroidism encapsulates what it means to advocate for yourself and your own health, which I think is incredibly important and something that I've learned along my thyroid journey.

Before my blog went live, back when I used to write about my experience as a coping mechanism, like a diary or journal if you will, for myself to read back on. I wrote a poem called, The Invisible, which I really wrote to try and encapture all the sides of living with thyroid disease, which is an invisible illness, and all the signs a lot of people don't understand or see. So, when I decided to start writing on a private blog space, I used the title of this poem, The Invisible, but felt that The Invisible Hypothyroidism described what I was writing about and wanting to convey much better.

And I just wanted to just, kind of, get out all of the sides of hyperthyroidism that people often don't see, and all the various sides that I was struggling with. And then eventually, I turned my little private corner on the web where I was blogging my personal experiences to a public setting, and my blog went public and I haven't looked back since. It's been really popular, and a lot of people seem to resonate with my experiences across the globe actually. And despite being based in the UK, about 60% of my traffic is from the U.S., which is quite interesting.

Dr. Hedberg: Excellent. So, of course, you've gone through this yourself. You've been diagnosed with hypothyroidism, Hashimoto's, chronic fatigue. So, that was obviously a motivation, but can you give us some more insights into what motivated you to become an advocate for thyroid patients, and also create The Invisible Hypothyroidism?

Rachel: Yeah. So, essentially, I'd had signs and symptoms of hypothyroidism and Hashimoto's for years. And I was frustrated that it took so long for doctors to find it and then get to the point where I was eventually diagnosed and then began treatment. I was just flabbergasted, if you will, that it had been missed for so long, and even worse, that there are still people out there who don't know that they have it, or like me, get diagnosed eventually, but still remain on poor treatment. And in some cases, don't get any treatment at all for it, especially those given the sub-clinical or borderline hypothyroid diagnosis like myself. It's really unhelpful.

As soon as I reached out and got in touch with our patients from across the globe online, I soon became quite shocked and astounded that so many people in the same position as me were still suffering, and most importantly, suffering needlessly as well. I mean, people living with hypothyroidism can live a full, good quality life. They don't have to crawl through each day like a zombie. And so after learning all of this myself, I decided that change needed to happen, and especially, for thyroid patients in the UK as well who are often quite under-voiced due to the lack of British Thyroid Advocates.

So, I began writing and quite scarily, actually, sharing my stories and personal experiences of what I had encountered so far online, and I soon realized that a lot of people were resonating with this. And so I expanded on what I was doing and just kept on going. I think behind everything that I do, I just want to let other thyroid patients know that they're not mad, they're not imagining things, and most importantly, that they're not alone. Which so many people do sadly feel so alone and isolated in what they go through with thyroid disorders.

Dr. Hedberg: Right. Yeah, your story is similar to a lot of people's that I see in practice. Usually, there's been a misdiagnosis, or patients are told it's all in their head. And then of course, if you have Hashimoto's there's really no conventional medical treatment for that, other than thyroid medication. So, there's a lot of people out there, especially women, who are suffering with this. So, you've got a lot of great information on your site, The Invisible Hypothyroidism, with some good advice. Do you have any... Is there a single, top piece of advice that you wanna give people out there with thyroid problems?

Rachel: The number one thing I always say to anyone living with hypothyroidism is to embrace being your own thyroid advocate. And that is the sort of, big tagline or slogan, if you will, across the top of my website. By this, I mean, learning what is part and parcel of having thyroid disease, and then what isn't, learning to stand up for yourself and your health so that you can make progress in how you feel. Unless this includes learning what lab tests you should be having done, what results you're aiming for, and this obviously, is taking into account optimal levels as opposed to just falling within a wide, outdated range often.

And includes researching, and reading, and embracing, being more involved in your own health care and treatment. The people who feel better and the ones who make progress are often the people working with their doctor. With a good doctor, often, within functional medicine even, and the people who embrace being their own advocate, they're the ones who tend to get better.

Dr. Hedberg: Right. Right. So, everybody's different when it comes to hypothyroidism and Hashimoto's, and what I do is I will look... Usually, we began with birth and childhood because we're learning a lot more about the connection with early, adverse, life events and the autoimmunity as an adult. So, for example, women have autoimmunity at a much greater rate than men, and if we look at traumas as a child or teenager, we're seeing significant connections there with adult autoimmunity, cardiovascular disease, inflammation, things like that. And a lot of these patients are very different in their first signs and symptoms when they develop this condition. So, can you give us some background on what your first signs and symptoms were?

Rachel: Yes. So, I think for me, throughout my childhood, there were early signs, sort of, dotted all the way through. For example, I never used the toilet regularly, perhaps once every one to two weeks, which is quite shocking really, and we know that constipation is a big symptom of an under-active thyroid. But from as young as I can remember, I can remember that that was just normal for me, but it was never really picked up on. I was often referred to as being lazy, especially as a teenager, and I think a lot of people passed that off as just being a teenager, sleeping in on the weekends or just being generally lazy or having a lack of energy, overall, or thinking that you can't be bothered or you are not motivated.

And I've also lived with anxiety my whole life, although I didn't realize at 19 that that's what it was, and I just put it down to being a worrier or overthinking things. But it really was anxiety and anxiety can be debilitating on its own. Again, that can be another symptom of thyroid issues and Hashimoto's, especially. But at age 16, this is where I look back and notice the real triggering of Hashimoto's beginning for me. Following catching swine flu, which you may remember was a huge outbreak out in the UK specifically in 2009, I never really recovered after it had gone.

I had achy legs and strong bouts of fatigue that would come and go. And this is really just the start of my health declining. It's quite sad really, that it started so young as well, at just 16 years old. And then over the next 5 years, I developed over 20 other signs and symptoms of hyperthyroidism that I would keep jotting down on a note on my phone because the doctors just weren't really believing me. They thought I was making all of these things up that included things such as cough cramping at night, depressive bouts, acid reflux, cystic acne, despite being 23 years old when I developed it. Irregular and heavy periods, dry skin, eczema, dermatitis, brain fog, gluten sensitivity, brittle nails, hair loss and the list just goes on. So, by this time I was diagnosed with hyperthyroidism and Hashimoto's at 21, I was a complete wreck and I was a shell of who I used to be.

In this podcast, I discuss the gut-brain axis with Dr. Jeff Moss.  This was a fascinating conversation about the latest research on the connection between gut microflora and it's intimate connection to the brain and nervous system.  We talk about this connection with neurotransmitter imbalances, autonomic nervous system dysfunction, Alzheimer's disease, Autism, gut healing strategies and much more.

Here is the transcript of my conversation with Dr. Jeff Moss on the Gut-Brain Axis:

Dr. Hedberg: Okay, well, welcome, everyone. This is Dr. Hedberg, and thanks for tuning into "The Dr. Hedberg Show." I've got a very special guest today, Dr. Jeff Moss. And Dr. Moss is a graduate of the University of Michigan Dental School 1974. He practiced dentistry in Grand Rapids, Michigan until 1985. And he employed clinical nutrition in that practice, and he decided to use that experience and enter the professional supplement industry.

So, for the last 24 years, Dr. Moss has operated Moss Nutrition, which supplies the Moss Nutrition professional line of supplements to practitioners. And, since 2000, he has served as adjunct faculty at the University of Bridgeport Nutrition Institute, starting with the vitamins and minerals class and most recently adding the assessment in nutrition class to his teaching responsibilities.

He's co-authored the textbook, the "Textbook of Nutritional Medicine" by Dr. Melvyn Werbach, and Dr. Moss was president of the International and American Associations of Clinical Nutritionists from August 2000 to June 2001.

Moss Nutrition's website is mossnutrition.com, and those of you who are patients of mine know that I'm a big fan of Moss Nutrition products because of the quality and because of all the research behind their products, and just fantastic customer service, and just a great company to work with across the board. So Dr. Moss has definitely been a mentor of mine. He's one of the only doctors out there in the functional medicine world who I listen to and respect, so I'm really excited to have him on. Jeff, thanks for joining me.

Dr. Moss: Well, thanks so much for having me.

Dr. Hedberg: So today we're gonna be talking about the gut-brain axis. This is a topic that is kind of sweeping the functional medicine landscape with good reason. We've been addressing this issue for a long time, but we're learning more and more about how the gut flora affect extraintestinal aspects of the body, and the brain, and the rest of the body system. So why don't we jump in, and can you just talk a little bit about how the gut microbiota actually interact with our nervous system?

Dr. Moss: Sure, there are really several different ways that it does it, and before I get into all of the ways, I guess the big picture here is that why this is so interesting and why it is important and so exciting is, because of the way we've traditionally viewed any type of central nervous system issue, either behavioral or neurodegenerative, we've kind of viewed as the central nervous system kind of hanging out there in space. We view the blood-brain barrier as basically impermeable to a lot of different things, and because of that the way we viewed it and the way we intervene was basically looking at it directly. There really wasn't connected to anything else in the body.

And I remember I got this very early on as a dentist. You know, the head is just kind of detached from everything else from a physiologic and mostly in terms of a diagnostic and clinical interventional therapeutic standpoint, and so I think that's the big picture here before we get into the complexities even if some of it's a bit difficult to understand. The big picture here is that the brain is incredibly influenced by what else is going on in the body, and particularly what's going on in the gut. So, with that in mind, there are really several different ways.

Number one is what is classically known...we have neuroanatomical pathways, the autonomic nervous system, the vagus nerve, the classic anatomy, and the gut flora can have a direct impact on that, but really that's only the beginning. It also can have impact on stress physiology, what is known as the hypothalamic-pituitary-adrenal axis.

Research shows that gut microflora...and I'll talk about how it does that in just a second, but it has an impact on stress physiology, the endocrinology, and the pathways involved, and how we respond to stressors. There, of course, is the immunologic impact. Gut microflora have a direct impact on the immune system in the gut, and most immune cells are in the gut, but beyond that, there's kind of a ripple effect where it has an impact on systemic immunity.

And the reason that is important, we now understand that behavioral and neurodegenerative illnesses are primarily inflammatory, that there is a neurologic immune system mediated by some cells in the brain called microglia. They're like inflammatory cells, if you will, like an inflammatory cell, like a lymphocyte or a neutrophil, but it's in the brain. They call them microglia, and gut microflora can upregulate activity of this microglia the same way they might do it systemically with the white blood cells we're all familiar with. So that's another way that it can do it.

It also has an impact on the blood-brain barrier. What I mentioned before, this idea that it's kind of impermeable, well, it will have an impact on the blood-brain barrier and may basically make it more permeable. We know that imbalances of gut microflora, for example, will affect the gut barrier, creating leaky gut. Well, the gut microflora can also create leaky brain, for lack of a better term.

The factors that are involved in terms of creating this scenario, gut microflora are responsible for producing short-chain fatty acids, and from a positive aspect, these short-chain fatty acids are well-known to [inaudible 00:06:47] butyric acid can improve the health of the gut lining. But there are other short-chain fatty acids, again, pre-produced, and when there's an imbalance, these short-chain fatty acids can actually get into the brain. If there's a leaky gut, they circulate, go through the leaky blood-brain barrier, get into the brain and cause disturbances in that way.

They also produce something that most of us aren't familiar with, GABA, gamma-Aminobutyric acid, which can have an impact. Another big way that the gut microflora interact, as most of us know, we all know about serotonin, and we tend to think about serotonin as a central nervous system issue. We're all familiar with SSRIs for depression. Well, in actuality, most of the serotonin is not produced in the brain. When you look at the total body production, most of it is produced in the intestine, and gut microflora, when there are imbalances, can affect the serotonin production in the gut. And this is fairly well-known as being related to...contributing to IBS, constipation, different types of IBS manifestations. But we now know that the serotonin produced in the gut, which is influenced by gut microflora, can also affect the central nervous system. It's not just a systemic IBS-type scenario.

Finally, I did wanna talk a bit more about its impact on the vagus nerve. This is significant. And the vagus nerve, of course, as we know from our anatomy days, this is a very large nerve that has several different functions, part of which relate to the gut. But, again, this can have systemic manifestations also.

Dr. Hedberg: Yeah, and one of the things that I see very frequently in practice which ties in with everything you just talked about links to early adverse life events. And if we go back to childhood and we look at antibiotic usage at a very young age, and not just antibiotics, but not being breastfed, C-section, poor diet, and then all those psychological and physical traumas that people can go through as a kid.

There are so many connections there kind of setting someone up for some difficulties later in life, not just with their microflora, but with mood disorders, and irritable bowel, SIBO, inflammatory bowel, and things like that. Did you have anything to add to that regarding early adverse life events and a disrupted gut-brain axis?

Dr. Moss: Yeah, you make a very good point. For about 100 years now, we've been conducting this uncontrolled experiment on manipulation of our microbial environment, both in the world around us and the world inside of us. Antibiotic use is about 100 years now, and it starts, of course, for most people in terms of direct administration, some people, as you say alluded to, very early on. But when you look at the antibiotics in the food supply, it probably starts in utero, before birth.

And so, yeah, you make a very good point, that in our society after a 100 years of antibiotic use, we have created some disturbances in our gut microflora let alone the microflora world around us. Now, unfortunately, this, of course, is not all black and white. Am I saying that we shouldn't have had antibiotics? History of infectious disease suggests that there's a lot of benefit, and I'm not going to argue against that for a minute.

There are certain scenarios of certain types of bacterial infections, and certain populations, certain individuals, particularly very young and the very elderly, where antibiotics have definitely...the benefits have definitely outweighed the risks. What's the problem, I think, is we have seen gross overuse and misuse.

If they were used the way that they intended in the '20s, when penicillin was first discovered, limited occasional use for significant bacterial infections, I don't think we would be having this conversation that we're having today, or we'd have this conversation, but it would've taken a very different path. It's the overuse and the misuse that has really put us where we're at. So I'm not condemning antibiotics. I'm condemning poor decision-making about antibiotic use.

Dr.

Approximately 90 million Americans now suffer from some type of sleep disturbance.  Rejuvenating sleep is an extremely important and fundamental part of feeling great and healthy. Unfortunately, too many of us are plagued with insomnia and miss out on sleep's wonderful healing properties.  You'll become more inflamed and more insulin resistant simply by getting 6 hours of sleep or less.  Your immune system will also suffer significantly if you don't get enough sleep making you more prone to colds and the flu.  This article will explain what you can do (and what you should avoid) to naturally cure insomnia at home.

 

Get Into the Rhythm

Getting good sleep is all about balancing your circadian rhythm.  The best thing to do to kickstart a healthy circadian rhythm is to expose yourself to sunlight before 8:30 am.  When you get up in the morning it is time to tell your brain that the sun is out and it is time to get your body and your hormones going.  Step outside and soak up some early morning sunrays or do a brisk walk first thing to get you going.

If your work schedule doesn't allow this, just try to set up your workspace near a window or get outside as much as you can during the day when you're on break or during lunch.

What About Exercise?

Exercise can significantly improve your sleep quality. The earlier in the day the better if you are going to exercise, but some exercise is better than none so do it late if you have to.  Moderate and intense exercise raises cortisol so if you are going to exercise late in the day be sure it is something light and gentle such as Tai Chi, light stretching, gentle flow yoga, or a walk around the neighborhood.

Stay Away From Drama

Avoid watching television before you go to bed as this can disrupt your sleep.  Watching the news can trigger negative emotions such as fear, anger, and frustration which will raise cortisol and adrenaline.  Avoid intense movies or reading material as this can stimulate your adrenals which will keep you awake.  Read some light fiction or learn something that is easy to understand and pleasurable.

Social media is the perfect way to upset your mind and your rhythm.  Social media increases the sleep-disrupting brain chemical dopamine with all the notifications, flashes, arrows, videos, ads, links, and inflammatory posts by your "friends."  Even if you don't have sleep issues I recommend avoiding social media outlets such as Facebook as I mention in this article on how Facebook could be making you sick.

Stay Consistent

Try and follow a regular sleep schedule. Go to bed and wake up at the same times every day.  Make going to sleep a ritual and stick with your plan even on the weekends.  Don't stay up late on the weekend and then try to sleep in.  This disrupts your consistency and throws off your rhythm.  If you really want to change your life and feel better then commit to a consistent schedule.

The hours you sleep from 10 pm to 2 am are the most restorative so get to sleep early enough so you're out by 10.  I go to bed at 9 pm and read very light material such as fiction and then turn out the lights around 9:30-9:45.  You'll notice a big difference in how you feel if you've become a night owl by training your body to go to bed earlier.  Don't try and make a big shift right away.  Start with 15-minute increments each night until you are falling asleep before 10.

Also wake up consistently at the same time every morning and shoot for about 7-8 hours of sleep each night.  Sleeping longer than that may make you feel groggy for the early part of the day so be consistent when you go to bed and when you wake up.

Can Meditation Help?

Begin a regular meditation practice. Meditation can calm the mind, reduce stress, anxiety and help you get clear on what is important so your mind is not racing. I highly recommend www.calm.com to teach you how to meditate. Just 5 minutes a day to start will begin to work and you can meditate up to 20-25 minutes a day if you can.  I like to do a "body scan" meditation before bed which relaxes all the muscles of the body.

I get into more detail on meditation and some great resources to help you meditate in this article.

Practice deep belly breathing like a baby breathes for 5 minutes every day.  Try doing it in the evening before bed to reduce tension in your body which will help you sleep.  You can tap into your parasympathetic nervous system simply by relaxing and doing deep belly breathing.  Your parasympathetic nervous system is your "rest and digest" part of your nervous system which is what you need to be activated for great sleep.

Sleep Caveman Style

Your bedroom should be completely pitch-black. No clock radio, lights or outside light of any kind should be in your sleep space. Even though your eyes are closed, your brain is still receiving light stimuli through your eyelids and your skin which can reduce melatonin levels. To illustrate this, try looking directly into the sun or a bright light with your eyes closed and you'll see a small amount of light coming through.  Even if you wear a sleep mask, your skin still responds to light of all types.

Make sure your drapes completely block out all light from your windows.  Turn off all electronic devices with lights or cover them.  Even those small red and green LED lights on electronics can disrupt your sleep.

Try Journaling

Journaling is a great way to empty your mind and reduce anxiety.  Write down three things that you are grateful for every night.  Also, write down anything good that happened to you that day so the last thing on your mind before bed is all the good things in your life.

Try writing down what you need to do the next day in the evening. This helps to clear your mind because now you know exactly what you need to do the next day and you can put it to rest.

Eat Right for Better Sleep

Covering a healthy diet is beyond the scope of this guide but I can give you a few pointers that relate to healthy sleep.

1. Try eating only protein and fat for breakfast without much or any carbohydrates. This sets the tone for healthy blood sugar for the next 24 hours. An egg and vegetable omelet or a protein shake with greens and nuts are two examples of this type of breakfast.

2. Only eat low glycemic carbohydrates for lunch and dinner so your blood sugar remains stable.

3. Some carbohydrates are required for glucose to get into the brain which carries tryptophan across the blood-brain barrier. This will ensure healthy serotonin and melatonin production at night. If you just eat a lot of protein at night with no carbohydrates then it may be difficult to fall asleep.

If you are extremely tired in the morning and are a “slow-starter” then this can mean a couple of things. The first is that you are insulin resistant and your blood sugar needs work. A fasting blood glucose and hemoglobin A1c are good markers for insulin resistance. This also ties in with adrenal function so be sure to get your adrenal hormones checked.

In order to get good sleep you should avoid the following stimulants:

Caffeine

Coffee

Chocolate

Teas that contain caffeine

Yerba Mate

Guarana

Alcohol

If you're going to consume caffeine in any form, just be sure to have it before 2 pm.  Also, be consistent with it every day.  So if you're going to consume coffee every morning, for example, be sure to drink it at the same time every day.  This will help establish consistency in your circadian rhythm.

It is very important to stabilize your blood sugar from the time you eat dinner until you go to bed. Make sure you eat a balanced meal of protein, low-glycemic carbohydrates, and fat. Bed-time snacks may be OK for you but they must be very small, balanced and not contain sugar or processed carbohydrates.

One example of something good to eat before bed is 1-2 tablespoons of almond butter. This is a slowly digesting food that will keep your blood sugar stable while you sleep.

It Could be Your Mattress

It may be time for a new mattress.  Did you know that approximately 1/3 of your entire life will be spent sleeping?  That means that one of your single most important investments should be in a quality mattress.

I've heard a lot of great things about Helix Sleep which custom builds your mattress so you've got just the right firmness.

I won't get into all the details of mattress buying but the above are three of the best choices out there.

Turn Off the Wi-Fi

Get all of your Wi-Fi devices out of your room when you go to bed.  A lot of people sleep with their cell phones right next to their beds which have a consistent Wi-Fi signal running into them.  This signal may possibly be going directly through your body depending on where your wireless router is positioned.  Give your body a break from Wi-Fi signals and you should notice an improvement in your sleep.

What Can You Drink at Night to Sleep Better?

One old school remedy is to drink warm milk. Casein peptides in milk have been shown to reduce anxiety and help people sleep.

Chamomile tea also helps to reduce anxiety but sometimes it has a paradoxical effect and causes insomnia. You'll know the first time you try it if it's not for you.  Try 1-2 bags of chamomile tea about one hour before bed.  You can combine chamomile with reishi tea which works extremely well for some individuals.  Reishi is a mushroom traditionally used for immune system health and infections but it also helps to regulate cortisol production which you need in a healthy range in order to sleep.  Steep 1-2 bags of chamomile combined with 1-2 bags of reishi in the evening or before bed to help knock you out.

I have gotten great feedback on Yogi brand “Soothing Caramel Bedtime” tea (Amazon.com) which contains chamomile, skullcap, poppy, and L-theanine. It can be found on Amazon.com or at your local health food store.

What About Your Hormones?

What is the MTHFR test?

The MTHFR test or methylenetetrahydrofolate reductase test has become extremely popular due to a number of alternative medicine practitioners promoting it as the source of many chronic illnesses.  But is it something you should worry about?

This test is basically looking for two types of genetic mutations known as C677T and A1298C that affect the MTHFR enzyme involved in folate metabolism in your body.

Proper MTHFR enzyme function ensures that homocysteine is properly metabolized to the amino acid methionine which then makes SAMe. SAMe is known as the “universal methyl donor” which is extremely important for serotonin, melatonin and your DNA.

Folate is a B-vitamin and is important because it is at the heart of metabolism and the production of all your cells. Without it, nothing really works well so our list of symptoms and health problems would be extensive.

The National Library of Medicine Genetics Reference states that MTHFR:

"The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase. This enzyme plays a role in processing amino acids, the building blocks of proteins. Methylenetetrahydrofolate reductase is important for a chemical reaction involving forms of the vitamin folate (also called vitamin B9). Specifically, this enzyme converts a molecule called 5,10-methylenetetrahydrofolate to a molecule called 5-methyltetrahydrofolate. This reaction is required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds."

How common is it?

Approximately 5-14% of the US population has two copies of the MTHFR mutation.  It is the most common in those of Mediterranean descent and lowest in those of African ancestry.  In America, about 25% of people who are Hispanic, and 10-15% of people who are Caucasian have two copies of C677T.

Should you worry about Homocysteine and MTHFR?

Although controversial in its connection with cardiovascular disease, elevated homocysteine levels may damage blood vessel walls leading to plaque (atherosclerosis) development and thus the potential for a heart attack, stroke or blood clot.

Homocysteine requires healthy levels of folate, vitamin B12, and vitamin B6 to be metabolized properly.  Recent data, however, shows that supplementation with these vitamins to lower homocysteine levels does not produce any benefit regarding cardiovascular risk reduction.  This is most likely due to the complexity of cardiovascular disease which doesn't have a single cause such as elevated homocysteine.

Elevated homocysteine levels, however, are rarely connected to a single genetic variant.  Patients with elevated homocysteine should be thoroughly evaluated for the causes of elevated homocysteine such as:

Hypothyroidism

Obesity

Diabetes

Insulin resistance

Inflammation

High cholesterol

High blood pressure

Lack of physical activity

Aging

Smoking

Medications (atorvastatin, fenofibrate, methotrexate, and nicotinic acid)

Are there any disease connections to MTHFR?

The only conditions with significant scientific support connected to MTHFR are the following:

Spinda bifida

Homocystinuria

Age-related hearing loss

Anencephaly (neural tube defect)

Blood clots

There are many claims on the internet that MTHFR is linked to cardiovascular disease, high blood pressure, stroke, glaucoma, certain cancers, and some psychiatric disorders.  All of the studies related to these conditions with MTHFR have mixed results with some studies finding no association.  So at this point, there is no clear scientific evidence that MTHFR alone has any connection to these disorders.

This is a classic example of cherry picking by alternative practitioners extracting the information from the mixed studies that support their own agenda and ignoring the opposing evidence.

According to Daniel Leclerc, Sahar Sibani, and Rima Rozen in their book chapter Molecular Biology of Methylenetetrahydrofolate Reductase (MTHFR) and Overview of Mutations/Polymorphisms:

"Although numerous clinical association studies have been performed on MTHFR variants, conclusions have been contradictory in some cases, due to the multifactorial nature of the disorders and our inability to identify the multiple genetic and environmental factors that can interact with MTHFR polymorphisms to impact disease risk. The biologic and tissue-specific impact of MTHFR deficiency has also not been adequately addressed since these types of investigations cannot be readily performed in human subjects; the availability of an animal model may be useful in this regard."

I would like to echo their conclusion that all of these conditions have multifactorial components so the disease cannot be linked to a single genetic polymorphism.

Additionally, there is no evidence that supplementing with methylated folate will prevent any of these conditions if the MTHFR polymorphism is present.  Practitioners who are instructing patients to take methylated folate to treat or prevent any of these conditions are going on pure speculation.

Why should you get the MTHFR test?

There really is no reason to get tested for MTHFR because this test is considered experimental and it does not give you any valuable information about your body.  If you are pregnant and concerned about neural tube defects then take a high-quality prenatal vitamin which will contain folate as well as the other b-vitamins.  If your homocysteine levels are elevated then have a knowledgeable medical professional evaluate you for the underlying causes as noted above.

There is no evidence that getting tested and supplementing with methylated folate will help you in any way with your health.  If you come across anyone promoting this test as something you should worry about then I would look elsewhere for credible health information.

Is MTHFR actually a good thing?

The MTHFR polymorphism may actually be a good thing such as a reduced risk of prostate cancer.  It also has a protective effect on the kidney when homocysteine levels are elevated as well as a protective effect in male infertility.  MTHFR has also been shown to be protective in preeclampsia.

Additional protective effects include:

Retinoblastoma

Oral cancer

Gastric cancer

BMI

Lymphoblastic leukemia

And even if your homocysteine levels are elevated due to MTHFR, it has been shown that having adequate riboflavin levels negates any negative effects from the elevation.

So as you can see, MTHFR is a normal genetic variant that you shouldn't worry about at all.  In fact, it has many protective effects for your body that one should be grateful for having if an MTHFR polymorphism is present.

Perhaps in the future, we will find strong associations between the MTHFR genetic variant and a specific condition but even at that point, we would have to perform follow-up studies with patients taking methylated folate and then follow them throughout life to see if it makes a difference.  Even then we wouldn't be able to clearly claim that the supplement alone was part of the risk reduction.  This is because there are so many other factors in life that come into play with all diseases.

Save your money and avoid getting tested for MTHFR because you have absolutely nothing to worry about based on the current scientific understanding we have of this genetic polymorphism.

Would you like additional information from a credible source?  23andMe which is currently the most popular genetic testing company has done the research on this and they came to the same conclusion as I have.  You can read their article on this here.

In this interview on The Dr. Hedberg Show, I had a great time talking to Shannon Garrett about Hashimoto's disease.

We started by talking about Shannon's personal journey with Hashimoto’s disease.  And then we got into how stress triggers Hashimoto's disease as well as emotions and early adverse life events in childhood and how they connect to autoimmune disease as an adult.

Shannon's book Hashimoto’s: Finding Joy in the Journey.

The many shades and stages of grief and Hashimoto's disease.

Shannon's eCourse and the FLT triangle of Hashimoto's disease.

We talked about LDN (low-dose Naltrexone) and if it is suitable for everyone with Hashimoto's disease.

Shannon's nutrition approach to Hashimoto's disease and why she doesn't always start with the autoimmune paleo diet.

Additionally, Shannon went through her process of gently helping women change their diets without creating additional stress or anxiety on the patient.

Shannon's Thyroid Fatigue Special Report which includes the de-stress the holidays eGuide and free 7-Day Fatigue Makeover Challenge.

Shannon's new book will be out in the 3rd quarter of 2018 called Hashimoto's R&R.

About Shannon Garrett

Shannon Garrett, BS, RN, CNN is an Autoimmune Thyroid Wellness Nurse Expert & Certified Functional Nurse-Nutritionist. Shannon is a Hashimoto’s patient, advocate, and educator who has dedicated her career to helping women diagnosed with Hashimoto’s live their best life.

Shannon received her degree in nursing (magna cum laude) from the prestigious Aquinas College School of Nursing, and her degree in human development & psychology from Amridge University. She has achieved multiple certifications specific for practicing holistic nurses in nutrition, environmental toxins, cardiology, and holistic stress & anxiety management.

She is also the author of The Hashi’s Sister’s Guide to LDN, Hashimoto’s: Finding Joy in the Journey and the soon to be released book (2018) Hashimoto’s R&R.

Shannon is a member of the Institute of Functional Medicine, the American Holistic Nurses Association, and the National Nurses Business Association. She serves on the advisory board of HeyHashi.org and is a volunteer advocate for the use of low-dose naltrexone in autoimmune thyroid disease. She is most well known as an LDN nurse educator and is a featured expert on LDN Research Trust.org website.

Shannon Garrett is committed to raising awareness on how to reverse the symptoms of Hashimoto’s through her blog, online programs, educational events and consulting services.

Please visit Shannon's website for more information.

"The dose makes the poison."

~Paracelsus

Are artificial sweeteners bad for you?  I recently received an email from another alternative medicine practitioner stating that “he couldn’t believe I recommended artificial sweeteners on my website!”  My response was, “So let me get this straight if one of your patients asked you if she could have a Diet Coke once a month you would say no?”

So many things in our world have become so black and white that people have forgotten about moderation as a sensible way of life.

Artificial sweeteners have been taking a beating since saccharin was lynched in 1977 supposedly being linked to cancer despite no real sensible data on humans to support it. The amount of saccharin you would have to consume to potentially have negative effects would be 4 cans of Tab every single day (Who still drinks Tab?).  Saccharin doesn’t really even exist anymore other than in Tab and a tiny amount in Sweet’N Low.

The main three artificial sweeteners in commercial use today are:

Aspartame

Sucralose

Acesulfame-potassium

Alitame

Cyclamate

Neotame

I’ll cut right to the chase, there is absolutely no evidence that long-term consumption of diet sodas consumed in a reasonable amount have any negative health effects.  What causes negative health effects related to diet sodas is simply too many calories and people who drink diet sodas tend to already eat too much food.  People who already eat a healthy diet and exercise tend not to gravitate towards diet sodas but if they want to enjoy them in moderation there are absolutely no health consequences in doing so.

What created the mass hysteria about artificial sweeteners?

A few studies on rodents showed that aspartame increased certain types of cancers but they were fed quantities of aspartame that no human could actually consume in a day. Imagine a pick-up truck with a big mountain of aspartame in the back and you would actually have to eat that mountain every day to possibly get cancer.  Then imagine a single granule of that mountain as a single diet soda consumed in moderation.

Additionally, rodents do not metabolize aspartame the same way humans do so we can’t even effectively make similar conclusions from these studies.

What about sucralose?

A safe amount of sucralose is 5mg/kg bodyweight but most people don’t even come close to this averaging about 1.6mg/kg bodyweight.  No studies have shown any detrimental effects from sucralose in these ranges.  You would have to consume 11,450 packets of sucralose every day to have any detrimental effects.

But don't artificial sweeteners spike insulin?

No, at least not to any significant level that would be detrimental to health.  There is no solid evidence to support that diet sodas spike insulin to an unhealthy level.  In fact, when aspartame was consumed with or without carbohydrates it did not spike insulin levels.  Even diabetics who consumed artificial sweeteners did not experience an insulin spike.

The only study to show it spiked insulin was done on rat pancreatic cells in a test tube when combined with sugar.

What about weight gain?

The CHOICE study actually found that eating a healthy diet and changing from regular soda to diet soda was effective for losing weight.

The PREMIER TRIAL found that if you reduce diet soda consumption you will not improve your weight loss numbers at all.

The NHANES study showed that if you increase your consumption of diet soda you will not eat more calories and gain weight.

The key points that researchers make about artificial sweeteners in regards to weight gain are that many people are eating poorly in the first place and then they change to diet soda to “do less damage” which clearly will not make much of an impact.  Those people who are eating a healthy diet in the first place and consume artificial sweeteners in moderation will have absolutely no negative effects.

If you’re eating a crappy diet in the first place then consuming diet sodas won’t make much of a difference.  If you order a Big Mac, Supersize Fries, and a Diet Coke, you’re not really doing anything positive.  However, if you order a burger made from grass-fed beef with some vegetables on the side and wash it down with a diet soda, then you won’t experience any negative effects from the artificial sweetener.

How do we interpret the research on artificial sweeteners?

It’s important to understand how to interpret the scientific literature so you can understand how studies differ.  Here are some key points to understand about these studies in particular:

Some of the negative studies about artificial sweeteners are either surveys or epidemiological studies.  These types of studies do not take into account exercise, pre-existing conditions, quality of diet, water intake, medications, mental status, relationships, supplementation, stress levels etc. etc.  This means that the data might come from large groups of people who never exercise and eat fast food every day so we can’t truly establish cause and effect.

One example is the Northern Manhattan Study which actually did control a few variables such as diet and they found no negative effects from diet sodas when everyone was eating relatively the same healthy diet.

Quantity and quality must be taken into account and this is simply missing in these types of studies.  How much diet soda consumed must be taken into account and the overall quality of a patient’s lifestyle and diet are paramount in coming to the right conclusion.

Most studies show that diet soda is actually consumed mainly by unhealthy people who consume unhealthy diets.  That means they already have at least one disease such as diabetes for example and they are trying to get “healthier” by switching from regular Coke to Diet Coke.  This clearly will not have much of an impact.

Are there any truly negative effects of diet soda?

The one clear problem from excessive consumption is poor dental health, especially in children.  Diet sodas are very acidic which has been shown to negatively affect dental health and yellowing of teeth.  But once again, these studies clearly explain that the negative effects are much worse when proper dental hygiene is not practiced in combination with the consumption.

Additionally, regular sodas with sugar are far worse than diet sodas in this regard for dental health.  Lastly, these studies clearly state that overconsumption of diet sodas create poor dental health.  Once again, this brings us back to quantity, frequency, and quality.

One other thing to note is that some people who are prone to migraine headaches may not do well on aspartame or sucralose which may trigger an event.

If you have the genetic condition phenylketonuria (PKU) then the phenylalanine in diet sodas may reach toxic levels if you consume too many diet sodas.  Phenylalanine is a naturally-occurring amino acid also found in aspartame but if you have PKU then your body won’t metabolize it correctly and you should avoid diet sodas.

There are some preliminary studies showing negative effects on gut bacteria resulting in insulin resistance and induction of similar bacterial colonies as those in obese individuals but again these are on rodents.  Even the researchers themselves state that it is far too soon to make any solid conclusions especially since the research was done on mice and not humans.

Even if future studies do show that artificial sweeteners negatively affect the gut microbiome in humans, it will take consistent and excessive consumption for that to happen.

So what course of action should you take?

If you are trying to lose weight by eating a healthy diet and exercising then studies have shown that using diet sodas to reduce calories is an effective strategy for weight loss. This allows you to have something sweet when you really want it during a dieting phase without depriving yourself or slowing down your progress.

Always be wary of sensationalized news headlines designed to grab reader’s attention and campaigns designed to create mass hysteria.  The media doesn’t understand how to truly interpret scientific information so they are not a reliable source for health information.

Stop worrying about artificial sweeteners but of course, don’t consume excessive amounts.  Enjoy a diet soda now and then such as when you’re at the movies or if you just want something sweet without the calories.  Technology can be really amazing and these sweeteners are examples of how science can improve your quality of life.

This article is written to alleviate any concerns about artificial sweeteners when consumed in reasonable moderation and its message is not to suggest you should start drinking more diet sodas.

Personally, I average about 1 diet soda every three months such as when I’m at a social event, the movies or when I’m dining out.  So that's about 4 diet sodas a year and I enjoy them without hesitation.    Although, if you consumed a little more than I do you would probably still be ok.  Enjoy your life!

Meditation for anxiety and depression is something I highly recommend for everyone suffering from these symptoms.  Sometimes some of the most powerful tools to improve your health are built right into your own body and are absolutely free.  Most of you are probably in a state of information overload with your mind racing at night, feeling stressed, out of control and you just can’t seem to calm down your mind to a state of happiness, clarity, and well-being.  I've been meditating almost every day for the last 14 years with many benefits.

Meditation is one of the most powerful tools you can use to reduce anxiety and depression, sleep better, manage stress, eliminate pain, and get clear on what you love to do on a daily basis.  And it doesn’t require any fancy or expensive tools to learn how.

Many studies have shown meditation to be helpful for the following:

Anxiety

Depression

Pain

Mental focus

Cardiovascular health

Improving empathy and concern towards others

Severe speech and physical impairments

Improve well-being

Meditation has even been used in cancer care to help individuals deal with the stresses of their disease.

The research on meditation is exploding with over 4,500 published papers indexed on PubMed which is the main hub for peer-reviewed scientific papers that doctors and scientists read to keep up with the latest literature.  Some newer studies are showing that meditation actually rewires your brain.

What type of meditation is best?

There really isn't a "best" form of meditation as there are so many types of meditation out there including:

Open Heart

Transcendental Meditation

Zazen (Zen Buddhist)

Qi Gong

Kundalini

Vipassana (Mindfulness)

Loving Kindness

There are many more types out there but the most important thing is to avoid any teacher who says that their way is the only way.  Many meditation practices and teachers use words like "energy" or "becoming one" with everything.

Energy is a very specifically defined term in physics yet it is used loosely in new age circles to describe people or places such as, "She has good energy", or, "This place has good energy."  Some people will also say that they can feel "energy" moving through their bodies.

It is fine to go along with these terms if they make you feel good with the understanding that they are incompatible with science.  The reason why we feel good about other people is because of the way they look, their facial expression, posture, smell, hormone levels (pheromones), and body language.  The same goes for places that we visit which feel good because of how things are laid out, the smell etc.

One of the reasons why people feel a subtle sense of euphoria that feels like "energy" is due to the fact that they are finally taking in plenty of oxygen through deep belly breathing.

My personal favorite is vipassana (mindfulness) meditation because there aren't any religious mantras and it is simply about focusing on your breath and everything that you experience.  Vipassana can be used in a secular way so anyone with any belief or non-belief system can use it.  After you have been focusing on your breath for a while you begin to become aware of sounds around you, thoughts, sensations etc. and you just go with what you are feeling.  If you find your mind thinking about other things like work, then you recognize that thought but let it go like clouds passing in the sky.

Are there any meditation apps?

Meditation is pretty simple to learn how to do on your own.  My absolute favorite is the Waking Up meditation app by neuroscientist Sam Harris.  The Waking Up app takes you through an entire course on mindfulness meditation guided by Dr. Harris himself.

Another one of my favorite free apps is called Calm at www.calm.com.  You can use it in any web browser such as Google Chrome or Firefox and it’s available on all Android devices and the iPhone or iPad.  Learning meditation for anxiety and depression should be easy for you with Calm.  Another app I recommend is called Headspace at www.headspace.com.

I highly recommend starting with the “7 Steps to Calm” if you have never meditated before or for a refresher if you have meditated in the past.  Each step only takes about 5-10 minutes a day and once you have completed the 7 steps I recommend beginning with just 5 minutes a day of guided meditation using the Calm “Guided” option.

Once you have mastered 5 minutes a day try choosing longer times and work your way up to 20-25 minutes a day.  It’s not a contest or something you should think you are trying to achieve, however.  You have enough on your plate so if you only want to do 5 minutes a day then stay with that.

One of the other cool things about Calm is that you can choose from a variety of different nature scenes and sounds such as ocean waves or the sound of rain to help you relax.

Dr. Sam Harris has also written a great article on how to meditate you can read by clicking here.

UCLA offers free meditation recordings through their Mindfulness Awareness Research Center which you can access by clicking here.

If you really want to do something that you will actually “feel” a difference from doing, then give me just 5 minutes a day of meditation and you’ll be on your way to a healthier and happier you.

The autoimmune paleo diet (AIP) also known as the autoimmune protocol diet is an extremely popular diet these days for autoimmune disease but there has never been any studies done to evaluate if it actually works.  Although testimonials should be taken into account, and there are many all over the internet,  the ultimate test for validity is a clinical trial.

As of August 29th, 2017, we now have a study that looked at this diet and how effective it was for autoimmune disease.  The paper is entitled, “Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease.”  Dr. Konijeti is the lead author and it was published in the journal Inflammatory Bowel Disease.

Let’s dig into the study and see what they came up with.  The study included 18 adults but three of them withdrew because they couldn’t commit to the diet so there were only 15 participants.  9 of them had Crohn’s disease and 6 had ulcerative colitis.  Crohn’s disease and ulcerative colitis are autoimmune inflammatory bowel diseases.

What causes these diseases?  The authors note that Crohn’s disease and ulcerative colitis are due to genetic factors, gut dysbiosis, dietary factors, environmental exposures, and immune system dysregulation.  This is mostly true for all types of autoimmune diseases but I would also include infections in this list such as viruses and bacteria.

To be more specific regarding dietary factors that increase the risk of inflammatory bowel disease, it is noted that a typical Western diet high in refined carbohydrates, omega-6 fatty acids, saturated fat, low in fiber, vitamins, and nutrient-dense foods are part of the problem.

What is the autoimmune paleo diet (AIP)?

The autoimmune protocol diet is also known as the autoimmune paleo diet since it is an offshoot of the classic paleo diet.  The following foods are eliminated from this diet:

Gluten-containing grains

Gluten-free grains

Dairy

Eggs

Nuts

Seeds

Refined carbohydrates and sugar

Legumes

Nightshades

Oils

Food additives

Coffee

Alcohol

Why are these particular items avoided in the autoimmune paleo diet?

The goal is to remove any foods that tend to be inflammatory in nature and can lead to dysbiosis.  Approximately 70% of the immune system is in the gut and the microbiota have key connections with the immune system so it makes sense to reduce inflammatory stress in this area as much as possible.

The autoimmune paleo diet consists of the following:

Fruit

Vegetables

Lean meats

Fish

Healthy Fats

Coconut

Sweet potatoes

A few additional items that are emphasized are fermented foods to help maintain a healthy microbiota and bone broth for intestinal healing and nutrient density.

How did the subjects eat in this study?

All subjects followed a 6-week elimination phase and then a 5-week maintenance phase where no foods could be reintroduced.  The participants had a lot of support including a private Facebook page where they could interact with each other and share recipes and ideas.

Additionally, they worked with a health coach and a registered dietician.  The subjects were educated on proper sleep hygiene, stress management, exercise instruction, grocery shopping and food preparation including how to make bone broth and the benefits of fermented foods.  Education against the use of NSAIDs was also provided since these lead to bowel inflammation and contribute to dysbiosis.

They were also given two books:  “The Paleo Approach:  Reverse Autoimmune Disease and Heal Your Body” by Ballantyne and “The Autoimmune Paleo Cookbook:  An Allergen-Free Approach to Managing Chronic Illness” by Trescott.  These are two excellent books on the autoimmune paleo diet.

C-reactive protein and fecal calprotectin were measured before and after the diet.  If you are a patient of mine you know that we always run c-reactive protein levels because it is an excellent marker of inflammation.  I don’t routinely run calprotectin which is a marker of inflammation in the gut because it is quite obvious when a patient has inflammation in that organ system.

Vitamin D and iron levels were also tested and replenished if found to be deficient.  Some of the patients were on various medications which they continued to take without any negative interactions with the diet.

What were the results?

11 out of 15 patients achieved complete remission at 6 weeks-more specifically 6/9 with Crohn’s and 5/6 with ulcerative colitis.  All 11 patients maintained remission during the 5-week maintenance phase.  One of the patients with Crohn’s disease who did not go into remission reported that his/her joint pain completely resolved.  2 patients with Crohn’s disease dropped out before the end of the 6-week period which resulted in no significant statistical difference in remission between ulcerative colitis or Crohn’s disease.

C-reactive protein and fecal calprotectin levels decreased in all patients but in some of them, it was not statistically significant.  Other markers tested did not change to a statistically significant level including hemoglobin, hematocrit, albumin, bilirubin, transaminases, creatinine, total cholesterol, HDL, LDL, and triglycerides.

One of the patients with Crohn’s disease developed a small bowel obstruction requiring hospitalization due to the significant increase in raw vegetables and meat but it was noted that he/she did not communicate properly with the dietician or health coach.

Most of the patients showed signs of reduced mucosal inflammation in the bowel through before and after endoscopy.

Dr. Hedberg’s Thoughts

I was glad to see that the authors pointed out the weaknesses in this study including the fact that the participants worked on stress reduction, sleep hygiene and exercise as well as having a tremendous amount of support from the Facebook group, health coach, and registered dietician.  We can’t specifically isolate the improvements seen simply based on the diet alone with all of these other interventions involved.

The other big weakness was the sample size of only 15 participants.  This isn’t enough to make any strong claims about the diet but it is definitely a great start.

No stool analyses were performed to identify specific microbial dysbiosis or potential parasites and yeast overgrowth.  And no testing was done for any infection connections to inflammatory bowel disease such as the Epstein-Barr Virus.

There was also no control group to compare the results of the autoimmune paleo diet alone.  One group could have been given a diet that included inflammatory foods which they thought were good for them and they also got the exercise instruction, sleep hygiene, stress reduction techniques, Facebook group support, and the help of the dietician and health coach. All of these can have profound impacts on healing.  This type of approach could have helped to separate placebo effect and other factors that contribute to feeling better.

The other thing we have to think about is whether or not this is an all-or-nothing approach or could a few of the foods still have been left in the diet?  What if someone eliminated all of the recommended foods but still had some nuts a few times a week?  Or some brown rice a few times a week?  This question will always be difficult to answer because each food would have to be studied in large numbers of patients.  My concern is how restrictive this diet can be and it is especially unhealthy for anyone who has a history of an eating disorder.

Many of the patients I see with autoimmune disease have already tried the autoimmune paleo diet but either got worse or didn’t notice any changes.  There are many reasons why this happens such as an unidentified infection or other causes of the autoimmunity such as post-traumatic stress disorder and small intestinal bacterial overgrowth (SIBO).

Overall, this study is a great start to researching the connection between the food we eat and chronic illness. Remember that this diet isn’t for everyone with autoimmune disease as we saw with the patient who was hospitalized with a bowel obstruction.  I do think this approach is too simplified for many patients with autoimmune disease but it clearly works for some individuals with excellent results.

As with any dietary changes, discuss the autoimmune paleo diet with your licensed healthcare professional and be sure that they are looking for all the other aspects of autoimmune disease so you aren’t left feeling worse or with no improvement at all.  I get great results with patients when we take a comprehensive approach to their autoimmunity which goes far beyond just diet.

Article reference:

Konijeti GG1, Kim N, Lewis JD, Groven S, Chandrasekaran A, Grandhe S, Diamant C, Singh E, Oliveira G, Wang X, Molparia B, Torkamani A.  Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Aug 29.

GMOs, or genetically modified organisms, are one of the most contentious topics in the world today.  We should however, consider the following questions:  What do we really know about them? Are these concerns justified?  People are so passionate about this issue that some misguided individuals have actually rioted and vandalized crops in Oregon, Australia, the United Kingdom and the Philippines.  This mob behavior is similar to the burning of women at the stake for committing imaginary crimes like witchcraft.

Unfortunately, public opinion oftentimes has absolutely nothing to do with scientific fact.  A Gallup poll showed that 48% of respondents actually believe that foods produced using biotechnology pose a serious health hazard, compared to 36% who think that they do not.

GMO labeling is a hot issue.  Currently, laws are being passed around the country requiring labels on all GMOs with Vermont being the first state to enact such a law.

What is a GMO?

Basically, scientists extract DNA from an organism, modify the DNA, and then incorporate it into the genome of the same species or a different one.  This transfer of modified DNA can be accomplished by using a “gene gun” to inject DNA-coated metal pellets into the plant cells, or by just using bacteria for delivery.

Another type of GMO is created by turning off a gene that is normally expressed without introducing a new gene.

Cisgenic GMOs are achieved by introducing genes from closely related species, and transgenic GMOs are the result of genes from distant species crossing over to other kingdoms of life.  For example, taking a gene from a bacteria and inserting it into a plant will produce a transgenic GMO.

Both of these types of genetic modifications actually occur in nature on a regular basis, so they are nothing new and completely “natural."

GMOs are truly one of science's greatest achievements that have yielded many benefits to humans other than food.  Two very important achievements include insulin that diabetics inject themselves with to regulate blood sugar to keep them alive and growth hormone that is used for kids with rare genetic disorders that prevent them from growing normally.  Both of these hormones are produced from GM bacteria.

How long have GMOs been around?

Did you know that genetically modified foods have been around for the last 10,000 years and that most of the foods you have eaten throughout your life are genetically modified?  The food you eat today bears little resemblance to what our ancestors ate thousands of years ago.

Apples are a perfect example of genetic modification through breeding practices for millennia.  Have you ever wondered why there are so many different types of apples such as Granny Smith, Golden Delicious, Macintosh, etc?  These are all genetically modified for various reasons such as taste, size, and resilience to climate change.

All bananas used to have seeds until they were bred out, and carrots used to be yellow and purple until the Dutch bred them to be orange in the 17th century.

Genetically engineered plants became a commercial product in 1994, but they have been around for the last thirty years.  Since these plants were developed, more than 1,700 scientific studies have been conducted to determine whether they are safe for human health and the environment.  The overall conclusion of these studies is that GMOs are completely safe for human health and the environment.

Why are people so afraid of GMOs?

The paranoia surrounding GMOs actually comes from the false idea that things that are “natural” are more wholesome and safe than those that are man-made or artificial.  This is known as a “logical fallacy,” because it is not based on valid information.  Farmers throughout history have always tried to create the best possible crop yield by breeding and “unnatural” cultivation methods.

If you were a farmer, you would pick seeds from the healthiest and most robust crops and cast aside those that couldn’t survive well in harsh climate conditions for example.  Or, perhaps you would want larger tomatoes to help feed your big family, so you would start the process of creating bigger tomatoes by breeding the largest tomatoes.  This was, of course, a slower process, but it was still genetic modification and “unnatural."

Creating a farm of any type can be considered “unnatural.”  For thousands of years, human beings did not have farms; they merely ate what was growing around them in the wild.

The agricultural revolution, which started approximately 10,000 years ago, can be viewed as a turning point from “natural” to “unnatural.”  If you buy into the “natural” logical fallacy, then at this point in time, you would not be eating anything other than what you can find yourself out in the wild.  Good luck with that.

What about eating “mutant genes” and “Frankenfoods”?

Newsflash:  all genes are mutants whether they are the genes in your body or the genes in the foods you are eating. The only reason you are alive and able to be reading this article is because of genetic mutations in yourself and your ancestors.  When you eat chicken (free-range or not), you are eating mutated genes.  When you eat broccoli, you are eating mutated genes.  All genes are constantly mutating based on our environment, food intake, stress levels, etc.  This type of hysteria is bred from simple ignorance about genetics.  If you really want a clear understanding of this concept, talk to a geneticist or evolutionary biologist to learn how ridiculous these claims have become.

Are anti-GMO fanatics making kids blind?

Fifteen years ago, the Swiss scientist Ingo Potrykus invented “Golden Rice.”  This rice is a genetically modified organism that is enriched with vitamin A.  Every year, approximately half a million children go blind due to vitamin A deficiency, and about half of them die within one year of going blind.

Dr. Potrykus, a humanitarian trying to make the world a better place, wanted to supply Golden Rice free of charge. Unfortunately, his product is not getting to children in need because of the unfounded opposition to GMOs by misguided fanatics.  It is hard to believe that so many children are going blind and dying because of mass ignorance.

How will we feed the world in the future?

Many opponents of GMOs have the delusional belief that if we all just grew our own food in fairytale-like organic gardens, then everyone would have plenty to eat.  The fact of the matter is, our planet cannot sustain the current population growth which will add an additional two billion people by 2050.  Currently, almost one billion people do not have enough food to eat, so what is the solution for the extra two billion on the horizon?  GMOs will not completely solve this problem, but they most certainly will help provide more food for those in need.

Are people and companies that produce GMOs evil?

This is debatable but I would like to focus on the individuals and scientists who work for these companies.  These people are just like you and me; they wake up every morning trying to live a good life and make a difference in the world.  Imagine what it must have felt like to be the biologists who discovered how to improve a crop yield by making foods more resilient to insects and requiring fewer pesticides.  These scientists are following their dreams to make the world a better place through science and innovation.

You may ask, “But aren’t all these companies just big corporations trying to dominate the world?”  Actually, hundreds of safety studies on GMOs are published by independent researchers who have no ties to any of these corporations and receive no funding from them.  The American Association for the Advancement of Science, the World Health Organization and about a dozen independent scientific groups have all published safety studies concluding that GMOs are completely safe for human consumption.

The focus of this article is on the health safety of GMOs so I’ll leave the big corporation debate for another day.

Do GMOs cause health problems?

A recent study out of the University of Perugia in Italy reviewed 1,783 studies on GMO safety, of which 770 looked specifically at human health.  The researchers concluded that there is absolutely no evidence that GMOs are harmful to human health.

In 2012, the American Association for the Advancement of Science concluded the following:   “...Contrary to popular misconceptions, GM crops are the most extensively tested crops ever added to our food supply.  There are occasional claims that feeding GM foods to animals cause aberrations ranging from digestive disorders to sterility, tumors, and premature death.  Although such claims are often sensationalized and receive a great deal of media attention, none have stood up to rigorous scientific scrutiny.  Indeed, a recent review of a dozen well-designed long-term animal feeding studies comparing GM and non-GM potatoes, soy, rice, corn, and triticale found that the GM and their non-GM counterparts are nutritionally equivalent.”

The National Academy of Sciences National Research Council states:  “To date, no adverse health effects attributed to genetic engineering have been documented in the human population.”

The World Health Organization also states:  “GM foods currently traded on the international market have passed risk assessments in several countries and are not likely, nor have been shown, to present risks for human health.”

The European Union which has not been all that favorable to GMOs for political reasons has even stated in their 2010 research review:  “The main conclusion to be drawn from the efforts of more than 130 research projects, covering a period of more than 25 years of research and involving more than 500 independent research groups, is that biotechnology, and in particular GMOs, are not per se more risky than e.g. conventional plant breeding technologies.”