How will your PCOS (Polycystic Ovarian Syndrome) affect your ability to breastfeed? What can be done? Find out more in my latest blog post!

You're taking vitamin D like your doctor told you to, but are you really getting the most bang for your buck? Find out how you can maximize the absorption of your vitamin D supplement in my new blog post!

Beyond the normal healthy eating advice (eat whole, fresh foods, eat a good balance of fats, carbs and protein) what else should a pregnant or lactating woman consider? Join me, and let's talk a little bit about vitamin and mineral need, calories, and cravings in this new article.

For the full article click the picture below or click here.

People ask me all the time "how do I find someone who does what YOU do?"

Finding a doctor is no easy task- much less one that is holistically minded and trained in functional medicine. That is why I wrote this recent article- I hope it helps everybody find a good functionally minded practitioner near them!

For the full article, click the picture below or right here.

Are you really treating your celiac disease by going gluten free, or are you simply masking a symptom? Is going gluten free the end-all-be-all in proper celiac disease management?

If treating the root cause of your celiac disease is important to you click this link or the photo below for the full article!

As you may have noticed, I don't update this blog much anymore. This is because I have started blogging on our new website: InfinityHolisticHealth.com! This is the website for my Functional Medicine office in Chapel Hill, North Carolina.

For more information about our office please visit InfinityHolisticHealth.com or call us at (919) 238-4094.

Anemia is a relatively common condition in which the blood's Oxygen carrying capacity has been compromised. This may be due to a loss of red blood cells, low Iron or hemoglobin, lack of B vitamins, or misshapen red blood cells as is seen in Sickle Cell Anemia.

The most common form of anemia both worldwide and in the United States is Iron deficiency anemia (IDA). Commonly seen in women, particularly those whom are pregnant, have a heavy menstrual period or are vegetarians, IDA is easily corrected by increasing your consumption of Iron. This is usually accomplished by taking a prescription Iron pill that I have nicknamed the "Home Depot Special Pill". Have you ever cut one of those things open? It looks like someone took a chunk of Iron ore from the Home Depot, made it into a pill, and painted it red!

IDA seems like a simple enough condition with an even simpler cure: take Iron. But after our last blog post where we discuss just how toxic inorganic Iron can be to the human body, it may leave our anemic readers a bit confused. On the one hand, you don't want to be anemic- without proper oxygenation of your tissues your body will be less able to build and repair itself and it will leave you feeling worn down. On the other hand, being the well-read, informed patient that you are, you probably don't want to take the Home Depot Special pills, either.

First we must ask the question, why is your Iron low in the first place? The many different causes of IDA require completely different treatments.

1. You lose a lot of blood. This is generally seen on a CBC as a high RDW value (above 15 on most labs). Perhaps you have a heavy menstral period because of a hormonal imbalance or PCOS, in which case addressing those conditions would correct the problem. Perhaps you have an internal bleed such as an ulcer, which would require a completely different work up and treatment than the above.

2. You don't eat enough Iron. Most people will tell you that this is seen in vegeterians, but I have found that vegan and vegeterian eaters can get along quite alright without extra protein and Iron. In my experience, this is more often due to just plain old unhealthy eating habits. There's not a whole lot of nutrients in Doritos last time I checked, guys. Stop fooling yourselves and eating that garbage.

3. You're not absorbing the Iron you are taking in. Honestly, I think this is by far the most common (perhaps in combination with number 2) reason people develop IDA. The big thing you need to know is that you need two things to digest and absorb Iron: Stomach acid (to break it down) and a healthy intestinal tract (to bring it into the body).

Low stomach acid, or hypochlorhydria, can be caused by a myriad of things including infection by a bacteria called H Pylori, or drugs that decrease stomach acid. For example, proton pump inhibitors (Prilosec, Omprezole) decrease the stomach cells' ability to make stomach acid. These drugs are used to treat ulcers, but all too often patients are left on these drugs for years after the ulcer has healed. Likewise, acid blockers such as Zantac and Pepsid have become increasingly popular and are often taken on a long term basis. These drugs are often advertised with the implication that you can now eat whatever you want without all those pesky unpleasant symptoms. I guess they forgot to mention the fact that those symptoms are just your body screaming please don't do this to me.. For Pete's sake put down the hot dog!!

Altering the state of the stomach's acidity not only leaves you vulnerable to nutrient deficiencies such as IDA, but it leaves the GI tract vulnerable to infection by opportunistic bugs like H Pylori. Because these drugs drastically alter your ability to digest your food properly (especially protein), food transit time through the stomach slows, allowing food to sit in the stomach for long periods of time and fester. This putrid food hanging out in the stomach longer than it's supposed to may produce symptoms of indigestion. Wait, wasn't that what we were trying to avoid in the first place?

Many, many things can cause malabsorption at the small intestine level. Celiac Disease, Crohn's Disease, Ulcerative Colitis, and Leaky Gut Syndrome have all been known to cause multiple nutrient deficiencies, and as you can imagine, their treatment involves far more than one little Iron pill. Another increasingly common reason for malabsorption in this country is due to malabsorptive surgery such as the gastric bypass. There are several various flavors of bariatric surgery, and they all have slightly different effects on the GI tract. For example, the gastric bypass mostly alters the stomach size, and therefore has the greatest impact on one's acid producing equipment. The Roux-en Y Gastric Bypass, on the other hand, is a procedure in which they actually bypass the first part of the small intestine all together. This sets the stage for great potential weight loss, but also for great potential nutritional consequences. Since about 90% of the vitamins and minerals in food are typically absorbed in that first, short portion of the small intestine, bypassing it severely handicaps that GI system for the rest of that persons life.

So what can we do to try to correct IDA without taking the Home Depot Special pills?

1. Stop to think, why am I anemic in the first place? Yes, getting to the root of the problem might be harder than simply popping a pill for the rest of your life, but it will be worth it. Really.

2. Stop with the acid blockers already! If this means going off a prescription medication communicate with your doctor, but be aware that they might think you've lost your mind. Your doctor should know that these medications were never meant for long term use, but if they give you a hard time just stick to your guns and explain why you are concerned.

3. Eat food that actually contains Iron. I know, it's a wild concept. And no, this does not mean that Iron fortified cereal is now a health food. I'm talking about real food that has real Iron- meats, spinach, kale, chard and other green leafy veggies. Keep in mind that meat will have the most bio-available form of Iron as most minerals in plants and grains are chelated (bound) to something else such as phytates, which typically impedes their absorption.

4. Even after all that if you are still Iron deficient (perhaps due to pregnancy), find a source of Iron supplementation that didn't come from a hardware store.


Floradix
is a pretty good, commercially available Iron supplement, for example.


In health,

I think this is the question on everyone's mind when embarking on a new diet- particularly diets that entail the cutting out of multiple foods like gluten, dairy, soy and eggs. This question comes up frequently in Paleo and Autoimmune Paleo (AIP) groups, especially.

The amount of "cheating" you can get away with and the ways in which you can cheat are dependent on four things: what type of reactions you are you having, where you are now, where you'd like to be, and the difference between the last two. 

Different types of reactions merit varying degrees of strictness. Food intolerances to things like oxalate, histamine/amines, FODMAPs, and salicylates are generally dose-dependent. This means you can eat a bite of two without much of an issue, but if you eat a whole plate of a "bad" food (like tomato sauce if you're doing the low histamine diet) you'll pay the price.

Food allergies, sensitivities, and autoimmune reactions like Celiac disease are different, though. The immune system doesn't care about quantity, only "is this bad thing around?" If you're gluten-free, casein-free, or peanut-free you have to be 100% strict if you want to make any progress. It is frustrating, but with these reactions 99% of the work frequently yields 0% results.

Where you are now. If you have fibromyalgia, an autoimmune disease, or cancer, for example, you really shouldn't be cheating at all on your diet. If you do, the consequences are likely going to be much more costly and your recovery from those cheats is going to be slow and painful. If, on the other hand, you are generally pretty healthy and not a lot of scary, acute stuff going on (or an autoimmune process), then you can likely get away with a little more.

Where you'd like to be. If you come to me and say that your goal is to run your first marathon in a year, then you'd better be ready to roll up your sleeves and work for it. If your goals are more modest, like just losing a few pounds so you look better in your sisters wedding this fall, then you won't have to work quite as hard to get there.

The difference. Imagine coming in with the first story (fibromyalgia or an autoimmune disease) and having the goal of running a marathon in a year. This is a HUGE change, and frankly may be an unrealistic amount of pressure to put on yourself. In either case, assuming that this is where your at and that is your goal, the difference between point A and point B is tremendous and will thus require a tremendous amount of effort to get there.


The key with any restrictive diet is finding "safe cheats". I don't think it's fair to put that much pressure on someone and make them think they have to be perfect- but you also can't go and sabotage your own plan if you hope to get better. Whether it's making coconut milk ice cream (yum!) or AIP gelatin gummies, find what's safe for you and allows you to have a treat every now and again.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

It seems like everywhere you look there's a new gluten free item on the supermarket shelf, a restaurant with a gluten free menu, or a friend "going gluten free". But what's all the fuss over this one little molecule? And why is it becoming increasingly popular to avoid it?

Gluten is the protein found in wheat, barley and rye, and it is what gives many foods their form and texture. Think of it as the "glue" that holds bread products together. Gluten enteropathy, or Celiac Disease (CD), is an autoimmune disease in which the individual reacts to gluten and produce an autoimmune-mediated attack on their intestines. Currently it is estimated that CD affects 1 in every 133 people in the US, with a predilection for Caucasian people and women. It is estimated that 80% of people with Celiac Disease are unaware they have the disease [1]. Diagnosis of CD requires either a positive Anti-gliadin antibody test or Tissue Transglutaminase test, as well as a biopsy of the small intestines showing gross damage to the villi of the intestines. Often times a third test is used, a genetic test that looks for the "Celiac genotype" of either HLA-DQ2 or HLA-DQ8.

Okay, so it makes sense that if you have CD you shouldn't eat gluten. But then there's the real weirdos out there: the 1.6 million Americans who are on a gluten free diet but are not diagnosed with Celiac Disease.

Why in the world would people without Celiac Disease go gluten-free?..
Because you don't have to be Celiac to have an immunological, and very real reaction to gluten.

As a matter of fact, scientists now believe that occult cases of CD account for an astonishingly low number of gluten sensitive individuals. As a matter of fact, research is now showing that those people with enteropathy (disease of the intestinal tract) represents only 1/3 of the patients with neurological manifestations of gluten sensitivity [3]. The vast majority of autoimmune patients are highly sensitive to gluten (as well as other food proteins) and feel much better when they remove it from their diets. Remember, just because the intestinal tract itself isn't being attacked doesn't mean that the immune system isn't attacking another tissue. In Celiac Disease it's the gut that gets chewed up; in Rheumatoid Arthritis it's the joints; in Hashimoto's it's the thyroid. In any case the immune system reacts to the foreign protein and stimulates an immune attack- it's just a matter of where they send the troops.

Here's what you need to know about gluten sensitivity testing and where you can go to get answers.

There are three main problems with traditional Celiac testing that cause gluten-sensitive folks to fall through the cracks.

1. The majority of testing uses the antibody IgA. However secretory IgA is commonly depleted in autoimmune patients, who make up a large percentage of gluten sensitive people. This means that the IgA test can come back low enough to fall into the "negative" range, when in actuality the patients' body was just not making any IgA, let alone IgA against gluten. To combat the risk of false negatives, look for tests that include either IgG or IgM in addition to IgA.

2. Celiac genotype testing is boarder-line useless, but many physicians will not consider you to have CD unless you have the HLA genotype. While 90+% of CD patients are HLA-DQ2 positive, approximately 30% of those of Caucasian decent have this genotype, too! This means that the genotype testing has pretty good sensitivity, but really lousy specificity. That and again, this test is looking for people with occult Celiac Disease, so those who are non-celiac gluten-sensitive would be passed by yet again.

3. The main problem with celiac and gluten testing is that the test only looks for sensitivity against one of the many components of wheat (see below [2]). The anti-gliadin antibody testing used do diagnose CD only tests for Alpha Gliadin- one of 12 or so components of wheat and gluten! Not only that, but most current testing does not test for reactions to wheat versus rye or barley- they assume that the structure is similar enough that they would all produce a positive test result to Alpha-Gliadin.

So what should you do if you believe you are one of the many who have an issue with gluten? The best advise I can give you is to listen to your body!

The cheapest way to find out if you have a food sensitivity is to do a good ol' fashioned food elimination test, although even this "gold standard" is not perfect in my opinion. The premise is simple enough- cut questionable foods out of your diet for a few months, then add it back in and see what happens. We need to re-learn how to listen to our bodies as a species. Back when we were in the bush we would simply know to avoid a food if it made us feel bad. Nobody needed blood tests and peer-reviewed, double blind, placebo controlled trials- it was common sense that your body knew what's best.

I recommend doing an elimination diet with the most common allergens: gluten, dairy, soy, eggs, corn and peanuts. Give your gut and your immune system a break from these inflammatory foods for a few months with absolutely no cheating. If you can do things to heal your gut (coming in a later post) during that time then all the better. After a few months have passed, slowly start re-introducing foods into your diet, about once every 3-4 days. Recall, it takes the epithelial cells in your gut approximately 3-5 days to regenerate, so it will take you that long to rebound from each new food. As you reintroduce foods, keep an eye out for any symptom: from restless leg syndrome, to gut problems, to pain or insomnia. Remember, the immune system lives in the entire body, so symptoms can pop up anywhere. If you have an autoimmune disease, specifically keep your eyes peeled for symptoms of your disease (ex. joint pain in RA, hypo or hyperthyroidism symptoms in hashimoto's or graves disease, etc). Of course, the entire point of the diet is to avoid the foods that produced any adverse reactions, so listen to your body and stay away from the stuff after that!

For those of you who like to see results that clearly tell you "you can eat this, you can't eat that", you are in luck. Cyrex labs offers phenomenal and, in my opinion, invaluable tests that will surely steer you in the right direction.

In health,

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

References:
[1] http://www.mayoclinic.org/news2012-rst/7008.html
[2] Chart recreated from Datis Kharrazian's seminar notes "Understanding the complexity of gluten sensitivity" 2011
[3] J neurol Neurosurg Psychiatry, 2007:72;560-563. Gluten sensitivity as a neurological illness.

Recommended videos:
[Tom O'Bryan] http://www.youtube.com/watch?v=DjvKrAvolMQ

Recommended websites:
http://www.theglutensyndrome.net/
http://www.glutenfreesociety.org/gluten-free-society-blog/grain-a-double-edged-sword/
[THE lab]  http://www.cyrexlabs.com/
[Great GFDF recipes!]  http://www.nourishingmeals.com/
[An example of how gluten attacks more than the gut]  http://www.livingwithout.com/issues/4_12/ataxia-2366-1.html

I've said it once. I've said it a million times. They haven't found a cure for Alzheimer's Disease because they don't know what causes Alzheimer's Disease. They don't know the cause of AD because there is no one cause. There are genes that make you more prone to the disease (such as ApoE), but there is no AD gene. There is no vitamin deficiency, toxicity, gene or one thing that causes AD. Instead, it appears that AD is a multifactorial disease that is caused by a different mix of things in each individual person.

The only true cause that continues to have overwhelming evidence confirming it's role in causation of AD is inflammation... But that's where the multifactorial thing comes in. Whether it be a bad diet, head injury, drugs, infections, thoughts, toxins or autoimmunity, many things cause inflammation. Therefore, many things can contribute to one developing Alzheimer's Disease. The Alzhimer's Disease brain is a brain on fire, and research continually shows us that the fire starts many, many years before we see the smoke. There is no magic bullet to prevent Alzheimer's Disease; you just have to live a healthy life.

Everybody has heard of heavy metals. The bad guys of the periodic table, heavy metals such as Mercury and Lead have been associated with a wide range of diseases and disorders. But what about other metals? What about the metals we thought all along were good for us? In comes Iron (Fe) and Copper (Cu), two transition metals that may be new culprits in the AD puzzle and inflammation in general. But everybody knows we need iron to make hemoglobin, so having too much couldn't possibly be a bad thing, right? Wrong. The type of Iron or Copper dictates how it functions in the body, and having too much of the "bad" kind can wreak all sorts of havoc on the body.

Transition metals are unique because they exhibit two or more oxidant states (for example, Fe+2 and Fe+3). This is what makes able to participate in chemical reactions and makes them particularly useful in day to day bodily functions. This characteristic also makes them remarkably able to bind with stuff we don't want them to bind to and create free radicals. Free radicals like the hydroxyl ion are then able to scamper about the body binding to molecules and altering their function... This is the hallmark of inflammation- free radical damage that alters the body's normal molecules, and subsequently alters the function of those molecules.

For simplicity's sake, there are two basic types of metals: free metals (inorganic) and metals that are bound to other stuff (organic). Weather or not these metal ions are bound to a molecule (such as a protein) will affect how they are absorbed and processed by the body. Organic Copper and Iron compounds are absorbed a little slower by the intestinal tract, but more importantly they are processed differently than their inorganic brethren. Food Copper (and Iron) must go through additional processing in the liver before it is allowed into systemic circulation (the blood stream). Typically the body keeps most of it's Copper bound to proteins and keeps the more unstable, inflammatory free Copper to a minimum (5-15% total Cu in the blood). When inorganic Copper is absorbed it immediately contributes to the free Copper pool in the blood steam, bypassing the liver and increasing the risk of inorganic Copper induced oxidative stress [1]. Similar is true of Iron's story.

The proposed mechanisms of how inorganic Copper and Iron contribute to the inflammation in AD are numerous, but here are a few:

Copper has been shown to bind with homocysteine (an inflammatory molecule that is related to one's intake of B vitamins) and increase the oxidation of LDL- the so-called "bad" cholesterol [1, 2]. Cu, unlike Zinc, Nickel, Aluminum, or Cadmium, has been shown to compromise the stability of Ubiquitin. The Ubiquitin-Proteasome System (UPS.. haha) is the main pathway by which we eliminate misfolded proteins from our cells such as the notorious Beta Amyloid of Alzheimer's Disease and the Lewy bodies that are seen in Parkinson's Disease [5]. This may result in decreased clearance of these proteins in the brain, eventually leading to a build-up, cellular toxicity and death. Even the so-called AD gene may be related to Cu metabolism! The three different ApoE Alleles differ in the number of cysteine binding sites they posses- the part of the molecule that is able to bind to Copper. ApoE 2 has two binding sites, ApoE3 has one and ApoE 4 has none. This correlates with the risk of AD associated with each of those alleles (2 is protective against AD, 3 is neutral and 4 increases your risk). It has now been postulated that the risk associated with the ApoE alleles is due to ApoE 4's inability to bind and remove Copper from the brain [2]. 

Like Copper, Iron is necessary for human life, but an excess of inorganic Iron may be one of the inflammatory triggers in the AD cascade. Several studies have shown that Fe accumulates in Beta Amyloid plaques [3]. Not only that, but the presence of Iron during plaque formation not only increases the synthesis of Beta Amyloid by it's interaction with PACE, but it has been shown to favor the more toxic form of the plaques [4].

As in all things in life, your current inflammatory status will play a role in how you handle further stressors. Inflammation disrupts the blood brain barrier (BBB) and alters it's ability to regulate the transport of Fe to and from the brain [4]. HAMP, the gene that is responsible for the production of Hepcidin (THE Iron homeostasis hormone in our bodies) is directly influenced by inflammatory cytokines such as IL-1B and IL-6 [4]. Similarly, the mechanism I mentioned above of how Copper binds to homocysteine to produce inflammation would probably not be that big of a deal if you didn't have high homocysteine levels in the first place!

So what can we do to avoid the damage caused by inorganic Copper and Iron?

1. Decrease your inflammatory burden. I've said it once. I've said it a thousand times. This is highly individual, since no two of us have the same health problems. Weather it be being overweight, not exercising, a crappy diet, diabetes, gastrointestinal issues, an autoimmune disease, or whathaveyou, get healthier. If you're not inflamed it appears that these pesky metals won't hurt you as much.

2. Avoid inorganic Copper and Iron. Brewer et al [1] and several others have identified the two major sources of inorganic Copper and Iron as being Copper in our drinking water from Copper pluming and multivitamins (like Centrum). Interestingly, Brewer et al [2] points out in his paper that all of the industrialized countries are dealing with increased rates of AD- Except Japan. This is noteworthy, because Japan is the only industrialized country that does not use Copper pluming. In contrast, about 85% of US homes have Copper pluming [2]. Here's what you can do to minimize the amount of Copper that leaches into your water and avoid inorganic Copper and Iron:
     A. Filter your water. Brita.com does state that their filters filter Copper, but I can not say to what extent. Reverse osmosis is the best at
     filtering things like Cu and Fe, but is more expensive.
     B. Do not get hot water from the tap- Hot water will leach more Cu from the pipes than cold water- Warm the water after it comes out of the
     faucet.
     C. Check the acidity of your water. The more acidic your water, the more it will etch the Copper pipes.
     D. Avoid multivitamins like Centrum. They look like a big ol' piece of metal that they painted red anyway, so who are we fooling when we
     take those? There is no substitute for the vitamins and minerals you get from a healthy diet. Period.

 3. Zinc has been shown to lower levels of free Copper in the blood [2], so making sure you have adequate Zinc levels may be a good idea if you think you're at risk of ingesting too much Copper (perhaps people who have really acidic water at home and can not afford to install a reverse osmosis system).


In health,

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. ​Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.

References:
[1] Brewer, G. Risks of Copper and Iron Toxicity during Aging in Humans. Chem Res Toxicol 2010, 23, 319-326 (PMID 19968254)
[2] Brewer, G. Copper Toxicity in Alzheimer's Disease: Cognitive Loss from Ingestion of Inorganic Copper. J of trace elements in medicine and biology 26 (2012) 89-92. (PMID 22673823)
[3] Batista-Nascimento, L. et al. Iron and Neurodegeneration: From Cellular Homeostasis to Disease. Oxidative Medicine and Cellular Longevity, May 2012 (PMID 22701145)
[4] Mesquita, S. et al. Modulation of Iron Metabolism in Aging in Alzheimer's Disease: Relevance of the Choroid Plexus. Frontiers in Cellular Neurosci. May 2012 (PMID 22661928)
[5] Arnesano, F. et al. Copper-Triggered Addregation of Ubiquitin. PLoS ONE 2009 Sept 16; 4(9) e7052 (PMID 19756145)