Mood, Mind and Methylation

Depression has become an epidemic in the United States. According to the National Institutes of Mental Health (NIMH), in 2013, 9.2 percent of adults in the U.S. reported either chronic, low-grade depression, or having had a major depressive episode, defined as a two week or longer period of low mood, coupled with other symptoms such as poor self-image, sleep difficulty, loss of appetite, poor concentration and low energy. Among U.S. adolescents, a disturbingly high 11.2 percent reported having experienced either major depression or low-grade depression lasting two years or more during their their lives, with 1.9 million (7.7 percent) severely impaired in their ability to function due to depression. (By comparison, about 5% of the world’s population is depressed, according to the World Health Organization.)

These statistics do not distinguish between depression that arises for no obvious reason, and what may be referred to as “situational” depression, which occurs in the face of a significant loss or life event, such as death of a loved one, chronic illness, or divorce. Depression, to a point, is a normal and necessary adaptive response to the inevitable changes and phases of life, so as diagnoses of depression have steadily increased over the past decades, some question whether this increase in diagnosis (and the ever-expanding range of conditions considered treatable by antidepressants) has been strategically fostered by “Big Pharma” to justify escalating antidepressant prescriptions as a response to increasing need. (Spend an evening watching network or cable television, and this theory doesn’t seem so far-fetched.)

On the other hand, many of the nutritional, lifestyle, social and environmental factors that strongly influence our ability to maintain a healthy “brain ecology” and adapt to the stress of loss and life changes have become increasingly disturbed in recent decades, contributing to a pervasive decline in mood.

For those depressed and/or anxious people who seek treatment (and a significant number do not), common treatment strategies increasingly include pharmaceuticals, often more than one prescribed in combination. Pharmaceutical antidepressants work by indirect methods to improve the balance of stress hormones such as norepinephrine (a form of adrenaline) and neurotransmitters (brain messengers such as serotonin and dopamine that influence mood, energy, focus and motivation).

Psychotherapy is another common treatment avenue for mood disorders. The benefits of appropriate psychotherapy can be profoundly and positively transformative and are without question a part of any committed approach to treatment of significant depression and/or anxiety.

Depression is not a chemical imbalance

The idea that “depression is a chemical imbalance in the brain” has come to be generally accepted as fact, a medical explanation for depression’s varied symptoms. If this statement is true, then it seems reasonable to apply to the problem of chemical imbalance, a chemical (pharmaceutical) solution. However, this statement is inaccurate in that it sidesteps the more precise and clinically important distinction that we humans are biochemical, not chemical beings. Moreover, the misperception that chemistry provides the best answer to biochemical imbalance denies the powerful therapeutic potential of non-drug , biochemical approaches that actually have the ability to promote true healing of the mind’s biochemical imbalances. (If this were merely a semantic distinction, the extensive field of biochemistry, distinct from that of chemistry, would not have come to exist as it does today.)

There is certainly a place for pharmacologic treatment for mood disorders, including depression. However, it is important to note that while pharmaceutical antidepressants have the ability to modulate levels of neurotransmitters and stress hormones, they do not support the brain’s innate ability to attain and maintain balance in this system. Even when pharmaceutical treatment is indicated, and in view of its associated risks and side effects, doesn’t it make sense to also address existing biochemical dysfunction?

Biochemical Treatment of Depression

Given the proper support, the body/mind has incredible recuperative ability. Humans do not have deficiencies of the chemical antidepressants Zoloft, Wellbutrin, or Elavil, helpful though they may be in some situations. However, we may have imbalances of biochemical such as serotonin, norepinephrine, dopamine, and cortisol, and the underlying mechanisms that naturally support healthy levels and interaction among them.

Elements of a biochemical, “functional” approach to depression and other imbalances of mood may include:

  • Nutritional evaluation and optimization, particularly focused on vitamin D, the Omega-3 fatty acids, the family of B-vitamins, amino acids as the raw materials for neurotransmitters, and other vitamin and mineral co-factors for healthy brain balance.
  • Functional laboratory evaluation of sex hormones, stress hormones and neurotransmitters, to identify and address imbalances.
  • Attention to lifestyle: improving eating habits to stabilize blood sugar; identifying and minimizing exposure to food intolerances; exercising; integrating mind and body through practices such as mindfulness, yoga, Tai Ch’I, or spending time in contact with Nature and the earth.
  • Detoxification: improving digestive tract function and microbe ecology; cleaning up one’s personal environment; obtaining guidance and support for identification and detoxification of internal and external toxicants.
  • Support for impaired methylation cycles.

What is Methylation?

Methylation is an essential biochemical process that occurs in every cell of the body, billions of times per second. The common currency of methylation is the “methyl group”, a biochemical “widget” that contains one carbon and three hydrogen atoms. These methyl group widgets are used to drive many different biochemical processes, through revolving “cycles” of methylation, like a biochemical game of poker, during which methyl groups are exchanged and passed around to perform necessary functions.

In the brain, the importance of methylation to healthy mood cannot be overstated. Methylation is involved in making hormones and neurotransmitters (such as melatonin, serotonin, cortisol, epinephrine and dopamine) that interact to promote a mind-state of serene, alert wellbeing and tolerance for stress. Methylation is also essential to the necessary metabolism, or breaking down for elimination, of hormones and neurotransmitters, among them dopamine, cortisol, histamine, norepinephrine, epinephrine, and glutamate. If methylation is impaired, the exquisite balance between production and elimination of stress hormones and neurotransmitters is skewed, and mental function and mood are negatively affected.

Supporting MTHFR, MTRR and COMT enzymes

MTHFR (methylene tetra-hydrofolate reductase), MTRR (methionine synthase reductase) and COMT (catechol-O-methyltransferase) are enzyme systems that act synergistically as brain methylation pathways to promote balanced brain biochemistry. Reduced activity of these enzymes can occur because of inadequate nutritional cofactors required for their function due to poor diet, nutrient depletion from stress, inflammation or toxicity, or because of genetic influences. Impairment of these enzymes increases vulnerability to depression (and other disorders such as anxiety, attention problems, and bipolar illness).

With the relatively recent identification of gene SNPs (single nucleotide polymorphisms, or mutations) involving these and other enzyme systems, genetic influences on depression have become more clear. Fortunately, it’s possible to reduce the impact of genetic vulnerability, by providing specific nutrient support targeting the genetic vulnerability associated with the SNP. In this way, the symptomatic expression of depression (and other mood disorders) may be “epigenetically” modified in a positive direction through nutrition and lifestyle. For example, if through testing a person learns that they received a SNP from both parents for the MTHFR mutation, which interferes with folate metabolism, she/he is significantly more vulnerable (36% according to one study) to depression. The good news is that this genetic vulnerability may be significantly neutralized by adequate nutritional intake of appropriate nutrients, including folate. It’s like taking a detour around a roadblock.

Nutritional “Antidepressant” Support for Methylation

The amino acid nutrients SAMe (S-adenosyl methionine) and MSM (methyl sulfonyl methane) provide raw material for and broad general support for methylation. Essential cofactors used in these pathways include the B-vitamin folate in the form of 5-MTHF (5-methyl tetrahydrofolate), vitamin B12 (as methylcobalamin), and activated, or phosphorylated forms of pyridoxine (vitamin B-6) and riboflavin (vitamin B-2). Additional nutritional methylation cofactors are trimethylglycine (also called betaine) and the minerals selenium and magnesium. For optimal bioavailability, particularly for those with genetic vulnerability to poor methylation, these nutrients must be provided in ready-to-go, partially metabolized forms, as noted above.

Because of the complex interrelationships between these enzyme processes and the nutrient cofactors that support them, it is recommended that nutritional intervention be undertaken under the supervision of a healthcare practitioner with a background in functional medicine and biochemistry as it relates to methylation and mood.

How Well Are You Methylating?

How can you find out if you have a problem with these naturally mood-stabilizing pathways? One of the most obvious indications of methylation impairment is a serum test for the blood protein homocysteine, available from any clinical laboratory. A serum homocysteine level above 8.0 tells you that methylation is not proceeding smoothly. Another indicator is an elevated MCV (Mean Cell Volume) on a CBC (Complete Blood Count). That said, a normal MCV can coexist in someone with an elevated homocysteine level, and not all methylation impairment can be identified through homocysteine. However, with the advent of relatively inexpensive genetic testing, it’s easy to find out if you have SNPs in methylation-relevant enzyme systems (including MTHFR, COMT, and MTRR). Armed with that information, it’s possible to create a truly personalized plan for improved methylation and better mood.

Sustaining Lifestyle Transformation: Staying on Course for the Life You Want

Change is not merely necessary to life – it is life.  Alvin Toffler

Change and transformation are part of every moment of all our lives.  Whether we recognize it or not, our bodies, our emotions, our minds, our spirits are changing every day:  cells are replicating, growing, performing their functions, and dying; our minds and hearts are perceiving, forming opinions and feelings, learning, and developing; our souls and spirits are experiencing this world, interacting with it, and evolving.  Our health is no different.  Whether we choose it or not, our body systems will alter over the course of our lives, gradually shifting in function and physiology as we mature, express the fullness of the life force, naturally decline and transform into non-physical energy as we leave this plane of existence.  What we do have influence over is the rate of change and the form this natural process will take  –  to a great extent, the trajectory of our health and the quality of our life experience are a matter of choice.  We can choose the path of “disease expectancy” our society has embraced, with declining health and an increase in medications and procedures starting in mid-life or even earlier; or we can follow the lead of cultures throughout the world (so-called “Blue Zones”) in which vitality and health persist far into the later years, and decline occurs only at the end of the lifespan.

Most people know, both instinctively and from available information, the outlines of the lifestyle that will create a healthier, more vital trajectory for their lives.  But as too many of us are aware, intellectual knowledge often submits to deeper, more powerful forces in the body and the psyche when real transformation appears on the horizon.  What is necessary is nothing less than a metamorphosis, a kind of death of the old self and emergence of a new one, and as we move closer to it this can bring up fears, resistance and encounters with parts of ourselves we have done our best to avoid, what the poet and writer Robert Bly calls the “human shadow”.

The shadow contains for each of us the parts of the personality that are hidden from us – we are often encouraged to turn away from shadow aspects of self by family, teachers, society, and cultural or religious institutions who themselves are uncomfortable with their shadows.  The shadow isn’t bad, however, it’s just human, and as Bly points out, the less we acknowledge it, the larger it grows.  Much as we would like to leave it behind, it is part of us and will follow us everywhere. When we embark on a plan of lifestyle change, shadow elements appear to whisper in our ears, urging us to do the very thing we have firmly resolved not to do: smoke a cigarette, take a drink, or eat that humongous piece of chocolate cake that has been beckoning us all evening.   This urge to sabotage our highest and healthiest intentions has been termed the “counter intention” by the life-coach Joe Vitale, and to persist in the work of successful lifestyle change we must engage with our counter intentions and shed light on our shadow.   Dialogue processes (such as Voice Dialogue techniques), journaling, working with a life-coach or therapist, and group support can give us tools to explore the underpinnings of such resistance to positive change.

It’s not that some people have willpower and some don’t.  It’s that some people are ready to change and others are not.  James Gordon, M.D.

Commitment to and patience with the process of change is integral to any serious program of lifestyle transformation.  After the “New Year’s resolution” phase has passed, we are left with the challenging and often merely tedious reality that many steps lie between us and the realization of the vision which first got us started on this path toward a healthier version of ourselves.   Rather than allow this to cause us to lose momentum (or give up on our dream entirely) it is helpful accept that behavioral change (which is what lifestyle transformation comes down to) takes time; it’s a process of learning how not to do what we have done habitually in the past, and instead learning new skills for living – eating, drinking, exercising, sleeping, resting, playing, thinking, working, interacting – that support a fuller, higher functioning life.

Change is a process, not an event.  James O. Prochaska, Ph.D.

Understanding more about how real change happens allows us to reframe the journey toward our vision from being goal-oriented to becoming process-oriented, from an unrealistic and perfectionist belief that our progress must be linear to an acceptance that movement “directionally in the right direction” may seem slower but is more aligned with realities of human nature and therefore ultimately more successful.  It allows us to take our dream out of the world of fantasy and the future and to bring it to earth in this moment and, step by step and over time, to make it real.

Man can alter his life by altering his thinking.  William James

The psychotherapist James Prochaska and colleagues developed a theory of behavior change that has come to be known as the “Stages of Change” model.  Originally applied to the field of substance addiction treatment, it has been shown to be a successful tool for many areas of behavior transformation, from bullying prevention to weight management.  Determining where in the stages someone is guides the approach to helping them move through each stage, from a state of denial about the risks of their behavior, to the point at which the new, desired behavior has become a habit.  These stages are 1) Precontemplation: the person sees no need for change, despite negative effects of the behavior; 2) Contemplation: the behavior is recognized as undesirable. The person is not ready to change yet and focuses on the difficulty of changing, but is thinking about it; 3) Preparation: not ready to take action yet to change the behavior, but taking small steps in that direction: a smoker tells family and friends they intend to stop smoking, and starts thinking about the benefits of not smoking; 4) Action: the person has changed the behavior (ie. they have stopped smoking), but the change is recent (6 months or less) and they are at risk of returning to the old, unhealthy behavior; 5) Maintenance: the new, healthy behavior has been practiced for more than six months.  It has become a healthy habit, replacing the old, unhealthy one. The risk here is that stressful situations or an environment that  triggers the former behavior, can contribute to a relapse, so ways of reinforcing the new behavior are essential to its maintenance.

You always pass failure on the way to success.  Mickey Rooney

It is perhaps frustrating, but true to realize that just about everyone who undertakes a significant lifestyle change will move back and forth within these stages, sometimes many times in various permutations, before the new behavior and its benefits are firmly in place.  But there are strategies that can make progress more sustained, more “directionally in the right direction”, that abbreviate time spent in the inevitable relapses, and allow for a shorter road to successful transformation.  Prochaska calls these “Processes of Change”, and learning and practicing these tools is integral to many effective programs of addiction treatment and lifestyle change:

1)      Consciousness raising: becoming aware of and informed about the unhealthy behavior (the health risks of overweight, for example) and the positive aspects of the healthy behavior (such as the benefits of exercise).  Reading books on the subject, doing internet research, talking to people who have changed the behavior in question, getting feedback from people in your life about their feelings toward the change you are making, can bolster your motivation to change.

2)      Dramatic Relief:  feelings of fear and anxiety about the unhealthy behavior (for example, people who have had a close call with their health – a heart attack or cancer experience, are often highly motivated to replace unhealthy with healthier behaviors); conversely, feelings of hope and inspiration in learning about others’ successful journeys to healthy behavior deepens commitment and joins knowledge with desire and belief in the possibility of change. Twelve-Step and other group meetings are excellent ways to obtain this kind of support.

3)      Reevaluation:  realizing that the healthy behavior expresses who you really are and the person you want to become; also seeing how the unhealthy behavior affects those around you, and the positive effects on others of the new behavior.  Seeing that society as a whole supports the healthy behavior.

4)      Self-Liberation: belief in your power to change, and acting on that belief : “Yes, I Can!”

5)      Helping relationships: seeking out people who support your process of change.  In my work, I have observed that many people want to “go it alone” and resist the idea of joining groups or seeking the support of others in their lifestyle change programs; yet I have seen even the most adamant loners find such support to be invaluable and a source of compassionate camaraderie for every phase of their transformation.  And I have noted that those who insist on going it alone often lose momentum and when difficulties arise, they are less likely to persist and succeed in the desired change. So, depending on your area of needed lifestyle change, here are some options for finding helping relationships for your process:  join a twelve-step program, or a support group (or form your own – online groups are an option); find one or more “buddies” among friends or in your community for mutual encouragement in your change process; work with a counselor or therapist with expertise in the area of your behavioral change; take a class that supports the kind of lifestyle change you are working on, such as a healthy cooking class.

6)      Counter-conditioning: developing healthy ways of acting and thinking to replace unhealthy habitual thoughts and actions.  (Example: having a cup of chamomile tea and a hot bath when you get home from a stressful day instead of a glass of wine as you watch the anxiety-inducing evening news.  Or, take a meditation or mindfulness class and learn how to reduce stress and anxiety with your breathing and awareness instead of with a cigarette or pie a la mode.)

7)      Reinforcement: rewarding yourself for healthy behavior and letting go of rewards associated with the unhealthy behavior. (Example: recognizing how great it feels to once again fit into clothes from a slimmer past, vs. the temporary satisfaction of your favorite self-sabotaging “comfort food”.)

8)      Controlling stimuli:  replacing reminders for unhealthy behavior with cues for healthy behavior.  (Example: Clearing your kitchen counter of sweets; replacing them with a bowl of fruit.)

One should eat to live, not live to eat.  Benjamin Franklin

Just as our psychology can help or hinder our motivation for lifestyle change, so can our biology and biochemistry support or undermine our commitment.  Unhealthy lifestyle behaviors do more than limit our enjoyment of life and put us at risk for chronic disease later – for everything from atherosclerosis and arthritis to diabetes and dementia has roots in lifestyle choices – they insidiously drive the very behaviors we want to change, skewing the healthy function of body systems designed to keep us in balance.

So one of the most important aspects of sustainable lifestyle change is regaining and supporting balanced body function and biochemistry.  Whether the goal is to put the smoking habit in your past, to lose weight, or to maintain sobriety, proactively using healthy eating, exercise, nutrition and stress reduction eases the transition to healthier behavior and raises the threshold for relapse.  In my work I use a program of therapeutic lifestyle change (TLC) which features a low Glycemic Index, modified Mediterranean-style diet and incorporates exercise, stress reduction, detoxification and nutritional support for balanced movement toward healthier lifestyle habits.

In addition, I evaluate and treat imbalances in systems whose proper function is crucial to supporting a particular lifestyle change:  for the overweight, we may look at insulin and thyroid function, test for food sensitivities (whose addictive component can sabotage dietary change), and measure stress hormones and neurotransmitters (brain biochemicals which modulate impulse control, mood, and motivation). We evaluate body composition (the percentages of fat and lean muscle) at the program’s start and throughout, to objectively track change and provide motivation to continue.  Nutritional support tailored to the individual helps to normalize biochemistry thrown off-balance by years of poor diet and depleted by the increased nutrient demands of unhealthy habits.

The only person we can truly change is our self.  L. Hunter Louins

By the time people present themselves in my office looking for guidance for lifestyle change, they’re often demoralized by repeated, failed past attempts. One of the questions I ask them is, “What do you think will make this time different?”   I ask this somewhat provocative question in order to confront and activate their core desire for authentic change.  If we keep using strategies which have been unsuccessful in the past, it’s unrealistic to expect a different outcome.  To create successful, sustainable lifestyle transformation we first need the touchstone of a deep desire for change; then we need to learn from our relapses, get support for each stage of the change process, and practice doing things differently long enough for a desired, healthy behavior to become a habit.

Resources Tips for health and happiness from the world’s most vital cultures.

A Little Book on the Human Shadow, by Robert Bly

Zero Limits, by Joe Vitale, Ph.D. for information and books on Hal and Sidra Stone’s Voice Dialogue technique

Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your life Positively Forward, by J.O. Prochaska, J. Norcross, and C. Di Clemente

The Pathway: Follow the Road to Health and Happiness, by Laurel Mellin


Irritable Bowel Syndrome in Children: Hope and Help

“Health begins in the colon”:  this fundamental precept of natural medicine was first introduced to me as a naturopathic medical student, and its homely but powerful wisdom has proven itself over time, through my clinical experience as a naturopathic physician and by a substantial and ever-increasing body of research.  What seemed to me a quaint, abstract concept in naturopathic medical school I now apply to almost every patient, whether they have gastrointestinal issues, chronic sinusitis, or anxiety.  So when children develop a problem such as irritable bowel syndrome, it’s even more important to view it from this holistic perspective: to consider the implications for not just the digestive tract but for the entire body (including the emotions and the mind), and to recognize that failure to resolve even mild, chronic bowel issues can have profoundly detrimental effects on health far into the future, even for life.

What is IBS?

In both adults and children, Irritable Bowel Syndrome, or IBS, is characterized by abdominal discomfort or pain, bloating, and flatulence (gas).   Constipation or diarrhea, which may alternate (a few days of constipation followed by loose or diarrheic bowel movements) are also common.  The intensity of symptoms ranges from mild to severe, and symptoms may be episodic or constant.  IBS may also be referred to as spastic colon, or mucous colitis.  It is considered to be a chronic condition, one which is uncomfortable and may impose lifestyle limitations on sufferers, but is less serious than inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease. 

For those with moderate to severe IBS, however, the condition can significantly erode quality of life.  For in addition to the discomfort of the physical symptoms and the fatigue caused by chronic pain, the loss of control of a private body function can create feelings of embarrassment and shame, and can contribute to anxiety and depression.  The physical, emotional and mental effects of IBS can be deeply experienced by children: to hear a child with chronic bowel irritability unemotionally express that he or she does not want to live if it means ongoing abdominal pain and exhaustion makes disturbingly clear the toll this condition can take.

A report from the National Institutes of Health notes that five years after diagnosis, most people with IBS still have it – a discouraging prognosis, but one which can be significantly improved upon with natural medicine approaches.

May I have your attention please?

The term “Irritable Bowel” is an accurate description of the underlying problem:  the bowel (the lower part of the digestive tract, between the stomach and the rectum) becomes irritated and “acts out” in the same way an unhappy or distressed child may act out with poor behavior.  It’s the body’s way of asking for attention, telling us that something’s wrong here, and it’s a pretty effective message.  After all, the symptoms of irritable bowel syndrome – the bloating and gassiness, discomfort or pain, constipated or abnormally loose bowel movements – are hard to ignore.  In responding to this request for attention, we can just focus on treating symptoms, which is the conventional medical response to IBS – or we can listen carefully, search for the deeper causes of digestive dysfunction, and work to heal them.

Common Pro-Inflammatory Foods

·         Gluten-containing grains, which include wheat (including spelt, kamut, and triticale), rye, and barley.  The inflammatory effect may or may not be associated with celiac disease.

·         Cow’s milk products, including butter, yogurt, cheeses, casein and whey proteins.

·         Eggs and products made with egg.

·         Soy products and products made with peanuts.

·         Beef, pork, and shellfish, including processed meats such as cold cuts, frankfurters, and sausages.

·         Condiments such as ketchup, prepared mustard, BBQ sauce, soy sauce and salsa.

·         Refined sugars such as white and brown sugar, molasses, corn syrup (including high-fructose corn syrup), fructose, dextrose, and glucose.  Artificial sweeteners are also to be avoided.  Therefore,  popular beverages marketed to children are out:  water and herbal teas are fine.

Food toxicity

The first place to start with IBS is with the most common, frequent source of irritation for the bowel:  the food and drink that goes into it several times a day.  Food toxicity (also called food sensitivity or food intolerance) refers to the effects of certain negative interactions between the immune system, specific foods, and the body; these interactions create inflammatory reactions in the tissues affected by them, and among the most common tissues targeted by these toxic food reactions are those of the digestive tract.  These reactions are different from those of classic food allergy, which are caused by a different part of the immune system and have different effects in the body.   And in contrast to a classic  food allergy reaction, in which symptoms appear quickly after exposure to the problem food (for example, an immediate hive reaction or life-threatening anaphylactic response to eating peanut or shellfish), food toxicity/ sensitivity reactions usually occur after a delay of anywhere from two hours to two days after exposure to the offending food.  This makes them difficult to identify – if abdominal pain intensifies two days after having eaten a toxic, inflammatory food, tracking back to what was eaten a  couple of days before is a challenge.  Add to this the cumulative effect of this kind of food reaction, such that eating two problem foods in a day may have little noticeable effect, but eating four or five of them kicks up symptoms badly, and trying to pinpoint the culprits can be very confusing.

If you’re trying to reduce the total burden of food toxicity in your child, a good place to start is with foods that have become identified as being “pro-inflammatory”, such as those listed in the sidebar.  Avoiding foods from this group for two to four weeks, then carefully  reintroducing each category in isolation from the others, can shed light on which are most toxic for your child.  Even avoiding a couple of categories, if they are thoroughly cleared from the diet in every form for this two- to four-week timeframe, can provide useful information.

However, if this exercise fails to clarify your child’s problem foods, it may be because their unique “pro-inflammatory” list includes otherwise perfectly healthy foods.  Because this issue is caused by an immune system which has developed an abnormal attitude towards foods, any food can become inflammatory – even garlic or broccoli! Even lettuce! Fortunately, there is testing available which uses a single blood sample to accurately determine which foods have become toxic for an individual, by measuring immunoglobulin G antibody levels in the serum (standard allergy testing looks for elevated levels of immunoglobulin E).  It is essential to use a lab with high standards of quality control for this testing, in order to minimize false negatives (in which harmful foods are missed) and false positives (In which foods are incorrectly identified as inflammatory and avoided unnecessarily).

Dysbiosis:  “Bad Bugs”

Our digestive tracts are home to a large number of microbe species, some “good bugs” and some “bad bugs”.  The majority of microbes present in the bowel ought to be beneficial, or probiotic species:  the Lactobacilli, Bifidobacteria, and healthy types of E. coli bacteria that do much to promote health both in the digestive tract and throughout the body.  Dysbiosis is digestive tract microbe imbalance characterized by insufficient numbers of beneficial probiotic organisms, and/ or the excessive presence of pathogenic (harmful) bacteria, yeast organisms, or even parasites.   In many children with symptoms of IBS, much of the inflammation and irritation to the bowel is caused by dysbiosis.  How does dysbiosis happen in a child?  The use and overuse of antibiotics, a high refined-carbohydrate, low fiber diet, steroid use (inhalers, topical steroids for eczema),  an “inheritance” of microbe imbalance passed on from parents (perhaps even in utero), the toxic impact of food intolerances – any of these negative influences can “tip over” the balance of healthy vs. unhealthy microbes in the bowel, .

In natural medicine treatment of IBS, special stool tests (more comprehensive than standard lab or hospital testing of stool) can be used to evaluate the levels of probiotic and dysbiotic microbes, to identify which herbs or other natural antimicrobials would be most effective to reduce any harmful microbes which are detected, and to get specific information about digestive enzyme function, nutrient absorption, and acid-base balance in the bowel.  This provides a good basis for correcting dysbiosis and ensuring that going forward, a healthier digestive tract environment is in place to better support the survival of probiotic organisms.

Nourish the bowel

It may seem odd to think of nourishing the bowel – we usually think of the intestine as helping us to get nourishment from our food – but yes, our intestinal cells, and the tiny, beneficial microbes (probiotics) that live in the digestive tract, all rely on us to feed them, and feed them well.  Unfortunately, the “Standard American Diet”, often referred to as the SAD, offers little of the nutrition our digestive tracts need to function properly, and plenty to throw them off balance.  “White foods” such as refined sugars and flours; processed foods, low in fiber and enzymes, flavor-enhanced and engineered for long-distance travel and high profit at the expense of nutritional quality; sweetened beverages, which have largely replaced that strange-tasting colorless liquid, water, in our children’s diets – these staples of the modern, ever “new and improved” food culture seriously disrupt the natural balance of digestion, nutrient absorption and elimination.  It’s not very surprising, given the dismally poor-quality diets on which many of our “overfed but undernourished” children subsist, that their digestive tracts eventually rebel.

If your child’s digestive tract is in rebellion (in about a quarter of IBS sufferers, gastritis or reflux is also an issue) you will need to feed her or him differently – better! – in order to resolve bowel irritability.

Basics of a “Better Bowel” diet

What is a “better bowel” way of eating? It provides fiber for good microbes to eat, so they can produce substances called “beneficial short chain fatty acids”, or SCFAs, which actually nourish the intestinal cells.  Fiber also makes for a fuller bowel, which stimulates the muscles in the intestinal wall to move things along, promoting a more regular bowel movement.  This way of eating just naturally creates a healthy acid/base balance (pH) in the stomach and small intestine, so that digestive enzymes can be activated and proteins, fats, and carbohydrates from food are broken down into particles that are well-absorbed through the healthy intestinal wall.  A “better bowel” way of eating forms a pH that also allows healthy bacteria (probiotics such as Lactobacillus acidophilus) to survive and thrive, and provides nutrients like amino acids, healthy fats, vitamins and minerals which keep the intestine well-nourished.

It isn’t complicated to eat this way, though it’s possible that getting there may take some time, particularly if the SAD has been your family’s accustomed way of eating.  Understandably, we tend to eat as our families ate growing up, more or less, and it takes conscious effort and intention to unlearn those old habits and to begin to learn about which foods support health, how to shop for them, how to prepare them, and how to transition your child (or even better, your entire family) to them.  If the idea of setting foot in a natural foods store is beyond consideration, you may as well stop reading now, and go stock up on whatever pharmaceuticals have been recommended to manage your child’s symptoms.  But if you really want to improve your child’s digestive function, fundamentally and for the long term, take this opportunity to use the simple tools of food and drink to begin to resolve the underlying issues of IBS.  The “Better Bowel” way of eating (see sidebar) is simply what Nature designed long ago for the body as a whole, so it’s no surprise that the digestive system thrives on the same: a diet of unprocessed or minimally processed high-fiber foods, which also happen to be high in nutrients and low in sugar. 

The Better Bowel Diet

·         Fresh vegetables and fruits (or when fresh is not available, frozen & organic as a second-best choice).   Try making a puree of vegetables cooked as soup, and serve it with a straw; freeze grapes, pureed berries or bananas for a healthy summer alternative to ice cream.

·         Whole grains (such as brown rice instead of white rice – or brown basmati rice as a milder, “transitional” version of brown; whole grain breads – but not fake, caramel-colored “whole-wheat” bread).

·         Beans, nuts and nut butters, seeds and seed butters – try bean dip, hummus, beans in soups.

·         Starchy veggies:  sweet potatoes, potatoes, yams, beets, parsnips. 

·         Fish, fowl, lean meat is fine too.

·         Water – jazzed up with a splash of fruit juice, or lemon or lime, if plain won’t work.  Or ice some herbal tea, and sweeten, if necessary, with a little agave nectar.

There are many books and a lot of online support for this process, and with children (of all ages) the idea of making change “slowly but surely” is an effective strategy.  The challenge is hanging in there until tastes change (and they do) and improvement is established enough for you and your child to see (and feel) that this health-food diet stuff is actually working.  

 Because a child with IBS has a digestive tract that is out of balance, there may be temporary reactions such as increased gas or a change in bowel movements in response to positive dietary changes; if these persist or are more than mild, you may want to enlist the expertise of a naturopathic or other natural medicine physician. My experience over almost thirty years of doing this work has been that once positive changes begin and children really see the connection between how they eat and how they feel, they become some of my “best” and most compliant patients.

Nutraceuticals for IBS

There are wonderfully effective natural medicines to reduce discomfort and accelerate the healing process for irritable bowel.  What follows is a partial list of readily available nutrients and herbs that can be used in liquid or powder form, or can be removed from capsules and combined with applesauce, dilute fruit juice, or any liquid or food for easier administration to a child. 

  • A good quality probiotic: in my practice, I often start child IBS patients on a high-quality probiotic designed to treat IBS, which guarantees 60 billion organisms per dose at the time of expiration, and is tested to ensure the purity and viability of each strain.  This product contains the NCFM strain of Lactobacillus acidophilus and Bifidobacterium lactis strain Bi-07, both of which have been found in research to be effective for IBS.  I start child patients on a probiotic gradually, with a dose as small as 1/8 tsp. daily, increasing over the course of a few weeks to a treatment dose which is determined based on results of testing.
  • L-Glutamine:  this amino acid is nutritive and healing to the intestinal lining.  It is available in powder form and tastes slightly sweet, so it’s easy for children to take.  I may prescribe 3 grams per day or more, in 2-3 doses divided through the day, for a child with IBS.
  • Slippery Elm:  this mucus membrane-soothing herb can be taken as a tea, removed from capsules and stirred into applesauce, or it may be found in combination formulas designed for digestive tract healing.
  • Licorice Root Extract:  deglycyrrhinated licorice, for the child that enjoys the taste of licorice, can be a pleasant-tasting way to promote a regular bowel movement and heal the mucus lining of the upper and lower digestive tract.  It is available as an ingredient of powdered formulations, or in chewable form.
  • Aloe Leaf Extract which has had the bitter elements removed to prevent a laxative effect, is anti-inflammatory to the intestinal lining, may reduce harmful yeasts in the bowel, and provides fiber to normalize the bowel habit.  It can be found as a single ingredient product in liquid form (but be sure the laxative components have been taken out!), or in combination formulas.  I often prescribe about 200mg. per day of a concentrated extract.
  • Other supplements which can be helpful in rebalancing digestive tract functions include digestive enzymes, peppermint oil, fish oil, turkey rhubarb, and magnesium.

Mind, Mood & IBS

Did you know that the majority of serotonin, the brain chemical that helps us to feel positive and motivated, is made in the intestine?  When a child has a functional bowel disorder such as IBS, stress hormones, neurotransmitters, and toxins can profoundly disturb mood, energy and mental function.  Treating IBS naturally, healing the underlying causes and returning the digestive tract to the healthy, balanced  state which is natural to it, often creates amazing transformations in children:  from depressed, exhausted, anxious and brain-fogged to energetic, happy, focused and motivated.  To watch this process of physical, emotional, mental and energetic transformation take place in a child with irritable bowel syndrome is a source of great joy for everyone concerned.

Debra Gibson, N.D. practices naturopathic family medicine in her Ridgefield, CT, USA office.  She can be reached at 203-431-4443 or at



Simple Natural Tips to Balance Blood Sugar

Whether you’re aware that your energy slumps, cravings for sweets or breads, bouts of irritability, or poor concentration relate to patterns of poor eating; or you need to pull out of a stall in the weight loss program you started earlier in the year; or you just want to improve your eating habits for greater health and vitality, better blood sugar balance is essential.  We now know that there are serious consequences for long-term uncontrolled blood sugar and its evil sister, hyperinsulinemia (high blood levels of the hormone insulin): increased risk for stroke and cardiovascular disease; high serum cholesterol/ triglycerides; Type 2 diabetes mellitus; inflammation; dementia, and many more members of the dysfunctional family of chronic degenerative diseases.  So achieving and maintaining blood sugar stability may be one of the most important and simplest strategies for health promotion in the short term and disease prevention for the long run.

While blood sugar balance involves complex interactions between the food we eat, many hormones, and multiple organs and body systems, when it comes down to it there are two essential elements around which the whole process revolves: the pancreas, which secretes the blood sugar-regulating hormone insulin, and the membrane of each cell, where glucose leaves the blood to be put to use inside the cells.

Blood Glucose and Insulin

Glucose is an end-product of the digestion of carbohydrate-containing foods from our diets: healthy, complex carbs are found in fruits; grains; vegetables, particularly the starchy ones such as potatoes; nuts; seeds; and beans.  Whether you have the garden-variety form of blood sugar imbalance called hypoglycemia (low levels of blood glucose); or the opposite problem of high blood glucose (hyperglycemia, which when advanced and chronic becomes diabetes mellitus), the net effect is the same:  not enough glucose inside the cell, where it can be put to use making energy and helping cells work properly.  Glucose enters the cell by crossing the cell membrane, and it does this through “doorways” in the membrane called glucose channels.  These doorways have “locks” on them called insulin receptors, which will only open if the “key” to the insulin receptor – the hormone insulin – turns smoothly in the lock.  When that happens – abracadabra! – the glucose channels open, glucose streams into the cell, and the cell makes energy with it.  The whole cell is happier, healthier, and more productive when this lock and key system works well; when it doesn’t, your cells can’t function well and neither can you.

Re-sensitize your insulin receptors

At the cellular level, balanced blood sugar depends on healthy, sensitive insulin receptors – so if your blood sugar is out of whack, it’s smart to ask, What will make my insulin receptors work better?

Just as an insensitive person may have poor listening skills, insensitive insulin receptors don’t “hear” insulin knocking at the door, so they don’t respond as they are supposed to, letting glucose into the cell.  While there are many nutrients that can help your insulin receptors to hear better, to keep it simple I’ll mention just a few of the most important:  the trace mineral chromium (the “trivalent” nutritional form, not the toxic, shiny metallic form); the antioxidant alpha-lipoic acid; the omega-three class of essential fatty acids; a high-potency B-complex vitamin.

Chromium picolinate or polynicotinate (yeast-free):  these two versions of chromium have shown better absorption than others; named “Glucose Tolerance Factor” when first discovered, trivalent chromium has been shown to improve glucose balance in numerous studies.  It is estimated to be present in low amounts in 90% of diets. Though I may use higher dosages clinically, daily intake of between 200 and 600 mcg. is reasonable and has been demonstrated to be safe and beneficial in human studies.

Alpha-Lipoic Acid:  this super antioxidant has been shown in studies to positively affect glucose balance and insulin sensitivity by means of several mechanisms.  While opinions differ as to which version is most effective (the R-form or a mixture of the two biochemical forms, the R and S forms), I have come down on the side of the R-form, and routinely prescribe a stabilized R-Alpha- Lipoic Acid, in doses ranging from 100-200 mg. twice to three times daily.

Omega-3 Fatty Acids (EPA and DHA): these healthy fats (EFAs, or essential fatty acids) are found in certain fatty fish, calamari, and krill, and have been found to improve glucose and insulin balance in Type 2 diabetics.  They keep cell membranes supple, enabling the receptors and channels seated in the membrane to work better, and their anti-inflammatory effects improve insulin receptor sensitivity for better glucose balance.  I may prescribe between 2000 and 6000 mg. daily of total omega-3’s when addressing glucose/ insulin intolerance.  Fish oil quality varies widely, and I am careful to choose those from manufacturers which adhere to pharmaceutical-level production practices and are sustainably sourced, are third-party assayed for contaminants (mercury, arsenic, cadmium, dioxins, PCBs), and are stabilized with natural antioxidants (such as tocopherol [vitamin E], ascorbyl palmitate [a form of vitamin C], or rosemary) to reduce the rate of deterioration in the bottle.

B-Complex vitamins: because of their role in turning glucose into energy, increasing chromium bioavailablilty, and promoting healthy essential fatty acid metabolism, no program for better blood sugar balance is complete without attention to B-vitamin status.  In my practice, I often prescribe 50-100 mg. daily of many of the B-vitamin family members; I also provide counsel regarding potential for and symptoms of toxicity for Pyridoxine (vitamin B-6).

Preserve your pancreas!

The pancreas, remember, is another major player in blood sugar regulation.  One of its primary functions is to secrete insulin from special cells called beta-cells.  In someone with insulin-dependent diabetes mellitus, the beta cells don’t make enough insulin, so the person must take it daily to keep blood sugar in balance.  When insulin receptors have become “hard of hearing” as described above, the pancreas tries to fix the situation by flooding the bloodstream with insulin, hoping to overcome the insulin insensitivity and push glucose into the cell.  This condition of hyperinsulinemia is bad enough, because it is associated with a host of serious, undesirable health issues, some of which have been described.  But even worse is the unfortunate reality that over time, the pancreas just can’t continue to secrete so much insulin; it becomes fatigued, so to speak, and can’t put out enough to manage blood sugar.  Of course, the best way to protect your pancreas from overwork and exhaustion is to minimize refined carbohydrates (foods which contain processed sugars and flours – so-called “white foods”), eat a whole foods, low-glycemic burden, Mediterranean diet, balancing complex carbohydrate and protein in five or six smaller meals and snacks spread through the day; to exercise; and to balance your stress response.

Gymnema sylvestre and Beta-cell regeneration

But what if your pancreas is close to burn-out, what can you do?  A number of botanicals have been found to positively affect glucose/ insulin balance, among them Momordica charantia (bitter melon), Vaccinnium myrtillus (bilberry) and Cinnamonium cassia (cinnamon).  A standout among botanicals for blood sugar control, however, is the herb Gymnema sylvestre (known in Hindi as gurmar, or sugar destroyer, because it reduces the taste of sweetness for a couple of hours after chewing on its leaves).  This mellifluously named herb has been used in India for 2,000 years to treat diabetes, and over the past decades extracts of Gymnema have become a focus of scientific research for their ability to increase pancreatic beta-cell insulin production and normalize blood glucose.  In naturopathic medicine, Gymnema is an important tool for improving insulin secretion in people with “pancreatic fatigue” and declining or low insulin output; in my practice I prescribe a formula which contains 100 mg. of Gymnema extract, standardized to contain 25% of the gymnemic acids which are thought to be the active components of the herb.  I usually prescribe Gymnema in two divided daily doses of 100-200 mg. each.

Take it slow and steady

Because they are very effective, if you have severe blood sugar imbalance and in particular if you take pharmaceutical medication for blood sugar/insulin regulation, you must start with lower amounts of these natural agents and you must monitor blood glucose carefully as you increase them.  If you take too much, too soon, it can cause an excessive drop in blood sugar: the goal is balance, so it’s best to take a gradual approach. If you’re on medication, adding these natural assists for healthier blood sugar may well enable you to reduce it over time, with the help of the physician who prescribed it (who knows, s/he might want to know how you did it!).

Gentle Detoxification for Health & Well-Being

Each year as Spring arrives, the world outside renews itself with greening rains and cleansing breezes that carry juicy smells of thawing earth and growing things.  Springtime can also inspire us to take time for self-renewal: to clear the stale and stuffy air of winter from our lungs, to take in the sights, sounds and scents of new life all around, to move with Nature’s own rhythm of renewal and rejuvenate our bodies, minds and spirits.  A springtime detoxification program is a great way to “go with Nature’s flow”, by letting go of accumulated toxins to awaken the vibrant energy and life force lying dormant within every cell of our bodies.

Why don’t more of us do a detox?  One of the reasons people put off such a program is the association of detoxification with unpleasant “detox symptoms”, such as fatigue, rashes, aches and pains, headaches, and changes in digestive function.  It can be discouraging and inhibiting to contemplate undertaking a program that might cause us to feel lousy for an indefinite period of time.  What many people don’t realize is that these unpleasant manifestations of toxin release can be reduced or eliminated simply by using nutrient and herbal support to help your body more easily clear toxic compounds.

Pathways of toxin clearance

In order to understand how this support works, it helps to know a little about how the body deals with toxins.  The liver, kidneys, intestines, lymph system, lungs and skin all participate in toxin elimination, and have very individual and specific ways of interacting with, neutralizing and clearing the various toxins we encounter.  When the body is healthy, our detox systems run smoothly, and toxins are transformed into neutral compounds and completely eliminated through appropriate channels. Together these systems represent a  sophisticated series of interlocking parts that work interdependently to maintain metabolic equilibrium by neutralizing external toxins from our increasingly toxic food supply, environment, and from medications; and internal toxins produced as a consequence of both natural bodily processes and unhealthy functional imbalances.  When we store toxins instead of clearing them, it may mean that one or more of the factors necessary to keep this complex machinery running well are not available.  When we embark on a program of detoxification, the idea is to release stored toxins from cells and tissues, so it becomes crucial to compensate for any inadequacies in the clearance pathways; otherwise not only will the process be more uncomfortable, but some toxins may re-circulate, exerting toxic effects as they do so, and then be stored again.

Move ‘em out

A simple way to help out the body with toxin removal is to promote a 1-3X daily bowel movement.  Increasing fluid intake may help, but adding a high-quality fiber supplement normalizes the bowel habit and in addition binds toxins released into the intestines and promotes the growth of healthy intestinal microbes.  Detoxification can disrupt bowel movements in either direction (diarrhea and constipation are both common detox symptoms) and different kinds of fiber absorb fluid to reduce diarrhea and provide roughage to improve constipation.  A supplement which contains more than one source of fiber is beneficial – arabinogalactans, ground flax seed, apple pectin, carrot or beet fiber, psyllium husk, oat or rice bran – these are fiber sources which may be included in better-quality formulas.  If you are unused to taking a fiber supplement, start with a small amount (perhaps 1 tsp. daily in water) and increase gradually to 1 Tbs. 2X daily over the course of several days.

Raise your pH

The acidity or alkalinity of the blood influences whether the products of detoxification are cleared from the body through proper channels.  An acidic systemic pH (pH is the scale for measuring acidity and alkalinity; for healthy detoxification, urine pH should be above 6.6) will obstruct healthy routes of elimination, leading to build-up of toxins in the blood and creating unpleasant “detox symptoms”.  Just as fresh vegetables, berries and fruits in the diet or in juiced form have an alkalinizing effect on internal body systems, concentrated greens formulas (which often contain a carefully chosen mix of veggies, berries and fruits) can be used during detoxification to improve systemic pH and encourage elimination of toxins.  Choose a greens formula that is attentive to organic sources of the ingredients (the last thing you want is pesticide residues in your detox program!), avoids bulking agents such as alfalfa and grain components, and uses primarily freeze-drying rather than spray-drying in the manufacturing process.  A greens product should be packaged to provide protection from the damaging effects of heat, light and moisture.  For purposes of detox support, I often recommend 1 Tbs. of the powder twice or three times daily mixed with water.

Balance Phase 1 & 2

Another reason for impaired detoxification and its negative effects is a mismatch between the two phases of liver detoxification.  The liver processes toxins in two steps, which are designated Phase 1 and Phase 2.  Toxins are first worked on by Phase 1 (cytochrome P450 enzyme systems) and then passed to Phase 2 to complete the detox process.  But what if Phase 2 can’t “catch” all that is passed to it?  When this happens, the partially metabolized toxins can’t be eliminated and they continue to circulate through the body; they are eventually stored in cells and tissues if Phase 2 just can’t finish the job.  Unfortunately, many of these intermediary metabolites are even more harmful than the original toxin.

It makes sense that many people who have symptoms and health issues that lead them to detoxification programs may already have impaired clearance pathways – so when they begin the work of releasing quantities of stored toxins, it is not surprising that the detox pathways become overwhelmed.  These “pathologic detoxifiers” often experience the most severe detox symptoms, but almost everyone who takes on a serious detox would benefit by addressing the nutrient requirements of the liver’s Phase 2 clearance pathways. In this way, Phase 1 and Phase 2 work with greater synergy and toxins are more effectively neutralized.

Hope for “Pathologic Detoxifiers”

A number of supplement formulations are specifically designed to provide broad support for Phase 2 reactions.  Phase 2 co-factors include amino acids such as N-Acetyl L-Cysteine, Glutathione, Glycine, Glutamine, MSM (Methylsulfonylmethane), Taurine, Ornithine and Methionine; B-vitamins, including folic acid, thiamine, riboflavin, niacin, pyridoxine/ pyridoxine 5-phosphate and vitamin B12; vitamin C; and minerals such as magnesium, manganese, zinc, molybdenum and selenium.  No single formulation will provide all these nutrients, so it may be appropriate to augment a Phase 2 support formula with an additional B-Complex or a high-potency multiple vitamin & mineral complex to fill in gaps.  Depending on the degree of co-factor deficiency or toxin overload, multiple doses through the day may be appropriate.  Essential fatty acids such as those from fish oil and borage oil are used in Phase 2 reactions, so doubling or even tripling your usual daily dose may be helpful; dry skin is often a sign of EFA deficiency, so increase intake if this appears during a detox.

The herbal flavonoids silymarin (derived from  Milk Thistle) and curcumin (a component of the spice turmeric)  have been found to increase levels of the Phase 2 enzyme glutathione S-transferase,  and are excellent additions to a detox supplement program.  I recommend phytosomal preparations, which enhance absorbtion, up to two or three times daily of Milk Thistle (standardized to 80% silymarin) 100 mg. and/ or Curcumin 250mg..

Easy = Effective

Years ago, detoxification programs seemed to align themselves with the “No pain, no gain” philosophy – if you weren’t miserable for at least some of your detox, you weren’t doing it right.  Time, experience and research have shown, however, that a gentler, well-supported approach to toxin clearance is not only more pleasant, it’s more effective.  The most successful detox processes are those which honor the needs of the body, mind and spirit.

Fish Oil and Your Child: A Better Brain for Life

By now the many benefits of fish oil and the essential fatty acids (EFAs) in it are common knowledge; in particular, the importance of specific EFAs, particularly DHA (docosahexaenoic acid) for infants and children is so widely acknowledged that it is now added to infant formula and has been a continuous focus of research  for a couple of decades.  The more we learn about these healthy fish oil fats, though, the more clear it becomes that they aren’t just for the littlest ones: ensuring an abundant supply for you and your child, from the moment you even think about conceiving, during pregnancy and throughout all the childhood years, is an intelligent – and intelligence-enhancing – gift that will keep on giving throughout their lives.

DHA in Pregnancy and after – the gift of a “better brain”

During pregnancy the only source of DHA is the mother’s intake from diet and supplements, and many diets are deficient in this nutrient – daily intake of DHA in U.S. women is estimated at about 50 mg., compared to 600-1200 mg. per day for Japanese women.    Several studies have affirmed the ”essential” nature of this fish oil fat for optimal brain growth and function (and for healthy retinal and vision development): mothers who supplemented their diets with DHA during pregnancy gave birth to children who scored higher on early childhood tests of mental processing and had greater head circumference (a measure of brain development), according to one study;  a 2008 Australian study looked at the effects of fish oil supplementation during pregnancy from 20 weeks to delivery, and found significant improvement in eye-hand coordination (a measure of brain function in young children) for these children at age 2 ½; in a third study, children of mothers who took DHA during pregnancy had better neurologic function at age 5.  Infants of mothers supplemented with DHA were calmer and had better sleep, too.

What’s the link between DHA and your baby’s brain?   During the last three months in the womb and during the first months of infancy, the brain has a “growth spurt”, requiring large amounts of the essential fatty acid DHA for incorporation into its tissues.  The more DHA is available to the child from the mother’s blood supply (in utero) and breast milk, the more the brain can soak up, and the better that brain develops and functions.  For mothers-to-be, a good daily dosage is 600-1200 mg. of DHA (there appears to be no toxicity) from dietary and supplemental sources (enteric-coated formulations can be easier on the digestive tract).

Fish Oil: Brain Food for Every Child

While the connection between DHA and brain development in infancy and early childhood is well documented, a 2011 study demonstrates that even at the age of 11, children whose moms take DHA during pregnancy  perform better on memory function and behavioral tests – pointing to a much more extended beneficial effect than has previously been recognized.  Another significant finding of this study was that those 11-year-olds who had higher blood levels of DHA at the time of testing scored even higher – which suggests that continuing to provide plenty of DHA throughout childhood is a very bright idea.  In my practice, I often prescribe child-oriented formulations which provide DHA in amounts of 100-200 mg. per day.

Mood, Behavior,  the “Alphabet Disorders” and EFAs

Brain health isn’t only about IQ, though; the brain is also the center of feeling and behavior – it’s where we “live” as humans.  The poet John Milton spoke of this most eloquently, in Paradise Lost: “The mind is its own place, and in itself/ Can make a Heav’n of Hell, a Hell of Heav’n.”  Too many children’s minds are bleak, unhealthy places where no one should have to live – driven in part by chaotic biochemistry, these beleaguered brains trigger poor behavior and foster emotional climates of chronic anxiety, depression, low self-esteem, mood instability, even rage reactions – an unfortunate recipe for misery in childhood and beyond.  These issues should be the exception in our youngsters but tragically, they are far too commonplace.  Depression, anxiety, dyslexia, OCD, ADD, ADHD, PDDNOS, ASD – there is a growing lexicon of names and acronyms for brain imbalances which, to a greater or lesser degree, have roots in disturbances of biochemistry and metabolism.  An incredible web of interconnection exists between brain centers, stress hormones, neurotransmitters, inflammatory substances and nutritional factors – and EFAs from fish oil are among the most important nutrients for maintaining equilibrium throughout this complex web.  Accumulated research evidence has clearly established the efficacy of fish oil/ EFAs for improving learning, behavior, and social interaction in children with developmental and psychosocial problems.

Supplementing with fish oil is a simple and effective way to begin to heal your child’s brain chemistry.  When prescribing for the vulnerable young groups described above, I may suggest dosages of DHA and its sibling, the anti-inflammatory Omega-3 EPA, which are several times the usual supplemental amounts.

Deficiency Signs

What are some hints that your child is deficient in the Omega-3 fatty acids?  Does s/he have dry skin? Rough elbows?  Even if these signs are only noticeable in winter (when the lubricating effects of the EFAs are most needed), they are telling you that your child’s EFA levels are marginal at best.  Eye irritation, blinking frequently, rubbing the eyes, can all indicate a lack of the lubricating EFAs from fish oil.  Skin problems, from cradle cap to eczema, from seborrheic dermatitis to acne, have a connection to EFA deficiency and warrant supplementation.  Allergies and asthma, similarly, benefit from EFA supplementation and suggest deficiency states.

Does your child have learning, behavioral, developmental or mood issues that may not meet criteria for a specific diagnosis, but are nevertheless limiting his or her potential and negatively affecting your family?  Think EFA deficiency.   And, because the diets & lifestyles which promote such deficiency tend to be familial, think EFAs for the entire family!

Finally, if you really want to get a precise picture of your child’s fatty acid status, testing is available through special laboratories which provide this kind of analysis for naturopathic and other functional medicine physicians.

How to Choose a Fish Oil Product

If there were one supplement I could prescribe for every child, it would be an excellent fish oil, made by a manufacturer using high standards of quality control.  A high-quality fish oil/ EFA supplement will probably cost more than many, but do take care to choose one manufactured in a facility which adheres to pharmaceutical-level production practices; which is third-party assayed for contaminants (mercury, arsenic, cadmium, dioxins, PCBs); and is stabilized with natural antioxidants (such as tocopherol [vitamin E], ascorbyl palmitate [a form of vitamin C], rosemary) to reduce the rate of deterioration in the bottle.  Quality supplements meet or exceed standards for fish oil purity set by IFOS (International Fish Oil Standards), GOED (Global Organization for EPA and DHA), U.S. EPA, and CRN (Council for Responsible Nutrition) organizations.  These products are often molecularly distilled, pharmaceutical-grade, and sustainably sourced; their labels are specific as to the marine animals from which the oils are extracted (eg. salmon, cod, mackerel, calamari, sardines, herring, krill).  A good fish oil supplement can have a slight seafood smell but, in the same way that the fish you buy for dinner can smell cleanly of the ocean but should not smell very “fishy”, it should not smell or taste (or burp) excessively of fish – this suggests rancidity.  And most children’s formulas add natural fruit flavors which make them quite tasty.

Grandma’s tales of being dosed as a child with cod liver oil speak to the long-recognized, powerful benefits of fish oil in many areas of children’s health and growth.  By taking the simple step of adding fish oil supplements to your child’s diet, you are supporting them in becoming the very best they can be.


Do you really need dietary supplements?

Is your diet as healthy as you think?

One of the most frequently asked questions in my work as a naturopathic physician is “I eat pretty well, doesn’t my diet give me the nutrition I need?”  The answer is, it all depends:  is your diet really as healthy as you think it is?  What standard are you using to gauge the quality of your food intake?  We now have ample evidence confirming that a nutrient dense, low glycemic burden (blood-sugar stabilizing) diet, rich in plant nutrients, healthy fats and fiber, supports good nutritional status, health and vitality; in contrast, the standard American diet (the so-called SAD diet of refined, adulterated foods which have journeyed from distant processing facilities to reach your table, losing nutrient value along the way) is more and more associated in medical research with the chronic health issues which have unfortunately come to be accepted as part of the aging process.

To the extent that your otherwise good diet contains elements that require your body to make withdrawals from its nutrient supply to metabolize them (the white-flour bagel you grabbed on the way to work this morning, the mid-afternoon cookie to lift your energy, that glass of wine with dinner), nutrient deficits can develop over time. No matter how your diet would measure up on close examination, even the most health-conscious among us has difficulty maintaining dietary perfection 100% of the time (and the pursuit of perfection carries health risks of its own!) – so supplementation to cover our nutritional bases has value from this point of view.

Toxins and Nutrition

Another consideration is the additional burden of toxins we encounter daily in modern times, a nutrient-depleting phenomenon of proportions for which we humans were never physiologically designed.  From the phthalates in  body lotion to the lead in lipstick to the styrene packaging beneath (even organic) chicken breasts and the acetaminophen we may take for aches and pains, each chemical requires a constellation of vitamins, minerals, amino acids and nutrient cofactors to complete its journey through and out of our bodies.  When we lack the nutrient support to make these detoxifying pathways run well, we store toxins in our body tissues, where they can impact health now and over the entire course of our lives.  Supplemental nutrients can support better toxin temoval from the body, providing proactive protection from our brave new toxic world.

How’s your digestion?

Our digestive tracts are beautifully designed to transform your breakfast, lunch and dinner from macronutrients (proteins, carbohydrates and fats) into micronutrients (such as vitamins, minerals, amino acids, and essential fatty acids), and to convey them by elegant mechanisms from your intestines into your blood stream and lymph channels.  “White foods” such as refined sugars and flours, alcohol, food allergens, inflammation, and stress compromise the effectiveness of digestion.  If you belch, or experience odorous flatulence and/ or abdominal bloating, one reason may be maldigestion, or ineffective breakdown of foods into usable nutrients.  If you have had your gall bladder removed, whose function is to store bile for fat digestion, you may not thoroughly digest fat-soluble vitamins (vitamins A, D, E and K),  important fatty acids and other fat-containing nutrients such as phospholipids, essential for healthy brain neuron and cell membrane receptor function.  If like many, your stomach acid production has declined over the decades, if you take antacids or a proton-pump inhibitor, the reduction in gastric acid changes the pH (acid-base balance) not only in the stomach, but throughout the “downstream” digestive tract, interfering with normal activation of digestive enzymes and the breakdown of foods.  Any of these digestion-compromising factors can create significant, multiple nutrient deficiencies.

How’s your absorption?

You may have heard the saying, “You are what you eat.”  This is true, but equally as important, we are what we digest – and what we absorb.

Part of the elegant design of the digestive tract is the refinement of the absorbtive processes for specific nutrients.  An example is the narrow range of acidity required for absorbtion of minerals such as calcium and magnesium, and amino acids such as tryptophan, which in the body is used to make the anti-depressant neurotransmitter serotonin.  Health issues or medications which reduce stomach acid levels (as discussed above) affect not only digestion, but also absorbtion of these and other nutrients.

The lining of the small and large intestine is the interface across which nutrients must travel to be used by the body to nourish cells, manufacture molecules, build muscle, bone and tissue, and help us live our lives energetically and healthfully. If the lining of the intestine becomes damaged or chronically irritated by inflammatory effects of toxic foods (an example of this is gluten intolerance or celiac disease, but any food has the potential to exert inflammatory effects on the membranes of the digestive tract); by immoderate alcohol consumption; stress; medications (such as non-steroidal anti-inflammatory medications and aspirin; or steroid drugs); microbe imbalance in the form of unhealthy bacterial, fungal, or parasite overgrowth; or any combination of these – nutrient malabsorbtion and nutrient deficiency are common effects.  It should be noted that malabsorbtion and the causes for it often exist below the level of our awareness, unless and until the process of inflammation becomes well advanced.

Biochemical individuality and nutrient needs

The biochemist Roger J. Williams, Ph.D. used the term “Biochemical Individuality” in his 1956 book of the same title to describe the uniqueness of each person’s nutrient requirements, based on genetics and other influences.   In contrast to the concept of RDA (Recommended Daily Allowance), which uses a generic calculation based on a review of currently available scientific literature to determine nutrient needs for “most people”, the principle underlying biochemical individuality disputes the idea of an average person, and says that biological diversity even between people who seem physically similar would dictate an individualized approach to determining and meeting nutritional needs.

Even within a given individual’s lifetime, nutrient needs vary widely as circumstances change.   Acute and chronic illness, stress, medications, injury or surgery, dietary changes, and environmental exposure present different nutritional requirements for healthy body function.  If you are fighting a cold or flu, or if you burned your hand making dinner last night, your nutrient requirements increase.  If you have been working longer hours, have been taking a cholesterol-lowering agent, are worried about finances or your child heading off to college, have undergone chemotherapy or radiation, your nutrient requirements are altered.  If in the past there was an extended period of time when your nutritional status was compromised – let’s say in college years when poor diet may combine with “recreational” drug and/or alcohol use – you may have created a “pothole” of ongoing nutritional deficit in the road of your life.  It can be difficult to repair such damage to nutrient status without intensive, “super-dietary” nutrient intake from supplements.

Nutritional Supplements as Therapeutic Tools

Using nutritional supplements in these ways, to repair the effects of present or past deficiency, or to protect against negative health consequences of current dietary insufficiency, digestive incompetence, environmental stressors, or medications, is part of my role as a naturopathic physician.  Beyond prevention and repair, though, is the realm of using nutrients with therapeutic intent, to improve health outcomes in acute illness and chronic disease.  Evaluating current nutritional status using physical signs and symptoms and laboratory testing, identifies of areas of need and appropriate supplementation.

Most of my work with nutritional supplements is in this area, grounded in the extensive and growing body of scientific evidence for the clinical benefits of such use, and the deep awareness that as humans, our physiology is based on biochemistry, not chemistry.  Nutritional approaches to treatment work in alignment with our biology and honor our human nature as biochemical beings.

How healthy do you want to be?

This may seem like a silly question with an obvious answer, but years of working with people and their health concerns has taught me that not everyone has the goal of “optimal health”.  Some seem fairly content with the assortment of illnesses, aches and pains, medications and procedures, and limited “vitality expectancy” which have come to be part of our cultural health standard.  If we define health as “the absence of disease”, nutritional supplements may seem expensive and unnecessary.  If the World Health Organization’s description of health as “a state of complete physical, mental and social well-being” is more compatible with our beliefs, we are more likely to consider nutrient supplementation as one way to preserve and increase our well-being.  For some, the idea of taking supplements feels too much like taking medication, and they prefer to focus on optimizing diet to create wellness.  Certainly, to eat and drink well, exercise, and develop strategies for healing from the stresses and toxic influences of our lives today – these are essential elements to create health and well-being, and supplements alone will not replace them.   However, to use supplements in conjunction with a healthy lifestyle can provide the benefits of each and the synergy of all for greater wellness.

Health Insurance from Broccoli

We all know that eating our broccoli is good for us, and many population studies have confirmed that people who eat more vegetables, and in particular broccoli and members of its extended family (the Brassicae), have better health and lower incidence of diseases such as cancer.  The reasons for this have been under investigation for the past few decades, and it turns out that these homely veggies are marvels of the plant kingdom, conferring protection against many cancers and common degenerative processes through a variety of sophisticated biochemical mechanisms. The Brassica family includes not only broccoli, but also Brussels sprouts, cabbage, kale, cauliflower, bok choy, arugula, radish, watercress and other vegetables.  For those who have an interest in nutrition, you may know of the unique health benefits of the Brassica phytochemical indole-3-carbinol (I3C) which is metabolized in the body into the active compound diindole-methane (DIM).  I3C and DIM act as antioxidants, assist in detoxification of hormones and potentially cancer-causing substances, and are linked in research with health benefits for hormonal health problems, and prevention of certain cancers, such as lung, colorectal, breast and prostate cancer.  Supplements which provide I3C and DIM have been available for years, and have been incorporated into the standard natural therapeutic approach for such health issues.

Super Sprouts

Now a “new” phytonutrient from the broccoli family is available in supplement form.  In recent years, much scientific attention has been focused on Sulforaphane glucosinolate (abbreviated as SGS), a substance found in high concentration in broccoli seeds and sprouts (the sprouts contain 30 to 50 times the amount of SGS as mature broccoli).  While SGS is found in other brassica vegetables such as cauliflower, kale, and cabbage, the greatest amounts by far come from broccoli.  SGS was identified twenty years ago by researchers at The Johns Hopkins University School of Medicine as the most potent of the isothiocyanates, a class of beneficial compounds derived from certain Brassica vegetables.   SGS was found to provide protection from chemical carcinogens by increasing levels of the Phase II liver detoxification enzymes quinone reductase and glutathione transferase, and powerful antioxidants such as glutathione and superoxide dismutase. What’s more, the antioxidant effects are extraordinarily long-lasting – as long as days after sulforaphane is in the picture, cells continue to have increased protection.

Subsequent and ongoing studies have found that sulforaphane, the active form of SGS, has multiple modes of action in the body, holds promise for cancer prevention and treatment, and has benefit for arthritis, cardiovascular protection, immune support, skin health, retinal  health, and brain cell health.  Without doubt, the list will continue to grow.