You already know this problem: Humans are in the midst of the worst chronic disease epidemic ever faced in our history.
- Americans are the biggest consumer of weight loss products (80%) in the world, yet still lead the world in obesity and unhealthy lifestyle.
- More than 70% of adults across the United States are already being diagnosed with a chronic disease and more than 75% of the nation’s healthcare cost being spent on managing and treating these conditions.
- Nearly every single chronic condition you can think of will not successfully be treated with prescription drugs or surgery. They can only offset the symptoms. This list includes: cardiovascular disease, type 2 diabetes, infertility, hypertension, sleep apnea, high cholesterol, high blood pressure, osteoporosis, depression, anxiety, stress, and many more.
- Heart Disease continues to kill more people than any other condition despite the fact that more drugs and surgeries are being performed to treat it than ever before
- Cancer continues to skyrocket and we are spending billions trying to treat it.
Reality Check: We are not getting obliterated by war, famine or disease spread from one person to the next. Today, billions are suffering from biological imbalance. Unfortunately, there’s every sign that things are going to get worse before they get better.
Today is the first generation of kids in modern history that’s expected to live shorter lifespans than their parents. If current trends continue, in two decades, 95 percent of Americans would be overweight and one in three would have diabetes.
So what needs to change?
We need a new approach to medicine, one that emphasizes healthcare over disease management. What would such a new medicine look like?
It would have three characteristics.
- It would recognize the exposome as the primary driver of health.
- It would embrace an evolutionary and ancestral perspective.
- It would apply a functional medicine approach to care.
So let’s look at each of these in a little more detail.
The Human Exposome is the Primary Driver of Health
The exposome is a concept originally proposed by Dr. Christopher Wild in 2005, and it refers to the sum of all nongenetic exposures in an individual lifetime, starting from the moment of our conception through the moment of our death.
For decades it seemed as though genetics would hold the key to human health and disease. Unfortunately, those promises didn’t really pan out. The limitations of using genes to predict and prevent disease became apparent pretty early on (especially following the sequencing of our entire genome in 2003.
Ironically, Craig Venter, who was one of the first to sequence the human genome, was also one of the first to recognize its limitations when he said, “We simply don’t have enough genes for this idea of biological determinism to work.”
We now know that genetics accounts for less than 20 percent of human disease and that the remaining causes are environmental, which is to say, they’re related to the exposome.
The exposome encompasses the food we eat, the air we breathe, social interactions, lifestyle choices, and inherent metabolic and cellular activity.
So what does this all mean?
The bad news is that the choices our parents and even our grandparents made affect our disease risk and our health and that choices that we’ve made—perhaps before we knew as much as we know now—affect our children’s and even grandchildren’s health.
The good news is that genes are not our destiny. Genes have an influence over our health, but changes we make in real time can affect our gene expression and, not only our own health, but if we’re still procreating, our children’s health and their children’s health.
Not everybody who has genetics that predispose them to a higher risk of a particular disease actually go on to acquire that disease or die early, and the environment or the exposome is almost certainly the main factor that determined which of those people that were at higher risk got sick and which stayed well.
So while we can’t control what our parents or grandparents did or our genes, we can control these diet, lifestyle, and environmental influences.
Embracing our Ancestry is Essential for Health
For 66,000 generations, humans ate primarily meat and fish, wild fruits and vegetables, nuts and seeds, and some starchy plants. We were physically active. We didn’t sit for long periods.
We lived in sync with the natural rhythms of light and dark in direct contact with nature and in close-knit tribal and social groups. Both our ancestors and contemporary hunter–gatherers who have been studied were lean, fit, and remarkably free of chronic inflammatory disease. They were also superior to us in nearly every measure of health and fitness, from body mass index to blood pressure to insulin sensitivity to oxygen consumption to vision to bone density.
You might be thinking, “So what? Why should we care about the health of our Paleo ancestors? They all died when they were 30 years old.” It’s true that our Paleo ancestors did have shorter life spans on average, but those averages don’t consider challenges that are largely absent from modern life, including high rates of infant mortality, warfare, trauma, accidents, exposure to the elements, and a complete lack of emergency medical care.
Studies have shown that when these factors were considered, contemporary hunter–gatherers and our ancestors lived life spans that were closely equivalent to our own today, but the difference is that they reached these ages without acquiring the inflammatory diseases that characterize our old age. They didn’t have obesity. They didn’t have heart disease. No diabetes, gout, hypertension, or most cancers. In other words, if our ancestors survived the threat of early childhood and escaped the threat of trauma, they lived long and healthy lives.
So, what happened? What transformed us from a healthy, vital people largely free of chronic disease to a sick, fat, and unhealthy people?
It was a one-two punch, and agriculture was the first blow.
Scientist Jared Diamond calls agriculture “the worst mistake in human history.” Hunter– gatherers were virtually guaranteed a healthy diet because of the diversity and nutrient density of the foods they ate, but once humans settled down and started farming, there was a major shift in our diet. In short – refined carbs went up and quality fibrous vegetable, fat and protein consumption went down.
Vitamin shortages also became common. Our new diet relied heavily on a limited set of crops such as wheat, rice, and corn, and it was lower in more nutrient-dense animal products. This led to diseases such as beriberi, pellagra, rickets, and scurvy that are caused by nutrient deficiency and were rare in hunter–gatherers but became much more common in people living in agricultural societies.
We also saw an increase in tooth decay and anemia due to iron deficiency, increases in infant mortality, and decreases in average bone density. All of these diseases, again, were rarely experienced by our hunter–gatherer ancestors.
The second blow was the Industrial Revolution.
There is no doubt that agriculture led to an overall decline in human health, but the Industrial Revolution was really the knockout punch. It brought us to where we are today when white sugar, flour, and vegetable oil make up over 50 percent of the calories that the average American consumes on a daily basis. We’re more sedentary than we’ve ever been before.
We sit while we work and increasingly even sit while we play. We’re chronically sleep deprived. A third of Americans sleep fewer than six hours per night, which is up from just 2 percent in 1965. We’re working harder than ever. American men and women are working 12 to 13 hours more per week today than we were in 1968. Stress levels are off the chart for most people.
We don’t feel like we have enough time for rest and leisure, and even when we do go on vacation, many of us compulsively check our email and social media accounts.
Finally, many of us live and work in isolating and alienating social environments that are disconnected from the natural world we evolved in and from other people.
The profound mismatch between our genetic heritage and the modern environment that we live in today is responsible for the epidemic of modern disease that we’re suffering from, and it also explains why the Paleo diet and lifestyle have helped so many people.
A Functional Approach to Medicine & Optimizing Health
The third principle of achieving health is that it applies a Functional Medicine approach to care.
As I said before, conventional medicine has some amazing characteristics. It’s remarkable in terms of trauma and emergency medicine and acute care, but again, I think we can all agree it’s not very good at treating chronic disease, which is the number-one problem that we face today.
Functional Medicine is investigative. It treats symptoms by addressing the root of the problem, which leads to more profound and longer-lasting results, whereas conventional medicine tends to be more superficial, in that it masks or suppresses symptoms but doesn’t address the underlying cause, and this tends to create patients for life.
For example, if you have high blood pressure, you get on a drug to lower it, and you’re basically told to take that for the rest of your life, and the same is true for high cholesterol.
Functional Medicine tends to be more holistic. It treats the body as an interconnected whole, and we recognize that in order to treat one part, all other parts must be addressed, whereas conventional medicine is more dualistic. It views the body as a collection of separate parts. In fact, there’s a doctor for every different part of the body, and there’s often very little communication between these doctors or acknowledgement of a connection.
In functional medicine, the patient is respected, empowered, educated, and encouraged to play an active role in their healing process, whereas in conventional medicine, the patient’s opinion is often discounted or ignored, little time is spent on education, and the patient is even sometimes actively discouraged to play a strong role in their healing process.
Functional medicine is integrative. It combines the best of allopathic and alternative treatments. It doesn’t exclude drugs or surgery when they’re necessary but does tend to focus more on diet, lifestyle, supplements, and herbs as the primary interventions, whereas conventional medicine is more limited in its scope. It typically relies almost exclusively on drugs and surgery despite risks, and while it does pay some lip service to the importance of nutrition and lifestyle, physicians are undereducated on these topics and often don’t have much time to devote to them in the typical patient interaction.
Functional medicine is preventative. It’s guided by the ancient Chinese proverb, “The superb physician treats disease before it occurs,” whereas conventional medicine tends to be a little more reactive. It really aims to manage disease after it occurs and often doesn’t intervene until disease has progressed beyond a certain point of no return.
As many of my patients know, I run a busy chiropractic office in Austin, Texas… but I also have a thriving Functional Medicine practice that allows me to consult with and help people all over the US and abroad.
Still, many of my you have been asking me questions surrounding Functional Medicine and what it entails.
My philosophy to health is pretty simple: Move Well, Eat Healthy and Cultivate Happiness.
As a chiropractor, my goal is to make sure that your spine is healthy, your joints are mobile and you have no physical limitations in movement. Functional Medicine allows me to address the other 2 components: eating well and cultivating happiness.
In this article, I’d like to discuss my approach and how it works.
Conventional medicine has a doctor for every part of your body. There are cardiologists for your heart, gastroenterologists for the digestive system, neurologists for the brain and nervous system, podiatrists for your feet, and ophthalmologists for your eyes.
Due to specialization, conventional medicine often focuses on individual body systems, rather than trying to understand the whole person and ultimately that individuals underlying causes of disease and chronic illness.
In light of this, symptoms are used to name a disease and find a corresponding drug. That’s typically your treatment.
- High blood pressure gets you blood pressure lowering pills.
- High cholesterol, gets you cholesterol lowering pills.
- Infections of any kind almost always get you antiobiotics
- Imbalanced hormones, gets you hormone replacement therapy.
- Etc. Etc. Etc.
Basically, your symptoms are treated with no regard for the “cause”.
In functional medicine, the goal is to view your body as an interconnected whole, within a larger environment.
In other words, your health is the sum of all nongenetic (your external environment) and genetic (internal environment) exposures in your lifetime, starting from the moment of conception to death. It encompasses the food we eat, the air we breathe, social interactions, lifestyle choices and inherent metabolic and cellular activity.
Functional Medicine doctors recognize that in order to treat one part of the body, all other parts must also be considered. This breaks apart artificial divisions of the body.
What Functional Medicine Addresses
I have a hierarchy of importance for which factors to address when starting with a patient:
- Diet, Lifestyle and Environment.
- Nutrient imbalance, gut and HPA-axis
- Cellular Dysfunction, Toxic Burden, Hormone Imbalance
- Chronic Infections and Immune Dysregulation
- Treating symptoms for diseases that cannot be fixed
Diet, Lifestyle and Environment
As a good rule, any doctor interested in improving health should begin with diet, lifestyle and environment. It is what it is and there’s no way to self-medicate, supplement or artificially create what life requires.
Nutrient Imbalances, Gut Infections or Dysbiosis and HPA-axis
There are two reasons why we address this next:
First, these factors are often at the root of, or at least strong contributors, of other pathologies such as hormone imbalances (Low T, Thyroid problems, PCOS, etc), cellular dysfunction (Energy balance, Diabetes, Heart Disease, Weight) and immune dysregulation (autoimmune disease, cancer, arthritis, tissue repair).
Second, even if there are other problems occurring, this will lead to a significant clinical improvement towards helping any other condition.
I believe that up to 80% of health problems can be addressed by simply getting #1 (Diet, Lifestyle, Environment) and #2 (Nutrient imbalances, gut infections or dysbiosis and HPA-axis) in check.
Cellular Dysfunction, Toxic Burden, and Hormone Imbalance
In some cases we have to dig deeper. This involves assessing methylation, heavy metals, mold/biotoxins, impaired detoxification, thyroid, sex and metabolic hormones. Again, most of these problems can be addressed by improving diet, lifestyle, nutrient imbalances, gut health and stress.
Chronic Infection and Immune Dysregulation
Some patients have infections (Lyme, co-infections, parasites) that are pretty nasty and almost always require a more specialized and even integrated (Medical Prescription) approach.
How can you get started?
If you’re interested in a functional medicine consult, here’s my flow:
The consult has 2 parts: A 20 minute case review and an hour to 2 hour case review
STEP ONE: INITIAL 20 MINUTE CONSULT
After purchasing an initial consult, we will setup a time for us to meet over the phone or in person. During this 20-minute appointment, I will interview you to determine which lab tests to order for your Case Review, based on your chief complaints and your history.
This appointment has two purposes: to make sure that I have all of the information needed to gain a comprehensive understanding of the factors affecting your health and to give you a head start on your treatment before you meet with me.
The exact lab testing ordered after the Initial Consult depends on your individual circumstances, but may include:
- A comprehensive blood chemistry panel. This is the single most efficient, effective and affordable tool for quickly evaluating your health. It screens for a wide range of conditions, including several types of anemia; gut, viral and bacterial infections; insulin resistance and hypoglycemia; liver and kidney issues; and thyroid and adrenal problems. It offers important clues for how to structure and focus your treatment to get the best results. It also provides a baseline of biomarkers that can be used to objectively track the progress of your treatment over time.
- Additional blood tests for specific conditions, such as high cholesterol, hypothyroidism, autoimmune disease and gluten sensitivity.
- Advanced stool testing to screen for parasites, fungal overgrowth, bacterial infections, intestinal inflammation, dysbiosis and a deficiency of beneficial gut bacteria.
- Urine organic acids testing to screen for small intestinal bacterial overgrowth, fungal overgrowth, problems metabolizing fat or carbohydrates, B-vitamin status, methylation issues, detoxification capacity, oxidative stress and neurotransmitter metabolism.
- Urine hormone testing for adrenal and sex hormone status.
You will also be provided the Case Review health history paperwork to complete.
This paperwork includes:
- A detailed health and medical history questionnaire
- A survey of your chief complaints and most important health goals
- An assessment of your most troubling and frequently experienced symptoms
- A diet survey and questionnaire
- A survey of your current supplements and medications
Once we’ve received your lab results and completed the Case Review paperwork, I will give you specific protocols to start working on before moving on to part 2: the case review consultation.
This typically occurs between 60 and 90 days after the Initial Consultation, because some of the labs we use take up to 8 weeks to deliver the results to us after receiving your sample.
STEP TWO: THE CASE REVIEW CONSULTATION
The Case Review Consultation is a 60-minute to 120-minute in-person, phone or video appointment.
Prior to the consultation, I will have reviewed the results from the labs that were ordered along with your Case Review paperwork, medical history, diet and supplement survey, assessment forms and relevant prior lab work. I will also create a Report of Findings, which is broken into three parts:
- A summary of the underlying patterns that are contributing to your symptoms.
- An outline of the suggested treatment plan, including dietary, supplement and lifestyle recommendations.
- Recommendations for further testing (this will typically be minimal, if necessary at all, because of the completeness of the Case Review process)
During this visit, I will present the Report of Findings as well as your treatment plan. I will also review all of your test results with you and answer any questions you have about the findings or the treatment plan.
In previous articles I discussed 2 of the most common, but worst supplements you could be taking for your health. These supplements included Iron and Calcium.
Certainly these 2 nutrients are important for our health… but when it comes to supplementing with iron and calcium, it can be detrimental to your health.
For example, iron is a pro-oxidant, which causes oxidative stress and when present in large amounts can literally lead to organs and tissue damage. Calcium is associated with a 139% increased risk of heart attack and a 20% higher risk of stroke.
In this article, I’d like to finish up my series of the “Most Common Worst Supplements” you may be taking by discussing Vitamin E, Vitamin A (Beta Carotene) and Folic Acid.
Vitamin E (Alpha-Tocopherol)
Let’s talk about vitamin E. Vitamin E is a potent fat-soluble anti-inflammatory vitamin that protects us from free radicals and tissue damage. It’s also involved in immune function, cell signaling, regulation of gene expression, and other metabolic processes.
There are three different types of vitamin E, or isomers. There are phenols, tocopherols, and tocotrienols. Alpha-tocopherol is the form that most supplements contain. While vitamin E is an important nutrient to get in the diet, I definitely don’t recommend supplementing with it, with the possible exception of tocotrienols.
Now, before we proceed it’s important to have some understanding of the difference between synthetic vitamins and whole food or natural isomers of vitamins.
When checking vitamin labels, natural vitamin E is usually listed as the “d” form followed by “alpha-tocopherol”. On the other hand, synthetic vitamin E will be listed as “d” followed by an “l” or dl-alpha-tocopherol”.
This is important when it comes to understanding research outcomes.
At best, dl-alpha-tocopherol (synthetic vitamin E) shows no benefit, but in several studies, it actually shows harm. For example, in a meta-analysis in JAMA with 230,000 total participants, vitamin E supplementation caused increased risk of death from all causes. Another review of 78 randomized controlled trials with almost 300,000 total participants found that vitamin E supplementation increased mortality by a small but significant margin.
So, again, you want to aim for whole-food sources of vitamin E only.
These include nuts and seeds primarily but also tomato sauce, cranberry juice, some fruits such as apricots and avocado, and fish such as trout.
The RDA is 15 mg a day. Most Americans get their intake from polyunsaturated vegetable oils. That is perhaps one of the only benefits of these industrial seed oils.
Paleo sources for people who are avoiding those oils or minimizing them, again include nuts and seeds, some greens, and some fish such as trout. It’s important, by the way, to eat foods that contain vitamin E, and any fat-soluble vitamin, for that matter, such as D, K2, and A, with fat because they are fat soluble.
Fat will be necessary to absorb fat-soluble vitamins such as vitamin E, and studies have consistently shown that when fat is consumed, the absorption of these vitamins is much greater.
Vitamin A (Beta Carotene)
Okay. Now let’s talk about vitamin A or beta-carotene. Beta-carotene gives plants an orange or yellow color, and this is a precursor for active vitamin A, retinol. Beta-carotene can also be converted into potentially harmful substances, and it can increase the risk of oxidative stress similar to Iron. Studies show that beta-carotene supplementation may increase the risk of heart disease and cancer in people who drink heavily or smoke.
High levels of betacarotene may have anti-vitamin A properties. This means it actually works against active vitamin A by disrupting the metabolism and action of active vitamin A.
Of course, the best option for getting beta-carotene is from food! And this is easy to do on a Paleo-type diet. Foods that are rich in beta-carotene include carrots, tomatoes, sweet potatoes, broccoli, cantaloupe, winter squash, bell peppers, spinach, lettuce, pumpkin, and kale.
However, if you are going to supplement… then make sure your Vitamin A’s label reads Betatene or Mixed carotenoid complexes. A complex of beta-carotene will include beta-carotene, lycopene, lutein and other carotendoids.
Folic Acid (Methyl Tetra Hydrofolic Acid)
Finally, let’s have a talk regarding Folic acid.
Folic acid is an oxidized synthetic compound that is only found in dietary supplements and fortified foods.
It’s now well understood that synthetic folic acid compounds are not metabolized by the body and can actually accelerate the progression of certain cancers. WOW… many physicians regularly recommend this to their patients.
Folic acid is not a natural form of folate found in nature. It was introduced into the food supply to reduce the risk of neural tube defects during a malnourished pregnancy, which it definitely does.
Folic acid can be converted into natural folate, but unfortunately, that conversion is limited in humans.
It undergoes initial reduction and methylation in the liver using dihydrofolate reductase as an enzyme, and if the patient has low activity of this enzyme, she can end up with high levels of unmetabolized folic acid in her system and circulation. A new study was released that found that nearly all babies, children, adolescents, and adults in the U.S. have measurable levels of unmetabolized folic acid in their systemic circulation, so this is a big problem that has only recently been recognized.
Why are high levels of unmetabolized folic acid in the blood problematic?
- They can mask vitamin B12 deficiency.
- They may lead to the deterioration of central nervous system function, especially in the elderly.
- They can cause anemia and cognitive impairment.
- They can accelerate the progression of certain cancers, including colon and prostate cancer.
- They can depress immune function, and they are associated with increased risk of death from all causes.
Folate, or Methy Tetra Hydrofolic Acid, aka natural folate on the other hand, which is found in foods in nature and in supplements with natural forms of folate is not only very necessary for health but is also safe to supplement with.
If you currently take a multivitamin and its a cheaper type of brand, you may want to make sure to look for folic acid. If it says folic acid on it or it doesn’t specifically mention that it is one of the active forms of folate such as 5-MTHF, metafolin, or folinic acid, then it probably has folic acid and should be avoided.
Foods that are naturally rich in folate include beef liver, and chicken liver is actually the highest source of folate and the best source; also dark, leafy greens such as spinach and collards. Lentils are a good source of folate if your patients tolerate legumes, as are beets, cauliflower, parsley, mustard greens, turnip greens, and even some lettuces.
The Real Food Multivitamin
For all the reasons listed above as well as in my previous articles on the dangers of iron and calcium supplementation, this is why I decided to start my own nutrition company a few years ago (DNA Formulas).
My multivitamin is a food sourced multivitamin made to contain the specific forms of vitamins that are deemed safe and actually necessary for optimal health.
How do you know if you’re vitamin is good or bad? I have a quick checklist when it comes to reading labels:
If you’re looking for a good multi, consider The Real Food Multivatmin!
I make numerous recommendations with respect to what nutritional supplements, herbs and botanicals a patient should take to improve their health.
In many cases, supplements are necessary for therapeutic treatment and I believe that many people cannot heal their bodies without them.
However, there are many supplements I know my patients are taking that are unnecessary and even harmful.
Last week I discussed the risk of Iron supplementation and how you should proceed with caution if you’re taking them.
This week, I want to continue the discussion with calcium supplementation.
The Risk of Calcium Supplements
Calcium is important for the proper formation of bones and teeth. It plays a role in cell signaling, contractability of muslces and excitation of neurons.
Calcium levels are tightly regulated by parathyroid hormone and vitamin D. If calcium intake isn’t high enough, calcium levels will be maintained at the expense of bone health. That’s something important to understand.
The RDA for calcium is 1,000 to 1,200 mg a day, though other experts have suggested that lower levels are probably adequate, especially if vitamin D and K2 levels are sufficient, because those nutrients help to regulate calcium metabolism.
This is exactly why I recommend taking my Vitamin D3+K2 supplement.
Quite honestly, the easiest way for someone to get their RDA of calcium is by consuming an ancestral or paleo based diet.
In short, consuming foods with anti-nutrients, or nutrients that block the absorption of vitamins and minerals, is what is causing massive human nutrient deficiencies in the first place. On a Paleo diet low in anti-nutrients, the need for calcium is lower due to increased absorption of dietary calcium.
As I mentioned, vitamin D and vitamin K2 are both required for optimal calcium absorption. So before taking calcium, make sure that your vitamin D and K levels are optimized!
You should also be aware that higher-protein diets increase calcium absorption, and higher intakes of calcium through supplements but not through diet can lead to hypercalcemia, which can be fatal if left untreated.
Certainly the media has contributed to the popularity of calcium supplementation.
This is especially true with older women wanting to help prevent osteoporosis. Most older women who come into my office are taking calcium.
Unfortunately, the overwhelming research shows that calcium supplementation doesn’t reduce fracture rates in the elderly and seems to actually increase them. The same research also indicates that it particularly harms men!
While calcium is a crucial mineral, supplemental calcium has been shown to increase the risk of cardiovascular disease and cardiovascular events. It’s not hard to understand why. We want our arteries to be soft and pliant. When our arteries become calcified and they become brittle and hard, that increases the risk of cardiovascular disease.
Supplemental calcium has a much greater effect on circulating calcium concentrations than dietary calcium.
Humans evolved to get calcium from diet just like all of the other nutrients, and our body has regulatory mechanisms for handling that, even if we’re getting more calcium than we need, but those regulatory mechanisms appear to be less effective with large boluses of supplemental calcium.
So make sure that you are getting adequate amounts of K2 and consuming enough vitamin D and vitamin A because all of those play a role in regulating calcium homeostasis.
Calcium and Cardiovascular Risk
In a study of 24,000 men and women aged 34 to 65 that was published in BMJ in 2012, those who supplemented with calcium had a 139 percent higher risk of heart attack versus those whose calcium intake came from food who had no change in risk.
Meta-analysis in BMJ of 12,000 individuals showed that those taking supplemental calcium had a 31 percent higher risk of heart attack, a 20 percent higher risk of stroke, and a 9 percent higher risk of death from all causes.
Finally, another analysis in JAMA Internal Medicine, also looking at 12,000 participants, found that intake of more than 1,000 mg of supplemental calcium per day increased the risk of death from cardiovascular disease by 20 percent.
So, now you can understand why I’m not a fan of supplemental calcium.
Even without purposefully supplementing calcium, many people may be accidentally supplementing because of fortified foods and multivitamins. Multivitamins almost always have calcium in them.
Foods such as orange juice; cereal; non-dairy milks such as almond milk, rice milk, or soy milk; bread; instant oatmeal; and several other foods are often fortified with calcium.
Best Food Sources of Calcium
I recommend that most patients get their calcium from food if possible, and I’ve listed the food sources of calcium on this slide based on serving size.
Things such as sesame seeds; sardines with the bones in; dairy products, of course; dark, leafy greens such as collard greens and spinach; and sockeye salmon with the bones in are a great source of calcium.
Sardines with bones in and canned sockeye salmon with bones are probably two of the best ways for you to get calcium.
If you’re concerned about bone health, then eat the foods listed above and lift heavy things!
Weight-bearing exercise is probably one of the most important things you can do to promote healthy bones.
I promise, if you are consuming enough dietary calcium as well as other synergistic vitamins and minerals such as K2, D, A, and magnesium and performing weight-bearing exercise, there is probably no need to supplement at all, and supplementing would likely do more harm than good.
I have many patients who ask what supplements they should be taking. The answer to that question is largely dependent on that individuals current health status, health goals and lifestyle.
But what about the supplements you most likely SHOULDN’T be taking?
In this article, I’d like to talk about the supplements you should be cautious with and in some cases, never take (unless you absolutely know what you’re doing).
Iron is a part of several enzymes and proteins in the body, and it’s found in foods as both heme and nonheme iron.
Heme iron comes from hemoglobin and myoglobin in meat, poultry, and fish. Despite being only 10 to 15 percent of the iron found in food, it makes up more than one-third of what we absorb.
Nonheme iron is found in plants, dairy products, and in some meats. Unlike heme iron, nonheme iron absorption is significantly influenced by food components in the same meal. These things include enhancers such as vitamin C and other acids as well as sources of heme iron and inhibitors such as phytic acid, polyphenols, and soy protein.
The recommended daily allowance for iron is 8 mg, except for in menstruating females, who need to get 18 mg, or pregnant women, who need to get 27 mg.
While iron is clearly an important nutrient, it is also essential to make sure you don’t get too much of it.
Hemochromatosis is a genetic disorder that causes aggressive iron storage and iron overload.
It is associated with a broad range of adverse effects and health Conditions such as liver disease, diabetes, metabolic syndrome, cardiovascular disease, Alzheimer’s dementia, Parkinson’s and other neurodegenerative disorders, impotence, infertility, and hypogonadism.
Why is Iron So Bad? Because iron is a pro-oxidant.
Meaning it causes oxidative stress (damage), and it literally leads to the organs and tissues in our body rusting. Another example of oxidative stress would be when you take a bite out of an apple, and you leave it out on the table, it turns brown.
That’s exactly what happens inside of our body when we have too much iron.
List of possible conditions associated with Iron overload.
A lesser known fact is that even mild iron overload (where iron levels are in the upper end of the reference range) can cause increased morbidity and mortality.
For example, the range for iron saturation in the U.S. typically goes up to about 55 percent, but studies show that increased mortality happens as iron saturation climbs above 50 percent.
Likewise, many of the lab ranges for ferritin in men go up to about 400 in the U.S. and in other parts of the industrialized world, but studies suggest that you see an increase in blood sugar and an increase in morbidity and mortality in men as ferritin climbs above 150 or 200.
These are people who don’t necessarily have hereditary hemochromatosis, or perhaps they are a carrier for hemochromatosis.
Iron overload is significantly associated in particular with impaired insulin sensitivity and glucose tolerance. So If you have high blood sugar, you should definitely get checked or screened for iron overload.
Iron reduces insulin synthesis and secretion. It decreases insulin sensitivity in the liver, and iron deposits in the liver can decrease glucose uptake.
Above, you’ll find my optimal ranges for the various iron indices. They’re based on the recommendations from the Iron Disorders Institute, which is a group that advocates for greater understanding of the effects of both iron overload and iron deficiency.
If you have been diagnosed with metabolic disease, diabetes, metabolic syndrome, liver abnormalities, weakness, lethargy, or skin hyperpigmentation, and you have iron levels that are outside of these ranges —and remember TIBC and UIBC are inverse markers, so low levels of these mean high iron—then you should be thinking about hemochromatosis or iron overload.
Iron Overload Treatment
Treatment for iron overload is typically either blood donation or prescription phlebotomy. Phlebotomy is the removal of blood, typically a unit of blood at one time. It’s the same when you donate blood or get a prescription for phlebotomy.
There is also a substance called apolactoferrin. It’s a natural protein that can help remove iron from tissues in the body, iron that is already stored in the body. The dosage there would be 300 mg of lactoferrin one to two times a day on an empty stomach.
Patients with hemochromatosis should not take supplements that contain iron. Unfortunately, you’ll often see people with iron overload who weren’t aware that they had it who are taking iron supplements. They may also need to avoid foods that are very high in iron.
The biggest offenders are shellfish and organ meats.
What I’ve found is that patients with iron overload definitely need to avoid shellfish and organ meats. Some studies suggest that just standard muscle meat such as beef and bison don’t make a huge difference for most people, so we start by telling them to avoid the organ meats and the shellfish.
I also want to advise patients to cook with ceramic, stainless steel, or glass instead of iron skillets. Finally, avoid substances that enhance the absorption of iron.
This includes limiting alcohol (limit consumption to two drinks a week), supplemental vitamin C, Betaine hydrochloric acid and high doses of zinc.
If you have iron overload, consider downloading this handout and iron reduction strategies:
Iron Reduction Strategies
40% of Americans have low-normal B12 levels
B12 deficiency is much more common than the conventional medicine establishment and general public realize. Data from the Tufts University Framingham Offspring Study suggests that 40 percent of people between the ages of 26 and 83 have plasma B12 levels in the low-normal range, a range at which many experience neurological symptoms.
Nine percent had outright deficiency, and 16 percent exhibited near deficiency.
Most surprising to the researchers was the fact that low B12 levels were as common in younger people as they were in the elderly.
B12 deficiency has been estimated to affect about 40 percent of people over 60 years of age. It can mimic the signs and symptoms of diseases that are commonly associated with aging such as Alzheimer’s, dementia, cognitive disorders, multiple sclerosis, Parkinson’s, and other neurological problems; mental illnesses such as depression and anxiety; cardiovascular disease; cancer; and low libido.
It’s entirely possible that at least some of the symptoms we attribute to “normal” aging such as memory loss, cognitive decline, and decreased mobility are at least in part caused by B12 deficiency.
B12 deficiency is often missed for two reasons.
- It’s not routinely tested by most physicians.
- The conventional serum B12 test that most doctors run only picks up a small fraction of people who are actually B12 deficient.
This test measures the total amount of B12 in the blood and does not rule out functional B12 deficiency, which means low levels of active B12. The low end of the laboratory reference range for serum B12 is too low. Many people who are B12 deficient have so-called normal levels of B12.
For example, the lab reference range goes down to 211 pg/mL in most cases, yet it’s well established in the scientific literature that people with B12 levels between 200 and 350, levels that are mostly considered to be normal in the U.S., may exhibit clear B12 deficiency symptoms.
In Japan and Europe, the lower limit for B12 is between 500 and 550, the level associated with psychological and behavioral manifestations such as cognitive decline, dementia, and memory loss.
Some experts have speculated that the acceptance of higher levels of normal in Japan and the willingness to treat levels considered normal in the U.S. explain the low rates of Alzheimer’s and dementia in that country.
In addition, more sensitive markers for B12 deficiency are now available, including methylmalonic acid, or MMA, and holotranscobalamin-2, or holoTC, although this is not yet widely available clinically in the U.S. sensitive and accurate for detecting the early stages of B12 deficiency.
Unfortunately, few clinicians are aware of them, and they are rarely used in clinical practice. You can’t find what you’re not looking for, so this is the real problem with B12. This is a serious problem because B12 deficiency can take years to become clinically evident, and the effects can be irreversible.
Screening for B12 deficiency is completely harmless and over treatment is hard to do because B12 is so safe to supplement with, whereas misdiagnosis is not because of the potentially irreversible neurological damage, which is completely preventable.
Primary Causes of B12 deficiency include:
- Inadequate intake (common in vegetarians and vegans
- Intestinal malabsorption due to low stomach acid
- Celiac Disease
- Crohn’s disease, or other gastrointestinal conditions
- Pernicious anemia
- Atrophic gastritis (caused by H. pylori infection)
The elderly is another population at risk.
H. pylori infection and chronic proton pump inhibitor use (Nexium or Prevacid) lead to low stomach acid, which decreases B12 absorption.
Remember, B12 deficiency is thought to affect up to 40 percent of people over age 60.
It’s not just the elderly who are at risk from proton pump inhibitor use. Anyone who regularly uses antacids can be susceptible to this effect, and that now includes a lot of people under 60 years of age.
Over 15 million prescriptions were filled for these medications in 2013, and the FDA in its infinite wisdom recently made omeprazole, or Prilosec, available over the counter in 2000.
This was soon followed by Prevacid becoming available over the counter. PPIs were only approved for short-term use of two weeks, but they are now taken for years or even decades.
Numerous studies have shown side effects, risks, and complications, but this has not affected their use. The next population at risk is those with digestive disorders that lead to malabsorption. This includes celiac disease, which blunts the intestinal villi and causes malabsorption of several nutrients, and Crohn’s disease, which causes inflammation of the terminal ileum in many cases, and the terminal ileum is where the intrinsic factor B12 complex is absorbed.
Finally, the diabetes drug metformin has been shown to deplete B12 levels, so if you or someone you know has been taking metformin for some time, you might want to consider getting tested.
Children and B12 Status
While kids are not at particular risk unless they fall into the other categories we’ve just talked about, the effects of B12 deficiency in kids can be particularly alarming.
Studies have shown that kids raised until age six on a vegan diet are still B12 deficient even years after they started eating at least some animal products. In one study, the researchers found a significant association between cobalamin status and performance on tests measuring fluid intelligence, spatial ability, and short term memory, with formerly vegan kids scoring lower than omnivorous kids in each case.
The deficit in fluid intelligence is particularly troubling, the researchers said, because it involves reasoning, the capacity to solve complex problems, abstract thinking ability, and the ability to learn.
Any defect in this area may have far-reaching consequences for individual function.
Now, I recognize that there are many reasons why people choose to eat the way they do, and I respect people’s right to make their own choices. I also know that, like all parents, vegetarians and vegans want the best for their children. This is why it’s critical for those who abstain from animal products to understand that there are no plant sources of B12, and that all vegans and most vegetarians should supplement with it. This is especially important for vegetarian or vegan children or pregnant women whose need for B12 is even greater than adults.
Things to Consider When Supplementing
There are two forms of vitamin B12 that you’re likely to come across – methylcobalamin and cyanocobalamin. Cyanocobalamin is much more common in multivitamins and B12 vitamins, but there are lots of strong arguments to replace this ingredient with methylcobalamin.
In short, Cyanocobalamin is the synthetic (less expensive) form of B12, while methycobalamin or adenosylcobalamin is the form that mimics nature more closely.
So if you’re considering supplementing, make sure you are using the better (methylcobalamin) form.