Hello and Happy Holidays to everyone. My name is Anna Midolo and I am a Registered Nutritional Consultant and Holistic Chef.  I am very pleased to be working with Dr. Gannage at 300 Main Street in Markham, Ontario and it has been a pleasure meeting and working with the wonderful families at the clinic who are dealing with GCSF Dietary requirements.  My GCSF (Gluten Casein Soy Free) Diet journey began approximately 20 years ago in an effort to help my eldest son Adrian with his health issues.  At the time my husband and I noticed that certain foods, namely breads and dairy products, really triggered Adrian's behaviour in a negative way, and that after eating these foods he would also suffer grandmal seizures. Thus, we sought nutritional advice and I decided to go back to Nutrition School and through diet modification, namely a GCSF Diet, we have seen Adrian make great strides in his behaviour, language, social skills and overall well being and health.  In working with many families that are on the GCSF Diet. I know that the Holidays can be a very challenging time.  However, I am here to say that the Holidays can be enjoyed and you can still savour many of your favourite foods be making some simple, creative and healthy changes to many of your festive favourites.  For example, I am including a wonderful recipe for Festive Turkey with a delicious rice based stuffing that is sure to please everyone.  Also a simple tip....... remember that when you are baking Holiday goodies you can use rice flour, gluten free flour, nut flours and coconut flour in place of wheat flour and that you can use Stevia in place of sugar.  If a recipe calls for butter you can use olive oil or ghee in its place and you can use applesauce instead of eggs.  It is also possible to substitute eggs with ground flax seed and water or with mashed ripe banana.    I hope that you enjoy the Festive Turkey Recipe and that your Holidays are Merry and Bright.  I look forward to meeting more of the parents and families in the New Year to continue to work together in creating a healthy, healing and happy kitchen for all.
Best Holiday Wishes
Anna

Festive Turkey with Wild Rice and Herb Stuffing:                                                                                            

Ingredients: 

• Please read entire recipe before shopping or beginning.
• 12-15 lb fresh organic, or free-range turkey (do not use self-basting turkey)
• Stuffing:
• 1/2 cup wild rice
• 1 cup long grain brown rice
• 1 medium onion, chopped
• 3/4 cup diced celery, about 1/4-inch pieces
• 2 cups sliced crimini mushrooms (optional)
• 1 medium green apple, diced about 1/4 inch pieces
• 4 medium cloves garlic, minced
• 1/2 cup chopped walnuts
• 6 dried apricots, coarsely chopped (sulfate free)
• 1/2 cup raisins (optional)
• 1/2 cup chopped fresh parsley
• 2 TBS chopped fresh sage (or 2 tsp dried sage)
• 3 TBS chopped fresh thyme (or 1 TBS dried thyme)
• 1/2 TBS fennel seeds
• 1/2 cup + 1 TBS chicken broth (home made or organic brand )
• salt and black pepper to taste
• Optional: cook liver for 10 minutes with gravy ingredients, remove from heat, chop and add to stuffing mixture.
• Gravy:
  
• 6 cups chicken broth
• 2 large carrots, chopped in large pieces
• 2 medium onions, cut into large pieces
• 2 celery sticks, cut into large pieces  
• 1/3 cup Gluten Free flour mixed with water
• 1 TBS chopped fresh rosemary (or 1 tsp dried rosemary)
• 2 TBS chopped fresh thyme (or 2 tsp dried thyme)
• salt and black pepper
• *optional 1/4 cup dried porcini mushrooms
• Serves: minimum of 8

Directions: Stuffing:

1. Bring 3-1/2 cups of lightly salted water to a boil. While water is coming to a boil, rinse the wild rice under running water in a strainer. When water is boiling add both wild and brown rice, cover, turn heat to low and cook for about 45 minutes, until tender. Do not overcook. You will most likely have excess water when rice is cooked properly. Put cooked rice in a strainer and drain out excess water. Set aside in a large enough bowl to mix everything together.
2. Heat 1 TBS chicken broth in a large stainless steel skillet.   Saute onion in broth over medium heat for 5 minutes. Add mushrooms and celery and continue to sauté for another 2-3 minutes.
3. Mix all the stuffing ingredients together in bowl and season with salt and pepper.Always stuff the turkey just before roasting, never ahead of time,  to avoid the growth of harmful bacteria. Have the stuffing hot and pack it loosely in the body cavity. 
   
   
   

Turkey: 

1. Rinse turkey well inside and out. Pat dry. (If you had to buy a frozen turkey, make sure it is completely thawed.)
2. Preheat your oven to 350°F (177°C) and put the oven rack on the bottom shelf. Right before roasting the turkey, stuff it loosely with the stuffing.
3. Cut about 18 inches of heavy kitchen twine. Truss the turkey by binding the legs together. 
4. Place turkey breast side up on a flat or V-shaped rack in roasting pan. Make sure you use a rack inside the roasting pan. Otherwise the skin may stick to the pan and tear. Add a cup of chicken broth to the bottom of the pan. Roast breast side up, basting about every 30 minutes with the pan juices for about 2-1/2 hours for a 12-15 lb turkey. 

     5.  Check the breast for doneness by inserting an instant reading thermometer at the thickest part of the breast toward the neck. This will give you an idea how much longer the turkey     will need to cook. It should read about 125°F (52°C) at this point. When the thermometer reads between 1657deg;F and 170°F (74-77°C) in the thickest part of the thigh the turkey is perfectly done. Check the stuffing by inserting the thermometer into the center of the cavity. The stuffing should read 165°F (74°C) to be done. If it has not reached this temperature, you will have to remove it from the turkey and finish cooking it in a baking pan on its own. It's important the stuffing reaches this temperature to be safe to eat. Check the thighs for doneness. Remove your turkey to a platter, but don't carve it for at least 20 minutes. 
Gravy: 

1. Simmer all the ingredients( except gluten free flour), thyme, rosemary, salt, and pepper for about 1 hour on medium heat.
2. Strain and discard solids. Heat 1/4 cup broth in a stainless steel skillet. Whisk in flour a little at a time to incorporate. Using a wire whisk, add the rest of the broth a little at a time on low heat. Keep whisking to avoid lumps until all the liquid is incorporated.
3. Add rosemary and cook for another 20 minutes on low heat, stirring occasionally. Season with chopped thyme, salt, and pepper.
4. AND ENJOY!!!!

The holiday preparations, parties and treats are upon us. Afterwards, there are many weeks of cold days. If you're not careful you may find at the end of 4 months that you've gained 15 pounds or more. Heck, some may gain that by New Year's Day. Here are some tips to help avoid the extra pounds.


DISCIPLINE AROUND FOOD  Learn to say no, particularly when out at social gatherings, to foods that you know are blacklisted. Your friends may respect and try to emulate you. Each year some may even join you - soon you'll have a circle of friends that has developed healthy dietary habits together.  Don't slide into consecutive days of poor food choices. If one day or night your diet (and alcohol consumption) takes a bad turn, be especially good for the next three. Make it a priority to focus on many servings of salad each day after the overindulgence, before the next party arrives, and drink lots of water too. Plan some activities that don't focus on food.

FIND COMFORT IN FRIENDS AND FAMILY, NOT FOOD. If it's a lonely time for you, due to loss or other reasons, make a point to make contact with special people (or bury the hatchet with someone you've been at odds with). Go beyond small talk and make an honest attempt at connection. Otherwise, loneliness leads to overeating, usually of the starchy, refined carb, sugary foods that can add the pounds and drain your energy.

REDUCE THE STRESS LOAD Stress can lead to more eating, and also causes hormone imbalances that result in weight gain. Ask for help - do pot luck dinner rather than the whole thing if you're hosting. Ask the kids for their participation.If shopping is a bother, try your hand on-line rather than stressing to find a parking space and rushing through the crowded malls. Delivery to your door of gifts you've intended for others can make a big difference toward allowing more quality time with friends and family.It certainly helps to plan ahead and not risk adrenal overload as you're hurried to meet the December 25th deadline.

ACTIVATE, DON'T HIBERNATE  Remember, it's a long winter. Don't hibernate with unhealthy snacks - activate with healthy exercise. We should all bundle up and get out there, choose a parking spot further away from the entrance, take the stairs, chase the kids in the snow, steer clear of hours in cyberspace or video-gaming. Tis the season to spend time with friends, volunteer yourself to those in need, exchange gifts, and connect spiritually. So go ahead and give like Santa - just try to avoid looking like him. Take some of the focus off food. And have fun! After all, it's meant to be a wonderful time of year!!

Exchange2011 in Portland has come to a close, where ACAM and AAEM combined to stage the General Session of education for Integrative Medicine Practitioners like myself. With the medical conference concluded, these are the impressions I was left with, as I sit in the hotel lounge at the Marriott:

1. Nutrition has likely been argued over, say, since at least the Neolithic Revolution 8000BC. It’ll be debated for the next 10,000 years and beyond. Dr. McDougall and Dr. Morstein provided the evidence - he of the starch-based, high carb approach to nutrition, she of the low carb, lose-the-oatmeal-for-breakfast approach. Each was talking about the best “diet” to manage Type 2 Diabetes.  The audience of PRACTITIONERS was left fired up, some dazed and confused - imagine how the public feels. 
2. Fluoridation of the public water supply has to be one of the largest public health failures, not successes, of our time.  Just ask Dr. Paul Connett, PhD of the Fluoride Action Network, who gave a rousing presentation detailing the hazards.
3. Sweating out toxins is effective, as I’ve advocated, according to evidence provided by Stephen Genuis, MD of Alberta. His research shows excellent excretion of lead and cadmium especially. By exercise, sauna or hot yoga, do SWEAT the small stuff - to detoxify.
4. Dr. Paul Cannell, of the Vitamin D Council, provided strong epidemiological evidence that Vitamin D deficiency leads to a multitude of health problems. The clinical data, detailing the best way to intervene - delivery route, oral dose (if any), optimal blood levels, tissue levels - was lacking, and thus many questions remain for me about the efficacy and safety of high dose oral D supplementation. In 2005, my newsletter about Vitamin D pertained to sun exposure. I still maintain the fallback position is “what did nature intend?”, and that the issue is sunlight deficiency for many populations. Shouldn’t it be corrected that way?
5. Drs. Wright and Sherman provided the take-home recommendation about supplementation of the week for me: naicinamide for diabetes.  Berberine for diabetes was a close second, and from the Chelation workshop Dr. Mark Houston provided ample evidence making the case for ribose, EFA’s, carnitine, and COQ10 for heart patients.
6. Dr. Jeff Bland, PhD of IFM once again provides the inspiration and motivation, with a compelling philosophical, scientific, reductionist and holistic two hour presentation to kick things off early Friday morning. Dr. Bland had a profound influence on my career and education in the mid-1990’s, and continues to captivate while being on the leading edge of research and thinking.

So I’ll leave Portland tomorrow, with kudos to the organizers from ACAM and AAEM for a wonderful conference. A special thanks also to the folks at The Courtyard Marriott at Lloyd Center for their hospitality and gracious hosting. 


And the final word is this: eat a balanced, chemical-free diet; get adequate exercise, with sun going in and sweat coming out if you can; and manage stress for better health. Let’s not get bogged down too much in the details. Keep it simple, keep it fun. 

Another GUEST BLOG, this time by Christine Jambrosic. Christine graduated from McMaster University with a Bachelor’s Degree in Kinesiology (BKin), with a particular interest in sports nutrition.  She went on to complete her PDHom through the School of Homeopathy as well as the Master Clinician Course through Luminos Homeopathy and has now been practicing homeopathy for 11 years. She sees patients in consultation at Markham Integrative Medicine and can be reached for an appointment at (905)294-2335. (The views and opinions expressed in a guest blog are those of the author, and are not necessarily reflective of Dr. Gannage's own opinions.)

Hello Everyone,

I’d like to take this opportunity to say how pleased I am to have joined the wonderful team here at Markham Integrative Medicine.  I’m really excited to be joining such an amazing group in a setting that really encourages true integrative medicine!   

First off, may I say that the human body is amazingly resilient and  capable of miraculous healing ability, despite the daily abuse that many of us put it through.  Look at our grandmothers who raised large families at home and nursed them through illnesses without hospitals, doctors or clinics...they would certainly say that the body is great at healing itself if given the right care and circumstances.  This is the lovely thing that lends itself to why homeopathy works.  

So what is homeopathy?  It is a well-established form of medicine that dates back to the 18th century and a German physician named Samuel Hahnemann.  It’s based on a principle called ‘The Law of Similars,’ or ‘Like Cures Like.’  For example, we know that poison ivy causes a certain type of reaction, a vesicular rash, in a healthy person.  If you take the homeopathic version of poison ivy, the remedy Rhus Tox (which has been diluted and succussed), it will cure this same kind of vesicular rash that an ill person may have.  So Rhus Tox can be a great choice for instance in some cases of chicken pox or eczematous skin conditions where the rash matches the rash that poison ivy creates.

Homeostasis is the fancy scientific word that describes this inner mechanism that we all have that helps our bodies come into balance if it’s given the right stimulus.  It’s like a pendulum on a clock that gets stuck in a certain position.  A homeopathic remedy is like the nudge you give it to get it swinging again, and eventually it will come to rest in the middle, in balance.  And when our systems are in balance, our bodies can show how fantastic they are at healing themselves.  This is the great thing about homeopathic remedies; they act to remove blocks and imbalances so that our bodies can begin to heal they way they are naturally inclined to.  No bandaids.  No quick fixes.

When you look at health and disease this way, you can see that homeopathy treats the individual then, and not the disease.  This is why it can get to the root of the problem, and not just give a quick but temporary fix.  Seeing this, we could easily find 5 people suffering from an eczematous rash, but only one of them may match up with and need Rhus Tox  as the remedy that will help them.  How do we figure that out?  By looking at the observable signs and symptoms that someone is showing.  These are the signposts letting you know what’s going on inside.  By gathering all of these signs and symptoms from someone, mental, emotional and physical, we can put them together into a snapshot and then look to see which remedy matches up to this snapshot the best. This is a big part of what takes place during an initial appointment with me. This is the practice of matching up the person with the one of thousands of remedies available for treatment.

I’ll be posting future updates to give you a better understanding of homeopathy and how it can play a role in your personal treatment plan. If you’d like more details on how homeopathy works, you can pick up a leaflet from the clinic, or email me with any questions you may have. Or if you’re ready to experience homeopathy for yourself please book an appointment with me by contacting Markham Integrative Medicine.

Wishing you happiness and health,

Christine Jambrosic, PDHom

1. DRINK WATER. There is not a more important, or inexpensive, endeavor physically than replenishing our bodies of clean water. All of our systems require water to function optimally - our cells bathe in it, wastes and nutrients flow because of it, our detoxification systems rely on it, digestion is impaired without it. At times chronic headaches and low back pain are related to water deficiency. We are 80 % water in our physical makeup. Two litres per day for most people is required; or take your weight in pounds, divide by 2 and drink that amount in ounces (e.g. a 150 lb woman would drink 75 ounces daily).  I suggest avoidance of chlorinated drinking water. Re-mineralized reverse osmosis is a good choice. 

2. A SALAD A DAY. At my clinic I routinely conduct a diet review with all new patients. I consistently find, especially in patients that are chronically fatigued, chronically pained and/or chronically constipated that, not only is their water intake diminished, consumption of fresh fruits and vegetables is much reduced. North American diets are horribly inundated with refined, packaged, nutrient poor foods, white flour and refined sugar. Eliminate these, and replace them with fiber, nutrient dense leafy greens and other vegetables. For those that have a challenge with gas and bloating from fruits and vegetables, a reasonable approach is to start with steamed vegetables. A useful intervention is digestive support, as with enzymes, during meals, and avoidance of food sensitivities. 

3. CHOOSE ORGANIC. Organic food has made its way into the marketplace for healthy reasons. Foods high on the food chain concentrate chemicals and hormones in their tissues, and yet we require many such foods for optimal nutrition balance. The dominance of hormones in our food supply accumulates progressively in our own tissues, leading to problems with reproductive tissue structure and function, and ultimately to the worst kind of pathology: cancer. Antibiotic use in livestock takes place at a huge cost to human health, affecting bowel flora balance and contributing to reduced effectiveness of antibiotics when required to fight life-threatening infections (i.e. antibiotic resistance). Organic food has been shown to possess 40% more nutrients than non-organic counterparts, since chemicals negatively impact soil richness. In Canada, our largest exposure to pesticides comes from our standard diet. One's greatest defense against environmental toxicity in general is nutrients. Our diets, therefore, must be sources of nutrients, not chemicals. 

4. PAY ATTENTION TO SYMPTOMS. Ignore, or worse suppress, symptoms at your own peril. Headaches, bloating, gas, fatigue, muscle pain, frequent colds, skin rashes and so on are all signs of an underlying disturbance calling out for correction, not mere suppression. Track symptoms, listen to your body, and learn to describe them in detail to a health provider who will listen. The greatest amount of information about one's health comes not from lab tests or scans, but from symptoms interpreted meaningfully. 

5. BE KIND TO YOUR LIVER. Sub-optimal liver function lies at the core of many medical symptoms. It is an organ with multiple roles, from detoxification, to digestion, to hormone metabolism, to regulator of circulation. Being kind to the liver means avoiding undue exposure to chemicals, both in the diet and around the household. It means paying attention to healthy intestinal function, thereby reducing bowel toxicity and autointoxication. It means using probiotics routinely, and other supplements, particularly antioxidants and herbs, that are therapeutically supportive to liver functions. It means understanding Eastern medicine concepts detailing the liver as an emotional organ, and its connection to anger. 

6. PRACTISE ACTIVE LIVING. Exercise has innumerable health benefits, for mood and sleep, for immune system strength, for cardiovascular function, for sweating and detoxification. A sedentary lifestyle is a choice for chronic medical conditions, and the options for inactive living are far too accessible. Computers, television and video games, combined with unhealthy snack foods and drinks, have assisted the development of our current pediatric obesity epidemic. Over 50 % of adult Ontarians are overweight and obesity is now recognized by experts as the second-leading preventable cause of death after cigarette smoking. For most of us, overweight or not, active living can also mean taking the stairs, raking the leaves, parking further away, or not driving at all. It is time to get back to active living, to get off the couch or desk chair, and to breathe some fresh air outdoors. 

GUEST BLOG by Rose Marie Randall, a Certified Nutritional Practitioner and author of The Nine Biggest Problem Foods and How to Live Without Them  - the cookbook which features recipes which features recipes that are all free of gluten (including wheat), dairy products, sugar (and artificial sweeteners), corn, yeast, eggs, soy, peanuts, and processed fats and oils. Her latest book, Affordable Nutrition, features recipes and remedies for people with food sensitivities who are short on Money and Time. Visit her at rorboooks.ca. 
(The views and opinions expressed in a guest blog are those of the author, and are not necessarily reflective of Dr. Gannage's own opinions.)


Only a few short decades ago, our culture’s consciousness of food intolerances was basically limited to life-threatening anaphylactic reactions such as the rare, but dreaded, peanut allergy. Not only are these types of allergies becoming more common, but more subtle food sensitivities that can disrupt life and erode its quality, rather than actually end it, have become unbelievably widespread. Now it’s almost normal for people to notice improved feelings of wellness when avoiding food that our forefathers ate all their lives without incident.

While we improve the health of our bodies and our planet by supporting local organic agriculture, reduce the number of chemical pollutants in our lives, and reduce our bodies’ toxic load through regular detoxification, we can take immediate action to minimize the impact of food intolerances. As a sufferer of food sensitivities whose condition eventually led me to become a Certified Nutritional Practitioner, I first had to come up with ways to deal with my own food-related challenges. I now share what I’ve learned with those whose needs reflect my own. What follows are seven key strategies I’ve distilled from my own experience.

1. Become familiar with your own symptoms. The most obvious, easiest-to-identify are the reactions which can show up within a few minutes to a few hours of eating the offensive food. Digestive symptoms (bloating, diarrhea, nausea, constipation), respiratory involvement (runny nose or stuffy sinuses, wheezing or asthmatic symptoms), or skin reactions (including short-term hives or chronic rashes, dermatitis, eczema and psoriasis,). But also look for more subtle symptoms that may not usually be attributed to food sensitivities: feeling inexplicably sad, irritated, or even elated or giddy; increased anxiety, feeling hyper or unable to focus or think clearly; headaches; subtle changes in handwriting, dexterity, and speech; joint pain; water retention; even accelerated heart rate, or an uncomfortable awareness of your heart beating may all be clues that you’re dealing with a sensitivity. Strong cravings for a particular food may also indicate an allergy to that food. And be aware that symptoms can present themselves up to three days after the offending food has been ingested. If it’s something you eat all the time, you may not even know that what you normally feel is actually a temporary symptom, until you’ve cut that food out of your diet.
2. Identify your sensitivities. The allergist’s skin-prick tests  deal with the type of immunity that governs reactions to inhaled and contact allergies and may not be very helpful at identifying most food intolerances. There are a couple of ways you can go about determining which foods you are reacting to. A good starting point before you make any changes to your diet is a food journal. Carry a small notepad around with you and write down everything you eat for a few weeks, as well as how you feel, and see if you can notice any cause-and-effect patterns between symptoms and foods eaten. You can then proceed to what I’d call a subtractive elimination method: you subtract one food at a time from your diet (start with a common offender, such as wheat or dairy, or anything your food journal has revealed to be a problem), and notice any changes after a week or two without that food. If you are still bothered by symptoms, subtract another food and repeat. Another way (which may be faster but will require a lot more discipline, as your food choices will be severely limited) is what I call an ‘add-back elimination method’: take out ALL common food allergens for a week or two (gluten grains, dairy products, corn, eggs, peanuts, yeast, soy products, shellfish, citrus fruit, tomatoes, strawberries, and chocolate), or you might prefer to eat a very limited, hypoallergenic diet of lamb, brown rice, and green vegetables for a week, or even fast for a few days (those who are underweight, pregnant, nursing, children, or who have serious health problems should fast only with qualified health guidance, if at all). After this initial elimination period, slowly add foods back one at a time and gauge any reaction. An experienced nutritionist can help with this process.
3. Identify the foods and meals you like and why you like them. Sit down and pinpoint specific aspects of the foods you or your family members like, such as flavour and texture. Then try to find less-allergenic ways to match them. For example, making porridge with quinoa flakes instead of oats will deliver a similar satisfying taste and feel; almond, rice, hemp, or coconut milk can provide creamy drinks for those who miss dairy or soy milk; and toasted sunflower seeds can provide that crunchy texture for the chip-nibblers in your life.   
4. Identify your greatest obstacles: those things that might sabotage your ability to stay away from your trigger foods and stick to a less allergenic eating plan. The most common I hear when coaching those with food sensitivities involves issues around time and convenience. If this is your bane, pick recipes and meals that are quick and simple. Temptation is another common saboteur. I always say that in the battle between willpower and biochemistry, biochemistry will usually win. If you’re addicted to the foods you’re trying to avoid (which is rather common), you had better be prepared for some moments of weakness. Planning ahead is really both the best time-saver and temptation-buster: have only healthy foods on hand, wash fruits and veggies as soon as you get home so they’re ready to go, and have some quick emergency snacks around at all times. If taste is an issue, don’t stop searching until you find healthy foods you love. They are out there! Also keep in mind that your tastes and cravings will change once you’re no longer comparing the subtle flavours of wholesome foods to the super-stimulating blasts of sugar and salt that dominate processed foods. If cost is your stumbling block, go for from-scratch foods rather than prepared ones. Milk alternatives, spreads, dressings, gluten-free bread, pasta, cereal, crackers – although so many of the products in health food stores are fine from a sensitivity perspective, they do tend to be pricey. But you don’t have to be wealthy to be healthy! Your best bet for cost and health are whole grains, legumes, and local, seasonal fruits and vegetables. Economize without sacrificing nutrition by buying certain produce frozen vs. fresh (such as peas and berries). Planning ahead, shopping with a list (and not shopping hungry) are other budget-saving practices. And extend your fish and meat budget by incorporating these foods into several recipes, rather making them the focal point (e.g. steak or chicken wings).
5. Arm yourself with good recipes. Find a cookbook that takes your sensitivities into account so you don’t have to tinker with substitutions at dinner time, which could tempt you to reach for a more convenient option. From that source, identify recipes that align with your current tastes, try them out, and pick several sure-fire dishes that consistently work for you and your family. Customize them a little if necessary, copy them, and put them all in a “Favourite recipes” binder for quick reference. You’ll never be stuck for meal ideas again!
6. Eat a variety of foods and rotate them. Food sensitivities can result from simply eating the same food too often , so wait 3 to 4 days before eating a particular food again to give the body a chance to rid chance to rid itself of the residues of that particular food before eating it again. This can take up to 3 days, which is why the rotation diet is a cycle in which one eats a food (or its close relatives) no more frequently than every 4 days.
7. Examine your food-related misconceptions. Were you raised to believe that anything other than cereal, toast or pancakes for breakfast is just wrong? Or that the lunch you take to school or work has to include a sandwich? Or that dinner must be followed by a sweet desert? Release yourself from these beliefs – they are only habits that don’t serve you. There’s nothing wrong with having steamed veggies, chicken and rice for breakfast, or eating your take-away lunch with a fork! The only rules are the ones your body lays out for you. Be easy on yourself and have fun. Rather than feeling deprived, thank your food sensitivities as opportunities to try new things that you might otherwise not have. You never know – in addition to feeling better, you might find you love your new discoveries more than the foods you left behind.

I had a patient ask me an interesting question some 6 years ago: “What do you think is the most important medical development that you’ve learned about in the past year?” At the time, because I had just returned from an ACAM conference and heard a presentation by Dr. Michael Holick, MD http://bit.ly/ovhAj6weeblylink_new_window, I responded: "The importance of Vitamin D deficiency in disease, how human levels are lowered by sunscreen use and  sedentary living indoors, and why it is important to keep Vitamin D in a healthy range.”  I meant it, so much so it was the cover story of my newsletter back then with the headline “Here Comes the Sun - And I Say It’s Alright!”, but he seemed caught off guard, expecting an innovative surgery or new genetic discovery I suppose.  Of course, now the Vitamin D story has been told, the bandwagon has been weighed down with all the converted, and more frequently we are hearing about disease connections related to D deficiency (although I remain cautious about massive oral doses, the subject of another blog perhaps).

What’s my point? Well, I like his question, and ask myself the same one in my head periodically: “What’s an important medical discovery that you’ve learned for yourself recently, John?” I like to answer with a theory or discovery that applies to my daily practice, something measurable and that is changeable - something that affects a cross-section of illness that, when treated, can have a profound impact on human suffering.  My answer is the subject of today’s blog: mitochondrial dysfunction, its impact on disease, and what I’ve discovered can be done about it in my patient population. I present some concepts in simplistic form.

I sketched the mitochondrion in Cell Biology on a large bristol board in 2nd Year University.  I loved studying the cell back then, adored biology, and spent countless hours perfecting my drawing of a human cell.  It’s ironic that 25 years later I’m writing about this cell organelle as a medical doctor (and looking at cells every day under a microscope!)

The mitochondria are the little power plants suspended in each cell alongside other cell parts like the nucleus.  There may be 2500 of them in a single cell (except RBC’S). An important mitochondria task is to make the energy used to power cell functions, and in turn required by tissues and organs for proper functioning.  They are important for brain, muscle and heart function in particular, as these organs utilize the most energy. On the folded membranes and in the matrix of a mitochondrion, units of energy are made after conversion from foods we eat, in a cascading of biochemistry known as Krebs Cycle and the electron transport chain. Nutrients are needed as cofactors in the cycle, oxygen is required, and contaminants like mercury, lead or pesticides can damage the membranes such that the processes slow down, energy is depleted and/or cells die.  This in turn leads to poorly functioning organs.  For the brain, this means impaired learning, decreased executive functioning, poor attention, speech and language dysfunction, and so on. This occurs because the brain disproportionately requires more energy and oxygen than the other organs do.

What’s interesting about mitochondria, as Figure 1 shows, is the presence of its own DNA, separate from the DNA housed in the nucleus of the cell.  Mitochondrial DNA can mutate and be damaged, in a fashion that impacts energy production, by toxins, viruses or radiation.  An important process in DNA damage and membrane leakage, leading to cell damage and death, is oxidative stress - accelerated by pollution of all kinds, and exacerbated by antioxidant deficiencies.

In my medical clinic, the practical application of these concepts translates first into a requirement to test for mitochondrial dysfunction, as I seek to manage developmental issues in children, particularly autism and global developmental delay.  And just like my testing of Vitamin D, when I too often found easily correctable deficiency, I often discover evidence for mitochondrial dysfunction in children with neurodevelopmental issues. The next step is to provide the nutrient co-factors that improve energy production in the brain and muscle, while simultaneously addressing pro-oxidant exposure in a child’s diet, intestinal and other tissues, home, and immediate environment. The mitochondria can be sped up, protected from damage, or increased in numbers to meet energy demands in vital organs like the brain. The results I’ve observed to date include: improved cognitive functioning, increased endurance, better muscle tone, and more easily attainable developmental milestones.  

Just like the Vitamin D story, starting out as an alternative view prior to becoming conventional practice, mainstream medicine will look to the mitochondria in the future to explain autism and other neurologic diseases, like Parkinson’s Disease, syndromes like Chronic Fatigue and Fibromyalgia, and I suspect cardiac cases as well.  It is a fruitful place to look, since it explains what I have always felt to be true: that much human illness, organ dysfunction and premature aging occurs at the interface between nutrient deficiency and toxic overload, with this organelle’s dysfunction acting as a major player. 

The medical community has recently seen a raft of literature instructing “aggressive” management of hypertension, diabetes and high cholesterol (the Big Three). The basic premise is to diagnose early and treat early, while at the same time lowering the upper limits of acceptability for these conditions. The aggressive intervention leads to polypharmacy, where a single one of these conditions is best managed with more than one medication, as conventional medical literature now recommends. In other words, if you have high blood pressure, your doctor has been instructed that control best comes from prescribing two medications. The goal is to reduce risk of death and morbidity due to heart disease, stroke and other complications.

The same literature often addresses lifestyle change, including nutrition considerations, as a footnote usually towards the end of a long article (similar to the proportion allocated to this topic when I was a medical student 25 years ago). Make no mistake: these three conditions do require the respect they deserve as risk factors for heart disease, the number one killer in North American society. But what do they have in common beyond the espoused aggressive management, and cardiac risk?

DIET, INSULIN AND METABOLIC SYNDROME

First line therapy in the management of these conditions comes through alteration of lifestyle habits - related to diet, exercise, and stress management. The fact that these conditions can be managed with a similar unifying approach tells us something about their commonality related to cause and biochemistry. The average North American diet, self-indulgent and high glycemic, triggers an insulin response that is self-destructive in many aspects. Consistently high levels of insulin, in and of itself, are damaging to the walls of arteries, leading to hardening and degeneration. Insulin is a fat-making hormone, explaining the relationship of each of the Big Three to obesity in many cases. In fact, diabetes, hypertension, obesity and heart disease, along with gout and hormone disturbances, can all be categorized into one syndrome: The Metabolic Syndrome.

At the core of Metabolic Syndrome is the high glycemic(sugar)-insulin connection, which leads to a cascade of biochemical disturbances. White sugar (and brown), white potatoes, white rice and white flour are all high glycemic foods that require restriction. The Glycemic Index of foods, gaining popularity worldwide in Westernized nations, was conceived by Toronto's Dr. David Jenkins. Food lists can be consulted to ensure a low glycemic diet, aiming for carbohydrates that are below 55 on the glycemic index scale.

HEALTHY BODY COMPOSITION, EXERCISE AND STRESS

Of course, successful management of excess weight is imperative. The hallmark of a good weight loss program, in my opinion, is not to achieve loss of the greatest amount of weight in the shortest time possible as the goal, but rather, with an emphasis on patient education and involvement, establishing HEALTH as the focus.

Obesity is indeed related to the aforementioned high glycemic diet, but also linked are exposures to toxins, lack of healthy bowel flora and sleep disturbances. The approach to weight management requires a comprehensive approach - with a low glycemic diet, incorporated beyond a temporary period, the foundation. Of importance is getting an early start to healthy body composition - studies link later heart disease to obesity beginning in adolescence, as an independent risk factor http://bit.ly/iCA1A6.  Indeed, pediatric obesity is one of the significant public health issues of our time.

Also of importance is the lack of exercise that aggravates the picture of Metabolic Syndrome. Exercise allows for better response of healthy cells to insulin itself, thereby improving blood sugar, fat and cholesterol metabolism. Exercise leads to the development of lean muscle mass, which has a higher level of cellular activity. Increased lean muscle is associated with decreased risk of acute and chronic illness, and healthier body composition long term due to less likelihood of regaining any lost weight. Simply put, exercise expends calories, lowers weight, increases muscle, lowers blood pressure, regulates blood sugar and improves the cholesterol profile, in addition to improving mood and sleep.

Stress chronically alters biochemistry as well, with increased output of cortisol long-term causing blood sugar disturbances and fat storage. Stress can heighten cholesterol levels through similar pathways, and is likely the single most important risk factor for heart disease.

HIGH CHOLESTEROL

High cholesterol is also an aspect of Metabolic Syndrome, and as a marker of the syndrome has been targeted for aggressive management mostly from a pharmacologic perspective. Sadly, when it comes to nutrition and cholesterol, if mentioned at all, the existence of myths remains pervasive in the medical mainstream.

Firstly, I am familiar with the school of thought that suggests cholesterol is misplaced as a dangerous chemical; that excessive lowering of cholesterol, which comprises 2 % of brain mass, is detrimental to neurologic health; that as a natural antioxidant substance, raised cholesterol is a programmed protective response to toxin exposure (suggesting a role for detoxification and antioxidant supplementation). Nonetheless, high cholesterol remains an entity most patients are not comfortable with, insomuch that treatment is desirable and requested.

Returning to the discussion of nutrition misperceptions, dietary cholesterol has virtually no effect on circulating levels of cholesterol in the bloodstream. Eggs are an excellent source of protein and nutrients, and should not be avoided for their cholesterol content. The lecithin that naturally occurs in the whole egg (with emphasis on whole) exists coincidentally with the egg's cholesterol for good reason. Mother Nature once again gets it right.

The myth that cholesterol can only be lowered a small percentage solely through dietary management has also been dispelled. This was the mainstay of medical thinking for decades, seemingly necessitating drug research and application. Dr. Jenkins and his colleagues at St. Michael's hospital constructed the Portfolio Diet, and showed results equal to the financially successful statin drugs in a study published by the prestigious Journal of the American Medical Association (JAMA)  http://jama.ama-assn.org/content/290/4/502.full.pdf. http://bit.ly/iVcqqd.  Statins lowered LDL by 30-33 percent and the Portfolio Diet lowered LDL by nearly 30 percent. The portfolio was rich in soymilk, soy burgers, almonds, oats, barley, psyllium seeds, okra and eggplant.

Interestingly, Reuters News agency reported: “… people who cannot tolerate the statin drugs because of side-effects can turn to the diet, which they [the researchers] said their volunteers could easily follow.” A worthwhile question might be why not use the diet as first line therapy, as has always been footnoted. We now have a study with clear results supporting dietary management of a common condition, and the advice is to consider it a secondary intervention.

THE BOTTOM LINE

Eat whole, choose low glycemic foods, exercise regularly, supplement thoughtfully and maintain healthy body composition. Your heart will be thankful.

Posted by John Gannage at 16:57 0 comments Email This BlogThis! Share to Twitter Share to Facebook Share to Google Buzz

Prenatal care from a conventional medicine perspective follows a standard that is an excellent starting point. Tobacco and alcohol restriction, measuring iron levels, checking fetal structural development, BP and urine measurements, and other aspects of primary care prenatally are important pillars. With more funding, and if asked to direct a higher standard of care, these are the additional recommendations I would make:

1. Disseminate information to would-be parents, prior to conception, that a pre-pregnancy session with a trained professional is advisable.

2. During the pre-pregnancy session, an individualized treatment plan would be outlined by a holistic professional, with the intention of optimizing mom's health. This session could be used to understand Mom's lifetime habits and exposures, address nutrition imbalances, optimize liver function, provide support for digestive and intestinal health, and detoxify tissues following the principles of functional medicine. Setting the target date for conception based on a measurable change in Mom's health would be advised. (The same process can be used for Dad based on research indicating the importance of  sperm health. http://www.ivf.net/ivf/sperm-damage-can-be-passed-to-children-o3239.html)

3.  During the pre-pregnancy session, a discussion would take place emphasizing the importance of: a balanced diet; the avoidance of dietary chemicals like high fructose corn syrup, MSG and aspartame; assessment and avoidance of food allergies, intolerances or sensitivities; organic food choices with direction on avoiding "the dirty dozen"http://bit.ly/ltSaBM;  the best fish choices http://bit.ly/Q5mC3; and the basics of hydration including the healthiest water sources.

4. A home survey would be conducted, with education about: the importance of avoiding home renovation projects during, and perhaps prior to, pregnancy; cleaning up indoor air quality; the common sources of household lead http://1.usa.gov/lj9KsB; and the strict avoidance of chemicals like pesticides. Scanning the home for EMF's and geopathic stress could be included.

5. A workplace survey would be included as well, again with the purpose of identifying and avoiding sources of poor air quality, excessive radiation, and oxidative stressors.

6. Provide sound advice about dental procedures and cleaning during pregnancy where amalgam fillings are involved.

7. Check Mom for an Omega 3 score, and optimize Essential Fatty Acid balance. EFA's are vital to fetal nervous system development.

8.  Measure Vitamin D blood levels, and supplement into a healthy range, while also avoiding calcium deficiency. 

9. Aggressively treat iron deficiency, which along with point 8. helps to avoid/lessen the impact of stored bone lead mobilized during pregnancy. 

10. Measure and ensure normalcy of Mom's glutathione and/or homocysteine levels.

11. Instruction on appropriate physical activity, air travel, emotional stress and other impactful daily activities that are often taken for granted.

This is a list that can be expanded as research develops regarding how to best protect a developing fetus from any negative influence of environmental  and nutrition factors. It is based on personal experience in my medical practice where taking detailed case histories, including pregnancy exposures, of a tremendous number of families has been part of my daily routine for over 10 years. 

The goal is ensuring the healthiest newborns and children possible, understanding that studies have shown that at birth 287 chemicals have been found in cord blood http://bit.ly/pIsyQ.  For some children, perhaps the ones with susceptibilities or compromised nutrition, a chemicalized start to life inside, and then outside, the uterus is a contributing factor in developmental disorders.

Parents are advised to bear in mind that fetal tissue concentrates many chemicals to a much higher level than what exists in Mom's tissues, that many chemicals move to the baby from Mom during pregnancy, and that the blood-brain barrier is not fully developed until at least 6 weeks after birth. A little education in this area can go a long way, which in my mind should begin prior to conception. Because the question needs to be asked: are we as a society, in the 21st century, doing all we can to ensure a healthier start for our newborns?

(Dedicated to my kids)