Coping with stress

“Let it go, Let it go!” Hah! It’s in YOUR head now.  So what does Elsa have to do with coping with stress? (Other than turning off the DVD.)  There are two primary effective coping mechanisms for stress, one is Problem Solving and the other is Letting Go.  Both are great in different circumstances, but one has been pulling ahead in the recent research.Elsa-and-Anna-Wallpapers-frozen-35894707-1600-1200

Problem Solving is taking action.  If you’re stressed about entertaining the family during an upcoming holiday break, buying a visitor’s guide and going through TripAdvisor reviews of local establishments takes action and diminishes stress.  By taking an active role and breaking down the stressors into “projects” the stress level can decrease.  This kind of coping works well in situations where you have control over the outcome – vacation plans, learning a new skill, writing a thesis, etc.

So what happens when you’re dealing with a stressful situation where you don’t have control over the outcome?  In 2009 researchers studied a group of people in a highly stressful situation wherein Problem Solving wouldn’t help them deal with the stress. These people were going through IVF, in vitro fertilization treatments for infertility.  IVF treatments are very intense but are generally uncontrollable.  The researchers found that people that dealt with the stress by “Letting Go”, mentally diving under the wave and emotionally riding through it, had a higher pregnancy rate.‡

Mindfulness is a technique anyone can use to let go.  Take a breath and notice what your feet are doing, how do they feel in your shoes? Are you barefoot? What surfaces are they in contact with? Can you feel your individual toes? Take a moment and just notice.  Now, what were you worried about? Do you feel a little calmer?

We constantly deal with stress in our lives, it’s part of the world that we live in.  Next time that you’re cut-off in traffic, stuck in the dentist’s chair, or waiting on hold listening to a voice reassure you that your call is important ask yourself, What Would Elsa Do?


‡ Rapoport-Hubschman, N., M.D., et al., ‘‘Letting go’’ coping is associated with successful IVF treatment outcome. Fertility and Sterility, Vol 92, No. 4, Oct 2009

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Image courtesy of Exsodus at

Image courtesy of Exsodus at

Salt (sodium) consumption is an interesting and convoluted topic. If you asked someone on the street about how much salt you’re supposed to have to be healthy they’d probably say something like, “Oh, less than I have. I don’t think you’re supposed to have much.”

The idea manifested in 1972 when the National High Blood Pressure Education Program started by the National Institutes of Health recommended a low sodium intake. At that time, the evidence supporting the assertion was weak.  In the subsequent almost half-century the scientific research hasn’t been clear either.

As Gary Taubes wrote for the New York Times, “In the years since, the N.I.H. has spent enormous sums of money on studies to test the hypothesis, and those studies have singularly failed to make the evidence any more conclusive. Instead, the organizations advocating salt restriction today — the U.S.D.A., the Institute of Medicine, the C.D.C. and the N.I.H. — all essentially rely on the results from a 30-day trial of salt, the 2001 DASH-Sodium study. It suggested that eating significantly less salt would modestly lower blood pressure; it said nothing about whether this would reduce hypertension, prevent heart disease or lengthen life.”

In 2013 The Institute of Medicine released a position paper suggesting that “The committee found no evidence for benefit and some evidence suggesting risk of adverse health outcomes associated with sodium intake levels in ranges approximately 1,500 to 2,300 mg/day among those with diabetes, kidney disease, or CVD. Further, the evidence on both the benefit and harm is not strong enough to indicate that these subgroups should be treated differently than the general U.S. population. Thus, the evidence on direct health outcomes does not support recommendations to lower sodium intake within these subgroups to or even below 1,500 mg/day.”

The idea behind restricting salt intake is based on body and kidney physiology. The idea that excess salt is harmful is not unreasonable.  High salt consumption causes the body to retain water in order to maintain a constant sodium concentration in the blood.  Salty foods make us thirsty, we drink more water and for a short period, blood pressure increases until the kidneys excrete the excess salt and water.  As high blood pressure is a risk factor for cardiovascular disease (CVD), the idea that chronic blood pressure increases caused by high salt consumption over time would increase CVD is reasonable.  The problem again is that there has been little evidence to support this idea.

Research about salt consumption is still murky. It’s looking like for people without high blood pressure there will probably be a minimum and a maximum recommendation for salt intake.  For those with high blood pressure, approximately 51% are responsive to salt consumption, so in those folks looking at their dietary salt would be beneficial.

As with most topics, this one is more complicated the deeper you go.  If you’re interested in looking at the research, check out the links below.

Thanks to Dr. Jacob Schor, ND, FABNO of Denver Naturopathic for his July 5, 2015 newsletter exploring this topic.



Schor, Jacob. How much Salt? July 5, 2015 National High Blood Pressure Education Program: Implementing Recommendations for Dietary Salt Reduction.  NIH.  Publication No. 55-728N, Nov 1996.

Vollmer WM, Sacks FM, Ard J, Appel LJ, Bray GA, Simons-Morton DG, Conlin PR, et al. DASH-Sodium Trial Collaborative Research Group. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med. 2001 Dec 18;135(12):1019-28.

Taubes G.   Salt, We Misjudged You. New York Times. June 2, 2012.

Adler AJ, Taylor F, Martin N, Gottlieb S, Taylor RS, Ebrahim S. Reduced dietary salt for the prevention of cardiovascular disease. Cochrane Database Syst Rev. 2014 Dec 18;12:CD009217.

Graudal N, Jürgens 2, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets areassociated with increased mortality: a meta-analysis. Am J Hypertens. 2014 Sep;27(9):1129-37.

Reinberg S. CDC salt guidelines too low for good health. HealthDay News, April 2, 2014.

Merino J, Guasch-Ferré M, Martínez-González MA, Corella D, Estruch R, Fitó M, Ros E, Salas-Salvadó J, et al. Is complying with the recommendations of sodium intake beneficial for health in individuals at high cardiovascular risk? Findings from the PREDIMED study. Am J Clin Nutr. 2015 Mar;101(3):440-8.

Guasch-Ferré M, Bulló M, Martínez-González MÁ, Ros E, Corella D, Estruch R, Fitó M, Arós F, et al; PREDIMED study group. Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial. BMC Med. 2013 Jul 16;11:164.doi:10.1186/1741-7015-11-164.

Armando I, Villar VA, Jose PA. Genomics and Pharmacogenomics of Salt-sensitive Hypertension. Curr Hypertens Rev. 2015;11(1):49-56.

Robert P. Heaney. Making Sense of the Science of Sodium. Nutr Today. 2015 March; 50(2): 63–66. Published online 2015 March 26.

Anderson CA, Johnson RK, Kris-Etherton PM, Miller EA. Commentary on Making Sense of the Science of Sodium. Nutr Today. 2015 Mar;50(2):66-71.


(Originally published Sept. 9, 2013)

I drink coffee. I usually brew a cup at home or get one from the local coffeehouse across the street. On Wednesday morning I went to Starbucks and ordered a medium coffee (Grande Pike Place) and I was so jittery I could hardly function! I felt like my heart was going to come up through my throat and I couldn’t sit still. (Any Wednesday patients, I apologize). How much caffeine was in there?

Well, in a 16oz Grande Pike Place there are 330mg of caffeine[1], so 20.6mg per ounce. To compare apples to apples there’s 13.5mg in an average brewed coffee, 5.25mg in an ounce of black tea, and 3.13mg in an ounce of green tea[2].


What about decaf? Decaffeinated coffee isn’t devoid of caffeine, it’s just lower. Caffeine is a natural component of coffee beans; therefore it is very difficult to completely remove. The United States set standards and regulations that define the maximum amounts of caffeine permitted in decaffeinated coffee. In the U.S. it is three percent.   In the world of naturopathic medicine, sometimes it’s not the caffeine I’m concerned about, it’s the process the beans go through to become decaffeinated. There are four methods of decaffeination: water, ethyl acetate, supercritical or liquid CO2, and methylene chloride[3].  Generally, the harder your liver has to work to process residual chemicals the harder it is on your body.


In 2008, Harvard looked at the relationship of coffee consumption and overall mortality and found that even people drinking up to six cups (48 oz) of coffee a day were not at any increased risk of death from any cause, death from cancer, or death from cardiovascular disease[4].


Caffeine works on the body in several ways[5]. Caffeine increases heart rate, increases urine production, and constricts blood flow.  It binds to the adenosine receptors in the brain speeding up the nerve signaling (very interesting article here). The increased nerve signaling affects the adrenal glands, stimulating the production of adrenaline. If your adrenal glands are already tired, it makes sense that jolting them into producing more adrenaline isn’t the most healthful decision.

If you find you must have that cup of coffee in the morning, consider getting some adrenal support or your cortisol levels tested.

(UPDATE MAY 2015 – I finally tested my own adrenal function and it was very sad. For the time being I’m helping my body to heal by (mostly) staying away from caffeine. Just in case you were wondering…)


[1] Mayo Clinic. Nutrition and Healthy Eating, Caffeine content for coffee, tea, soda, and more.

[2] Energyfiend.

[3] International Coffee Organization.

[4] Harvard School of Public Health.

[5] Stuff You Should Know. How Caffeine Works.

Good Meats

happycowThere are a few healthy options out there for meat-eaters.  If you go to the butchers at someplace like Whole Foods you’ll probably see some meat labeled Organic.  That sounds good right? You’re right, it’s good, but it’s not necessarily the best option when choosing your meat.

Organic Meat:  The animal must be born and raised on pastureland that has been certified to be free of synthetic pesticides, fertilizers and other amendments. All the feed that the animal receives must also be certified as organically grown grasses and grains. The animal could never be given antibiotics or hormones and must have ready access to open pasture.  But that doesn’t mean that they are grass fed.

The majority of the meat we consume in the US is grain or corn fed, not grass fed. Feeding our stock grain or corn not only increases the fat content of the meat, but also the quality of the fat. Grassfed meat is lower in saturated fat, and higher in nutrients like beta-carotene, Vitamin E, and Omega-3 fatty acids.  But, that doesn’t mean that the animal was raised without antibiotics or hormones.

There is a label you can look for from the American Grassfed Association. They require that the meat sold with their label was raised entirely on grass, with no hormones or antibiotics. grassfed label

All animals (including people) store the majority of the toxins we can’t immediately process in our fatty tissues, so that means that when you’re eating a fatty portion of meat that you want it to be as free of toxins as possible.

Look for grass-fed beef, pork, and lamb; wild caught fish, and organic chicken. There are several good sources at local farmer’s markets, occasionally Whole Foods, and independent places like Marin Sun Farms.  There are online sources available too: U.S. Wellness Meats and Grass Fed Traditions.

Additionally, be mindful of seafood high in mercury. Usually seafood high in mercury is high in lead as well. Avoid these types of seafood options or eat them sparingly. The Monterey Bay Aquarium has a good resource called Seafood Watch where you can check the quality of your seafood.

Healthy Fats

You can think of dietary fats by lumping them into two general categories: saturated fat and unsaturated fat.  The difference is in the structure of the fatty acid chains.  Imagine a ball with some streamers attached to it, like a comet (you’re imagining a phospholipid). The ball is called a glycerol head and the streamers are fatty acid chains. If the streamers are in a straight line behind the ball, with no kinks or bends, then it’s a saturated fat.  If the streamers have kinks and bends then it’s an unsaturated fat.  good-fats

When our body makes cells the wall of the cell is made from two layers of the phospholipids nose-to-nose.  In order for anything to get in or out of a cell it has to go through the phospholipid layer. So, if those streamers are packed in solid and straight it’s hard to things to get through, but, if those streamers have wiggles and bends in them it allows things through the wall. We want our cells to be flexible and a wall made of saturated fat is hard and inflexible.

Ready for some more?

We can classify our saturated and unsaturated fat even further.

Saturated fats we can divide into animal sources and plant sources.  Animal sources are the ones you’re already thinking of: butter, meat, cheese, etc.  Those saturated fats are considered long-chained fats, and in too high a quantity they can lead to inflammation and heart disease.

Plant sources of saturated fats are from coconut oil. Back in the 1970’s coconut oil got a bad rap because research was done on processed coconut oil.  Recent research on virgin non-processed coconut oil has shown that the medium-chain fats can provide easy fat burning so it’s easier on the liver. Organic coconut oil is a good alternative to shortenings and butter, and should be used for low or medium heat cooking.

Unsaturated fats can be divided into trans fats and cis fats.  You’ve probably heard of one of those, right?  Trans fats are not good for us, our body doesn’t know how to break them down properly and a trans fat diet can lead to cardiovascular disease, inflammation, and other health problems.  Usually trans fats are found in fried foods, donuts, margarine, cake mixes, Bisquick, breaded frozen foods, to name a few. Trans fats have a nice crispy mouth feel so we tend to crave the foods that contain trans fats, but try to avoid them!  This bit is a little confusing, but unsaturated fats are generally good with the exception of trans fats.

Cis fats are also unsaturated, and they’re what we think of when we consider the healthy unsaturated fats.  Cis fats are either monounsaturated (olive oil, avocado oil, sunflower oil) or polyunsatured (flaxseed oil and our omega 3, omega 6, and omega 9 oils). Monounsaturated fats are at the heart of the highly touted Mediterranean diet.  The cis fats are beneficial for our heart, our arteries, and our immune response. When we eat a diet rich in essential fatty acids (like Omega-3) our bodies produce more beneficial prostaglandins and leukotrienes (immune modulators) which relaxes blood vessels, airways, muscle spasms, and helps reduce inflammation.  As Americans, we tend to eat too much Omega-6 fats which are not good for us, so stick with the Omega-3’s and 9’s.

There are entire books written on this subject, so you can probably expect some more blog posts from me in the future. If this is interesting to you though, go research it!

Fact or Fiction?

Originally published March 28, 2013

If it says “natural” on the box, it’s good for you. Fiction. The FDA doesn’t have a definition for the use of the term natural, so when you see it on a label it doesn’t mean much. It usually indicates that the food doesn’t contain added color, artificial flavors, or synthetic substances but not necessarily. So, on that box of granola/ bottle of juice/ bag of Cheetos (not kidding), double check the ingredients.

Diet soda is better than regular soda. Fiction. Ok, the diet soda might have fewer calories, but, and this is a big but, that’s not the entire story. A lot of people that turn to diet soda tend to drink it because it’s no or low calories, so it’s “free”. There is evidence that just the taste of sweetness causes a rise in insulin which can lead to insulin sensitivity. Also, the constant exposure to sweetness increases your desire for sweetness, eventually leading to weight gain. If you’re going to drink a soda use it as a treat. It’s a once-in-a-while dessert, so go for it and have a regular soda. For your daily liquids, drink water.

Drinking-water8 glasses a day is plenty of water. Fiction. It’s not bad, it’s a good amount to aim for, but remember not all of us are 5’5” and 120 pounds. A better calculation is to take your body weight in pounds, divide it by two, and drink that much in ounces per day. Example: 200 pounds / 2 = 100 oz of water a day.

There are a million natural health approaches out there. If you have a question, ask your naturopathic doctor – we’re experts in this field so ask us! We love to help.

Ahh, pollen

Originally published March 7, 2013

Ahh… red eyes, headache, runny nose. But it looks pretty!

Ahh… red eyes, headache, runny nose. But it looks pretty!

It’s allergy season… oh boy! Have you heard of a Neti pot? Using a Neti pot can work great to clear out the nasal passages. It can be a little bit tricky to figure out how to make it work, but look it up on YouTube. There’s a Neti pot called Nasopure that’s been developed by a pediatrician for kids to use (and adults!). It’s a little easier than the traditional version and doesn’t require the neck yoga.

There was a Neti pot scare in the news a while back, so make sure you use purified water in your Neti pot.

Certain herbs can be helpful during allergy season, specifically, turmeric[i][ii] and nettles leaf[iii] have been proven to be helpful. Nettle leaf extract comes from the stinging nettles that you may have experienced walking through fields. The extract acts on the body’s inflammation pathways to limit inflammation and it’s an antihistamine. Turmeric is a spice that is commonly used in foods from South and East Asian countries. The active component of turmeric is curcumin. Curcumin has been shown to be an excellent anti-inflammatory, and is often used for allergies.

Vitamin C, quercetin[iv], Bromelain and NAC are common ingredients in many natural allergy remedies. Quercetin is a bioflavonoid found in red wine, grapefruit, onions, apples, black tea, and, in lesser amounts, in leafy green vegetables and beans. It acts as a natural anti-histamine and mast cell stabilizer.


[i] Anat Cell Biol. 2010 Mar;43(1):36-43. Epub 2010 Mar 31. Inhibitory effects of curcumin on passive cutaneous anaphylactoid response and compound 48/80-induced mast cell activation. Choi YH, Yan GH, Chai OH, Song CH.

[ii] Mol Nutr Food Res. 2008 Sep;52(9):1031-9. Immunomodulatory effects of curcumin in allergy. Kurup VP, Barrios CS.

[iii] Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis. Roschek B Jr, Fink RC, McMichael M, Alberte RS. Phytother Res. 2009 Jul;23(7):920-6.

[iv] Role of quercetin (a natural herbal compound) in allergy and inflammation. Shaik YB, Castellani ML, Perrella A, Conti F, Salini V, Tete S, Madhappan B, Vecchiet J, De Lutiis MA, Caraffa A, Cerulli G. J Biol Regul Homeost Agents. 2006 Jul-Dec;20(3-4):47-52.

Three things to consider when taking a multi

Because few Americans eat the recommended amount of fruits and vegetables, and since the state of our food supply leaves our food nutrient deficient, taking a daily multivitamin is a choice many people make. When perusing the plethora of options out there, I suggest considering the following:

capsules varietyAbsorbability – Capsules dissolve better than tablets. In order to get the nutrients you’re already paying for, ensure that your body gets the most out of them by looking for encapsulated supplements.

Presence of fillers, excipients, preservatives, etc. – Magnesium Stearate is the most commonly seen excipient in supplements. When combined with powdered material it allows the material to “flow” and not clump and clog pharmaceutical manufacturing equipment. Research shows that even small amounts of it decrease the ability of the material it’s combined with to dissolve. So, adding a little bit of magnesium stearate to Vitamin C, means you don’t get as much Vitamin C into you.

Amount of products – many supplements offer 100% of RDA, but the Recommended Daily Allowance (RDA) is only the amount necessary to prevent development of disease, it doesn’t consider optimal nutritional needs. For example, the RDA of Vitamin C is 60mg/day, but someone under a lot of stress will need significantly more Vitamin C on a daily basis, as high as 100mg/day or more.

Ok ,I have a fourth item. The quality of the nutrients involved is possibility the most important element in high-quality nutritional supplementation. For example, calcium carbonate is the most poorly absorbed form of calcium and yet one of the most common forms found in supplements. Consult your naturopathic doctor for more information about specific nutrients.


What is Naturopathic Medicine?

natural-herbal-medicine-vector_tightNaturopathic medicine is a distinct method of primary health care – it is based on the belief that the human body has an innate healing ability.  Naturopathic doctors use methods and substances which work in harmony with the body. Some of these include natural therapeutics such as botanicals, nutritional supplements, herbal remedies, dietetics, traditional medicine, homeopathy, and prescribing bio-identical hormones.

Naturopathic doctors work with their patients to prevent and treat acute and chronic illness and disease, restore health and establish optimal fitness. This is accomplished through:


Naturopathic doctors emphasize the prevention of disease-assessing risk factors, heredity and susceptibility to disease and making appropriate interventions in partnership with their patients to prevent illness.


Diagnosis and evaluation of the individual’s state of health are accomplished by integrated modern and traditional, and appropriate methods of laboratory and clinical diagnosis.

Treatment and Care

Therapeutic methods and substances are used which work in harmony with the person’s inherent self-help process, including: dietetics and nutritional substances, botanical medicine, prescription hormones, homeopathy, acupuncture and counseling.

Fish Oil vs Prostate Health

Spoiler: probably fine.

As you may be aware, an article published in the July 2013 issue of the Journal of the National Cancer Institute suggests there is an association between elevated blood levels of omega-3 fatty acid and a heightened risk of prostate cancer. I interpreted this study with a significant degree of caution for a variety of reasons:

fish-oilThe information came from what is referred to as a retrospective, nested, case-control study. The data was extracted from another, much larger, previously conducted trial that was not originally intended to examine the relationship between omega-3 fatty acid levels and prostate cancer. In other words, the original study was not designed to determine any of the conclusions reached in the analysis contained in the article.

The study’s results conflict with the results from other studies that do suggest that omega-3 fatty acids offer a protective benefit against prostate cancer; and these other studies were, in fact, designed to analyze that very outcome. (See link

Identifying one particular physiologic marker in a group of individuals with a given condition – in this case, an elevated omega-3 level in men with prostate cancer – does not prove causation, especially when that marker can be influenced by diet or behavior and is only measured at a single point in time.

It is also hugely important to realize that the authors of this study did not assess any of the participants’ dietary intake of fatty fish or omega-3 nutritional supplements – the study’s conclusions are based wholly on the results of a single blood test.

The omega-3 index, which measures both EPA and DHA within red blood cells, is a much more accurate indicator of long-term omega-3 intake and tissue status than is the plasma omega-3 level, which is subject to significant day-to-day variability.

A number of confounding risk factors might have influenced the purported outcomes in the study, despite attempts by the investigators to account for them:

  • 53 percent of the subjects with prostate cancer were smokers.
  • 64 percent of the cancer subjects regularly consumed alcohol.
  • 30 percent of the cancer subjects had at least one first-degree relative with prostate cancer.
  • 80 percent of the cancer subjects were overweight or obese.

Considering the extensive body of literature that supports the anti-inflammatory effects of omega-3 fatty acids, there is no credible biological mechanism, nor is one suggested in the article, that would explain why these essential fatty acids might increase one’s risk of cancer.

Summary: Given the inconsistent data attributable to omega-3 fatty acids and prostate cancer, and acknowledging the broad range of health benefits that are almost universally accorded to omega-3 fatty acid consumption, it would be premature to stop eating fish or to discontinue taking omega-3 nutritional supplements on the basis of this study.

I encourage you to ask me about our Omega-3 Index bloodspot test so we can determine what your individual levels of EPA and DHA are. It’s a simple finger-prick test that can give us a lot of information.

Information used in this article was drawn from the knowledgeable Dr. Robert Rountree, MD, Chief Medical Officer of Thorne Research, Inc.