White Sweet Potato Turkey Soup

If you have followed me for any bit of time, you may have seen this recipe posted on my Facebook page from the Castaway Kitchen. Her Sweet Potato White Turkey Chili has been a fan favorite in this house for awhile now. However since I don’t tolerate FODMAPs (ie leeks in this recipe) very well I decided to post my low-fodmap version.

I know it’s 90+ degrees across most of the USA, but my kids love this soup no matter the temperature outside. So here’s to cooler weather and yummy soup!

Dr. Hartzler

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White Sweet Potato Turkey Soup
This soup is amazing any time of year. It's super forgiving if you want to change up some of the ingredients. I've done 1/2 turnips before to decrease carbs and even thrown in some zucchini recently to give some more nutrients to the kiddos! It turned slightly green but tasted just as good. My kids eat this up like I haven't fed them in days. I hope it becomes a staple in your house too.
Course Soup
Prep Time 10
Cook Time 30
Servings
Ingredients
Potato Base
Turkey
Toppings
Course Soup
Prep Time 10
Cook Time 30
Servings
Ingredients
Potato Base
Turkey
Toppings
Instructions
  1. First begin by peeling your sweet potatoes. (On the Castaway Kitchen Blog she has you save the peels to fry which you can, but I typically don't have time.)
  2. Heat pressure cooker on sauté mode. Cut your bacon into 1/4 inch pieces. Add it to the pot and cook until crispy.
  3. Cut your sweet potatoes into large cubes.
  4. Once your bacon is crispy remove it from the pot.
  5. Add in the sweet potato and sauté for a few minutes in the bacon grease. Depending on how much fat was on the bacon you can pour off some of this if you would like.
  6. Add in the broth, salt, white pepper, nutmeg, and cinnamon. Cancel saute function. Close the lid. Set to PRESSURE COOK: steam mode.
  7. You can wait until the pressure cooker is done and saute the turkey in the pressure cooker to have only 1 pot to clean up, but I'm normally short on time so I cook the turkey separately on the stove top. To do this, place your ground turkey in a skillet or pan with salt, mustard, and cook until done and set aside.
  8. When the pressure cooker is done, release the pressure manually to speed up the process. Then transfer all of the contents to a blender, carefully. Blend the potato mix until smooth. Add in more broth as desired. Place the insert back in the pot an heat on saute mode. (can cook turkey here if you haven't already)
  9. Pour your soup base into the pressure cooker and bring to a simmer with the turkey, this won't take but a minute or two. Stir in MOST of the bacon, save some for topping. I also top with chives. This will make a lot, about 5-6 bowls, which is about 8-10 cups.
Recipe Notes
  1. I leave out the white pepper often for the kids because it has a bit of a kick, but it's pretty amazing with it!
  2. The White Sweet Potatoes (Japanese yams) are fodmap foods too in nature, but generally a regular serving of something like this isn't a huge trigger for most, especially when swapping chives instead of leaks, and garlic-infused oil in place of regular garlic. If you don't need to be low-fodmap, throw in all the garlic you would like. You could sauté it with the bacon at the beginning!
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The NEW Nutrient Duo – Vitamins D and K2

I’ve been meaning to get a post up on this topic for awhile now, my fabulous former student and intern who just graduated with her PharmD, Dr. Kara Lish wrote this for you.  It has a lot of content, so hopefully the length won’t overwhelm you but help you see how Vitamin K2 is an essential nutrient that many of us are lacking in our diets. I will be doing a facebook live on this topic this on Thursday June 14th at 8 pm EST to answer questions!

Dr. Hartzler

 

For years, vitamin K has really only been known for its role as a cofactor to assist calcium in the regulation of blood clotting. Likewise, vitamin D was thought to aid calcium absorption to promote strong bones. It was not until recently that we learned it is vitamin K, particularly vitamin K2, that actually assists vitamin D to get calcium into the bones and to keep calcium out of the arteries, organs, and joints. In fact, various studies have shown that the supplementation with vitamin K2 actually strengthens the bone and reduces the risk for osteoporosis, and bone fractures. Additionally, vitamin K has been shown to promote cardiovascular health and arterial elasticity and to boost immune function as well. Read below for a complete guide in understanding how vitamin K works and what types exist and their specific benefits.

What is vitamin K? What types are beneficial and what dietary sources include those types?

Vitamin K is a fat-soluble vitamin that occurs naturally as either vitamin K1 (phylloquinone) or vitamin K2 (menaquinones). Vitamin K1 is found in green vegetables, like spinach, whereas vitamin K2 is found mostly in grass-fed dairy products, such as fermented milk or kefir. To a lesser extent, vitamin K2 can also be produced by bacteria in the digestive tract of animals, like chickens or cows. Unlike K1 where most goes directly to the liver where it stays to regulate normal blood clotting, vitamin K2 quickly passes through the liver before being redistributed throughout the entire body to be absorbed to help aide in various functions. For example, vitamin K2 is redistributed to the bones and blood vessels to support bone and cardiovascular health. Deficiencies of vitamin K1 have been linked to an increased risk of bleeding and less vitamin K2 available to the rest of body since the liver will then hold onto it to clot blood properly. Deficiencies of vitamin K2 have been associated with osteoarthritis, osteoporosis, and vascular calcification among other things, like a decline in cognitive function.1,2 Because of their vital roles in overall health; men and women, including expecting and lactating mothers, should obtain 120 and 90 μg per day of vitamin K1 and 45-185 μg per day of vitamin K2.3,4

Where does vitamin D come into play?

Focusing on vitamin K2 and bone health, there are three vitamin K2 dependent non-clotting proteins regulated by vitamin D3 that have been shown to prevent osteoarthritis, osteoporosis, and vascular calcification (strengthening) of bone. Vitamin D controls how much calcium is absorbed from the diet. Vitamin K2 directs the absorbed calcium to the bones where its new role is to promote bone building and prevent its breakdown.

 

Vitamin D3 regulates the amount of calcium and production of a certain protein, osteocalcin, which plays a vital role in bone health once vitamin K2 activates it. Once activated, vitamin K2 then helps bind osteocalcin to calcium before directing the absorbed calcium to the bones, where it binds to the bone matrix to build bone and prevent its breakdown. Without vitamin K2, osteocalcin would remain inactivated and calcium would neither be able to bind to it nor reach its destination in the bones. As a result, it would be impossible for the body to build or strengthen bone to prevent against fractures or breaks.1,2,5,6

In fact, studies have demonstrated an increase in activated osteoclacin after the administration of vitamin K2, and thus, correlated inactivated osteocalcin with the risk for clinical fractures.5 Vitamin K has also even been shown to help maintain bone mineral density or bone strength. It does this by decreasing the breakdown of bone.7 Thus, vitamin K2 stimulates cells that promote bone building, while inhibiting cells that break down bone, resulting in greater calcification or bone strength.

Evidence showed that vitamin K2 helps to strong bones and to reduce bone fractures.8 Gajic-Veljanoski and group found that the daily use of 800 IU vitamin D, 45 μg vitamin K2, and 1200 mg calcium reduced the lifetime risk of a fracture by 25%.9 Similarly, Cockayne and colleagues demonstrated that vitamin K2 supplementation reduced bone loss and prevented hip, nonvertebral, and vertebral fractures by 77%, 81%, and 60%, respectively.10 Comparing osteoporotic patients who received 150 mg calcium with or without 45 μg vitamin K2, those who received only calcium lost 2.5% of their bone strength and experienced 45% more fractures versus those who received both, calcium and vitamin K2.11 More so, other studies have proven that vitamin K2 can even reduce bone fractures induced by certain medications, like glucocorticoids, as well as to maintain and increase bone strength in liver-dysfunction-induced osteoporosis and paralytic patients with cerebrovascular disease.8

Not only are adequate levels of vitamin K2 desired in adults, particularly in the elderly population and pregnant women, but also in children.6 Recent studies have shown that even most healthy, prepubertal and pubertal children have high levels of inactive osteocalcin, which in turn signifies inadequate levels of vitamin K2, when compared to adults. Long-term, this could prevent the nonessential vitamin-K proteins from functioning, prohibiting optimal bone development to cause early onset osteoporosis. Karpinski and group’s study actually identified children as being the most deficient in vitamin K2 due to only 10% of it being found in the typical Western diet. Like the previous studies, they too recommend at least 45 μg vitamin K2 daily to increase levels to then increase osteocalcin activation, which to reiterate is the vitamin K dependent protein that helps bind calcium to promote bone mineralization, and thus, bone health.2 On the other hand, other studies found that the relationship between the administration of supplemental vitamin K2 and the improvement in osteocalcin carboxylation is dose dependent, so Inaba and group recommend ≥100 μg vitamin K2 per day.12

How do I get more vitamin K2 in my daily diet?

To obtain more, you can either eat foods high in vitamin K2 (see below) or choose an appropriate supplement for you. When choosing a supplement, it is important to keep these 5 things in mind:

  • Choose the right vitamin K2: MK-7 is best due to it’s longer half-life, but a mixture of MK-4/MK-7 is fine.
  • Pick an appropriate dose: Adults opt for at least 100 μg (MK-7) daily.
  • Eat with fat: It is fat-soluble; intake with fat sources maximizes absorption.
  • Remember its companion: Vitamin D and K work synergistically. Other supplements, like magnesium and zinc, can further increase bone mineralization.

Adults and children require adequate amounts of both, vitamin D and vitamin K to create the ultimate duo for bone health!

  • Consider current medications/dietary needs: If you are on a blood thinner, like warfarin, then talk to your doctor or pharmacist before supplementing with vitamin K2. If you have an allergy, intolerance, or dietary preference, then rest assured knowing there are options to meet these needs as well!

Take a look at these different products as well as the dietary options below, and talk to your doctor and pharmacist to see which may work best for you, but remember… Adults and children require adequate amounts of both, vitamin D and vitamin K to create the ultimate duo for bone health! If you don’t need additional Vitamin D, Orthomolecular also as a K2 only product. Dr. Hartzler recommends the liquid D3/K2 frequently because when it is in the MCT oil drops, the oil helps the nutrients absorb since they are fat soluble.

Dr. Hartzler will be on Facebook live this Tuesday evening June 12th at 8 pm EST to answer any questions you have about Vitamin D/K2. There some additional benefits to K2 as well that we will discuss beyond bone building!

Other Dietary Foods High in Vitamin K2, specifically MK-4/MK-7.


References:

  1. Flore R, Ponziani FR, Di Rienzo TA, et al. Something more to say about calcium homeostasis: the role of vitamin K2 in vascular calcification and osteoporosis. Eur Rev Med Pharmacol Sci. 2013;17(18):2433-2440.
  2. Villa JKD, Diaz MAN, Pizziolo VR, Martino HSD. Effect of vitamin K in bone metabolism and vascularization: A review of mechanisms of action and evidences. Crit Rev Food Sci Nutr. 2017;57(18):3959-3970. doi: 10.1080/10408398.2016.1211616.
  3. Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press; 2001.
  4. Mercola J. Mercola. Vitamin D and K2 work in tandem to slow arterial calcification. https://articles.mercola.com/sites/articles/archive/2013/10/19/vitamin-d-vitamin-k2.aspx. Published October 19, 2013. Accessed February 10, 2018.
  5. Vergnaud P, Garnero P, Meunier PJ, et al. Undercarboxylated osteoclacin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS study. J Clin Endocrinol Metab. 1997;82(3):719-724. doi: 10.1210/jcem.82.3.3805.
  6. Karpiński M, Popko J, Maresz K, Badmaev V, Stohs SJ. Roles of Vitamin D and K, nutrition, and lifestyle in low-energy bone fractures in children and young adults. J Am Coll Nutr. 2017;36(5):399-412. doi: 10.1080/07315724.2017.1307791.
  7. Weber P. Management of osteoporosis: Is there a role for vitamin K? Int J Vitam Nutr Res. 1997;67(5):350-356.
  8. Iwamoto J, Takeda T, Sato Y. Effects of vitamin K2 on osteoporosis. Curr Pharm Des. 2004;10(21):2557-2576. doi: 10.2174/1381612043383782.
  9. Gajic-Veljanoski O, Bayoumi AM, Tomlinson G, Khan K, Cheung AM. Vitamin K supplementation for the primary prevention of osteoporotic fractures: Is it cost-effective and is future research warranted? Osteoporos Int. 2012;23(11):2681-2692. doi: 10.1007/s00198-012-1939-4.
  10. Cockayne S, Adamson J, Lanham-New S, et al. Vitamin K and the prevention of fractures: systemic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2006;166(12):1256-1261. doi: 10.1001/archinte.166.12.1256.
  11. Shiraki M, Shiraki Y, Aoki C, Miura M. Vitamin K2 (Menatetrenone) effectively prevents fractures and sustains lumbar bone mineral density in osteoporosis. J Bone Miner Res. 2000;15(3):515-521. doi: 10.1359/jbmr.2000.15.3.515.
  12. Inaba N, Sato T, Yamashita T. Low-dose daily intake of vitamin K(2) (Menaquinone-7) improves osteocalcin y-carboxylation: a double-blind, randomized controlled trials. J Nutr Sci Vitaminol (Tokyo). 2015;61(6):471-480. doi: 10.3177/jnsv.61.471.

Low Carb Waffles

Confession time, our household is addicted to waffles, all 4 of us. 🙂  Our favorite weekend breakfasts normally include some type of waffle or pancake, mostly the low carb or paleo variety. Thankfully it’s super easy to make a gluten free or paleo option.  This recipe is inspired by Danielle Walker at Against All Grain and her Grain-Free Waffle Recipe. We used to make hers a lot, but honey and my stomach don’t always get along and I tried to figure out a way to make them less sweet, but not taste a ton like eggs.

Last weekend Dustin was busy with WordCamp Dayton and we had a friend staying with us, Adam Silver of Kitchen Sink WP, who attended the conference.  He tells me he has cashews in hand, waiting on me to post the recipe, thanks Adam for your help with the photography!

Enjoy!

Dr. Hartzler
Print Recipe
Low-Carb Waffles (Grain Free)
If you are looking for a waffle that fits a low-carb diet, look no further. You might even think you are eating the real deal!
Servings
Ingredients
Servings
Ingredients
Instructions
  1. Add the raw cashews to a bowl and cover with water. Then add in the vinegar. I generally let them sit overnight, but at least 4-6 hours would be best to help reduce the phytic acid on the cashews and make them easier to digest!
  2. After soaking has been completed, drain water off completely. I use a strainer.
  3. Preheat your waffle iron.
  4. Then add the rest of the ingredients into a high-speed blender. Blend until smooth, you can add the almond milk a bit at a time to make sure it does not get too runny.
  5. Cook the waffles for about a minute, more or less depending on the heat of your waffle iron. If they release easily with a fork when you open the lid, they are probably done. We have a nonstick waffle iron, so if yours is not non-stick, make sure you add a little oil before cooking.
  6. Top with your choice of fruit or homemade whipped cream with stevia!
Recipe Notes
  • Thrive Market has the best deal on the Primal Kitchen Collagen Fuel. You seriously will not regret trying it. It's the best low carb protein powder I've come across. I love that it's easy to digest great for the gut. I feel super comfortable with my kids having collagen as well. Use my link to try out Thrive Market and make this waffles soon!
  • Since the protein powder I used has a bit of fiber in it, depending on the type you have, you may have to adjust the liquid or coconut flour slightly.

 

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Eczema & Probiotics

The majority of this post was written by Dr. Taylor Edwards, who was a medical student that rotated with me earlier this year, now she is a Doctor of Osteopathic Medicine off to residency!  I take medical students from Ohio University and work with the pharmacists in my area to expose them to different areas of pharmacy practice. I also talk to them a lot about functional medicine and depending on the speciality they are interested in, we look at what they could study that will impact how they treat patients in the future.  Dr. Edwards. is training to be a dermatologist so of course we talked about gut health and it’s relationship to atopic conditions such as eczema. I hope you enjoy her post!

Dr. Hartzler

 

Eczema, also called atopic dermatitis, is a common, chronic and relapsing skin condition characterized by extreme itching. Currently, the incidence of eczema in industrialized nations is 20%, representing a 2-3 fold increase in recent decades.1,2 The reason for this increase remains unclear due to the complex etiology of the disease. However, it is reasonable to assume that this increase cannot be explained by genetic factors alone. Research has demonstrated that food allergy, defects in the gut mucosal barrier (ie leaky gut), and increased intestinal permeability may play a role in the development of eczema.3 Dietary manipulation remains a controversial topic in the treatment of atopic diseases, however, some studies show promise for the use of probiotics in the treatment and prevention of atopic dermatitis in young children.4

Probiotics are normal, healthy bacteria of the human gut that can be consumed in food or as dietary supplements.5 Lactobacilli and bifidobacteria are the most studied types of probiotics and are thought to assist the neonatal immune system in creating T-regulatory immune cells that are vital in preventing atopic disease.3,6-8 One large study supports the use of probiotics as preventative care due to findings that the incidence of eczema was 20% lower in infants and children that were exposed to probiotics early in life or during gestation.9

Another study demonstrated that probiotics may represent a helpful adjuvant therapy in the treatment of eczema. Forty young children between the ages of 3 months and 6 years with a diagnosis of eczema were divided equally into two groups and treated with probiotics (a mixture of 7 strains including Lactobacilli and bifidobacteria gena) or placebo. At the end of 8 weeks, the children that were treated with the probiotic mixture demonstrated a significant reduction in the severity of their eczema.10 While not all studies regarding probiotics as a modality to improve eczema have demonstrated consistent results, one large meta-analysis that evaluated data from ten studies and 678 patients found that when compared to placebo, probiotics may play a role in reducing the severity of eczema.11

Along with probiotics, cow’s milk is another area of interest for eczema researchers. Many parents believe the development of eczema in their child was temporally associated with the introduction of cow’s milk or cow’s milk based formula. Nearly 100 studies have examined the influence of hydrolyzed formulas versus cow’s milk based formulas in the development of eczema.  The most well-known study, the GINI study, found that infants given exclusively hydrolyzed formula were 50% less likely to develop eczema compared to infants who were fed cow’s milk based formula (hydrolyzed formula did not show benefit over breast milk).12-16 Soy based formula is often believed to be less allergenic than cow’s milk based formula, however, research does not support this claims.17

Exclusion diets have also been studied in individuals with eczema with less promising results. However, children with eczema and suspected egg allergy may benefit from a diet excluding eggs.18 In situations where special diets are attempted, it is recommended to adhere to the diet for a limited time of 4-8 weeks and then return to a normal diet to assess the efficacy of dietary interventions.4

So the PharmToTable Rx for eczema definitely includes quality probiotics (find them in my fullscript store!) and addressing gut health! My favorite quality probiotics include those by OrthoMolecular, Metagenics, Klaire Labs, and Young Living. For kids omega-3’s and vitamin D are certainly another good idea to reduce inflammation and support gut healing. For breastfed babies, elimination diets for mom are also important if you can figure out the trigger. For formula fed babies, a hydrolyzed formula is a good place to start, but possibly further reducing allergens by moving to a corn-free and hydrolyzed option like Alimentum Ready Feed may be necessary. You definitely have to give it at least a month if not two months to see the full effect.

Also check out this post by the National Eczema Association as well for further reading on this topic! There is also some interested new thoughts and emerging evidence about using probiotics topically to help heal the skin. This article discusses the topic.

References: 

  1. Thestrup-Pedersen K. Treatment principles of atopic dermatitis. J Eur Acad Dermatol Venereol. 2002;16(1):1-9. http://www.ncbi.nlm.nih.gov/pubmed/11952283. Accessed February 11, 2018.
  2. Eichenfield LF, Hanifin JM, Beck LA, et al. Atopic Dermatitis and Asthma: Parallels in the Evolution of Treatment. Pediatrics. 2003;111(3):608-616. doi:10.1542/peds.111.3.608.
  3. Isolauri E. Intestinal involvement in atopic disease. J R Soc Med. 1997;90 Suppl 30:15-20. http://www.ncbi.nlm.nih.gov/pubmed/9176124. Accessed February 11, 2018.
  4. Finch J, Munhutu MN, Whitaker-Worth DL. Atopic dermatitis and nutrition. Clin Dermatol. 2010;28(6):605-614. doi:10.1016/j.clindermatol.2010.03.032.
  5. Salminen S, Bouley C, Boutron-Ruault MC, et al. Functional food science and gastrointestinal physiology and function. Br J Nutr. 1998;80 Suppl 1:S147-71. http://www.ncbi.nlm.nih.gov/pubmed/9849357. Accessed February 11, 2018.
  6. Smits HH, Engering A, van der Kleij D, et al. Selective probiotic bacteria induce IL-10–producing regulatory T cells in vitro by modulating dendritic cell function through dendritic cell–specific intercellular adhesion molecule 3–grabbing nonintegrin. J Allergy Clin Immunol. 2005;115(6):1260-1267. doi:10.1016/J.JACI.2005.03.036.
  7. Prescott SL, Björkstén B. Probiotics for the prevention or treatment of allergic diseases. J Allergy Clin Immunol. 2007;120(2):255-262. doi:10.1016/J.JACI.2007.04.027.
  8. Pessi T, Sütas Y, Hurme M, Isolauri E. Interleukin-10 generation in atopic children following oral Lactobacillus rhamnosus GG. Clin Exp Allergy. 2000;30(12):1804-1808. http://www.ncbi.nlm.nih.gov/pubmed/11122221. Accessed February 11, 2018.
  9. Pelucchi C, Chatenoud L, Turati F, et al. Probiotics Supplementation During Pregnancy or Infancy for the Prevention of Atopic Dermatitis. Epidemiology. 2012;23(3):402-414. doi:10.1097/EDE.0b013e31824d5da2.
  10.   Farid R, Ahanchian H, Jabbari F, Moghiman T. Effect of a new synbiotic mixture on atopic dermatitis in children: a randomized-controlled trial. Iran J Pediatr. 2011;21(2):225-230. http://www.ncbi.nlm.nih.gov/pubmed/23056792. Accessed February 11, 2018.
  11.   Michail SK, Stolfi A, Johnson T, Onady GM. Efficacy of probiotics in the treatment of pediatric atopic dermatitis: a meta-analysis of randomized controlled trials. Ann Allergy, Asthma Immunol. 2008;101(5):508-516. doi:10.1016/S1081-1206(10)60290-6.
  12.   Laubereau B, Brockow I, Zirngibl A, et al. Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life—results from the GINI-birth cohort study. J Pediatr. 2004;144(5):602-607. doi:10.1016/J.JPEDS.2003.12.029.
  13.   Banks JR. THE EFFECT OF HYDROLYZED COW’S MILK FORMULA FOR ALLERGY PREVENTION IN THE FIRST YEAR OF LIFE: THE GERMAN INFANT NUTRITIONAL INTERVENTION STUDY, A RANDOMIZED, DOUBLE-BLIND TRIAL. Pediatrics. 2004;114(2):521-522. doi:10.1542/peds.114.2.S1.521-b.
  14.   Oldaeus G, Anjou K, Björkstén B, Moran JR, Kjellman NI. Extensively and partially hydrolysed infant formulas for allergy prophylaxis. Arch Dis Child. 1997;77(1):4-10. http://www.ncbi.nlm.nih.gov/pubmed/9279143. Accessed February 11, 2018.
  15.   Halken S, Hansen KS, Jacobsen HP, et al. Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention: a prospective, randomized study. Pediatr Allergy Immunol. 2000;11(3):149-161. http://www.ncbi.nlm.nih.gov/pubmed/10981524. Accessed February 11, 2018.
  16.   Nentwich I, Michková E, Nevoral J, Urbanek R, Szépfalusi Z. Cow’s milk-specific cellular and humoral immune responses and atopy skin symptoms in infants from atopic families fed a partially (pHF) or extensively (eHF) hydrolyzed infant formula. Allergy. 2001;56(12):1144-1156. http://www.ncbi.nlm.nih.gov/pubmed/11736743. Accessed February 11, 2018.
  17.   Osborn DA, Sinn JK. Soy formula for prevention of allergy and food intolerance in infants. Cochrane Database Syst Rev. October 2006. doi:10.1002/14651858.CD003741.pub4.
  18.   Lever R, MacDonald C, Waugh P, Aitchison T. Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. 1998;9(1):13-19. http://www.ncbi.nlm.nih.gov/pubmed/9560837. Accessed February 11, 2018.

 

Natural Approaches to Migraine: Part 2

As promised, I’m back with another post by Dr. Christine Lewis, PharmD. Last week we put up Part 1 which focused on the underlying cases of migraines, part 2 now focuses on the treatment to address those causes. The goal is to determine the root cause and address the root cause. The treatments mentioned below are non-pharmacological methods that migraine sufferers can try under the guidance of a healthcare professional to address the root cause (or eliminate a root cause) of their migraines. Just this week I had a patient with migraines daily that have significantly decreased by addressing yeast overgrowth. Sometimes it makes me jump up and down on the inside like a little kid when there are victories like that! Next step is looking at this particular patient’s nutritional deficiences. Hope you enjoy the rest of our discussion on migraines.

Dr. Hartzler

Is it stress? Is it diet? Is it lifestyle?

A good place to start is the elimination diet to discover if there are any food sensitivities, intolerances, or allergies. Complete the elimination diet (without cheat days) for 21-28 days and slowly re-introduce eliminated foods one at a time. A good elimination diet includes the Whole 30 Program or a diet that eliminates grains, refined sugar, dairy, soy, gluten, peanuts, processed meats, eggs, whey, butter, vegetable oil, caffeine, and alcohol. Both diets focus on whole foods with lots of vegetables, healthy sources of protein, and healthy fats. Neither diet is intended to help you lose weight but to identify and eliminate aggravating foods. Slowly reintroduce food groups one at a time and keep a food diary to track your symptoms. Remember that symptoms can present minutes to a couple of days later with food sensitivities. It is important to listen to your body and monitor for signs of intolerance such as bloating, gas, irregular bowels, allergies, headache, skin reactions, etc (1).

Other things to consider include supplementation with magnesium glycinate 200-300mg twice daily and/or vitamin b-complex (includes riboflavin, niacin, folate and vit B12). Other supplements that have been beneficial in clinical studies include CoQ10, alpha-lipoic acid, l-tryptophan, vitamin C, omega-3, vit D and calcium, feverfew, butterbur, and melatonin. Below is a chart with some common dosage forms and recommendations (2-7).

SupplementStudied DosesNotes
Butterbur50mg-75mg twice daily Look for PA (pyrrolizidine alkaloids) free
Magnesium glycinate100mg-300mg twice dailyMay use magnesium oxide but may have GI side effects
Coenzyme Q1060mg-300mg once daily
Riboflavin15mg-400mg once daily
Folic acid5mg once daily5-MTFH is the active form
Alpha-lipoic acid 100mg-600mg once daily
Feverfew6.25mg three times dailyNot recommended in pregnancy
L-tryptophan500mg two to four times dailyShould not take with anti-depressants, tramadol, triptans
Vitamin D35000 IU daily if deficient
1000-2,000 IU daily to maintain
Supplement dosage (not specific to migraine). Best to take with Vitamin K2!
Omega 31200mg-6000mg once dailyCan increase risk for bleeding when on blood thinners
Melatonin3mg once daily Take 1-3 hours before bedtime

High quality supplements can be found at my FullScript Store. If you need help selecting a product that is right for you, don’t hesitate to reach out.

It is also important to restore hormone balance by exercising regularly, obtaining adequate sleep, and eliminating caffeine, alcohol, and sugar. Also, having adequate levels of b-vitamins is important for healthy metabolism of hormones. Talk to your provider about hormone level testing if lifestyle and diet modifications are not effective to see if there are underlying imbalances or deficiencies.

During an acute migraine, the use of essential oils has been shown to be effective. Lavender oil when inhaled can provide relief and relaxation after 15 minutes from migraines (8). Peppermint oil can also be of benefit for the treatment of migraine headaches. Peppermint oil can be applied to the forehead, temples, and back of the neck. It provides a cooling sensation, relaxes the muscles, and increases blood flow to the area (9,10). Both should be diluted appropriately. Check out my free e-book when you sign up for email updates for more about essential oils. You can find high quality essential oils here.

Other effective therapies that can address root causes of migraines and have been found to decrease frequency include acupuncture, chiropractic manipulation, mind-body techniques, yoga, and reflexology (11,12). It is suggested that these modalities can decrease stress, alter bio-feedback, block pain signaling, and other mechanisms that can be effective for the treatment of recurrent migraines.

If these treatments are not effective a thorough evaluation may be needed to find other underlying cause of migraine attacks. Hopefully this gives you a helpful starting point for various ways to attack your migraines!

 

References:

  1. Żukiewicz-Sobczak WA, Wróblewska P, Adamczuk P, Kopczyński P. Causes, symptoms and prevention of food allergy. Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii. 2013;30(2):113-116. doi:10.5114/pdia.2013.34162.
  2. Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention of episodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012 Jun;52(6):930-45.
  3. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353. doi:10.1212/WNL.0b013e3182535d0c.
  4. Gaby, AR. Migraine. Nutritional Medicine, 2ndEdition. Concord, NH: Fritz Perlberg Publishing; April 2017.
  5. Sándor PS, Afra J. Nonpharmacologic treatment of migraine. Curr Pain Headache Rep. 2005 Jun;9(3):202-5. Review.
  6. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/butterbur. Updated September 2017. Accessed April 9, 2018.
  7. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/feverfew. Updated November 2016. Accessed April 9, 2018.
  8. Sasannejad P, Saeedi M, Shoeibi A, Gorji A, Abbasi M, Foroughipour M. Lavender essential oil in the treatment of migraine headache: a placebo-controlled clinical trial. Eur Neurol. 2012;67(5):288-91.
  9. Kligler B, Chaudhary S. Peppermint oil. Am Fam Physician. 2007 Apr 1;75(7):1027-30. Review.
  10. Göbel H, Schmidt G, Dworschak M, Stolze H, Heuss D. Essential plant oils and headache mechanisms. Phytomedicine. 1995 Oct;2(2):93-102.
  11. Chessman AW. Review: Acupuncture reduces migraine frequency more than usual care, sham acupuncture, or prophylactic drugs. Ann Intern Med. 2016 Oct 18;165(8): JC44.
  12. Millstine D, Chen CY, Bauer B. Complementary and integrative medicine in the management of headache. BMJ. 2017 May 16;357: j1805. doi: 10.1136/bmj.j1805.

1 Natural Approaches to Migraine: Part 1

I had the opportunity to host another pharmacist, Christine Lewis, over the last few weeks at my practice site. Dr. Lewis is actually doing a residency in Arizona but has a huge passion for functional medicine and heard me speak at the ASHP Midyear Clinical Meeting last December and called me up and asked if she could do a rotation at my site. She is also working on an elective in functional medicine for the pharmacy school there. It’s exciting to see more and more pharmacists engage with this type of practice. I was flattered that she wanted to come out to my small practice in Ohio (she didn’t know it was going to snow in April before she signed up!). This month as part of her projects, she put together a two part series for you on migraines. Enjoy and stay tuned for part 2!

Dr. Hartzler

Migraine headaches are a debilitating condition that affects as many as 12% of the US population (1). Migraines are more common among women than men and occur more frequently between the ages of 18-44 (2). Migraine headaches typically are one-sided, pulsating, aggravated by daily routine activity, and can vary in duration from 2-3 hours to days (3f).

The Headache Society guidelines, which are what many providers refer to when treating patients, recommend anti-seizure medications and beta-blockers (blood pressure/heart medication) for migraine prevention and a class of medications called triptans and non-steroidal anti-inflammatory medications (like ibuprofen) for acute symptoms (4). While these agents have been shown to be effective, these agents come with side effects including mood changes, nausea, dizziness, and fatigue (5). Not to mention there are many drug-drug interactions with anti-seizure medications.

Fortunately, a 2012 update to the guidelines include evidence supporting alternative therapies (such as supplements) that are effective at prevention of migraines (6). In my experience many providers are not aware of this update and routinely still only recommend pharmacologic methods for migraine prevention. Some providers may recommend their patients to keep a migraine diary so that potential triggers can be identified. While the migraine diary is good advice, the guidelines treat all patients suffering from migraines similarly. Biologically we are all unique with differences in genetics, environments, exposures, diet, lifestyle, etc. thus having different factors affecting the etiology of migraines.

Functional and natural approaches to  migraine headaches include to identify the root cause. Three people may have migraines, but they could have different underlying root causes. One person could have a food sensitivity or allergy, one could have a magnesium deficiency, and one may have hormone imbalances. For providers it’s important to gather a patient’s history that includes environment, toxin exposure, diet, stress management, and lifestyle as well as requesting appropriate laboratory assessments to determine each patient’s underlying cause of migraine headaches.

Common causes of migraine headaches
Food sensitivities/ intolerances/ or allergies:
Food sensitivities intolerances, and allergies are common and can contribute to disease by causing chronic inflammation. Common food culprits include gluten, eggs, soy, dairy, or peanuts (7). Many patients may not realize that they have a sensitivity to a food group until that group is eliminated and later reintroduced. If you are a follower of this blog, you have read about leaky gut and why the number of people with food sensitivities is increasing.

Nutrient deficiency:
Nutrient deficiency is thought to cause migraines in some patients such as magnesium deficiency or some b-vitamin deficiencies. Magnesium deficiency is prominent. In 2005 over 48% of the population did not consume enough magnesium in their diet (9). Even if you do eat healthy and have lots of fruits and vegetables in your diet you still may be deficient in certain vitamins, minerals, and phytonutrients. This is due to nutrient depleted soil, because decreased crop rotation, the use of pesticides, GMO’s, and the lack of animals fertilizing the soil. Vegetarians and vegans may be more susceptible to nutrient deficiencies for multiple reasons but should be cautious of B-vitamins, magnesium, calcium, and iron.

Stress:
As we get busier and busier in our day to day our bodies are vulnerable to becoming chronically stressed. Those of us that have recently lost a loved one, moved, changed jobs, have other health conditions are more susceptible to adrenal fatigue or dysregulation of the stress response in our system. During the stress response the body produces more cortisol. While we need cortisol to handle stress and engage the fight or flight response, chronically elevated levels of cortisol can cause headaches and have other adverse effects on our health as well (10).

Hormone imbalance:
Stress, sedentary lifestyle, high sugar intake can all affect hormone balance negatively. When hormones become unbalanced it can trigger migraine headaches. Some women only experience headaches in premenstrual times demonstrating that for some, migraines are caused by hormone imbalances. Some studies have found that estrogen is possibly effective at the prevention of migraines (6). Evidence to support only using estrogen therapy alone is not strong and may not be appropriate for everyone. Hormone replacement therapy should be personalized and should be balanced for optimal outcomes. Other women may be deficient in other hormones other than estrogen such as progesterone or testosterone which can also contribute to headaches (11).

Other:
Other causes of migraine headaches for some may be blood glucose dysregulation, electrolyte imbalances, inadequate sleep, infections, high sodium intake, decreased hydration, and vasoactive foods such as chocolate, cheese, citrus, and alcohol (7).

Stay tuned later this week for Part 2 which includes natural treatment approaches and supplements.

References:

  1. About migraine. Migraine Research Foundation.http://migraineresearchfoundation.org/about-migraine/migraine-facts/. Accessed April 5, 2018.
  2. QuickStats:Percentage of Adults Aged ≥18 Years Who Reported Having a Severe Headache or Migraine in the Past 3 Months, by Sex and Age Group — National Health Interview Survey, United States, 2015. MMWR Morb Mortal Wkly Rep 2017; 66:654. DOI: http://dx.doi.org/10.15585/mmwr.mm6624a8
  3. Headache disorders. World Health Organization. http://www.who.int/mediacentre/factsheets/fs277/en/ Updated: April 2016. Accessed April 5, 2018.
  4. Loder E, Burch R, Rizzoli P. The 2012 AHS/AAN guidelines for prevention ofepisodic migraine: a summary and comparison with other recent clinical practice guidelines. Headache. 2012 Jun;52(6):930-45.
  5. He A, Song D, Zhang L, Li C. Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis. The Journal of Headache and Pain. 2017;18(1):26. doi:10.1186/s10194-017-0720-7.
  6. Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012;78(17):1346-1353. doi:10.1212/WNL.0b013e3182535d0c.
  7. Gaby, AR. Migraine. Nutritional Medicine, 2ndEdition. Concord, NH: Fritz Perlberg Publishing; April 2017.
  8. Żukiewicz-Sobczak WA, Wróblewska P, Adamczuk P, Kopczyński P. Causes, symptoms and prevention of food allergy. Advances in Dermatology and Allergology/Postȩpy Dermatologii I Alergologii. 2013;30(2):113-116. doi:10.5114/pdia.2013.34162.
  9. Andrea Rosanoff, Connie M Weaver, Robert K Rude; Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutrition Reviews, Volume 70, Issue 3, 1 March 2012, Pages 153–164, https://doi.org/10.1111/j.1753-4887.2011.00465.x.
  10. Ramachandran R. Neurogenic inflammation and its role in migraine. Semin Immunopathol. 2018 Mar 22.
  11. Li W, Diao X, Chen C, Li C, Zhang Y, Li Y. Changes in hormones of the hypothalamic-pituitary-gonadal axis in migraine patients. J Clin Neurosci. 2018 Apr; 50:165-171.

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Can Fat be Healthy?

Guest Post: Why Dietary Fat is Healthy

A student and I originally wrote this post for my friend Laurel who writes over at Hickory Creek Lane.  We wanted to share some evidenced-based wisdom on some of the confusion that surrounds fat consumption. There is lots of confusion about which foods or fats can be “good” or “bad” and it gets complex. Sometimes it can even come down to our genetic make-up or gut microbiome! We are all individual but this is some general guidance on why we need some healthy fat in our lives! Enjoy! 

Why is Fat Healthy?

If you think the title of this blog entry seems a bit contradictory, you are not alone. Many of us have been told for decades that fat leads to high cholesterol, weight gain, heart disease and stroke. In the early 2000’s, food companies began labeling “0 grams of trans fat” in packages as the FDA granted a petition intended to help Americans follow appropriate diet recommendations.1 Today, many mainstream trends focus on low-fat diets to promote weight loss and improve cardiovascular outcomes. However, this shift does not necessarily make us healthier, likely because we are cutting back on healthy fats while also increasing the amount of foods high in carbohydrates and sugar.

But why is fat good for us?

Virtually all natural foods contain some fat. In fact, fat is contained in foods as it serves as the primary source for the body’s energy needs.  Fat (or triglycerides) from food is broken down into fatty acids and glycerol (a sugar alcohol intermediate) in a process called lipolysis.2 These fatty acids are again broken down for energy or used to make glucose (sugar) that is important for cellular respiration and functions of the human brain – which consumes 60% of blood glucose in fasting, sedentary individuals.3 All of this to say, our bodies were designed to intake fat!

Heart Disease and Fat

  • Myth: Heart Disease is caused by saturated fat intake
  • Fact: There is an inverse relationship between saturated fat and stroke

Historically, saturated fat received a bad name in 1953 when a paper was published comparing saturated fat intake and heart disease mortality.4 However, this theory was flawed for several reasons: Frist, the study surveyed 22 countries yet only included the results from 6 of the 22 countries, disregarding almost three-quarters of the data collected. Second, the results of the data collected from the select 6 countries simply indicated a correlation between saturated fat intake and heart disease mortality. It is important to note that correlation does not equal causation. For example, the number of Nobel Peace Prizes won by a country may correlate well with per capita chocolate consumption, but this does not equal causation. Newer studies indicate that the relationship between saturated fat and heart disease is little to none.5 In fact, there is an inverse relationship to saturated fat and stroke.6 This means that consuming saturated fat may be beneficial to your health!

Coconut oil is composed of 92% saturated fat. Roughly 50% of this fat content is made up of an ingredient called lauric acid.7 When coconut oil is consumed, lauric acid is converted in our bodies to monolaurin, which has anti-viral, anti-bacterial, and anti-protozoa properties.8 Because of this, coconut oil has demonstrated significant health benefits in areas such as immune system support, anti-inflammatory, and focus and mental performance. Additionally, coconut oil has added digestive support oral hygiene through fighting irritation and infection from Candida (yeast infection).9

Other natural and healthy sources of fat include:10-13

  • Tallow (beef/mutton fat) from grass-fed (pastured) animals
    • High concentration of conjugated linoleic acid (CLA) which is good for cholesterol levels
  • Lard (Unprocessed and un-hydrogenated)
    • Combination of saturated, monounsaturated, and polyunsaturated fats for heat stability
    • High in vitamin D
  • Pastured butter (emulsified if >250°F)
    • Rich in butyric acid, which can decrease inflammation
  • Pastured ghee (clarified butter)
    • Smoke point of 450°F; Does not contain lactose or casein
  • Avocados
    • High amount of monounsaturated fats, vitamin E, folate, and protein
  • Extra virgin olive oil
    • Demonstrated to reduce the incidence of heart attack and dying of heart disease
    • Not recommended for cooking at high temperatures; great for salad dressings
    • When purchasing:
      • Look for a seal from the International Olive Oil Council
      • Check the harvesting date on the label (avoid “light”, “pure”, or “blend”)
      • Opt for dark bottles to protect from oxidation

The underlying problem…

The gut immune system, the largest immune system in our body, actively responds to pathogens (invading microorganisms) while at the same time remaining relatively unresponsive to food (non-pathogenic) ingested.14 Essentially, cells in the intestine are exposed to bacteria and food breakdown products all the time.15Malabsorption means the failure of the Gastrointestinal (GI) tract, usually the small intestine, to absorb one or more substances from the diet (let’s say, fat). This is generally the result of some defect or damage to the mucosal lining of the small intestine, where most of our nutrient absorption takes place. Common causes of malabsorption include diabetes, bacterial overgrowth, past intestinal surgery, AIDS, radiation to the abdomen, lymphoma or motility disorders. 16,17

 What we eat and drink plays a huge role inInflammation

Inflammation is a defense reaction of the body against injury, and is traditionally characterized by redness, swelling, pain, heat, and impaired body function.18 However, chronic inflammation can lead to conditions such as inflammatory bowel disease, stroke, heart disease, Type 2 Diabetes Mellitus and more. Refined carbohydrates and sugars are high in glycemic load (the impact of a carbohydrate quality and quantity on blood glucose levels). This leads to high insulin levels followed by a plummet in blood glucose, encouraging low-grade inflammation.18.19

Foods that can cause inflammation are:

  • Grains (especially improperly prepared grains)
  • Sugar
  • Conventional Dairy
  • Other foods may contribute to inflammation once the gut is “damaged” and leaky and the immune system is overresponsive

Big picture:

When our gut is damaged or inflamed, healthy fat is not appropriately processed in our body. As a result, plaque builds up in the artery walls and makes it hard for blood to get through, ultimately leading to cardiovascular complications. (See leaky gut post for a more in-depth description)

The solution!

As you may be aware, there are a variety of fats in our food. Having a good understanding of how different fats affect our health is important to establish the concept of why fat is healthy. Some people have referred to these different types as “good fats” and “bad fats.” The types of fat that exist are:20-22

 

Unsaturated “good” Fats Saturated “in-between” Fats Trans “bad” Fats
Liquid at room temperature

Includes (mono-) and (poly-) unsaturated fats and omega-3,6

Naturally occurring, found in animal foods and certain plants Made by heating liquid vegetable oils via hydrogenation

Should be avoided

Sources: Peanut oil, avocados, high-oleic safflower and sunflower oils, most nuts, fish and flax seeds (omega-3) Sources: Red meat, coconut and coconut oil, cheese, whole milk and yogurt Partially hydrogenated vegetable oils are the foundation for fried and processed foods

Consuming fat does not directly make you “fat.” In fact, consuming fat is necessary for our body to function and have energy for daily activities. Instead, an imbalanced diet, malnutrition, bacterial imbalances, sedentary lifestyles and large portion sizes are the leading factors to excess weight gain. Unfortunately, a focus on fat intake alone distracts from the more appropriate focus on total energy intake and physical activity levels.

A healthy diet should include fat.

Looking at the literature

A recent study combined 21 studies with over 23 years of data looking at saturated fat intake in nearly 350,000 people. Despite popular belief, it was ultimately concluded that there is not enough evidence to claim saturated fat increases the risk of heart disease.23Additionally, the analysis also concluded that more data is warranted to determine if heart disease is related to other nutrients used to replace fat. In particular, one of these studies found that saturated fat consumption in 50 heathy men for 5 weeks had no effect on systemic inflammation markers.24

Another study focused on weight-reducing regimens through dietary interventions. It was found that the group of men receiving a diet high in monounsaturated fats saw significant weight loss and reduction waist circumference.25

As mentioned above, coconut oil is an example of a saturated fat. One of the main components of coconut oil is lauric acid. This saturated fat is a medium length fatty acid and has been shown in other studies to have an antimicrobial effect against certain bacteria (gram-positive) and yeasts.26 Even compared to other acids, lauric acid ultimately gave better results in fighting infections and inflammation.27

How do I choose which fats to eat?

 When it comes to cooking, there are many options to incorporate healthy fat into the diet.  Like all foods, however, fats contain calories and should be consumed in moderation in order to regulate calories to acceptable daily intake levels.

Using coconut oil is another great option. While unrefined coconut oil may be stable enough to resist mild heat-induced damage, it should still be used with caution and not cooked at elevated temperatures (350°F) due to oxidative stress, causing fragmentation and polymerization of the oil leading to damaging effects to the body.  Refined coconut oil can be used at a higher cooking temperature (400°F).28

A diet rich in monounsaturated fats has also been proven to improve the blood cholesterol profile.29 Monounsaturated fats are found often in foods like olive oil, nuts, avocados and whole milk. The most common monounsaturated fat found in food is oleic acid, a fatty acid that occurs naturally in vegetable and animal oils.

Best Monounsaturated Fats30

Some of the best sources of monounsaturated fats are:

  • Olive oil
  • Avocados
  • Almonds
  • Cashews

Eating polyunsaturated fats in place of highly refined carbohydrates reduces harmful LDL cholesterol and improves the cholesterol profile. It also lowers triglycerides.31 Additionally, our bodies require but do not produce these fats. Omega-3 fatty acids are involved in normal growth and development, play a role in the prevention of coronary and cardiovascular diseases, of diabetes mellitus, of arterial hypertension, arthritis and cancer.31.32 Common quality sources of omega-3 fatty acids include flaxseed, chia seeds, and fish. Additionally, current research suggests there may be beneficial effects of omega-3 fatty acids on athletic performance.33

Fat is necessary for a well-balanced diet.

Whether you are trying to lose weight, gain energy, or simply promote an overall healthy lifestyle, incorporating fat into your diet is essential to maintaining your health. Fat is necessary for many normal functions such as digestion, hormone function, and energy extraction. Staying away from greasy, fried foods high in trans-fat and oxidized fats and replacing these with naturally occurring sources such as avocados and coconut oil are great steps towards your wellness journey.

Thanks to Danielle Baker, PharmD Intern who wrote the majority of this post while on rotation with me in the fall!

References:

 

  1. Division of Nutrition Programs and Labeling, Office of Nutritional Products, Labeling, and Dietary Supplements in the Center for Food Safety and Applied Nutrition (CFSAN) at the U.S. Food and Drug Administration.
  2. Duncan, Robin E.; Ahmadian, Maryam; Jaworski, Kathy; Sarkadi-Nagy, Eszter; Sul, Hei Sook (August 2007). “Regulation of Lipolysis in Adipocytes”. Annual Review of Nutrition27(1): 79–101.
    doi: 10.1146/annurev.nutr.27.061406.093734.
  3. Berg JM, Tymoczko JL, Stryer L. Biochemistry. 5th edition. New York: W H Freeman; 2002. Section 30.2.
  4. Keys A. Atherosclerosis: a problem in newer public health. J Mt Sinai Hosp N Y 1953;20:118 –39.
  5. Hooper L, Martin N., Abdelhamid A, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Systematic Review, 2015.
  6. Cheng P, Wang J, Shao W, Liu M, Zhang H. Can dietary saturated fat be beneficial in prevention of stroke risk? A meta-analysis. Neurological Sciences: Official Journal Of The Italian Neurological Society And Of The Italian Society Of Clinical Neurophysiology. July 2016;37(7):1089-1098.
  7. Eyres L, Eyres MF, Chisholm A, Brown RC. Coconut oil consumption and cardiovascular risk factors in humans. Nutrition Reviews. 2016;74(4):267-280. doi:10.1093/nutrit/nuw002.
  8. Dayrit F. The Properties of Lauric Acid and Their Significance in Coconut Oil. Journal Of The American Oil Chemists’ Society (JAOCS]. January 2015;92(1):1-15. Available from: Food Science Source, Ipswich, MA.
  9. Lui Dwen T, Ame Suciati S, Emma R. Exposure time of virgin coconut oil against oral Candida albicans. Padjadjaran Journal Of Dentistry, Vol 28, Iss 2 (2016) 2016;(2)
  10. Kawahara S., Takenoyama S., Nagato, et. Evaluation of beef tallow as a natural source of conjugated linoleic acid. Animal Science Journal, 73: 533–538. doi:10.1046/j.1344-3941.2002.00073.x
  11. Kon SK, Booth RG. The vitamin D activity of butter: An attempt to elucidate the nature of the labile factor in butter antirachitic for the rat. The antirachitic potency of lard, olive oil, egg oil and the fatty acids of butters and lard. Biochemical Journal. 1934;28(1):121-130.
  12. van der Beek C, Dejong C, Troost F, Masclee A, Lenaerts K. Role of short-chain fatty acids in colonic inflammation, carcinogenesis, and mucosal protection and healing. Nutrition Review. April 2017;75(4):286-305. Available from: Food Science Source, Ipswich, MA.
  13. Patel S, Shende S, Arora S, Singh R, Rastogi S, Singh Rawat A. Antioxidant potential of herbs and spices during deep frying of ghee. International Journal Of Dairy Technology. August 2014;67(3):365-372.
  14. Ji Y, Sakata Y, Tso P. Nutrient-induced inflammation in the intestine. Current opinion in clinical nutrition and metabolic care. 2011;14(4):315-321. doi:10.1097/MCO.0b013e3283476e74
  15. Johansson MEV, Sjövall H, Hansson GC. The gastrointestinal mucus system in health and disease. Nature reviews Gastroenterology & hepatology. 2013;10(6):352-361. doi:10.1038/nrgastro.2013.35.
  16. Williams AJ, Merrick MV, Eastwood MA. Idiopathic bile acid malabsorption–a review of clinical presentation, diagnosis, and response to treatment. Gut. 1991;32(9):1004-1006.
  17. Wake Gastroenterology. Malabsorption Syndromes.
  18. Kiecolt-Glaser JK. Stress, Food, and Inflammation: Psychoneuroimmunology and Nutrition at the Cutting Edge. Psychosomatic medicine. 2010;72(4):365-369. doi:10.1097/PSY.0b013e3181dbf489.
  19. Hakansson A, Molin G. Gut Microbiota and Inflammation. Nutrients. 2011;3(6):637-682. doi:10.3390/nu3060637.
  20. Liu A, Ford N, Hu F, Zelman K, Mozaffarian D, Kris-Etherton P. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutrition Journal. August 30, 2017;16:1-15.
  21. Remig V, Nece T, Street J, Kostas G, Franklin B, Margolis S. Trans Fats in America: A Review of Their Use, Consumption, Health Implications, and Regulation. Journal Of The American Dietetic Association. April 2010;110(4):585-592.
  22. O’Sullivan T, Hafekost K, Mitrou F, Lawrence D. Food Sources of Saturated Fat and the Association With Mortality: A Meta-Analysis. American Journal Of Public. September 2013;103(9):e31-42.
  23. Mozaffarian, D., R. Micha, and S. Wallace, Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med, 2010. 7(3): p. e1000252.
  24. Hwalla N, Torbay N, Andari N, Adra N, Azar S, Habbal Z. Restoration of normal insulinemia and insulin sensitivity in hyperinsulinemic normoglycemic men by a hypoenergetic high monounsaturated fat diet. Journal Of Nutritional & Environmental Medicine. March 2004;14(1):29-38.
  25. Baer DJ, et al. Dietary fatty acids affect plasma markers of inflammation in healthy men fed controlled diets: a randomized crossover study. Am J Clin Nutr. 2004;79(6):969–973.
  26. Salleh E, Muhamad II. Starch-based antimicrobial films incorporated with lauric acid and chitosan. AIP Conference Proceedings. 2010;1217(1):432-436.
  27. Huang W, Tsai T, Chuang L, Li Y, Zouboulis CC, Tsai P. Anti-bacterial and anti-inflammatory properties of capric acid against propionibacterium acnes: A comparative study with lauric acid. J Dermatol Sci. 2014;73(3):232-240.
  28. Good, Jennifer. Healthiest Cooking Oil Comparison Chart with Smoke Points and Omega 3 Fatty Acid Ratios. The Baseline of Health Foundation. April, 2012.
  29. Jamison J. Cardiovascular health: a case study exploring the feasibility of a diet relatively rich in monounsaturated fats. Journal of Nutritional & Environmental Medicine [serial online]. September 1998;8(3):257-263.
  30. American Heart Association. Monounsaturated Fats
  31. Kim H, Kim H, Yoon K, et al. Comparative analysis of the efficacy of omega-3 fatty acids for hypertriglyceridaemia management in Korea. Journal Of Clinical Pharmacy & Therapeutics. October 2016;41(5):508-514.
  32. Hals P, Xiaoli W, Yong-Fu X. Effects of a purified krill oil phospholipid rich in long-chain omega-3 fatty acids on cardiovascular disease risk factors in non-human primates with naturally occurring diabetes type-2 and dyslipidemia. Lipids In Health & Disease. January 17, 2017;16:1-16. Available from: Food Science Source, Ipswich, MA.
  33. Gligor S., Gligor R. The potential role of omega-3 fatty acids supplements in increasing athletic performance. Timisoara Physical Education & Rehabilitation Journal

Low Carb Peanut Butter Jam Cups & Cookie Dough Bites

I can’t believe we are almost half-way through February already. It’s been a rough few weeks in our house with germs, and we are getting stir-crazy staying at home trying to avoid more germs! I also start teaching my endocrine module in one week, and despite having taught this course 3 previous times, I’m a little behind on updates. Since I teach diabetes, and there are constantly new studies being reported, new drugs, and new guidelines, it makes for a good time updating it. Sometimes I get jealous of history or math professors that don’t have to update their content much. Despite the crazy time, we did have time to mix up some yummy and healthy treats. Both of these snacks are 3 year old approved!

I’m also excited to make some Valentine’s Day cards with our daughter. She loves anything she can paint, draw, or add sparkles too. 🙂 I hope you enjoy the holiday even though it is a “commercial” or “Hallmark” holiday, and sometimes “love” seems out of reach or you may have been hurt by someone that once loved you…remember you are loved by an amazing Father. If you want to learn more about His amazing, steadfast, never ceasing love, let’s grab a cup of coffee with these jam cups even if it’s a “virtual” date. Praying that the Lord is in your midst as you love on your family, friends, neighbors, and city this month…”The LORD your God is in your midst, a mighty one who will save; he will rejoice over you with gladness; he will quiet you by his love; he will exult over you with loud singing.” Zephaniah 3:17

Print Recipe
Low Carb Peanut Butter & Jam Cups
These low carb sweet snacks will leave you full and satisfied any time of year. Healthy collagen from the grass fed gelatin is a great way to treat yourself and take care of your gut.
Servings
Ingredients
PB Cups
Servings
Ingredients
PB Cups
Instructions
  1. Line a regular muffin pan with 12 silicone or parchment paper liners. (I used a wilton heart shaped pan that was six much larger servings)
  2. In a medium saucepan over medium heat, combine the frozen raspberries and strawberries. Bring to a boil and the reduce the heat and simmer 5 minutes. Mash the berries with a fork. Stir in stevia, you can keep adding until it's to the desired sweetness. Whisk in the grassfed gelatin and let cool while preparing the peanut butter mixture.
  3. In a microwave safe bowl, combine the peanut butter and coconut oil. Cook on high for 30 to 60 seconds, until melted. Whisk in sweetener, depending on how sweet you like it you can add more. Add the vanilla and stir to combine.
  4. Divide half of the peanut butter mixture among the 12 cups and set in the freezer to firm up, about 15 minutes. Divide the raspberry mixture among the cups and top with the remaining peanut butter mixture. Refrigerate until firm. Keep refrigerated.
Recipe Notes
  • I used this fun festive mold.
  • My favorite Monk Fruit source is Jillians Bakery because it is pure monk and doesn't have any other fillers. It's a tad expensive but last such a long time because only such a little amount is needed.
  • This type of liquid stevia is a good choice from Thrive Market.
  • Inspired by All Day I Dream About Food. 
Share this Recipe
Print Recipe
Cookie Dough Bites
These bites are a yummy energizing treat to have as a snack or dessert! Or even a couple with your morning cup of joe can be a good start to your day. Makes 8-10 balls depending on how much batter you sample. 🙂
Servings
Ingredients
Servings
Ingredients
Instructions
  1. Place all ingredients EXCEPT coconut flour and cacao nibs in a high speed blender or food processor, and blend until creamy.
  2. Stir in coconut flour until fully combined, then stir in cacao nibs. Then shape dough into balls or hearts.
  3. Serve right away, or store in a covered container in the refrigerator until ready to eat.
Recipe Notes
  • I used this protein powder. It has stevia which makes these a touch sweet, feel free to add other stevia or monk fruit if your protein source isn't sweetened.
  • I used these Cacao Nibs.  Chocolate chips would be yummy too but obviously not quite as healthy. 🙂
  • These were inspired by this recipe from the Paleo Running Momma.
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Cookie Dough Bites

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Cookie Dough Bites
These bites are a yummy energizing treat to have as a snack or dessert! Or even a couple with your morning cup of joe can be a good start to your day. Makes 8-10 balls depending on how much batter you sample. 🙂
Servings
Ingredients
Servings
Ingredients
Instructions
  1. Place all ingredients EXCEPT coconut flour and cacao nibs in a high speed blender or food processor, and blend until creamy.
  2. Stir in coconut flour until fully combined, then stir in cacao nibs. Then shape dough into balls or hearts.
  3. Serve right away, or store in a covered container in the refrigerator until ready to eat.
Recipe Notes
  • I used this protein powder. It has stevia which makes these a touch sweet, feel free to add other stevia or monk fruit if your protein source isn't sweetened.
  • I used these Cacao Nibs.  Chocolate chips would be yummy too but obviously not quite as healthy. 🙂
  • These were inspired by this recipe from the Paleo Running Momma.
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Low Carb Peanut Butter & Jam Cups

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Low Carb Peanut Butter & Jam Cups
These low carb sweet snacks will leave you full and satisfied any time of year. Healthy collagen from the grass fed gelatin is a great way to treat yourself and take care of your gut.
Servings
Ingredients
PB Cups
Servings
Ingredients
PB Cups
Instructions
  1. Line a regular muffin pan with 12 silicone or parchment paper liners. (I used a wilton heart shaped pan that was six much larger servings)
  2. In a medium saucepan over medium heat, combine the frozen raspberries and strawberries. Bring to a boil and the reduce the heat and simmer 5 minutes. Mash the berries with a fork. Stir in stevia, you can keep adding until it's to the desired sweetness. Whisk in the grassfed gelatin and let cool while preparing the peanut butter mixture.
  3. In a microwave safe bowl, combine the peanut butter and coconut oil. Cook on high for 30 to 60 seconds, until melted. Whisk in sweetener, depending on how sweet you like it you can add more. Add the vanilla and stir to combine.
  4. Divide half of the peanut butter mixture among the 12 cups and set in the freezer to firm up, about 15 minutes. Divide the raspberry mixture among the cups and top with the remaining peanut butter mixture. Refrigerate until firm. Keep refrigerated.
Recipe Notes
  • I used this fun festive mold.
  • My favorite Monk Fruit source is Jillians Bakery because it is pure monk and doesn't have any other fillers. It's a tad expensive but last such a long time because only such a little amount is needed.
  • This type of liquid stevia is a good choice from Thrive Market.
  • Inspired by All Day I Dream About Food. 
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