Nutritional Consulting for a Hypothetical Client with GI Issues

Nutritional Consulting for a Hypothetical Client with GI Issues

By Laura Sheehan

March 19, 2018
My client Mrs. Green has come to me for help with her GI issues. Her symptoms include diarrhea, constipation, and recent unintended weight loss. She works full-time as a social worker and is also working on her master’s degree. She and her husband cook some of their meals and she also buys ready-made food at a gourmet shop.
Mrs. Green is wondering whether she might have IBS but based on her food record it appears she has already determined that she has it. Her consumption of fiber is very high. Fiber is a commonly recommended treatment for IBS by physicians1. But Mrs. Green may be consuming too much, or the wrong types of fiber2. I would suggest that she start to limit all types of fiber in her diet (i.e. beans, wheat berries), at least until her symptoms improve. I would also have her examine her continuing consumption of Metamucil and Colace, especially since she is currently not constipated. If she would agree to cutting them out or at least reducing them, we could see how that would affect her symptoms.
Another possible cause of her bowel issues is Lexapro. I do not know how long she has been taking it and I would attempt to get this information from her, especially because both diarrhea and constipation are listed as “common side-effects” of the drug3. If the bowel issues seem to have begun relatively concurrent or subsequent to her taking Lexapro, I would suggest that she talk to her doctor about potentially switching medications for her depression and anxiety.
My biggest concern about Mrs. Green is that she might be gluten-intolerant. Her reliance on gluten-containing foods is evident from her Food Frequency Questionnaire and 24 Hour Recall. Considering that cutting out gluten could help her IBS symptoms4, I will focus on this in the next section.
Mrs. Green appears to be an overall health-conscious eater. Among her favorite foods, she lists fish, salads, vegetables and fruits. Most of her foods appear to be fresh and not processed. Even the foods she buys pre-prepared at the gourmet shop look like they are made from scratch. This is good.
I am recommending that Mrs. Green do a trial of a gluten-free diet. I do not think this will be difficult for her as she will not have to change her current food selection habits very much. She will need to learn to replace gluten-containing foods in her diet with gluten-free options. It is likely that her gourmet food shop has gluten-free food selections that are prepared fresh and not processed. For example, instead of buying wheatberry salad, she could buy quinoa or buckwheat salad (although it would be better to buy tuna salad since I would like her to cut back on the fiber). Gluten-free foods are usually more expensive but this will likely not be an issue for her considering her demographic.
In order to increase the chance of compliance, I will try to transition Mrs. Green slowly to gluten-free. From her 24 Hour Recall, it looks like she consumes a gluten-containing food three times daily. I will work with her over time to reduce this to two servings a day and then gradually to zero servings. This should be relatively easy to do since she is motivated to make the necessary changes, and will be especially motivating for her if she sees changes in her symptoms.
The seed pizza is a favorite of Mrs. Green’s and for this reason I will provide an alternative gluten-free recipe for her. Here is the original recipe:
Seed Pizza
1 13- to 14-oz. pkg. refrigerated whole-wheat pizza dough
2 Tablespoons shelled pumpkin seeds, plain sesame seeds, and black sesame seeds
2 Tablespoons toasted pine nuts
3 cloves of roasted garlic
3 ounces of fresh mozzarella, cubed
½ tsp. red pepper flakes
1 tsp. olive oil
Preheat oven to 425 degrees. Lightly grease a large baking sheet. Unroll pizza dough onto a lightly floured surface. Using your hands, shape dough into a 12×9-inch rectangle. Brush the pizza dough with the roasted garlic. Sprinkle with seeds and pine nuts and lightly sprinkle with salt and red pepper flakes. Sprinkle cubed mozzarella evenly over pizza. Drizzle olive oil over pizza. Bake for 8 to 10 minutes or until cheese is completely melted. Cut and serve.
Gluten-free modification:
Substitute a pre-packaged gluten-free pizza dough for the whole-wheat pizza dough in the recipe.
The gluten-free pizza dough should taste similar to the whole wheat pizza dough. In keeping with my philosophy of not changing too many things at once, I am making a relatively simple change in the recipe. I love the idea of a homemade cauliflower crust, but that would be a lot more work and Mrs. Green is already busy and stressed. Keeping the changes simple and straightforward will increase compliance. Plus Mrs. Green will get to keep the “crunch” she enjoys in her pizza.
Nutritionally, the whole-wheat and gluten-free pizza crusts are quite similar, at least from a macro-nutrient perspective5,6. According to the nutrition information supplied by the manufacturer5,6, each crust has about 150 kcal per serving and comparable amounts of carbohydrate (about 31 g/serving). Both recipes are low in fat and protein. There is only a small amount of fiber (2g) in each pizza crust.
Once I’ve made headway with Mrs. Green in cutting out dietary gluten, I would then assist her in eliminating refined sugars from her diet in the context of her overall carbohydrate consumption7. The degree to which I would eliminate the sugars depends on her response to the changes she will have made thus far.
In conclusion, I will work with Mrs. Green over a series of consultations to systematically identify and alter potential issues with her diet that are contributing to her symptoms. I will help her transition to a gluten-free diet and rule out issues with her fiber and laxative intake. I will also encourage her to examine potential unwanted side-effects of the Lexapro she is taking with her doctor.
1. El-Salhy M, Ystad SO, Mazzawi T, Gundersen D. Dietary fiber in irritable bowel syndrome (Review). International Journal of Molecular Medicine. 2017;40(3):607-613. doi:10.3892/ijmm.2017.3072.
2. Talley N. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. Yearbook of Gastroenterology. 2010;2010:46-47. doi:10.1016/s0739-5930(10)79444-7.
3. Lexapro Side Effects by Likelihood and Severity. WebMD Web Site. Accessed March 18, 2018
4. Vazquez–Roque MI, Camilleri M, Smyrk T, Murray JA, Marietta E, Oneill J, Carlson P, Lamsam J, Janzow D, Eckert D, Burton D, Zinsmeister AR. A Controlled Trial of Gluten-Free Diet in Patients With Irritable Bowel Syndrome-Diarrhea: Effects on Bowel Frequency and Intestinal Function. Gastroenterology. 2013;144(5). doi:10.1053/j.gastro.2013.01.049.
5. Whole Wheat Pizza Dough. Web Site.
Accessed March 18, 2018.

6. Schar Gluten-Free Pizza Crusts. Thrive Market Web Site. Accessed March 18, 2018.
7. Goldstein R, Braverman D, Stankiewicz H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. IMAJ. 2000; 2(8): 583-587.

Don’t Delay care after a Car Accident

Don’t Delay care after a Car Accident

By Dr. Jennifer Green

The human body was not designed to handle the sudden impact and force that most automobile accidents can generate.Even a low-speed crash can cause lasting damage to the neck and back. In stressful situations, our bodies release adrenaline, dopamine and norepinephrine to cope with the shock and trauma that may mask the pain.

Being involved in an accident, even a minor one, causes some type of initial shock. Nobody is ever prepared to be in an accident, and even if you realize it’s going to happen and cannot prevent it, you are still pretty shocked right after it occurs. If you are not in immediate pain after your accident, it may not cross your mind to see a chiropractor. However, if you are injured and do not realize it, not being treated could hurt you in the long run. When you seek immediate chiropractic care after a motor vehicle collision, you could avoid years of chronic pain.

Not all car accident injuries are immediately apparent; the body will go into survival mode, releasing endorphins that mask your pain.Many accidents cause harm to the joints, ligaments, and other internal issues in the body which can lead to significant pain, reduced range of motion, and other future problems. One of the most common car accident injuries that may take 24 hours or more to present symptoms is whiplash.

Common symptoms of whiplash include blurred vision, neck stiffness, headaches, dizziness, and tingling in the extremities. When you see a chiropractor immediately following your accident, they will be able to diagnose and treat whiplash symptoms early on. This is the best way to avoid the worst of the pain and to have the injury resolved, so it does not linger into the future.

Chiropractors promote pain management without the use of addictive pain medications. By utilizing non-invasive chiropractic adjustments and corrective exercises to strengthen muscles, we are able to reduce pain from car accident injuries and promote the body’s natural ability to heal. Chiropractic adjustments help to realign the spine and joints, which reduces pain and promotes healing.

If you are in a car accident see a chiropractor to get you out of pain and help you heal properly. Through chiropractic care you can avoid the use of harmful painkillers, surgeries, and avoid future problems.

For more blog posts on Auto Accidents click here!

Foreman & Croft, Whiplash Injuries: Cervical Acceleration/Deceleration Syndrome, 3rd Ed., Lippincott Williams & Wilkins, 2002.

Woodward MN, Cook JC, Gargan MF, Bannister GC, “Chiropractic treatment of chronic Whiplash injuries,” J. of Injury, 1996, 27 (9): 643-5;

Khan S, Cook J, Gargan M, Bannister G, “A Symptomatic classification of whiplash injury and the implications for treatment,” J. Orthopedic Med. 1999, 21: 21-5.

Berglund, A, Alfredsson, L, Cassidy, JD,, “The Association Between Exposure to a Rear-End Collision and Future Neck or Shoulder Pain: A Cohort Study,” J Clin. Epid., Vol. 53 (11), 11/2000.

Hypothetical Case Study #1 Obesity and Metabolic Syndrome

Hypothetical Case Study #1: An Approach to Obesity and Metabolic Syndrome

By Laura Sheehan

I am going to discuss my hypothetical client Marilyn. Marilyn has come to me for nutritional help, with the goal of making dietary modifications to get off her medications. She is 65 years old and obese.

Multiple definitions for Metabolic Syndrome (MetS) have evolved over the past two decades 1. The most recent and applicable definition to my clinical practice is the NCEP ATP III (2005 revision). In order to be diagnosed with MetS, my imaginary client Marilyn would need to meet three of the following five criteria: abdominal obesity (waist circumference >35 inches in women), high triglycerides (≥ 150 mg/dl), low HDL cholesterol (< 50 mg/dl in women), high blood pressure (≥ 130/≥ 85 mmHg), and high fasting glucose (≥ 110 mg/dl). According to these criteria, Marilyn fits all the criteria for MetS. She has obesity, type II diabetes with a fasting glucose of 190 mg/dl, hypertension (180/90 mmHg), high triglycerides (202 mg/dl), and low HDL cholesterol (40 mg/dl).

Insulin resistance has been proposed as the common thread linking the symptoms of MetS 2. In response to diminished sensitivity to circulating insulin, the pancreas produces more and more of this necessary hormone, and the result is high levels of glucose and insulin in the blood. These elevated levels of insulin and glucose are damaging to the body and are associated with a myriad of negative health effects, especially cardiovascular disease and diabetes mellitus, with its complications of increased susceptibility to infection, diabetic retinopathy, cataracts, and chronic renal disease3. To help Marilyn, I will need to focus on reversing her insulin resistance and MetS. I will need to provide guidelines to make her body more insulin sensitive.

Several metrics will help me to monitor Marilyn’s progress towards her goals of increasing her insulin sensitivity and getting off her medications. I will try to regulate Marilyn’s measurements toward normal. Her waist circumference should be progressively decreasing to below 35 inches, her fasting glucose toward normal (80-100 mg/100ml), her triglycerides toward normal (70-110 mg/dl), HDL cholesterol increasing toward ≥ 55 mg/dl4, and blood pressure toward normal (120/80 mmHg).

Although there is quite a bit of debate in the literature, simple biochemistry indicates that MetS and insulin resistance are effects of too much sugar in the diet. It makes sense that I would consider recommending changes to Marilyn’s carbohydrate consumption. Lowering the overall glycemic index of carbohydrates in Marilyn’s diet could be successful5, but It would be simpler in practice to reduce Marilyn’s total carbohydrate intake6. Both approaches could be successful in reducing waist circumference and hyperlipidemia. A carbohydrate restricted diet combined with added soluble fiber could increase HDL and decrease LDL levels78.

Within Marilyn’s carbohydrate-restricted diet, I will emphasize that she avoid processed sugars and focus on complex carbohydrates in their whole form. Processed sugars, especially high-fructose corn syrup, have been shown to contribute to MetS by increasing the deposition of fat in the liver9. I will also stress increasing soluble fiber as the literature suggests a benefit to lipid profiles7. After implementing these changes, provided Marilyn can stick to her diet long enough, she should see improvements in her MetS criteria and be able to visit her family doctor for a medication review.

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1. Huang PL. A comprehensive definition for metabolic syndrome. Disease Models & Mechanisms. 2009;2(5-6):231-237. doi:10.1242/dmm.001180.

2. Reaven G. 1988 Banting Lecture: role of insulin resistance in human disease. Diabetes 1988; 37: 1595-1607.

3. Hall J. Insulin, Glucagon, and Diabetes Mellitus. In: Hall J. Guyton and Hall Textbook of Medical Physiology. Philadelphia, PA: Saunders Elsevier, 2011: 939-954.

4. Weatherby D, Ferguson S. Blood Chemistry and CBC Analysis: Clinical Laboratory Testing from a Functional Perspective. Jacksonville, OR: Bear Mountain Publishing, 2002.

5. Finley CE, Barlow CE. Glycemic Index, Glycemic Load, and Prevalence of the Metabolic Syndrome in the Cooper Center Longitudinal Study. Journal of the American Dietetic Association. 2010;110(12):1820-1829. doi:10.1016/j.jada.2010.09.016.

6. Volek JS, Phinney SD. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids. 2008;44(4):297-309. doi:10.1007/s11745-008-3274-2.

7. Wood RJ, Fernandez ML. Effects of a carbohydrate-restricted diet with and without supplemental soluble fiber on plasma low-density lipoprotein cholesterol and other clinical markers of cardiovascular risk. Metabolism. 2007;56(1):58-67. doi:10.1016/j.metabol.2006.08.021.

8. Yancy WS, Westman EC. A Randomized Trial of a Low-Carbohydrate Diet vs Orlistat Plus a Low-Fat Diet for Weight Loss. Archives of Internal Medicine. 2010;170(2):136. doi:10.1001/archinternmed.2009.492.

9. Havel P. Dietary Fructose: Implications for Dysregulation of Energy Homeostasis and Lipid/Carbohydrate Metabolism. Nutrition Reviews 2005; 63(5): 133-157.

Carbohydrate Diets in Clinical Nutritional Practice

Carbohydrate Diets in Clinical Nutritional Practice

By Laura Sheehan

I have been using low-carbohydrate diets in my nutritional consulting practice for three years. The results have typically been very good. For the most part, people lose weight, reduce inflammation, improve their digestive function and have better energy. I don’t have a one-size-fits-all diet that I recommend but help people to reduce their carbs to a reasonable level where they start to feel better. This level is different for everyone. People that have severe metabolic issues such as diabetes, heart disease, or obesity, I would recommend that they go even lower carbohydrate. When these people follow a ketogenic diet, they have reversed diabetes and lowered inflammatory blood markers. I do not believe everyone needs to go keto to be healthy however (many nutritionists are espousing this right now).

Some of the most dramatic “low-carb successes” I have witnessed have been Alzheimer’s clients. There have not been very many of them, I admit. But when they do choose to agree to follow a very low carbohydrate (no more than 30 grams of carbohydrates a day) and high fat diet, I have observed amazing results. People that didn’t seem quite “all-there” in the room with you suddenly begin to look you in the eye and engage you in meaningful conversation. It stays that way as long as people are willing to keep the ketogenic diet going. I can immediately tell if they have indulged in sugar when I meet with them.

What would account for this observed effect? A study1 showed that ketone bodies are protective of hippocampal neurons in vitro that have been exposed to a a fragment of amyloid protein, Aβ1–42, a substance found to produce a deficit similar to Alzheimer’s disease.

I have come across many different viewpoints on low carbohydrate diets and their effect on health. The scientific data are mixed2. I personally believe that human beings can be healthy and eat a vast array of different types of diets. What I am looking to do in my practice is to balance out the incredible over-consumption of sugar that most of my clients are guilty of. To this end, a continuum of different lower-carbohydrate diets appears to be useful. Even though the scientific debate is clearly not settled, I believe I have been helping people get healthier, lose weight, and feel better on lower-carbohydrate diets.

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1. Kashiwaya Y, Takeshima T. d-β-Hydroxybutyrate protects neurons in models of Alzheimer’s and Parkinson’s disease. Proc Natl Acad Sci U S A. 2000 May 9; 97(10): 5440–5444.
2. Nordmann AJ, Nordmann A. Effects of Low-Carbohydrate vs Low-Fat Diets on Weight Loss and Cardiovascular Risk Factors. Archives of Internal Medicine. 2006;166(3):285. doi:10.1001/archinte.166.3.285.

How Safe is Your Car in a Car Accident?

How Safe is Your Car in a Car Accident?

By Jennifer Green

Car accidents happen – we know we need to wear seat belts, it’s the law. It is widely accepted and documented, that with the introduction of mandatory seat belt laws, there is a reduction in deaths and serious injuries after motor vehicle crashes, but there is a significant INCREASE in neck sprains.

A seat belt actually increases pain in the soft tissues of the neck tissues after a car accident to remain. It does this by anchoring the body in place and thus allowing the head free.The sudden jerking motion of the head forces muscles and ligaments supporting the spine and head to move past their normal physiological limit and can overstretch or tear these structures. Additionally, the impact can force vertebrae out of their normal alignment causing the muscles to naturally spasm as a protective mechanism to limit your range of motion.

What about my headrest – isn’t it supposed to protect my neck in a car accident?
That is a great question, the headrest only protects your neck if your head it touching it or is close to it, you can check your headrest for something called Head-Restraint Geometry.

Head-Restraint Geometry has to do with how close or far the headrest of the vehicle, was located with relation to your head. More than two inches away from the head and the efficacy of head restraints drops off significantly. You can go to (Insurance Institute for Highway Safety) to find out if your car’s headrest is properly aligned to protect you in an accident.

Navin F, Romilly D, “Investigation into Vehicle and Occupant Response Subjected to Low-Speed Rear Impacts,” SAE, 1989, 159-168;

Hirsch S, Hirsch P, Hiramoto H,, “Whiplash Syndrome: Fact of Fiction?” Ortho. Clinics of North America 1988, 19 (4): 791-795;

Porter K, “Neck Sprains After Car Accident,” Brit. Med. Jour., 1989, 298 (973-974); Evans, R, “Some Observations on Whiplash Injuries,” Neurologic Clinics 1992, 10 (4): 975-997.

Let’s Take a Closer Look at Soy

Let’s Take a Closer Look at Soy

By Laura Sheehan

I was a vegetarian for 20 years and consumed more than my fair share of soy foods. I drank soy milk and ate tofu almost every day. I didn’t have a well-researched reason for doing this. Soy was just available, and from what I heard it was a complete protein, so great, give me lots of soy. I became a very good tofu cook and learned to love the taste of soy milk. Over time, I heard more and more about soy foods. I can’t remember the exact time line, but I started seeing commercials touting the benefits of soy on TV. I began to see tofu for sale at the regular grocery store. Wow! I thought. They are catching up! So, from the age of 14 until about 34 I practically wallowed in soy. My ears didn’t fall off, nor did I develop a thyroid condition (that I knew of).

This assignment is causing me to reflect on how I feel about soy. Firstly, not being vegetarian anymore, I pretty much don’t care if I never see it again. I’ll eat it occasionally if I go out to eat at an Asian Restaurant (which I practically never do–too many carbs). I also avoid soy milk like the plague because I have heard it’s bad for your thyroid. Are all the terrible things about soy (which I admit I have bought into) true? Let me examine some of my current assumptions one by one, and see if they hold up to the evidence. I consulted Mark Messina’s 2016 review 1 to help me sift through some of the research. I realize with these reviews it is still possible for the authors to cherry-pick the research they like and explain away the research they don’t like. In any case I would need to thoroughly examine all the studies in a pro- and an anti- review and compare the relative merit of both to truly reach a satisfying conclusion. I will attempt to begin this process here.

Assumption #1: Soy is bad for your thyroid. Messina1 made a very clear point that neither soy foods nor isoflavones have been shown harmful to humans. It was interesting to me that he noted that soy’s negative effects on the thyroid are demonstrated only in vitro or in experimental animals such as rats1. Conversely, one study 2 suggested that soy formula increased the risk of autoimmune thyroid disease in children. Messina did not address this concern.

Assumption #2: Soy is estrogenic and for that reason will mess up your hormones. Doerge’s and Sheehan’s review 3 suggests that this is true. They cite many rat studies, which to Messina may not be necessarily applicable to humans. A 2011 study 4 correlated serum isoflavone concentrations with precocious puberty in Korean girls. Although Messina cited another study 5 done in the United States that contradicted the Korean study, I don’t feel he explained the Korean study away adequately enough, and I still have concerns about the estrogenic effects of soy isoflavones.

Assumption #3: Soy should be fermented if you’re going to eat it at all; never consume isolated soy products.There seems to be a lack of evidence to either or affirm or refute my assumption here. Messina indicates that the isoflavone profile is somehow altered in fermented soy, although he does not discuss the potential health effects of this1. An interesting study from 2010 6 examined the correlation of fermented soy food consumption and lower rates of Type II diabetes among Asian groups. It just makes sense that eating a food the way people traditionally prepared it (that is in this case, fermented) would be healthier. But clear evidence is lacking.

Interesting Incidental Finding: Consumption of soy is protective against breast cancer! 7 This definitely makes me feel better.

In conclusion, from this brief examination I would say soy is neither the nutritional savior that it’s touted to be by the soy industry, and neither is it the nutritional demon that the Weston A. Price people would have you believe. That leaves me pretty ambivalent about soy. There are a lot of other much more important nutritional problems to tackle (like eating too much refined sugar and carbs). I’ve only got limited time with a client and rarely is too much soy, or lack of soy, the problem. So I don’t talk about soy, and most of the time people don’t ask me about it. In one of the rare situations where I have a “soy discussion” with a client, I would have them steer clear of too much industrially processed soy (since it’s pretty much all industrially processed) and focus on whole, traditionally prepared fermented soy foods. This is my general philosophy about pretty much any food, so it can’t do any harm that I can see to extend that philosophy to soy. And since unsweetened soy milk doesn’t really taste very good, I would recommend something like unsweetened homemade cashew milk instead for a dairy intolerant person who absolutely required a milk substitute.
When it comes right down to it, here’s what I believe about soy, and what I would likely tell a client: “There’s a lot of controversy around soy, so it’s probably not a good idea to eat too much soy.”

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1. Messina M. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients. 2016;8(12):754. doi:10.3390/nu8120754.

2. Fort P, Moses N, Fasano M. Breast and soy-formula feedings in early infancy and the prevalence of autoimmune thyroid disease in children. Journal of the American College of Nutrition. 1990;9(2):164-167. doi:10.1080/07315724.1990.10720366.

3. Doerge DR, Sheehan DM. Goitrogenic and Estrogenic Activity of Soy Isoflavones. Environmental Health Perspectives. 2002;110(s3):349-353. doi:10.1289/ehp.02110s3349.

4. Kim J, Kim S. High serum isoflavone concentrations are associated with the risk of precocious puberty in Korean girls. Clinical Endocrinology. 2011;75(6):831-835. doi:10.1111/j.1365-2265.2011.04127.x.

5. Segovia-Siapco G., Pribis P., Messina M., Oda K., Sabate J. Is soy intake related to age at onset of menarche? A cross-sectional study among adolescents with a wide range of soy food consumption. Nutr. J. 2014;13:54. doi: 10.1186/1475-2891-13-54.

6. Kwon DY, Daily JW. Antidiabetic effects of fermented soybean products on type 2 diabetes. Nutrition Research. 2010;30(1):1-13. doi:10.1016/j.nutres.2009.11.004.

7. Lu L-J, Nayeem F. Adolescent and adult soy food intake and breast cancer risk: results from the Shanghai Womens Health Study. Breast Diseases: A Year Book Quarterly. 2010;21(2):120-122. doi:10.1016/s1043-321x(10)79512-6.

Effect of Carbohydrate Intake on Depression

Effect of Carbohydrate Intake on Depression

By Laura Sheehan

I was never formally diagnosed with depression and I have never taken depression medication, but I can attest to the effect that altering my carbohydrate intake had on my depression symptoms. In short, I am cured of my symptoms when I avoid refined white sugar, and my symptoms return when I begin to consume refined white sugar again.

Research by Akbaraly et al.1 concluded that a processed-food based diet is associated with increased risk for depression while a whole food based diet is protective. In another older study 2, nondepressed individuals were found to consume more protein relative to carbohydrates, but in depressed individuals it was the other way around.

So does this mean that high carbohydrate diets are associated in general with increased risk for depression? Recent research has revealed that depression is more a result of systemic inflammation than a chemical deficiency in the brain.3 Because of the inflammatory effect of high blood glucose 4, one can conclude that eating too much sugar and carbohydrates causes depression.

Many nutrition textbooks state that carbohydrate intake should be no lower than 50-100 grams per day. 5 It is my clinical experience that lowering carbohydrate intake in general to these levels can have a positive impact on mood and help individuals with depression.


    • 1. Akbaraly TN, Brunner EJ. Dietary pattern and depressive symptoms in middle age. British Journal of Psychiatry. 2009;195(05):408-413. doi:10.1192/bjp.bp.108.058925.
    2. Christensen L, Somers S. Comparison of nutrient intake among depressed and nondepressed individuals. International Journal of Eating Disorders. 1996;20(1):105-109. doi:10.1002/(sici)1098-108x(199607)20:1<105::aid-eat12>;2-3.
    3. Leonard B, Maes M. Mechanistic explanations how cell-mediated immune activation, inflammation and oxidative and nitrosative stress pathways and their sequels and concomitants play a role in the pathophysiology of unipolar depression. Neuroscience & Biobehavioral Reviews. 2012;36(2):764-785. doi:10.1016/j.neubiorev.2011.12.005.
    4. Dandona P, Ghanim H. A. Insulin infusion suppresses while glucose infusion induces Toll-like receptors and high-mobility group-B1 protein expression in mononuclear cells of type 1 diabetes patients. American Journal of Physiology-Endocrinology and Metabolism. 2013;304(8). doi:10.1152/ajpendo.00566.2012.
    5. Insel P, Ross D. Carbohydrates. In: Nutrition. 6th ed. Burlington, MA. Jones & Bartlett Learning; 2016: 138-171.

Car Accidents

Car Accidents

By Dr. Jennifer Green

Car accidents happen. Consulting a chiropractor after the accident should always be one of your first steps. Even if you are not feeling any pain. Delays in the onset of pain are very common. Joint injuries in auto accidents may cause post-traumatic osteoarthritis, which is a speeding up of the arthritis process and develops at an earlier age than in people who have not had traumas relating to automobile accidents.

Often times, injuries suffered during an auto accident cannot be seen externally, such as soft tissue injuries (injuries to muscles, ligaments and discs) and can heal with scar tissue, which can ache years later. This damage to the spine can lead to recurring headaches, neck pain, stiffness, chronic muscle tension and spasms, lower back pain, spinal disc degeneration, inflamed arthritis, sore and tight inflexible muscles, greater chance of repeat injury and contribute to poor posture.

Most people assume that injuries only occur during high-speed accidents, but a change in speed of just 2-3 miles per hour during an accident can cause injuries. When the body goes through a trama like an auto accident, the muscles naturally spasm as a protective mechanism.

Additionally, the actual spinal cord and/or nerve roots in the neck can get stretched and irritated causing even more pain that we call “radiculopathy.” All of this damage and instability can result in pain in the entire neck (cervical spine), mid-back (thoracic spine) and even the low back (lumbar spine).

When you treat an injury like this right away, you are putting the body in the best possible position to heal and recover quickly.Chiropractors can help put the spine in line and help the body start healing right away. Chiropractors also help relieve pain and can provide exercises that can act as physical therapy for injuries.

Foreman & Croft, Whiplash Injuries: Cervical Acceleration/Deceleration Syndrome, 3rd Ed., Lippincott Williams & Wilkins, 2002.

What You Need to Know About Heartburn

Heartburn is a common complaint we see. Here’s what you need to know about how to help with heartburn.

Here are somethings you need to know about heartburn:

1. The person has to get down their refined food.
To distress the digestive tract and liver. Especially flour and grain products as well as sugars. If you’re not a real athlete, then you need to get your carb count down to about 70 per day. All that extra sugar and processed carbs will be tough on the digestive tract and it’s also difficult for the liver to process. And the liver is very important in handling heartburn.

2. Identifying and handling any kind of food intolerance.
The top ones we see are grains, refined sugars, and pasteurized dairy. Even if people don’t show up with these problems initially in the testing, it’ll tend to show up down the road. It’s better to cut them out.

3. Check all the digestive organs, to see which one is not responding properly using NRT.
The main ones you’ll see with heartburn is liver and gallbladder problems, not stomach. This is because we consume processed carbohydrates that are very toxic to your liver.

4. Supplements for the liver include:
Livaplex. For the gallbladder we mainly use Choline, AF Betafood, and Cholacol.

5. The second most common organ you see come up with heart burn is the stomach.
You’re going to use the acid and enzyme point in NRT protocol. With the acid point, use Zypan or D-Diges supplements. For the enzyme point we use Mulitzyme and Lactenz. If it’s bad enough and the person is not getting better, you can also text for Gastrex and Okra Pepsin E3 which will put out the fire in the stomach

6. The 3rd most common organ seen in Heartburn is the large intestine.
This is because when you don’t digest your food it goes down into the large intestine and ferments there which puts a lot of pressure on the kidney to detoxify which contributes to heart burn. If a person is constipated enough, the food can’t come down and it’ll stay in the stomach too long and cause heartburn,

7. Supplements to take for constipation are first Fenco and choline for liver and large intestine drainage.
If these don’t work you look at Colax.

8. If there is no constipation then you’re looking at a bowel flora problem.
Which then you’d use Zymex, Lactic Acid Yeast, Lact-Enz, Spanish Black Radish, Garlic, Pro Symbiotic, and Gut Flora Complex.
If you handle the three main causes of refined carb intake, food sensitivities, organ dysfunction, and proper supplementation, then in 95% of cases with heartburn will be about 95% better in about a month or two.

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The Best Breakfast for Health and Weight Loss

A holistic approach to weight loss

As a holistic doctor, one of the most common questions I get from people about diet is “what do I eat for breakfast?” About 4 years ago, I learned from a world famous trainer named Charles Poliquin, that you should basically be eating meat and nuts for breakfast.  This is the best breakfast for weight loss and to feel better. The reasons for this are very basic-it will:

  1. lower blood sugar fluctuations, and
  2. subsequent insulin surges.

This is important for five reasons. Lowering blood sugar fluctuations and insulin surges will help:

  1. Lower cortisol levels (the primary stress hormone)
  2. Lower inflammation (the primary factor in most chronic diseases)
  3. Reduce food cravings
  4. Strengthen the immune system
  5. Build muscle and lose fat
  6. Balance hormones (including estrogen, progesterone, testosterone, and thyroid hormones)
  7. Help you lose weight

So, basically, you need to cut your carbs, ESPECIALLY in the morning, in order to be healthy. The problem is, most people don’t want a piece of fish or a hamburger for breakfast. But there are other solutions. What I tell people to eat is protein and nuts, not necessarily meat and nuts, for breakfast. If you absolutely CANNOT eat in the morning, you can substitute a low carb protein shake (recipe below). The reason I say this is that back in the day, I took a whole lot of body fat measurements on my patients (I would still do it, but it took too much time, and I had to charge accordingly). People consistently lost a lot more fat if they ate protein rather than drank it. So that’s why drinking your protein is a distant second. Here’s some choices of what to have for breakfast:

  • Eggs
  • Bacon
  • Sausage
  • Burgers
  • Fish

Feel free to mix and match these, don’t eat the same thing every day. Along with your protein, eat a handful of nuts. I recommend going easy on the peanuts, though, because they’re actually a legume, and some people don’t handle them well. Also, it goes without saying, that organic, local sausage, bacon, and eggs are much better than commercial. But like the saying goes, get the quality of food up after you’ve cut down the quantity of poison you put into your body (sugars and refined carbs).

If you must, must have a protein shake, here’s what I recommend. One, use my protein, Sheehan Whey, and/or Standard Process SP Complete. These proteins are the best ones I’ve come across, have no artificial sweeteners, and have no sugar. Two, mix these with water, sugar free coconut milk, almond milk, hemp milk, cashew milk. NO soy milk, as soy is a major food allergen, may be a hormonal disruptor, amongst other problems. There are better options, so use them instead. Three, if you like your shake creamier, add ½ to 1 avocado. If you must put a fruit in there, you can add berries, just not cherries, as they are high in sugar. Four, if you’re feeling really adventurous and healthy, add some greens, in the form of baby spinach, kale, whatever. It’s actually not bad. So here’s a shake synopsis:

  • Liquid (water, sugar free coconut milk, almond milk, hemp milk, cashew milk)
  • Sheehan Whey and/or SP Complete
  • Avocado (optional)
  • Greens (kale, baby spinach-just add a little, don’t want to overpower the rest of the shake)
  • Berries (raspberries, red or black, blueberries, etc.)
  • Essential Balance Oil (a properly balanced oil that has omega 3, 6, and 9 in the right proportions). You should definitely add this for the healthy fat; protein by itself won’t hold you.
  • Other spices of you like-like organic cocoa, cinnamon, cardamom, turmeric, stevia, you can get creative here.

Use these guidelines to create your own unique shake. Just make sure that it has protein, fat, and low carb. Go crazy!

So there you have it, what to eat for breakfast. This should satisfy everyone. And remember, breakfast is the most important meal of the day! So let’s get healthy with a healthy breakfast each and every day!

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