Low Testosterone Part 1: Treating the  root cause

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Talking about testosterone with my male patients is becoming very common. The most frequent reasons cited for seeking testosterone therapy are no sex drive, no muscles, and no energy. In this stressed out, sleepless, toxic world of ours in which men are living longer it is no surprise they struggle with these symptoms. Is testosterone the answer? There are few topics in men’s health with a narrative that has as much controversy, passion, and intrigue. We are talking about manhood and potency, so to expect anything less would be foolish.  

 What is it?

Although most known for its role as a sex steroid, testosterone also has effects on many body functions. In the brain, it influences mood, memory, and intellect in addition to sex drive. Testosterone maintains muscle strength and growth and helps maintain normal blood counts and bone strength. It may also be important for normal cholesterol balance. Testosterone maintains erections, fertility, and prostate function. In summary, testosterone is an essential hormone for a healthy male body.

Keeping it up

After the age of 35 men begin to experience a 1 to 2 percent drop in testosterone levels per year. This drop can be significant, affecting 20 to 40 percent of older men. Since we are living longer and 60 is the new 40, men who experience a loss of vigor are looking for answers. As they should, because all of the important functions listed above can be affected. Why should a man have to experience loss of vitality and optimal performance due to a decline in testosterone? They shouldn’t, but here are some important points to consider:

  1. Loss of vitality is not always due to testosterone. We have to get to the root cause. Lack of sleep, limited exercise, no stress relief, too much alcohol or pot, poor food choices, obesity, toxins, diseases like diabetes, and even your genes play a role. My golden rule for hormones: Look for root causes and lifestyle factors and treat them first. Ultimately, this will lead to better overall health and performance. Recently I had a patient with low testosterone who had a genetic predisposition to convert too much of his testosterone into estrogen. On top of that he was overtraining, not sleeping, and had no stress management plan for his overbooked life. First, I taught him the importance of rest and recovery and improved his post-training nutrition. Those changes alone led to better sleep, more energy, and better results in the gym. Meditation was added to enhance stress resilience and things only got better as he reported more focus and, wait for it… better sex. When testosterone (which was in the low-normal range), was addressed it was done so indirectly by slowing his conversion of testosterone to estrogen. This resulted in higher levels of testosterone and increases in lean muscle mass. No testosterone was needed.
  2. Low testosterone is a question of hormone balance. As exemplified in the example above it is never just testosterone. If testosterone is low I consider the hormone producing organs, most notably the adrenal glands and thyroid. An under active thyroid can lead to low testosterone and low sex hormone binding globulin (SHBG). SHBG helps active testosterone circulate. Stress results in the adrenal glands producing high levels of cortisol which plays a critical role in blocking testosterones influence. You can have all the testosterone in the world but if you have not addressed potential adrenal and thyroid issues you will not see the results we were hoping for.
  3. Just don’t replace, optimize. Ultimately men are looking for optimal results in the gym, enhanced vitality, and overall excellent performance. Testosterone alone will not do it. As I have discussed thus far it takes attention to details of lifestyle like nutrition, sleep, stress, exercise, and healthy relationships. Once that foundation is laid and we have addressed gut issues, stealth infections, toxins, immune dysfunction, and metabolic disorders then we tackle hormone balancing. When I do start testosterone therapy it is after detailed hormonal testing that looks at metabolism of hormones, not just totals. This allows me to address imbalances most effectively. I always do genetic testing to assess for gene variations that impact hormone metabolism, response to exercise, detoxification, oxidation, and inflammation. Finally, I adjust therapeutic interventions around a patient’s preferences and needs. 

In my next blog I will discuss  the nuts and bolts of Testosterone replacement, hormone balance and optimizing results with peptides. 

 

My 14 year old daughter Isabel brings up the rear behind two older brothers, who are 19 and 22. This isn’t my first adolescent rodeo. The boys took my wife and I to the brink of sanity but we survived and recovered just in time for another adolescent siege. When getting Isabel out of bed in the morning started to feel like performing a resurrection, it harkened back to our experience with the boys, so we didn’t make too much out of it. Besides, she was a spirited girl with a passion for life and could marshall energy for all of her activities, which included school and club soccer, theater, church youth group, sleepovers, etc. Then she started taking naps after school. Dead to the world naps that would last through dinner. She would wake up, eat something, and make her best effort at homework before falling asleep for the night.

My wife and I kept rehearsing our rationalizations. She learns differently than her brothers and is expending huge amounts of energy during the school day. She just started her cycle. She doesn’t eat great. She just had a soccer tournament. She had a sleepover. Then about a month ago she went for her annual well visit with her pediatrician, who has taken care of Isabel most of her life. My wife returned from the visit dismayed. When she had mentioned Isabel’s extreme fatigue, the pediatrician offered us the same rationalizations that we had determined were shrouding our objectivity. I was appalled at the pediatrician’s laissez faire approach. I decided to take matters into my own Functional Medicine hands.

I decided to run a number of tests on her for everything I could think of that might be the culprit behind her fatigue. When Isabel returned from the lab she feigned collapse from exsanguination. “How many tests did you order, Dad?” “Enough to figure out what is making you so tired, and I am sorry it took me so long check into this,” was my chagrined response.

The results were startling. Iron deficiency anemia. Antibodies to gluten, egg, milk, casein, whey, soy, corn, oat, and wheat. Hypothyroid. When I saw that her thyroid was underactive I freaked out. That meant there was a good chance her immune system (triggered by gluten) was making antibodies against her thyroid. Fortunately, further testing revealed that this was not the case. Additional testing for Lyme, and screening test for mold, heavy metals, and celiac disease were negative.

So what has this Functional Medicine parent uncovered in his little girl?

  1. Non-celiac gluten sensitivity
  2. Leaky gut
  3. Hypothyroid
  4. Iron deficient anemia

It really made sense in retrospect. Isabel was a “picky eater”—she avoided or limited certain foods, including ones she liked like ice cream and pizza. She frequently complained of belly aches. Often, after meals, she spent prolonged periods in the bathroom, which incited her brothers’ wrath as they assumed she was avoiding clean up. She had difficulty concentrating and sustaining focus. She was moody and irritable. As I explained the results to Isabel and the connection to how she was experiencing life, she was relieved. She was also excited at the prospect of experiencing life in absence of these annoying and uncontrollable symptoms.

Healing Isabel the Functional way starts now, not later

In Functional Medicine you always start in the gut. In Isabel’s case her constant exposure to gluten resulted in two things. First, a breakdown in the function of the gates that control what can get into the body from her gut. That is known as “leaky gut.”

Second, because of “leaky gut,” her immune system was under attack from proteins it would usually not see, resulting in inflammation and antibodies being produced against commonly eaten foods. Gluten can also trick the immune system into making antibodies against self tissues like the thyroid. These antibodies inflame the thyroid, causing it to be underactive.

This can all be reversed.

The gut-thyroid connection

Poor digestive health is connected to thyroid function. 20 percent of thyroid function depends on an abundance of healthy bacteria to convert the inactive thyroid hormone T4 to the active thyroid hormone T3. When dysbiosis (an overgrowth of bad bacteria) occurs, the good bacteria are crowded out, curtailing the production of active thyroid hormone. This was the case with Isabel.

To restore gut integrity and improve thyroid function I employed the classic “4 R” program. The Remove phase removes harmful foods from the diet. The Reinoculate phase restores healthy gut flora, necessary for T3 conversions, with probiotics. The Replace phase supports healthy digestive function by adding digestive enzymes until the GI tract is running well on its own. Lastly, the Repair phase includes the use of specific herbs and nutrients to reduce gastric inflammation and regenerate the intestinal walls. When all this has happened, nutrients like iron will be absorbed supplying the body with everything it needs to make energy. In the end, Isabel will be restored to her healthy active self.

What your pediatrician doesn’t tell you may hurt your child in the long run

The conventional approach to fatigue is to do nothing until more symptoms appear. The problem is that when you are told that extreme fatigue is normal, a child like Isabel will just assume that her experience is part of life and learn to live with it and adapt. All the while, inside her body, malicious events are conspiring to create irreversible damage. Though science has not figured out all of the details, there is ample evidence that gluten is a potentiator of inflammation and autoimmunity. Suppose Isabel passes through her high school years then off to college with nothing that makes her sick enough to raise the suspicion of her doctor. She stops mentioning her fatigue and other symptoms because she has grown accustomed to this as “normal.” Eventually, though, it is quite possible that she could develop full blown hypothyroidism, due to Hashimoto’s thyroiditis. There is evidence that autoimmunity plays a role in other diseases like fibromyalgia, lupus, diabetes, and Alzheimer’s or dementia. It happens all too often that not until symptoms of these end-stage diseases propagate, are the right questions asked and tests ordered. Treatment then focuses on the disease, not the root cause.

So how can I know if my teen’s symptoms aren’t normal?

As a Functional Medicine doctor and as a dad, here’s what I suggest you do if you’re unsure whether your pediatrician is ignoring symptoms in your child that concern you:

  1. Write down all your concerns. Take this list with you to the visit. Being organized and prepared will get you doctor’s attention.
  2. Do your homework. Search for “Functional Medicine Approach to…[fatigue].” Read about possible causes of your child’s symptoms and possible tests that could be run to rule out or confirm conditions.
  3. Be your child’s advocate. Be persistent in asking your doctor questions, e.g. “I was doing some reading about this . . . Do you think it could be anemia? Is there a test we could run to look into that?”
  4. Trust your instincts. If you think something is wrong and your doctor says it’s probably fine, keep at it. Get a second (or third) opinion; of course, I recommend it be with a Functional Medicine physician.

If you have had to follow your instincts and advocate for child, I would love to hear your story.

Harper was a bright, engaging, humorous 10 year old. She was perfectly healthy and her mom had no concerns. I happened to see them outside the office and she was every bit of the energizer bunny I expected she would be. Several months later, she was the in the office with a sore throat. We did a rapid strep test which was negative and sent off a throat culture. In the meantime, I suggested supportive care with salt water gargle, elderberry, herbal tea, vitamin C, and bone broth. Several days later her culture came back positive for group A Streptococcus, the bacteria that is the cause of strep throat. Simple stuff; this usually just means taking an antibiotic and continuing supportive care. I was certain she would be up running again in 10 days or less… not this time though.

Mom called several days after Harper had finished antibiotics. She was alarmed because Harper was very anxious. She was obsessively fearful about eating because she was afraid she would get sick. She was avoiding social situations that involved food and could not make it through a whole day of school due to anxiety. This was very strange behavior for Harper, who had no history of these behaviors. There was no family history either. I suspected PANDAS.

PANDAS is a cute acronym for a not-so-cute disorder that can start immediately after a strep throat infection. In 1998, Dr. Susan Swedo published a paper describing Pediatric Autoimmune Neuropsychiatric Disorders associated with streptococcal infections—PANDAS for short. PANDAS is characterized as the sudden onset of obsessive behaviors, anxiety, depression, motor tics, decline in math and handwriting abilities, sensory sensitivities, restrictive eating, irrational fears, sleep disorders, and somatic complaints like nausea or upset stomach.

Recently the term Pediatric Acute Onset Neuropsychiatric Syndrome, PANS, has been adopted to include the sudden onset of neuropsychiatric symptoms observed with PANDAS but not found to be associated with a group A streptococcal infection. From a clinical perspective this was important because there are children who meet the criteria for PANDASbut do not have laboratory evidence of a recent group A strep infection. PANDAS is now considered a subset of PANS. In either case, your formerly healthy, happy kid is suddenly nowhere to be found. This is an overwhelming disease that leaves parents and doctors grasping for answers. PANDAS Network estimates that PANDAS/PANS affects as many as 1 in 200 children. So what the heck is going on?

Playing tricks on the immune system: PANDAS is an autoimmune disorder

Group A strep (GAS), the bacteria that causes strep throat, has previously been shown to trigger several immune based diseases including rheumatic fever, scarlet fever, a kidney disorder called post streptococcal glomerulonephritis, and Sydenham Chorea, a motor tic disorder. This has led researchers to conclude that PANDAS is an autoimmune disorder. Autoimmune means that your immune system starts making antibodies against itself. This is how it works. GAS bugs put on disguises to avoid detection and attack by your immune system. Using a process called “molecular mimicry” they pretend to be human cells. Ultimately, the immune system recognizes the invaders and the antibodies produced by the immune system attack the GAS bugs, and unfortunately human cells, too. In PANDAS, these autoantibodies are directed against brain cells.This results in inflammation within the basal ganglia, a portion of the brain responsible for speech, involuntary movement (tics), and emotion. This also results in an abrupt onset of neurologic and psychiatric symptoms.

Ups and downs: What is the course of PANDAS?

PANDAS is characterized by an abrupt onset followed by recurrent flares later in the disease. The flares remit but can increase in duration and intensity with each episode. Subsequent episodes can be caused by other environmental and infectious triggers different from the original infection.

 

PANDAS isn’t black and white: Getting answers

PANDAS is a clinical diagnosis, meaning that the doctor will listen to the whole story, make a comprehensive list of symptoms, and examine your child in order to consider the diagnosis of PANDAS. This is where it can get frustrating for parents because not all doctors even know what questions to ask. In addition, the symptoms may be remitting and your child may appear perfectly fine at the time of the exam, only to experience a flare-up later. Unfortunately, because PANDAS and PANS are not well understood, children are misdiagnosed. Medical professionals may attribute the personality changes to rebellious developmental stages, poor parenting, or a mental health disorder. If PANDAS is considered, there are several lab tests that you should know about that may help confirm the diagnosis. It is always great to prepare yourself with as much information as possible in order to work most effectively with your doctor. These are some tests you should know about:

Rapid Strep Test: Getting a rapid throat swab and 48-hour strep culture is a good first step. These will determine if bacterial pharyngitis, or sore throat, is caused by GAS.  The Rapid Strep Test is a rapid antigen detection test that identifies the GAS by the antigens (tags it carries on the cell surface). The test is completed in a matter of minutes and is correct about 85% of the time.

Throat Culture: A 48-hour throat culture tests for the presence of GAS by taking a sample swabbed from the back of throat and seeing if GAS bacteria grow from it over a 48-hour period. They either grow or they don’t, which makes this test the gold standard for diagnosis of pharyngitis caused by GAS.

When there has not been a recent diagnosis of a GAS infection but a GAS-related disorder like PANDAS is suspected, there are two tests that can help establish the connection.

ASO titer: The Antistreptolysin O (ASO) titer measures antibodies produced by your body in response to a strep infection caused by GAS bacteria. But, many times the titers will be only moderately elevated – and at times not elevated or extremely elevated. This is the variable nature of the strep bacteria. Like I said, it is not black and white.

Anti-DNase B antibody test: Antideoxyribonuclease-B antibody is one of the most common of several antibodies that are produced by the body’s immune system in response to a strep infection with group A Streptococcus. This test measures the amount of antibodies to one of the streptococcal antigens (anti-DNase B) in the blood. It may be done with or following the ASO test.

The Cunningham Panel: This provides laboratory results that assist physicians in diagnosing infection-induced autoimmune neuropsychiatric disorders. The panel measures the level of circulating antibodies directed against target antigens in the brain. Autoimmune antibodies that bind to these targets may trigger movement and neuropsychiatric disorders, along with OCD and abnormal neurologic behavior.

 

Conventional treatment approach:

The conventional approach to treating PANDAS/PANS will focus on treating the strep infection and the psychological symptoms, and suppressing the immune response.

If an active strep infection is diagnosed then your doctor will prescribe antibiotics like Penicillin, Amoxicillin, or Azithromycin. Antibiotics may be prescribed for longer to suppress the symptoms or to avoid recurrence of the symptoms.

Psychiatric symptoms may start to improve with antibiotics, but they’ll likely still need to be addressed separately. OCD and other psychiatric symptoms are generally treated with cognitive behavioral therapy (CBT) and psychiatric medications called selective serotonin reuptake inhibitors(SSRIs), a type of antidepressant. Some common ones include: fluoxetine, fluvoxamine, sertraline, and paroxetine.

For severe and refractory symptoms, your doctor may suggest other treatments aimed at controlling the immune response. These include the use of intravenous immunoglobulin, steroids, and plasmapheresis (plasma exchange therapy, in which blood is withdrawn from an individual and the liquid portion is removed and replaced and the blood is transfused back into the individual). For both treatments, the “offending” antibodies are removed. Steroids are less effective, because, although symptoms decrease during the treatment, they return soon after stopping the drug.

 

Functional treatment approach:

There is a benefit to these treatments; however, in Functional Medicine, the treatment focus is on the root cause, not the symptom. The goal is to support the healthy function of the the body’s systems, not suppress them. In addition, there must be a recognition that each patient is different. We are all made up of systems that work together to respond to the external forces that act to disrupt the balance of health. However, individual lifestyles, nutrition, genetics, toxin exposures, stealth infections, and mental and emotional stressors are different and make each individual more or less susceptible to disease.

In Harper’s case, it certainly appeared on the surface that a group A strep infection, strep throat, was the cause of her immune response. She had a positive throat culture, elevated ASO, and antibodies to neuronal tissue were found on her Cunningham panel. But why Harper? What was going on that made her immune system more likely to make autoantibodies than another kid her age? This became an important question to answer because despite initial response to antibiotics her symptoms of fear, obsessive behaviors, food restriction, and isolation quickly returned.

In Harper’s case, we looked closely at her gut function because she had been mostly gluten-free due to previous struggles with bloating and distention. These symptoms had improved but not entirely resolved. Since there is such a strong connection between gut health and healthy immune function, Harper had stool and breath testing done that revealed she had a compromised gut filtering system that was exposing her immune system to a flood of foreign proteins. In essence, her immune system was already in hyperdrive when exposed to GAS bacteria. Additional testing found that Harper had genetic variances that can affect how the brain breaks down chemical messengers used to communicate from one part of the brain to another and to the rest the body. Her assessment also included tests for heavy metal toxins that can disrupt the immune system and for stealth infections like Epstein Barr Virus and Lyme disease. In Harper’s case, her Lyme testing was positive. Wow, that is a lot going! We have not even talked about the emotional stress experienced by Harper and her parents. Antibiotics, psych meds, and immune-suppressing medications alone will not return Harper (and ultimately her parents) to optimal health.  The matrix of health is complex and requires complex investigation to get to the root cause(s).

Harper started working with a nutritionist to heal her gut first. An autoimmune nutrition plan and probiotics were started. She started targeted supplements to account for her genetic variances and support neurotransmitter metabolism and healthy brain function. Her Lyme disease treatment was started with an herbal protocol. Just as important, the family started attending a mindfulness group to help everyone develop the tools to deal with the stress related to Harper’s illness.

Harper’s story can likely be told by many families, maybe even yours. If her story sounds familiar, then work with your doctor or find a doctor who will be willing to consider the diagnosis of PANDAS/PANS and do the following:

  1. Check for the presence of a strep infection.
  2. Do antibody tests to assess for autoimmunity: Cunningham panel and anti-Dnase-antibodies.
  3. Look for stealth infections like Lyme disease and Epstein Barr virus.
  4. Assess the gut for inflammation and possible autoimmune triggers.
  5. Consider testing for heavy metals and immune disruptors like organophosphates.
  6. Check for common genetic variances that impact neurotransmitter metabolism.
  7. Create a support system for your family to help you through emotional and spiritual challenges that come with dealing with devastating illness

 

As I said before, PANDAS is a complex and devastating illness with more questions than answers. The research is evolving and there is no definitive treatment. The key is to see the body as set of integrated systems that work together to protect and heal the body. Thus, in diagnosing a problem, one must look for the root cause disruptors and treat the systems, not the symptoms. Treat the child as a whole including providing support and understanding for the whole family through the process of healing.

You don’t need experts to tell you we have a big fat problem, but obesity statistics are more staggering than you might imagine. The latest information from the National Health and Nutrition Examination Survey(NHANES) shows 39.6 percent of Americans are obese. Overall, there are over 100 million obese people in this country. As these numbers continue to climb, they estimate almost half of the world’s adult population will be overweight or obese by 2030. Obesity doesn’t discriminate among demographics: Studies show we have a global epidemic of obesity in all age groups for both developed and developing countries. In 2017, The Guardian reported that there are now 124 million obese children worldwide.

Researchers define obesity as a condition where fat accumulates in the body to become a risk factor or marker for many chronic diseases including diabetes, cardiovascular diseases (CVDs), and cancer, as well as adversely impacting overall health.

While practitioners use other measures to determine whether someone is overweight or obese, body mass index (BMI) is one of the most common. Researchers define a BMI of 25 to <30 as overweight and BMI ≥ 30 as obese.

The Problem

Obesity isn’t aesthetically pleasing, but it also paves the way for many physical and psychological problems including type 2 diabetes, cardiovascular disease, and nearly every other disease on the planet. Research shows obesity is often a major risk factor for development of disease, significant disability, and premature death.

Obesity also comes at a financial cost. Researchers find American health care for obesity-related problems costs about $147 billion annually.In 2014, the global economic impact of obesity was estimated to be an astonishing two trillion dollars.

Healthcare costs aside, obesity also creates lost productivity and missed economic growth because of things like lost work days, lower work productivity, mortality, and permanent disability.

The Conventional Approach to Weight Loss

Obesity presents a real problem, but experts are unsure exactly how to handle this condition. Every year new diet books appear, fad diets or “superfoods” get positioned as “miracle cures” to melt away fat, the government tells us to not eat dietary fat, and gyms become packed with people determined to lose weight once and for all.

And yet, obesity rates continue to skyrocket.

Healthcare practitioners recognize obesity as a chronic illness with vast and potentially deadly consequences, but they seem at a loss about how to treat this condition. A conventional doctor might offer dietary advice including reducing calories, reducing dietary fat, or eating specific foods. He or she might also suggest increasing physical activity.

Many conventional doctors lack the time and knowledge to effectively treat obesity. Seeing a patient for only 10 minutes doesn’t allow much opportunity to educate someone about how to eat healthy. And some doctors are themselves overweight or obese.

Instead, conventional practitioners often outsource patients to dietitians or other healthcare professionals. They might also suggest a number of over-the-counter or pharmaceutical drugs that address various aspects of weight loss, including suppressing appetite or blocking fat absorption.

As obesity rates continue to climb, pharmaceutical companies will likely develop new drugs that address this epidemic. What these drug companies and conventional healthcare practitioners often neglect to ask is why someone becomes obese to begin with.

The body is a wonderfully complex mechanism, and taking a one-size-fits-all approach focused on calories-in-calories-out, reducing dietary fat, using a drug to address the problem— whatever—overlooks the underlying condition. Overeating might be the reason a patient is obese, but I find something deeper and more complex often creates this condition.

A Functional Medicine Approach to Weight Loss

Why do obesity statistics continue to increase? I have some ideas: We eat fewer whole foods and more processed foods, more inflammatory foods, and we’re taking in more environmental toxins. Many of us work sedentary jobs and don’t get enough exercise. We’re not eating enough foods rich in probiotics and prebiotics that support gut health.

At the same time, these are simple answers to a complicated problem. Like many diseases, obesity is multifactorial. Addressing it with mainstream medicine’s approach—take a drug, move more, cut down on your food intake—dramatically oversimplifies the solution.

Using functional medicine I take  a dramatically different approach to obesity.  I look at the whole person to determine the underlying reasons you might be overweight. Even if it “runs in your family,” genetics are far from the whole story when it comes to obesity.

Instead, I look at metabolic, hormonal, environmental, and other factors that might be keeping you from losing weight. While that sounds complex, the underlying approach for weight loss is really simple: Take out the bad and add in the good.

The Solution

Research shows what I’ve long seen in my practice: Weight loss provides significant health and economic benefits. You look better, feel more confident, reduce your risk for nearly every disease including type 2 diabetes, and increase longevity. As long as you do it intelligently and healthily, there is no downside to becoming your ideal weight.

Every patient is different. I take the time to really get to know them, understand why obesity became a problem, and create a customized protocol based on their budget, preferences, and particular needs. That takes time and effort, but this comprehensive approach not only helps you reach your goal weight but maintain it and great health for your life time.

Here are some of the underlying principles I have used with 100’s of patients to lose thousands of pounds and keep them off! Losing weight starts with your diet, but lifestyle modifications are also crucial to lose weight and keep it off. From that perspective, I’ve found these 10 strategies work for nearly everyone:

  1. Focus on whole, real, unprocessed foods. These are the foods your great-grandmother would recognize and eat regularly. They will always be the foundation of a high-quality, nutrient-dense diet. Most of your plate should ideally be plant-based foods including non-starchy vegetables, low-sugar fruits like berries and avocado, legumes, nuts, and seeds. The rest should be wild-caught seafood, grass-fed beef, or another high-quality animal protein. If you’re vegan or vegetarian, focus on plant-based proteins including legumes and quinoa.
  2. Reduce or eliminate sugar and other food sensitivities. Researchers note that we consume up to 152 pounds of sugar each year, and that doesn’t include the starchy foods that convert to sugar in our bodies. Even so-called healthy foods like almond milk can contain hidden sugars, so scrutinize labels very carefully. Food sensitivities including dairy and gluten, which trigger an immune system in overdrive and inflammation, can also keep you overweight or obese. One study found what I commonly see in my practice: A gluten-free diet with plenty of real, whole foods (not gluten-free junk foods) reduces inflammation, excess weight, and insulin resistance.
  3.  Eat plenty of gut-supporting foods. Animal and human studies show when your gut microbiome—which consists of trillions of bacteria—becomes imbalanced, all sorts of problems including obesity and metabolic syndrome can occur. Many of my patients aren’t eating enough high-fiber foods, and they eat few, if any, fermented and cultured foods like kimchi and unpasteurized sauerkraut. A high-quality probiotic supplement containing billions of microorganisms can really help here.
  4. Manage inflammation. Overall, we eat too many inflammatory omega-6 fatty acids (in foods like vegetable oils and grain-fed beef) and too few anti-inflammatory omega-3 fatty acids. Chronic, low-grade inflammation contributes to obesity and other metabolic disease. A vicious cycle ensues as inflammation makes your body cling to fat, which makes you more inflamed. To shift that omega ratio more favorably, dial down the inflammatory fats and increase your intake of anti-inflammatory foods including wild-caught fish, freshly ground flaxseed, and walnuts.
  5. Keep good sleep hygiene. “Lose Sleep, Gain Weight: Another Piece of the Obesity Puzzle,” Angela Spivey titles one review. She notes that in epidemiologic studies, shorter sleep correlates with increased obesity, hypertension, and other metabolic disorders./ In our technology-heavy, work-into-late-hours society, sleep sometimes gets the short end of the stick. Weight loss becomes easier when I have patients prioritize sleep. Turn off electronics a few hours before bedtime, find a sleep ritual that helps you unwind, and aim for 8 – 9 hours of quality, uninterrupted sleep every night.
  6. Manage stress levels. Research shows chronic stress can contribute to obesity for several reasons: You’re more likely to assuage that stress with comfort foods, for one. And you keep levels of your stress hormone cortisol ramped up when they should taper, which stores belly fat. You can’t eliminate stress, but you can learn to manage it with strategies including deep breathing, meditation, walking, and yoga.
  7. Set yourself up for success. In my practice, I’ve learned people who think ahead—things like prepping ingredients, planning what they take to work for lunch, and stocking up on grocery essentials—are more likely to succeed at losing weight and keeping it off.

Here are four success strategies I use with my patients:

  1. Make eating a priority. Block out time in your schedule to fully enjoy your meal. Don’t work and eat. You will be far more productive after a healthy, restful meal.
  2. Plan what you are going to eat. If it’s  a busy day away from home, then take a “lunch box” filled with good nutritious foods from you diet menu. If you leave the house with no food and just a credit card, you will find yourself in that dark place where diets go to fail.
  3. Identify your food triggers and avoid them. Make a list of people, places, circumstances, and things that trigger your hunger and make a list of different options you can choose instead.
  4. Avoid all spontaneous compulsive eating. Don’t walk by the leftover pizza on the counter and grab a slice on your way out the door. Always ask yourself these three questions before eating anything: Is it the right time time to eat? Is it a healthy food to eat? If so, how much can I eat? If the answers are all yes, make the time, space ,and place to eat and enjoy. Take control of the food, don’t let it control you.

Taking guesswork out of the equation makes things so much easier when you, for instance, come home from a long day at work and feel tempted to order take-out. You’re far less likely to succumb to temptation when you have a meal pre-prepped in the fridge.

  1. Determine the type of diet that works for you. Biochemical individuality underlies Functional Medicine. That means everyone is different, and you’re more likely to adhere to a diet plan that you enjoy and can maintain long-term. Some people feel better eating a mostly plant-based diet, whereas others thrive on a high-fat ketogenic diet that includes plenty of non-starchy vegetables. Finding out what works for you might take some trial and error, but you’re more likely to succeed once you’ve found it.
  2. Avoid food fights. Put a Paleo advocate and a vegan in the same room and civil war may break out. Interestingly, most plans aren’t thatdifferent when you consider a foundation of whole, unprocessed foods. Diehard devotees of a particular plan can get locked into rigidity and a holier-than-thou attitude about anyone who doesn’t agree.   Instead of trying to adhere 100 percent to one plan, consider a hybrid diet. Dr. Mark Hyman recommends what he calls a Pegan Diet, which combines the best principles of Paleo and vegan plans. What ever you choose, stick with it.
  3. Diet first; exercise second. Research shows you can’t out-exercise a bad diet. That doesn’t mean you shouldn’t exercise. In my practice, I’ve found patients who find a workout plan that works for them lose weight and maintain that loss more easily than those who don’t exercise. Figure out a routine that works for you and commit. That might mean weight resistance, high-intensity interval training (HIIT), brisk walking, or a vigorously paced yoga class.

If you’ve struggled with obesity and attained (or maintained) weight loss, I’d love to hear what strategies you would add to this list. Please share yours below.

“You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes.” – Morpheus to Neo in The Matrix

Five years ago, I woke to up to a horrifying realization: I was a great doctor. I call this realization horrifying because I didn’t believe in the kind of medicine I was being forced to practice. According to the standards set by those same healthcare plans and insurance companies, my patients should be healthier, but they weren’t.

Insurers and healthcare plans ranked me as a top physician for meeting quality measures. I could see 25 patients in a day and ensure everyone met the quality measures assigned to them based on age, gender, and disease.

When I started my practice, I felt convinced that lifestyle interventions like good nutrition, daily exercise, and stress-reducing activities could restore health and vitality. I had the passion to believe I could change healthcare, one life and one community at a time.

Somehow, I was swept radically off course.

I ran out of time, for one. If I spent an hour listening to a patient and crafting a personal plan to help them recover their healthy lifestyle, they felt satisfied, but I would be an hour behind for the rest of the day.

Patients weren’t satisfied that they had to wait. Impatient glares and, occasionally, verbal assault showed everyone in the office they were unhappy.

That discontent revealed something deeply troubling: There was no time left for personal care in conventional medicine.

Equally bothersome, many patients—swayed by media advertisements from pharmaceutical companies and healthcare plans pushing their products and procedures—suddenly had little interest in lifestyle changes. Instead, they wanted—demanded—a pill for their every ill. They seemed hypnotized and plugged into the matrix of drug-driven disease management, and I had become a party to this madness.

It wasn’t just patients. Institutions that I relied on to inform me of the best new approaches to support wellness and treat chronic disease were pumping “evidence-based” protocols that were disease, drug-centric, and biased by pharmaceutical sponsorship.

Sadly, conventional medicine doesn’t focus on prevention. Instead, it pours money and energy into things like getting patients to undergo a colonoscopy to look for a cancer that might be there. It does nothing to prevent that cancer from developing in the first place.

Insurance companies and healthcare plans were also forcing conformity and compliance toward using certain drugs and treatment protocols in schemes called “pay for performance.”

Here’s how it works: The insurer pays less per visit and withholds a portion of the payment. They return that money as “reward” if we meet thresholds of performance for using the drugs and protocols they deem appropriate.

The entire office process, then, becomes built around meeting and documenting these measures. Susan may come in with a complaint of hair loss, but I’ll spend half the time on my computer reviewing her chart to document whether she had the recommended immunizations, had her mammogram and pap smear, and that she was taking drugs determined to be appropriate for her chronic disease or condition.

Scarily, I had become great at documenting and reporting my compliance to these programs and drug-based disease management protocols. I was plugged into the matrix, too!

I decided everything had to change.  I wanted to practice medicine according to the ideals that initially fueled my passion. The only way to do that was to get back the time that had been stolen from my patients. I did that by flipping my business model upside down. It worked, but that’s a story for another time. Now, I had time to treat wellness. When chronic disease existed, I could treat the root causes and not just the symptoms.

Those principles form the foundation of Functional Medicine, an understanding that the body is a sum of systems interdependently connected and constantly engaged in dynamic interactions to respond to the world around us.

That world is made up of things like food, toxins, microbes, stress, and trauma. Any of these can disturb the balance, disorder communication, and distort appropriate responses to our systems. The metabolic chaos that ensues leads to system imbalance and breakdown.

We experience these conditions as symptoms that are typically categorized as a disease, which doctors then treat. Yet when symptoms of that disease are the focus of treatment, the root cause of the system breakdown that creates the disease may never be addressed. The patient may never achieve full health.

As a Functional Medicine doctor, my aim is to help you figure out the root cause of your imbalances and treat your systems, not your symptoms.

Let’s say John shows up complaining of heartburn and bloating after meals. With only 10 minutes to see John, the old Dr. George practicing conventional medicine would make a quick diagnosis of gastroesophageal reflux. I would then prescribe a pill like Nexium, the “purple pill” everyone knows from the television commercial. I would instruct John to avoid the foods that trigger his reflux. That drug would suppress John’s symptoms and he would be happy.

The problem is that the little purple pill works by suppressing stomach acid. This keeps food from being broken down properly, resulting in vitamin and protein deficiencies. Bacteria that stomach acid previously prevented from entering the intestines now begin to overgrow in the small intestine, eventually creating a whole other set of problems.

Today, I take a radically different approach to patients like John. Functional Medicine Dr. George asks John, “When is the last time you felt well?”

Now I learn the whole story, not just the symptoms. John tells me he was promoted to executive vice president of his company a year ago. Suddenly, the company went into crisis mode when a very large client left. The ensuing year has been hugely stressful.  He has very little time with his family and stopped going to the gym. His erratic diet consists of a muffin and coffee for breakfast, sugary protein bars in-between meetings, and dinner includes a glass or two of wine.

Understandably, then, John develops heartburn and bloating after meals and finds himself tired all the time. The symptoms are heartburn and fatigue. The root of the problem is a leaky gut with overgrowth of bacteria and fatigued adrenal glands from constant stress.

The solution is not a pill to cover the symptoms. The solution is an elimination diet to get rid of the offending foods, adding in nutritious healing foods, using probiotics to restore gut balance, using targeted botanical supplements to support adrenal function, hitting the gym for high-intensity interval training, and enrolling in a mindfulness program to deal with stress.

Soon, John feels better than ever. He now has the tools that bring balance, creativity, and joy back into his life.

That’s my goal today with every patient: To treat you as a whole person, not just one system or organ at a time. That starts with listening to your story.

While I occasionally use traditional medicines, I limit their use. The body responds to compounds more effectively in their natural state. From that perspective, I use food as medicine along with targeted supplements to help your body do what it does best: Establish balance and restore vitality to your life.

Finding the underlying causes for symptoms can be challenging and sometimes requires trial and error. Yet, as I’ll show you in future blogs that provide practical strategies to tackle obesity, disease, and more, Functional Medicine is actually quite simple: Take out the bad, add in the good, and let your body do its miraculous job of finding balance and healing. That’s something you could never, ever replicate in a pill.

Addiction is a powerful force that can sabotage your life and hurt those who surround you. Whereas researchers once considered addiction a weakness of character, in recent decades we’ve learned that brain-chemistry imbalances often underlie addiction to drugs like cocaine, heroin, and methamphetamine.

Rather than slap another drug onto that addiction, Functional Medicine seeks to find the root cause of those behaviors. Functional Medicine doctors dig deeply to ask what triggers those behaviors, what continues to mediate the behaviors in a positive or negative way, and identify biologic systems that have been disrupted. Once we find those, we can craft interventions to help the systems recover from addictions.

Among the imbalances that contribute to addiction is dopamine, a neurotransmitter involved in motivation and reinforcement. Even low alcohol doses can increase dopamine release, contributing to its rewarding effects that can lead to addiction. Likewise, drugs like cocaine can release two to 10 times the amount of dopamine as natural responses.

That impact on your brain’s pleasure circuit dwarfs the natural feel-good rewards for things like food and even sex. Your brain becomes stimulated and you’re motivated to reach for those drugs again and again, reinforcing the addiction.

To complicate matters, for about 30 percent of the population, genetics also impacts addiction. Researchers now know we have at least two variant forms of the human dopamine D2 receptor gene (DRD2), which regulates the number of D2 receptors and how much dopamine our brain receives.  Those carrying one form—the DRD2 A1 form—get less dopamine and are more prone to addiction.

Considering about 30 percent of us are born with low dopamine brain function, how can we avoid excessive craving behavior that leads to addiction?

In Functional Medicine, we believe while genetics play some role in addiction, they are far from the entire picture. Lifestyle factors including sleep, exercise, stress, and diet can dramatically impact gene expression and help you manage addiction.

Addiction is very complicated and involves numerous imbalances, including your feel-good neurotransmitter serotonin as well as hormones like testosterone. While Functional Medicine never takes a one-size-fits-all approach to any issue, addiction especially demands an individualized approach.

At the same time, how you live and eat can have a profound affect, and Functional Medicine creates a solid foundation to treat addiction. In my practice, I’ve found these 7 strategies help patients manage addiction and create positive change in their lives:

  1. Change your plate. What you put on the end of your fork can have profound impacts on addiction. Studies show eating a high-sugar diet can create a dopamine release similar to drug addiction. (It’s no exaggeration, in fact, to call sugar a drug.) On the other hand, eating a protein-rich diet provides neurotransmitter precursors like the amino acids tyrosine and phenylalanine that help build dopamine, and the omega-3 fatty acid docosahexaenoic acid (DHA) in wild-caught seafood can help balance neurotransmitters while improving mood and cognition. 
  2. Fix your gut. Your gut is enveloped in a neural network that feeds directly back to the brain on a superhighway called the vagus nerve, producing a wide range of hormones and around 40 different neurotransmitters. Gut bacteria help create these mood-impacting neurotransmitters including dopamine and feel-good serotonin. In fact, your gut produces about 95 percent of serotonin, and neurons in your gut can generate as much dopamine as those in your brain. Intestinal permeability (leaky gut) and other gut problems can have a profound effect on your mood, and healing these issues can positively impact addiction. This isn’t a one-size-fits-all solution, and I highly recommend working with a Functional Medicine practitioner if you suspect gut issues.  However, almost everyone benefits from eating fermented foods like kimchi and sauerkraut that support good gut bacteria. Prebiotic-rich foods like dandelion greens can help feed those good gut bugs, and I recommend taking a probiotic supplement for additional support.
  3. Manage stressResearch shows chronically feeling stressed out lowers dopamine. Among its benefits, yoga can help balance neurotransmitters like serotonin and improve your overall quality of life. So can meditation, deep breathing, or any other activity that balances the chronic stress that permeates 21st-century life. The important thing is to find things that work for you and do them regularly.
  4. Get great sleepResearchers find sleep deprivation can adversely alter serotonin production,  setting the stage for mood disorders and other neurotransmitter imbalances. At the very least, aim for 7 hours (preferably 8 or 9) of high-quality, uninterrupted sleep every night. Sleep hygiene becomes crucial here. Turn off electronics a few hours before bed and find a way to unwind into deep, restorative sleep.
  5. Exercise regularly. You’re likely familiar with that invigorating feeling after a great workout. That’s because regular exercise boosts feel-good neurotransmitters like serotonin.  Burst training and weight resistance make great exercise, but the important thing is to find something that works for you and that you’ll stick with.
  6. Nutrients can help balance neurotransmittersResearch shows 5-Hydroxytryptophan (5-HTP) is a clinically effective serotonin precursor, acid (GABA) can influence dopamine activity.  I recommend working with a Functional Medicine practitioner or knowledgeable nutritionist who can find the correct doses for these and other neurotransmitter-balancing nutrients.
  7. Practice random acts of kindnessStudies show when we help others, we can also help ourselves. Among its benefits, doing something kind for others can boost dopamine levels, helping you feel happier. The next time you’re down, try buying a stranger a cup of coffee or tip an extra few dollars at a restaurant and see if that doesn’t make you feel better than retail therapy.

    Addiction is a highly complex condition that presents a challenge like few others in Functional Medicine. At the same time, the Functional Medicine paradigm becomes the perfect way to address complex chronic conditions like addiction that require both dietary and lifestyle modifications to successfully alter negative behaviors.

I recently had the honor to answer some of my patients’ health questions, many of which inquired about  various aspects of having a  broken brain.

One wondered whether someone with moderately severe Alzheimer’s would be okay eating ice cream if he’s doing everything else correctly. Another asked how Functional Medicine, which looks at the whole person rather than the disease, could help addiction.

In addition to these astute questions, I address  things like Parkinson’s disease and the gut-brain connection, as well as how high blood pressure could contribute to brain disorders like dementia.While most questions related to brain health, others focused on whether a ketogenic diet would be okay after you’ve had your gallbladder removed.

I even discuss how Americans often spend the most on healthcare but have the most chronic disease.

For many of these issues, my Functional Medicine approach encompasses things like diet, nutrient deficiencies, exercise, stress management, sleep, and overall quality of life. It provides a more comprehensive, effective approach that addresses the root of the issue rather than looking for an easy answer.

Based on these patient questions, I’ve compiled 10 takeaways that I believe will empower you to take control over your health issues, whether you’ve got a loved one with Alzheimer’s or are curious about the ketogenic diet.

  1. Functional medicine is the foundation to transform healthcare.Functional Medicine finds the root cause or causes of your issue, addressing the whole person rather than just putting a label on the condition. This approach requires more time than simply writing a prescription or sending someone to a specialist for further diagnosis, but I truly believe it provides the correct approach to remedy any health problem.
  2. Eating a ketogenic diet is neuroprotective. A ketogenic diet—about 75 percent fat, 20 percent protein, and five percent carbohydrate—is a great way to stabilize blood sugar, reducing your risk of disease and helping you lose weight. It also makes a great diet for brain health. I’ve found a ketogenic diet can prevent or reverse disorders such as Alzheimer’s, Parkinson’s, and depression.
  3. The best medicine is on your fork. Nourishing foods like omega-3 rich wild-caught fish, healthy fats like avocado, clean sources of protein, and tons of phytonutrient-rich veggies belong on your plate at every meal. Beyond those foods, I like health-boosting ingredients like ginger, apple cider vinegar, sour foods like lemon and citrus fruits, and fermented vegetables to enhance your gut microbiome.
  4. Nutrient deficiencies can exacerbate disorders. Deficiencies in nutrients like vitamin D and vitamin B12 can adversely impact brain health. At the very least, I recommend a good multivitamin/mineral, fish oil, and (especially if you’re not eating fermented foods) a probiotic supplement. Beyond that, I address nutrients for specific conditions including antioxidants like curcumin and coenzyme Q10. I recommend speaking with a Functional Medicine practitioner to address specific nutrients for your condition.
  5. Gut health plays more of a role in overall health than you might imagine. To heal a broken brain, the first place to start is your gut. Consider that your gut produces about 40 neurotransmitters, including dopamine and serotonin that impact cognition, mood, and other brain-health factors. Leaky gut and other gut issues can increase inflammation, autoimmunity, and diseases like Alzheimer’s and Parkinson’s. People with Parkinson’s are also 25 – 50 percent more likely to have small intestinal bacterial overgrowth (SIBO). You get my point: To fix your brain, start with your gut.
  6. The conditions of many diseases overlap. The labels might be different, but many problems have very similar origins. I make similar recommendations for different conditions because stress management, optimal sleep levels, exercise, and diet play a significant role to alleviate many of these conditions. For instance, I often talk about Alzheimer’s and Parkinson’s interchangeably. That’s because disrupted glucose metabolism, inflammatory markers, toxicity, oxidation, and gut issues like leaky gut from bacterial imbalances, contribute to both brain disorders.
  7. How you live matters too. You might be eating the highest-quality diet in the world, but if you’re not exercising, managing stress, sleeping soundly, and challenging your brain with new activities regularly, you’re not going to gain all the benefits of better brain and overall health. Your diet matters, but so do lifestyle factors.
  8. Your genes are not your destiny. With addiction, I talk about how almost a third of us carry a defective gene that lowers dopamine levels. Things that stimulate dopamine (like alcohol or gambling) can especially become habitual  for those people. Genetics are hardwired, but they don’t determine our outcome. Dietary and lifestyle factors can go a long way to create a successful outcome for these problems.
  9. Broken brains don’t just happen to older people. A strong link exists between high blood pressure and many diseases including Alzheimer’s. This doesn’t just happen to elderly people. Hypertension in your 30s and 40s has the same effect on your brain, shortchanging blood flow to this vital organ that can contribute to many neurodegenerative diseases.
  10. Staying hydrated matters more than you might think. Staying hydrated is crucial to supporting stomach acid levels if you’ve had your gallbladder removed, but optimal hydration can benefit many other health conditions as well. Being under-hydrated can manifest in various conditions including hunger and skin problems. To optimize hydration, drink about 32 ounces of water upon waking and then another 32 ounces throughout the day. To optimize digestion, avoid drinking water 30 minutes before or after meals. Otherwise, drink up!

Whatever your conditions, these 10 takeaways provide a powerful foundation to cultivate the healthiest, happiest version of you in 2018.

Stop a second and consider this:  You share your body with about 100 trillion other organisms. These bacterial cells live in your skin, mouth, nose, yet most of them reside in your digestive system and especially your large intestine.

Imagine that. 100 trillion orgasms. In fact, these bacterial cells outweigh human cells by about 10 to 1.

Among their duties, these bacteria allow you to get nutrients from food. They’re responsible for training your immune system to know what can hurt you and how to stop it. They even protect your genes by preventing toxic material from leaking through your gut tissue.

Researchers are only beginning to understand the many roles these bacteria play as well as their impact on health and disease. A decade ago they estimated we harbor about 200 species. Today, that number is closer to 10,000 and will probably only increase.

The more researchers learn about these good bacteria, the more we realize how connected they are to overall health.

You’ll always have some bad bugs, but the good ones should dominate. When your gut bacteria get out of balance – when those bad bugs take over – systemic havoc ensues, creating a wide range of diseases.

Whenever I see patients with health issues like irritable bowel syndrome (IBS) or leaky gut, I usually suspect gut flora imbalances.

But these imbalances go far beyond just gut health. Name a health problem and gut bacteria probably plays some role.

Studies connect bacterial imbalances with Type 2 diabetes, arthritis, fibromyalgia, chronic fatigue syndrome (CFS), and migraines. These imbalances can even inhibit weight loss and make you overweight.

A new patient with an an autoimmune disorder called fibromyalgia, presented to me relating chronic gas, bloating and distention. She was also worried about worsening anxiety and brain fog. Once we fixed her gut, 90% of her symptoms resolved. That makes sense considering about 70%  of your immune system lies within your gut and that the gut is also wrapped in a neural network with a direct connection to the brain. That gut-brain connection is very powerful. Fix the gut and you can impact not only anxiety and brain fog but other neurologic and mood disorders like ADHD and depression.

As a Functional Medicine doctor, restoring gut balance is actually very simple: I take out the bad and replace it with good.

Among the factors that adversely impact gut balance are antibiotics, environmental toxins, artificial sweeteners, and a bad diet, but also things you might never suspect like anti-bacterial soaps.

Once I’ve identified the culprits, my focus becomes creating and maintaining a healthy gut that fosters a rich diversity of good bacteria.

That usually begins with what you put on your fork. When patients make the right food choices and fix a few lifestyle components, their gut health improves. They feel better and lose weight.   Here are some of the strategies I use to fix gut health:

  1. Focus on whole, quality foods. Whenever you can, choose nutrient-rich organic plant foods and foods from animals fed their natural diets like grass-fed beef and pasture-raised eggs.
  2. Eat more fiber. Good bacteria thrive on dietary fiber, and insufficient amounts make it difficult to thrive. A wide array of plant-based foods like legumes, nuts, seeds, berries, and vegetables can feed good gut bugs that help to edge out the bad ones. For patients who find getting enough dietary fiber a challenge, I recommend a high-quality fiber powder.
  3. Increase your anti-inflammatory fats. When I see patients with gut imbalances, they often have chronic inflammation. Omega 3-rich sources like wild-caught fish, freshly ground flaxseeds, walnuts, and quality fish oil supplements are among the ways you can put out that inflammatory fire that holds your weight and health hostage.
  4. Eliminate  the food that feeds bad bugs. A diet high in refined, sugary foods allows pathogens to grow. So do food sensitivities like gluten, dairy, and corn. While we eliminate these problem foods, I ask patients to keep a food journal because many of them can sneak into the diet.
  5. Eat (and drink) more fermented foods. Sauerkraut, pickles, kimchi, and coconut kefir come packed with natural probiotics that add to your gut bacteria diversity. For therapeutic amounts of probiotics, I also recommend a high-quality supplement.
  6. Feed your good gut bugs. Prebiotics are what your probiotics feed on. Foods rich in prebiotics include Jerusalem artichoke and dandelion greens. You might also choose a prebiotic-rich powder like inulin or potato starch, but go slowly: Too much at once can create gastric distress.
  7. Exercise regularly. Among its benefits, regular exercise can foster a community of good gut bacteria. Find something you enjoy that helps you move – that could be yoga, weight lifting, or walking – and do it regularly.
  8. Sleep better. Getting inadequate or poor-quality sleep could adversely impact your gut flora. Aim for eight hours of solid sleep every night. I find technology can inhibit falling to sleep, so I ask patients to turn off electronics (including TV and laptops) at least an hour before bed.
  9. Curb stress. Chronic stress takes a direct hit on  your good bacteria, creating an environment where  bad bugs can  thrive. While you can’t eliminate stress, you can reduce it with tactics like deep breathing and meditation.

If you’ve struggled with gut issues in the past, what would you add to this list to restore good bugs and edge out the bad ones? Share your thoughts below or on my Facebook page.

“He’s so bright but he’s failing because he won’t turn in homework and tunes teachers out,” one parent began when we first met. Another said during our first consultation: “She would do better if she wasn’t constantly talking and disrupting the class.”

These understandably frustrated, worried parents bring their child into my office often because a school official expressed concern about their disruptive behavior, lack of cooperation, or inability to pay  attention. Parents, on the other hand, see their kids as too active, lazy, disorganized, easily distracted, or just “being a kid.”

These and other symptoms suggest Attention Deficit Hyperactivity Disorder (ADHD), which the National Institute of Mental Health defines as “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

The American Psychiatric Association argues about five percent of children have ADHD, but other experts estimate higher rates.https://www.cdc.gov/ncbddd/adhd/data.html

To understand ADHD, think of your brain as having crisscrossing wires that go in many directions. For most people, a thought moves from point A to point B. For someone with ADHD, a thought starts out at point A, but before it gets to point B, points C and maybe even D capture their attention first. They become completely distracted before point B.

This isn’t lack of attention. In fact, a child with ADHD pays attention to and becomes interested in nearly everything they hear and see. They focus on one extremely interesting subject, blocking out everything else. To a parent or teacher, this looks like a child with ADHD is ignoring them.

This faulty cross-wiring creates two issues:

  1. Executive functioning – staying organized to, say, follow a project from start to finish. Oftentimes, multi-step projects become overwhelming so a child with ADHD doesn’t know where to start. (Parents can help by breaking down chores into individual steps and creating reminder systems, like putting  a backpack near the door so the child doesn’t forget it.)
  2. Self-regulation – the ability to manage impulsiveness. A child with ADHD might do something without first considering consequences. They fail to pick up on the behavior of those around them and behave similarly. Instead, they act on a random thought impulsively, oftentimes angering those around them.

Many times, children I see with ADHD have very low self-esteem and trust issues. If I can get a child to open up and put frustration and confusion into words, I have a greater chance of gaining trust, which yields more effective treatment and minimizes these issues.

I’m always clear during consultations that ADHD does not doom a child to a life of under-achievement. In fact, many of our greatest discoveries and inventions were made by people with ADHD.

Rather than put a label on a child based on symptoms or conditions, as a Functional Medicine doctor, I focus on what triggers ADHD. Most children have multiple triggers including genetics, environment, food intolerances, toxicity, and a poor diet.

While medication and behavior modification certainly help, diet also plays a role and can exacerbate symptoms. From that perspective, I’ve found these five dietary strategies can benefit nearly every child with ADHD.

  1. Incorporate anti-inflammatory foods and nutrients. Chronic inflammation underlies ADHD, and the typical American diet is highly inflammatory. Whereas studies show medications can have “severe side effects and intolerance,” researchers find omega-3 fatty acids can benefit children with ADHD.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968854/ That’s because drugs used to treat ADHD can stimulate the brain’s dopamine receptors. So can omega-3 fatty acids: In therapeutic doses, these fatty acids can increase dopamine production and receptors.https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml Most children don’t regularly eat wild-caught fish, so I’ll recommend other anti-inflammatory foods like walnuts as well as a professional-grade fish oil.
  2. Try an elimination diet. Gluten, dairy, and other potential food sensitivities can put your immune system in overdrive, increase inflammation, and create problems like intestinal permeability (or leaky gut). Studies show an elimination diet can benefit ADHD. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)62227-1/abstract. In my practice, I’ve found eliminating these problem foods can do wonders for children with ADHD. They feel better, become more focused, and perform better in school.
  3. Focus on whole, nutrient-rich foods. Researchers find sugar – particularly the simple sugars in processed foods – can increase a child’s risk for ADHD. One study correlated higher sugar intake with a higher level of hyperactivity and ADHD-like attention deficiencies.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3133757/ Other research shows artificial colors and preservatives can become driving factors in ADHD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322780/ While it might feel like a challenge, moving children with ADHD into a whole, unprocessed foods diet that includes plenty of fruits, vegetables, and high-quality animal foods can create dramatic improvements in behavior and focus.
  4. Optimize nutrient intake. Many children with ADHD are deficient in crucial vitamins and minerals. Studies find significantly low levels of vitamin D in children with ADHD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670977/Likewise, a systematic review found magnesium could help treat ADHD. https://www.ncbi.nlm.nih.gov/pubmed/23808779 I find a good multivitamin-mineral (and sometimes extra vitamin D and magnesium) can restore nutrient status.
  5. Mind your gut. Researchers continue to learn about the gut-brain connection. Studies show diet influences gut microbiota, which plays a key role in disorders like ADHD. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3139398/Probiotics, prebiotics, and other fiber-rich options feed good gut flora and crowd out the bad. Studies show probiotics can be effective among ADHD treatments.https://www.ncbi.nlm.nih.gov/pubmed/18444966 I encourage parents to focus on gut-healing foods including fermented choices like sauerkraut and fiber-rich options like nuts, seeds, and legumes.

My ultimate goal is to make life at school and at home easier for everyone, but also to show that ADHD is not a bad thing. Children with ADHD are often remarkably smart and creative. With the correct treatment, they will become future leaders, creators, artists, and scientists.