Q: What dietary supplements should I consider while breastfeeding? I eat healthy diet most of the time but do not eat any red meat, eggs sometimes, and very little fish. I try to avoid dairy products because they make my allergies worse. I'm pretty busy with a two year old and my newborn.

A: Lactating mothers require a higher intake of calories and fluids. The milk secreted in four months represents about the same amount of energy used by your body to maintain the pregnancy during the nine months. Nutritional deficiencies are found in breast fed infants. You might find that a fruit smoothie with protein powder convenient and helpful. It is important for the mother to eat a nutrient dense diet (no empty calories). Women need approximately 500 extra calories throughout lactation. As far as supplementation goes some of the more important nutrients include:

• Vitamin K - Babies are born with bacteria free bowels. These normal flora produce most of the vitamin K in humans, breast milk is also low in this vitamin. Most infants are given vitamin K injections at the hospital to protects them against vitamin K dependent hemorrhage disease of the newborn. If your baby was not given the injection oral vitamin K can be given to the infant for months one, two and three or mom can take the vitamin K. In addition to help blood form clots vitamin K a necessary for normal bone development.
• Essential fatty acids (EFAs)/ DHA - Infants need these fats for nervous system development. Approximately 25% of the brain is composed of DHA. The proportion of fatty acids in breast milk reflects dietary intake. Although the World Health Organization recommends up to .5% supplementation of infant formula by weight the FDA bans its use in US formulas. We recommend that lactating moms supplement with a high quality Cod Liver oil providing at least 200 mg/ day of DHA. This will also supply vitamin A and D.
• Vitamin D - Levels in human milk are low and each year children with rickets are seen in US hospitals. Sunlight can help your baby create vitamin D and only need 30 min per week if in diaper only or 2-hours/ week if clothed with no hat. Maternal exposure to sunlight does not affect vitamin D levels in breast milk.
• Continue to take your prenatal multivitamin - We recommend that mom stays on the prenatal multivitamin throughout lactation. Increasing the mother's intake of nutrients to levels above the RDA ordinarily does not result in unusually high levels of the nutrient in her milk.

Q: I have been taking Cranberry juice and vitamin C for a urinary tract infection but it does not seem to be working. I get two or three of these infections a year. Are there any safe and effective alternatives?

We feel D-mannose is superior to antibiotics because when an antibiotic is taken, it kills both the unwanted microorganisms, as well as "friendly" microorganisms important for maintaining a health ecosystem in the body. Women often get yeast infections after broad-spectrum antibiotic use. This happens because the normal flora is killed off whereas the yeast is not affected and can grow unchecked.

During the childbearing years the normal flora of the vagina is largely composed of acid producing Lactobacillus. These Lactobacilli keep the pH between 4 and 5. This pH is optimal for the growth and survival of the lactobacilli but inhibits other organisms. Therefore, we recommend a course of oral or vaginal Lactobacillus suppositories to prevent and treat urinary tract infections.

Long-term or repeated antibiotic use can lead to the overgrowth of pathogenic organisms in the relative ecological vacuum produced. In contrast, D-mannose doesn't have this indiscriminate antimicrobial effect.

D-mannose treatment of E. coli bladder and urinary tract infections is an effective natural solution. You can also use ½ teaspoon twice a day as preventive measure. You may not find D-mannose at you local pharmacy or health food store because it is not sold over the counter.
Where can you get this? To get D-mannose or a quality Lactobacillus product visit our online dispensary.

Male related factors are to blame up to 40% of the time! Among women, pelvic conditions account for 30% to 40% of cases, while problems with ovulation and the cervix each contribute another 10% to 15%. Approximately 5% are due to other causes. Roughly 10% remain unexplained even after thorough investigation.

Infertility has a number of causes many of which are not treated by herbs or nutrition. Naturopathic doctors focus on treating the cause of the problem not just the symptoms. However, if your physician has done a complete work up and no abnormalities were found the below recommendations could be implemented and /or discussed with your physician while you try to conceive.

Recommendations

1. Take a high quality prenatal multivitamin. Taking a multivitamin/mineral supplement has been shown to increase female fertility. Also, see your doctor to check for iron deficiency. Even subtle deficiency of iron has been tentatively linked to infertility.19
   
2. Decrease stress: Stress may lead to infertility, and treatments for reducing stress might help increase fertility. ,
   
3. Diet: Eat a balanced, unprocessed, whole foods diet with emphasis on organically grown foods. This makes good sense as a general health measure. There is also some evidence that certain agricultural pesticides and plastics used in packaging can act as "xenobiotics", either increasing or decreasing normal sex hormone levels in the body. We recommend that women trying to get pregnant avoid caffeine. Studies have shown that alcohol consumption can negatively affect the chance of conceiving and caffeine may actually enhance alcohol's negative effect. Consumption of one to four cups of coffee per day in some studies has been associated with delayed conception in women trying to get pregnant. , , Caffeine consumption at more than two cups of coffee per day has been associated with an increased incidence of infertility due to tubal disease or endometriosis and a 50% reduction in fertility.
   
4. Avoid cigarette smoke: Smoking has been linked to reduced fertility and increased risk of miscarriage. , Because of this possible danger; you should avoid second-hand smoke as well.

Herbs and Eastern medicine?

Vitex (Vitex agnus-castus) Vitex is useful as an herbal treatment for infertility in cases where the second half of the menstrual cycle is abnormally short and flow is irregular or absent. High levels of the hormone prolactin levels can also be found. Elevated prolactin levels can also cause a woman's period to become irregular and even stop. Vitex works by suppressing the release of prolactin from the pituitary gland. In one study, 48 women diagnosed with infertility (ages 23 to 39) took vitex once daily for three months.21 Seven women became pregnant during the study, while in 25 of the women, progesterone levels normalized, which may increase the chances for pregnancy.

Acupuncture: Problems with ovary function can lead to infertility. Acupuncture may be helpful. In one study, women who did not ovulate were treated with acupuncture 30 times over three months. Acupuncture lead to marked improvement in ovulation in the majority of these women. . Ear acupuncture was compared to standard hormone therapy for treatment of infertility. In both the acupuncture and hormone therapy groups, 15 out of 45 patients became pregnant. Although the pregnancy rates were similar with either treatment, acupuncture has no negative side effects.

Men's Concerns

The following are some medicines we use:

• Vitamin C. This vitamin protects sperm from free radical damage and improves the quality of sperm in smokers. When sperm stick together fertility is reduced. Vitamin C reduces sperm stickiness.
• Zinc. For men with low testosterone levels, zinc supplementation raises testosterone and also increases fertility. For men with low semen zinc levels, zinc supplements may increase both sperm counts and fertility.
• L-arginine. Most research shows that several months of L-arginine supplementation increases sperm count and quality and also fertility. However, initial sperm count is extremely low (such as less than 10 million per ml), L-arginine will have little effect.
• Coenzyme Q10 is a nutrient used by the body in the production of energy. While its exact role in the formation of sperm is unknown, there is evidence that it will increase sperm count and motility.

• Vitamin B12 is needed to maintain fertility. Vitamin B12 injections have increased sperm counts for men with low numbers of sperm. These results have been duplicated in double-blind research.

• L-carnitine is necessary for normal functioning of sperm cells. L-camitine has been found to improve sperm motility and sperm maturation.

• Selenium. In a double-blind study with infertile men, supplementation with selenium significantly increased sperm motility, but had no effect on sperm count.

• Asian ginseng may prove useful for male infertility. A study found that Asian ginseng given for three months led to an improvement in sperm count and sperm motility.

How stressed are you?
Like an athlete who is over- training, typical symptoms of over-stressing include insomnia, depression, fatigue, headache, upset stomach, digestive disturbances, and irritability. Some deal with this by using drugs, overeating, watching excessive television, having emotional outbursts, feeling helpless, or overspending. The best way to find out if you are overstressing is to have a complete workup including an adrenal stress profile.  

It’s how you handle stress that matters
How an individual handles stress plays a major role in determining their level of health. For years researchers have been looking at the association between stress and heart disease, including the beneficial effects of relaxation therapies.  Chronic diseases are usually caused by an inability of a person’s body to maintain optimal balance. Stress profoundly affects the delicate balance primarily through altering your body’s output of hormones, central nervous system, and immune system; although other systems are affected as well.

According to Hans Selye (the father of modern stress research ), stress alone should not be viewed negatively. It is not the stressor that determines the response; instead it is the individual’s reaction which triggers the response. This internal reaction is highly individual. One person's stress may be another person's medicine.

The Important point here is that you need to be able to adequately handle stress.  While eliminating excess stress might be optimal, usually is is not practical (we all have to work and live).  Our goal is to help you develop an appropriate response to stress by "preparing you body to take it."

What should you do?
Get a comprehensive stress evaluation. This may include a complete history, physical exam and laboratory or functional tests depending on the case. If you are not in our area we can set up the next best thing through a phone consultation. Our treatments will vary depending on the situation and can include relaxation training, dietary modification, natural medicines, nutrition, and eliminating food allergies/sensitivities. 

A: Nutritional and botanical approaches for  patients with decreased ability to  handle stress include supporting the adrenal glands. Long-term stress can cause the adrenal glands to become dysfunctional, aggravating the stress symptoms of anxiety, depression, or chronic fatigue.

Abnormal adrenal function, either deficient or excessive hormone release, significantly alters an person's response to stress. The adrenal gland may become exhausted as a result of constant demands placed upon it. This is what people are referring to when they say " I have adrenal burnout". An individual with adrenal exhaustion will usually suffer from chronic fatigue and may complain of feeling "burnt out" or constantly anxious. These patients typically have allergies and get infections and colds easily. In addition to exercise, diet and adding relaxation to one’s life the we have success with magnesium and certain herbs.

Importance of magnesium
Magnesium (Mg) deficiency is common in the US. Levels of this mineral have been reported to be low in people with chronic fatigue. Magnesium given orally or injected has been used with success in studies on fatigue. When magnesium deficiency exists, stress increases the risk of heart damage (hypertension, stroke, arrhythmias and sudden cardiac death). Stress induced stimulation of fat breakdown can intensify its deficiency because Mg gets bound to the broken down fat which are liberated into the bloodstream. A low Mg/Calcium (Ca) ratio (more Ca than Mg ) increases release of adrenalin, which lowers tissue  Mg levels further. A low ratio may also make the blood “thicker” and reduce blood flow; a low Mg/Ca ratio also directly favors blood coagulation (formation of clots). Stress, whether physical (exertion, heat, cold, trauma), or emotional increases the need for Mg. We give Mg to break the cycle of stress leading to low Mg.

Herbs
Herbs such as Asian ginseng and Siberian ginseng may be used because they support the immune system and help people handle stress. Other botanical we sometimes employ are Licorice Glycyrrhiza glabra and Ashwagandha. Licorice root contains glycyrrhizin. Licorice is anti-inflammatory and inhibits the breakdown of the stress hormone cortisol. In late stages of adrenal burnout cortisol is low. Its best not to self prescribe Licorice because it can raise blood pressure, deplete potassium and may interact with prescription drugs. Scientists have studied Ashwagandha for its ability to activate the immune system, inhibit inflammation and improve memory. 

Children's Health Concerns

A: Tantrums are a normal and can be dealt with effectively by changing the way you react to the event. For children, temper tantrums are an emotional outlet. They are resorted to when the child feels overwhelmed and unable to comply with parental or teacher requests or demands, when social schedules of family routines interrupt a child's play or work, and when children try to force parents to give them what they want or think they need. Tantrums also occur frequently in the active, determined child who has his/her autonomy thwarted, or when boredom, fatigue, hunger, or illness reduces the child's tolerance for frustration. Parenting practices that may encourage tantrums include inconsistency, excessive demands, being too strict, and being over-protective. When temper tantrums occur it is important to stay calm and give the clear consistent message that the child will never get what they want by this type of behavior.

Use the following step by step approach when dealing with tantrums:

1. REMAIN CALM. Set a positive example by remaining in control of yourself.
   
2. PAUSE BEFORE YOU ACT.
   
3. DISTRACT. Try to get the child's attention focused on something else.
   
4. REMOVE. Take the child to a quiet, private place to calm down. This should be a quiet place that is away from other children. Avoid trying to talk or reason with a screaming child.
   
5. IGNORE. Children will sometimes throw tantrums to get attention. Try to ignore the tantrum and go about your business as usual. Do not reward the behavior in any way.
   
6. HOLD. Holding a violent child calmly is sometimes necessary to keep him from hurting himself or someone else. Tell the child that you are going to hold them until they calm down because is not OK to hurt people.
   
7. WAIT UNTIL THE CHILD CALMS DOWN - THEN TALK. It's difficult to reason with a screaming child. Insist on a "cooling down" period, and follow up with a discussion about behavior.
   
8. COMFORT AND REASSURE THE CHILD. Tantrums scare most kids. Often, they are not sure why they feel so angry and feel rather shaken when it is all over. They need to know that you disapprove of their behavior, but that you still love them.
   
9. DISCUSS WAYS THAT THE CHILD MIGHT AVOID FUTURE DISAPPOINTMENT AND FRUSTRATIONS.

A: The great thing about treating children with natural remedies is that they typically respond quickly. The trick is for the parent to adhere to and enforce the necessary changes. Having said that, the number one thing that needs to be addressed is sugar intake. Researchers have demonstrated that just one teaspoon of sugar adversely affects the immune system function by 50% for up to a few hours. Think of what that means when your child is eating sugar throughout the day! Researchers have demonstrated that 75 grams of glucose taken orally depresses the immune system’s ability to respond to an attack.  This may be caused, in part, to an increase in insulin levels. Simple sugars and some starches cause insulin to increase more than other foods. Below is a chart, which illustrates the effect of refined sugars on insulin levels (Glycemic index). Proteins and fats tend to have the lowest scores whereas sugars and starches tend to have higher scores. The lower the number on the glycemic index, the better.
GLYCEMIC INDEX OF COMMON SUGARS

Where does the sugar come from in your child’s diet? 
Fruit juice
Starches such as bread
Sports bars
Dried fruit
Cereal (don’t be fooled, even the health food store variety adds ‘natural sweeteners’)
Soymilk with added sweeteners
Soda
Cookies, candy
Honey
Jam, jelly
Peanut butter (check the label!)
Yogurt (flavored)
Children’s multi vitamins especially liquid or chewable

Immune Enhancement Tips:
There are natural therapies you can implement to keep your child healthy, such as identifying and eliminating food allergens and getting them on a good multivitamin. Use an adult powdered multivitamin and divide the dose based on your child’s age. Add extra vitamin A, vitamin C, vitamin E and zinc, but consult with a physician who is knowledgeable to help determine what amounts are safe for your child. One of the great naturopathic doctors, Dr. Bastyr, would use just two things to keep your child healthy, Cod liver oil and vitamin C. (Beware, cod liver oil contains vitamin A, so you must be careful of the overall dosage of this vitamin.  Also, vitamin C can cause diarrhea at large dosages, please consult with a physician.).

What do these vitamins do for the immune system? 
Vitamin A has been shown to stimulate or enhance the function of a number of immune system cells in order to better combat infection. Not only does vitamin C have antimicrobial effects, it also has been shown to improve the body’s resistance to disease. Vitamin E and zinc share some similarities in that a deficiency in either of these two nutrients has been shown to have a dramatic decrease in both the T-cell and B-cell immune functions.

Botanical medicine is also safe for children to keep their immune system strong. Astragalus (a Chinese herb), medicinal mushrooms and Echinacea are just a few. For more details on this, watch for future publications on this website or take advantage of our consultation service, and we can provide an individualized treatment plan for your child’s needs.

Fitness

There are numerous theories as to exactly how stretching works to produce the sensation of decreased pain and increased flexibility. Researchers now think that stretching causes an increase in stretch tolerance as opposed to increased elasticity. This means that patients feel less pain for the same force applied to the muscle. This is thought to be due to an analgesic effect. The result is increased range of motion, even though true stiffness does not change.

While I was being trained in massage in naturopathic medical school we were taught that stretching and massage could fix most musculoskeletal pain syndromes. While massage and stretching may help a number of conditions resulting from injury or trauma they do not always address the cause of the dysfunction. Additionally, overstretching may cause damage to the muscle and tendon or the joint capsule itself.

Generally if you are experiencing pain there could more going on than tight muscles/tissues. See your physician for a proper diagnosis then follow his/her treatment advice. If you don't like the advice you get contact us at "the center" for possible alternatives.

1. Exercises to generally avoid
   a. Full head circles - are not recommended because they apply excessive pressure to the vertebrae and disks.
   b. Toe touching - can apply excessive forces to the lumbar disks when performed while standing with knees locked in extension.
   c. The Yoga plow - places excessive strain on the lower back and cervical spine (neck).
   d. Hurdler's stretch - The version where you sit down with one or both legs bent so the foot is next to the hip while you lean back can cause damage to the medial collateral ligaments (knee ligaments on the inside of the knee), compress the medial meniscus (cartilage inside the knee joint), and may dislocate the patella (the knee cap). The modified version where the foot touches the opposite inner thigh is fine.
   e. Back bends - can apply excessive pressure to the vertebrae and disks. These should be done with caution unless you are skilled at yoga.
   
2. Stretching myths
   a. Stretching should be used before exercise as a warm up. Muscle temperature should be elevated before stretching to reduce the risk of injury and maximize the effect of the stretch. The best way to elevate muscle temperature is through exercise and should therefore be done after the workout or after a light warm up before a workout. Stretching is most effective if done after exercise while the body is cooling down.
   b. Pulsing is better than bouncing. Short bounces at the end of your range of motion are less effective than static technique. Ballistic stretching is dangerous because the muscle may reflexively contract if re-stretched quickly following a short relaxation period and these contractions may increase the risk of injury.
   
3. The bottom line
   a. Only warm-up is likely to prevent injury
   b. Static stretching is probably safest. Hold the stretch for at least 30 to 60 seconds.
   c. Stretching should not hurt….if it is painful tissue damage is likely to be occurring
   d. Stretch while cooling down after exercise for maximum benefit.

Further reading:
Shrier I, Gossal K. Myths and truths of stretching: Individualized recommendations for healthy muscles. Physician and Sportsmedicine 2000 August;28(8):57-63.

A: In our practice and as we consult with professional athletes all over the country, a common concern is combating depression and anxiety without the side effects from prescription drugs. Every athlete responds to these drugs differently just as every person is so unique. With natural medicine, we are able to help the individual find the underlying cause of their depression or anxiety and achieve results with only the positive side effect of optimizing their health and performance.

The conventional use of Zoloft, Wellbutrin and other prescriptions often interferes with the athlete’s competitive drive or motivation to exercise. From clinical experience it seems that SSRI’s are better for most athletes than the tricyclic anti-depressants, although everyone is different. The physiological effects of SSRI’s are to inhibit the uptake of serotonin and bind receptors that would cause anticholinergic, sedative and some cardiovascular side effects (PDR). Of course this would make one feel a lack of motivation or competitive drive. Exercise is one of the most powerful treatments for depression and anxiety. It increases endorphins, enhances self-esteem and provides social stimulation. But, despite regular exercise, many athletes still experience depression and anxiety.

Depression and anxiety are normal responses, feelings or states. They can also be a symptom of underlying disease. Steadman’s Medical dictionary defines depression as a reduction in ones level of functioning; a temporary mental state or chronic mental disorder characterized by feelings of sadness, loneliness, despair, low self-esteem and self-reproach. Anxiety involves apprehension of danger or dread accompanied by restlessness, tension, tachycardia (racing heart beat), and shortness of breath unattached to a clearly identifiable stimulus

The causes of depression may be organic such as hypothyroidism, adrenal hypo-function, nutrient deficiency, hypoglycemia, allergy, infectious disease and environmental factors. How many friends do you know who have low thyroid and are also on anti-depressants? Are these friends overmedicated? Anxiety may be cause by a learned behavior or response, a side effect from medications or nutrients, allergies, adrenal fatigue, or a neurotransmitter imbalance. It is important for the doctor to identify what the underlying cause of depression or anxiety is when helping the athlete achieve optimal health.

Blood tests to check for blood sugar deregulation, thyroid disorder or allergies are pertinent. Checking sex hormones and adrenal function with saliva testing may also be used. Is your libido low, and are you waking up at 3am every night, especially after a hard workout? These tests could find the answer for you. To determine neurotransmitter and amino acid levels, alternative medicine doctors are now using high-tech urine tests. With the information from these tests, high doses of amino acids are used to balance the neurotransmitter levels in the brain instead of using prescription medications.

A Naturopathic approach to depression and anxiety involves first and foremost identifying the underlying cause for each individual patient. By identifying the underlying cause, we can target our strategy and optimize wellness, naturally.

Natural Ways to Combat Depression and Anxiety

*These substances are contraindicated with the use of certain prescription medications and disease conditions. Please consult a physician before use.