 One of the most frustrating things in family medicine is when a patient comes to me with a host of symptoms, I order testing, and everything comes back normal. It’s NOT in your head, I swear! For some people, the more obvious stomach ache or change in bowel habits gives a clue to food being the culprit, but for others, it’s a change in behavior, headaches, or mood changes. Other times it can be breathing problems, joint pain, rash, weakness or just not feeling well. These latter symptoms don’t always lead people to look at their diet.
Just about everyone has heard of the saying, “You are what you eat.” And nowadays, research is clarifying a fascinating connection between your gut and your mind. I often turn people to elimination diets to help parse out the relationship between their symptoms and food. Of course, we can do food allergy testing, but these test results don’t always add up to real-life symptoms: One can test positive for egg allergy, for example, but has eaten eggs all of their life without problems. This can be because the test is looking for a true allergy (immune reaction) and what the person is experiencing is actually an intolerance (difficulty digesting). Even then, sometimes the problematic agent is not something we can easily test for. People can be affected by food additives or coloring too. Elimination diets, while there are many, are generally made up of 2 phases: elimination and reintroduction. They are pretty straightforward, but do require commitment and planning. The majority of elimination diets, are about 6-8 weeks long for both phases.
Some popular elimination diets include the Whole30 (cutting out inflammatory foods), Conscious Cleanse (changing the way you pair foods), low FODMAP diet (FODMAPs are short-chain carbohydrates that some people cannot digest), and the Feingold Diet (removing food additives and coloring). Gastroenterologists found that the Six Food Elimination diet helped reverse Eosinophilic Esophagitis, a condition of the immune system that masquerades as gastroesophageal reflux but is really allergy related. Depending on your current diet and your symptoms, one may be better for you than another and you may need to try more than one type of elimination diet (avoiding histamine provoking foods and food additives, for example). My general approach in working up symptoms through diet is to start with an elimination diet as a way to collect more information. Keeping a diary/journal is very important during an elimination diet, I recommend it during the elimination phase as well, starting with an inventory of symptoms before you eliminate anything. Be sure to be slow and methodical about the reintroduction phase. It’s best to work with your doctor or a nutritionist especially during this phase so you can maximize learning from the sneaky delayed reactions that happen with some food groups. At Direct Osteopathic, we also add in supportive supplements, hoping to reverse reactions by rebalancing and healing the microbiome. This fosters resilience in your gut so that minor food reactions don't cause significant symptoms, which allows people to maintain a more balanced diet. Getting back into the driver's seat with food that makes you sick is very empowering. Many elimination diets are too restrictive to continue on an on-going basis (unless, of course you are affected by ALL of the foods you cut out!). Ultimately, eliminating what causes problems and keeping in what doesn’t is more sustainable and, frankly, more enjoyable. You are what you eat, but you can’t let what you eat control who you are! Have you thought about doing an elimination diet? Need some guidance? Schedule your visit or consultation with us, we can dive right into it with you. Dr Lisa
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In case you missed it watch our video to find out:
 Welcome Fall!
It is officially here and I am overjoyed! I am among many who enjoy Fall. Like others, I love taking in the briskness each morning, sweater weather, cozying up to a warm drink, a sense of getting to slow down a bit, and of course, FOOD! Besides all the chilis and soups and stews that you can make, there's football, Halloween, Thanksgiving, Hanukkah, Christmas and MORE football! This always seems to be a double edged sword for people: on the one hand, it is such a social time, family and friends, so many excuses to get together. On the other hand, there is SO MUCH FOOD! And with that, we are faced with so many temptations to pull away from our healthy habits. The International Food Information Council Foundation found that 36% of Americans have tried a specific eating plan in the past year. Interestingly, this past year the fad diet of choice was intermittent fasting (stay tuned, we are going to dive into that). Nowadays, it's not just for weight loss. Countless people are realizing that some foods are making them sick. Or they just don't feel well and want to explore whether food is the culprit. Others have been diagnosed with a condition that forces their diet to change forever more. As we approach the season of celebration, being on a diet becomes more than just discipline, it is exponentially more stressful. You'd think I was crazy then, when I decided to do the Whole30 a couple of years ago, in October. The Whole30 is an easy to follow diet that is essentially an elimination diet with a paleo focus. But it was hard for me. We were ramping up for cold and flu season and all I could think about was food. Planning food. Cooking food. The next time I could eat food. But by the end of it, I felt better: my face was clearer, I had more energy, I didn't get "hangry", I hadn't realized that I was perpetually bloated until I wasn't anymore. And then Thanksgiving and the rest of the holiday season came and habits returned. The benefits were short-lived, but the experience was eye-opening. I know that I would feel better repeating the Whole30, when I muster up the focus and determination again. Starting this Fall, we are launching an educational series, with a new topic each quarter. As we continue to learn, you can too! Our first topic, in light of the nature of this season, will be on Nutrition. In family medicine, I get a variety of patients, from those who are dealing with health problems such as diabetes, thyroid problems, or IBS to those who just want to lose some weight and I often get asked, “What diet should I be on?” This is a difficult question to answer and in fact, I don’t often have a "one size fits all" answer! Each person is so different and the health problems they have are so varied, there is never just one answer, let alone an easy one, to that question. However, this fall, we will review the most popular eating plans so that you can understand what's out there and decide if any of them are right for you. If you want a more detailed, personalized plan you can always see me for a consult, I love guiding people through this process.What if you just want to lose weight?? We'll talk about that too, from factors that impact weight to all the different options, including medications and surgery. As your healthcare providers, we strive to stay up to date and are constantly learning. Our goal is to build a platform to facilitate information sharing and exchange so that you can make informed decisions about your health as you head into the extravagance of the holiday season. Join us as we all continue our journey towards wellness. Dr Lisa Nguyen
October brings the beginning of holiday foods and habits. Listen to this video for mindful tips on:
School is starting up again, and while it’s an exciting time it can also mean extra stress for students and their parents! Helping adults and kids calm the mind at bedtime is key to good, restorative sleep. Try this technique of progressive muscle relaxation. It’s good for all ages!
My kids are getting ready for school this week, as many are. This year they will be in 1st grade and pre-kindergarten. I am struck by the courage they have inside as they face this transition. Shopping among the back to school isle at Target today, I noted that every mom was heads down reading off their phones to check off the list of supplies requested for another year. Much has changed since you bought a trapper keeper, a pencil holder and a ream of three-hole punched paper and considered yourself prepared. My daughter is convinced her new teacher is “her favorite” and is counting the days to see her friends again. My son is still not in complete realization that he will be changing schools. He makes the transition to the elementary school setting this year and big days are ahead.
A few new clothes ease the transition between our summer vacation and brave new world. I can see and feel the excitement in them, laced with the nervousness that we all have during times of change. I observed some of the same this past week in the first Osteopathic manipulation lab I taught at Rocky Vista. The new first year medical students are getting to know each other, asking the usual, “Where did you go to undergrad?” Everyone is settling in. Nervous. Anticipating. Change abounding. Facing these transitions truly does require courage. Courage, “the ability to do something that frightens one” according to Google, or per Merriam Webster “mental or moral strength to venture, persevere and withstand danger, fear or difficulty.” Is courage mental and emotional? Is our ability to flex with change endogenous – natural and inborn? Do we learn to cope with change from our environment – how we observe those around us that teach by modeling? It is the age old question: Nature or Nurture? I am certain, it is a bit of both. Our neurotransmitters strongly influence how we respond to the stressors around us. In testing neurotransmitters over the past few years, a newer approach to holistic mental health, I see there are subtle, but real variations. Some have more of our calming neurotransmitters – serotonin, gaba. Too little of these players can cause a tendency toward depression or anxiety. Others have an excess in the excitatory neurotransmitters – glutamine, dopamine, norepinephrine and epinephrine. Too much of team excitatory puts your body always on edge, like fight or flight – ready to jump at any moment. Of course, there are many things that impact neurotransmitters from your parents to their parents, and their parents, etc. Traumas or joys of early childhood impact brain chemistry. Drugs, alcohol and even smoking can change things from a moment to moment basis, and even long term. And some of neurotransmitter balance is simply, “how you are.” Luckily, there are the things you can do to control how you feed into this system. Eating a diet high in health proteins and amino acids increasing the building blocks available for your nervous system. Sleeping adequately and with good quality has tremendous impact on your brain. Even breathing shifts our mental and emotional state. Meditation and exercise impact your mind. Being aware of “cognitive distortions” can help you figure out how to work with the neurotransmitter make up that you have at this moment, with this stress and in this situation. That is a skill that takes practice, but it can become stronger that even the genes you were given. Learning, modeling and teaching coping skills is essential if you are a parent. If you are a parent to no one other than yourself, understanding how you cope with stress remains and important. I often ask patients, “How do you cope with stress? What are your healthy and your unhealthy coping skills?” We all know that we have both. In times of stress and transition, how can you parent yourself to get outside and move your body instead of go home and distance the worries with wine or chocolate? Now there is a time and place for everything, so don’t give me a reputation for being that doctor that recommends against wine and chocolate. We all need anti-oxidants after all! We can learn from our children. We can watch them as they approach the new year with nervous excitement and calm courage. We can talk about healthy ways of working with being anxious to start new things, meet new people and push ourselves. We can acknowledge the bravery we see. We can remind our each other that it is normal to go into school with a belly of butterflies and a mind full of mixed emotions. This goes for moms and dads too! Here’s a few tips for all of us as we transition from the fun of summer to the discipline, structure and routine of fall.
Cheers to another school year. And to fall, the arrival of cool weather, the change of leaves and, of course, football… Dr Brie
Amrito Cross Spirit Coach, Yoga and Meditation teacher joins Dr Brie for Mindful Mondays this week from beautiful Lake Tahoe, CA. Watch our Facebook Live to learn:
Bringing mindfulness into the work life balance equation can help with day to day transitions from home to work and vice versa.
Watch our Mindful Monday Facebook Live to learn:
In honor of bike to work this Wednesday, June 27th, today for Mindful Mondays we are highlighting applying mindfulness to your exercise routine.
Join us for answers to the questions:
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The Breath
It is always with you. It is an easy tool to help harness your own physiology. Lets take a moment to practice working with breath intentionally. Watch Dr Brie's first Mindful Monday on Facebook and get a new technique you can use every day to bring mindfulness with you anywhere you go. Controlled breathing has been shown to:
For more information on the breathing technique used in this video visit Dr Weil's website here. Watch Now |
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April 2019
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