A Guide to Supplement Shopping

The subject of supplements comes up a lot with my patients and the brand you choose has a lot to do with whether or not it is going to work for you. There are some not great companies out there selling substandard product. Here's all the information you need to navigate this area of health. In this blog post we cover:

-How to distinguish quality products from inferior products.

-How to ensure safety in dosage and use.

-A few strategies you can use to maximize benefits.

-Some general recommendations

First: How to distinguish quality from inferior products:

In 1994 the FDA passed the DSHEA (Dietary Supplement Health and Education Act. It laid the responsibility for the products safety on the shoulders of the manufactures, and left as well the responsibility of screening and testing on the companies as well. As long as no one is watching, many companies would just as well not do the testing, or put out inferior products knowing there would be no repercussions for it. From he FDA website: 

“the dietary supplement or dietary ingredient manufacturer is responsible for ensuring that a dietary supplement or ingredient is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements.”

This means that it is up to use to police these supplements. There are a lot of ways that manufacturers can create inferior products. The first thing to understand is that there are a lot of possible ingredients in a supplement besides just the ingredient you are looking for. Let’s say your taking milk thistle for liver health. Well, there may be much more than just milk thistle in your supplement. Here’s a picture of the typical anatomy of a supplement:

As you can see there is much more going on here than just the main ingredient. In a lot of cases these other ingredients may be causing serious harm in your future, while you think you are taking care of your health. Here’s a look at some of the most dangerous additives to supplements:

Parabens: Common preservative material, have estrogen like activity in the body affecting both men and women:

-Methyparaben

-Ethylparaben

-Polyparaben

-Butylparaben

Pthalates: Used as a plasticizer. Estrogen like material that will stimulate our receptors. Resulting in infertility, sexual dysfunction, and increase risk of cancer.

-Benzylbutylpthalate

-Di2ethylhexylpthalate 

-Diisodecylpthalate

Notice that “paraben” or “pthalate” is only at the end of the ingredient name, without knowing this, you might well pass right over the ingredient name as you scan through.

Titanium Dioxide is another interesting additive. In it’s natural form it is pretty benign. But much of the titanium dioxide is in the form of superfine particles, or nanoparticles. These have been found to cause some pretty significant health issues. Here’s Christopher Chang from the May, 2010 issue of the “Journal of Autoimmunity.”

“Nanomedicine has already opened up a new avenue of research in cancer therapy, drug delivery, and immune regulation. While the benefits of this new science to human civilization are seemingly immeasurable, it is also important to appreciate that these particles can also lead to harmful effects on human health.”

-and again:

“Increased mutation frequency has also been described in cultured human lymphoblastoid cells exposed to ultrafine TiO2 particles. TiO2 nanoparticles have been shown to be cytotoxic in mouse fibroblast cells...”

And a paper out of the UCLA research laboratories found that titanium dioxide damages cells and the genetic level.

Artificial colors are another issue. Many studies have shown that artificial colors contribute to, or exacerbate the symptoms of autism, ADHD, and other behavioral disorders. The artificial colorings are usually found as either “lakes” or “dyes” the difference is that the lakes are the fat soluble forms of coloring and the dyes are those used for water soluble applications. Fat soluble toxins are more damaging than water soluble toxins, because they detoxify from our bodies differently and likely will be present for longer in our tissues that water soluble. If you have to chose between a product containing “lakes” and another containing “dyes,” I’d recommend the dyes. But there are many natural ingredients that can be used for color, including caramel, beet juice, and beta carotene, so in truth there is no need for any artificial dyes or colorings in our supplements.

Magnesium Stearate: is an excipient that is often added to supplements for a few reasons. First it provides bulking so that it can fill out a supplement to a larger size if that is something that makes taking the supplement more convenient. Second it is added to help lubricate the machines. As the tablets or powder moves through the processing and manufacture machinery it is likely to cause binding, slowing, or may stick to the machines. Magnesium stearate is a fatty acid (stearic acid) bound to magnesium and as a result it’s presence in supplements results in less physical friction in processing. In and of itself it is already present in our diet. However its presence does decrease the speed at which supplements break down, and if it is used in excess in supplements then it can decrease our absorption of the ingredients. My recommendation would be to consider it a necessary evil in some brands, and to not necessarily exclude a product by virtue of seeing magnesium stearate on the ingredients, but rather to look for where it appears on the ingredients. It should be a minor player. In unethical and poor quality manufacturing it may make up 50% or more of the weight of the product. It should appear near the end of the additional or inactive ingredients list. Here's some more information on this.

Allergens: are often present in supplements. Due to the relative freedom that supplement companies enjoy, the presence of things like corn, soy, and wheat may not be clearly stated on products containing them. If you have an issue with any of these, or other items I would recommend that you seek products that clearly state they do not contain these ingredients. You can also call the company and have them send you confirmation that these ingredients are safely absent (in writing or email), not just verbal confirmation. Some things to look for include:

Zein: a corn derived protein coating.

Gluten: even if it doesn’t say on the ingredients assume it’s there, unless it states that it is free of it.

Maltodextrin: a corn derived starch

Whey, Casein, and Lactose: dairy derived ingredients

Soy Lecithin: soy lecithin is typically extracted from soybean oil, rather than from the bean itself and is rarely allergenic, however it still can be in people who are especially sensitive. 

Dosage and Use

Supplements and herbs are capable of interacting with medications and their use should ideally be evaluated by an herbalist, naturopath or your acupuncturist. If you are on any of the following medications you are especially at risk for interactions. 

Serotonin modifying medications such as Zoloft, Prozac, Celexa, Lexapro, etc.

Highy protein bound drugs: Warfarin, Phenytoin, Carbamazepine, Valproic Acid, Valium.

Digoxin

Some supplements, such as PGX and Huang Lian Su may be used specifically to decrease absorption, and will interact with your absorption of many medications. Magnesium can interfere considerably with the amount of thyroid medication absorbed. There are a number of contraindicated herbal combinations in traditional chinese medicine because the actions cancel one another out. Such combinations include seaweed and licorice and ginseng and radish. This is another reason that it is best to consult with a trained herbalist or naturopath when selecting supplements. 

In general it is best to avoid supplements with long lists of ingredients. In that case there is often too little of each ingredient to have a significant benefit for your condition. If you have any adverse effects, you won’t know which ingredient you need to eliminate. 

If a little bit of a supplement is good, more is not necessarily better. There is often an ideal therapeutic dose, below which you won’t get results and above which you either won’t get results, or you’ll get adverse reactions. Vitamin C is a good example of this. Above a certain dosage the Vitamin C is no longer absorbed and will result in diarrhea instead. Another concern is that when you take in a supplement your body requires particular metabolic pathways in order to convert that supplement to a usable form for you, or as it works in your body you need to metabolize the byproducts of it’s actions. Above a certain dosage your body can’t keep up with the byproducts. Toxins buildup and instead of helping you, your supplement is slowly poisoning you. Stick to your dosage recommendations. 

Make sure you supplements have been independently analyzed by a third party. Any supplement company worth spending your money on will have their products independently analyzed by a third party. Because the FDA doesn’t do this, many companies realized the need to prove to their customers that their brands actually contain what they say they do. In order to do that they pay another company to come in and do quality analysis on their supplements. They ensure purity, potency, shelf stability, the lack of any contaminants, and the proper dissolubility of the products. Usually this will appear on the supplement. There are a few logos you can look for on your products to ensure that they are independently analyzed: 

USP stands for United States Pharmacopeia. It is a non-profit group that analyzes products and those that pass are able carry their logo on the product:

There are quite a few other companies as well, and just because a product you are looking at doesn’t carry the USP logo doesn’t mean it isn’t quality assured. You often need to call the company and request a copy of their certificate for the product you are getting. 

Maximize your benefit:

Water soluble vitamins get cleared out of the body faster, to maintain idea levels these need to be dosed multiple times per day. Examples include Vitamin C, B vitamins, and Choline.

Fat soluble supplements should bring more caution when it comes to pollutants and contaminants. Make sure that these especially are coming from reputable sources. Examples include: fish oil, flaxseed, CoQ10, Vitamin D, A, E, and K.

Minerals such as magnesium, iron, calcium and zinc are best absorbed with a small amount of an acidic material such as orange or tomato juice (this is especially true in the elderly who often have insufficient stomach acid production).

Phytates are naturally occurring molecules that plants use to store phosphorus. When these are consumed they bind to minerals in our diets, especially iron and zinc, but also magnesium and calcium and pull them out of solution (chelate) so that we cannot absorb them. Beans, tofu, grains, and nuts are some the largest sources of phytates in our diets. Taking mineral supplements with meals containing these molecules will significantly decrease the absorption of these minerals. (Also remember that a lot of grains and flours are enriched with these types of minerals, however they do us little practical good nutritionally because we can’t absorb them bound to phytates.)

Synthetic vs Natural: Vitamins are complex molecules and as such they possess the quality of "chirality". This means that they can exist in two mirror images configurations. When you look into the mirror you see yourself not identical to how people see you, but reversed, the same is true of chiral molecules. They can exist in what’s called a D or an L configuration. Identifying which is which involves shining light through a tube of the molecule and seeing which way it rotates the light. (I know, pretty far out huh?). When these molecules are being used by our bodies they are being plugged into enzymes and receptors. That means it matters which configuration they are in. In order to visualize this think about your two hands. They are chiral, in that they are mirror images of one another, that cannot be superimposed on one another. They look identical otherwise, but when you go to shake someone’s hand, if you have your right hand full and you go to shake their hand with your left hand, it doesn’t really match up and you have an awkward handshake, the right hands, or left hands however fit together nicely. Such is the case with the enzymes and receptors in your body. They are used to seeing molecules come in with a particular configuration, all of life has pretty much agreed that all amino acids are used in their L configuration and all sugars are used in their D configuration. When biological process create these molecules they are in their correct orientation. When the ingredients in your supplement come from natural sources they work well with the body. When they are synthesized in a laboratory they are made in equal parts D and L (in fact a good way to spot a synthetic supplement is to look at the ingredients and look for ingredients preceded by DL, such as DL alpha tocopherol). The part we can’t use needs to be excreted from the body, requiring biological energy that could be better used on making sure you are healthy and thriving. 

Here’s your take away: make sure your supplements are:

-All independently quality assured.

-Sourced from natural means rather than synthetic.

-Not interacting with your medications.

-Not chalk full of additives, binders, flavorings, and colorings.

-Taken in a way to maximize the benefits and minimize the harms.

My list of recommended supplements. Unless you are totally dialed in when it comes to diet, I think these are things you should be on to maintain optimal health. These are links to these supplements available from manufactures I trust and use for my own patients.

-Magnesium
Pure Encapsulations Magnesium - Citrate - 180 capsules
-Cod Liver Oil

Green Pastures - Blue Ice Fermented COD Liver Oil, Unflavored, 120 capsules
-Probiotics

Jarrow Formulas Jarro-dophilus EPS, 120 Capsules
-Vitamin D3

Metagenics, D3 5000, 120 Softgels

Thanks for reading!

How to make Bone Broth to Heal Joints, Digestion, and Improve Health.

I've recommended making bone broth to a number of my patients in the past. It's a fantastic source of nutrition for a lot of reasons that I'll get into in a moment. The problem is, I've had a lot of patients come back and tell me that either it was too much work to make, or it didn't taste very good and so they stopped doing it. I'm writing this post to try to make the process easier and make the final product more flavorful.

When made properly it's rich and flavorful. In classical french cuisine, bone broth is the first step in making the mother sauce known as Demi Glace. If you've eaten at a four star restaurant and ordered lamb, steak, or wild game chances are the sauce used on your plate started with a version of the recipe below. It's not only very good for you, it's also very, very tasty.

First, why is it so nutritious? Bone broth is rich in the amino acids proline and glycine. These amino acids are involved in various processes in the body, most importantly including the formation of collagen. These amino acids are linked together in long chains that ultimately become the collagen in your joints, the gut lining, your skin, and your hair as well as any wound healing that is occurring in the body. Proline and glycine are known as non-essential amino acids, meaning the body can make them out of other amino acids. In a normal state (not healing from an injury, without any chronic joint issues, and obtaining sufficient nutrition) the body does pretty good at making these two amino acids to meet demand. But in the case of people with injuries, gut issues, poor nutrition or very active lifestyles it is unlikely that enough of these amino acids are being made to fully meet demand. For these people it is important to get them from the diet. Bone broth is also rich in micronutrients such as calcium, magnesium, silica, chondroitin, and hyaluronic acid.

It's important to start with high quality ingredients: bone from traditionally raised animals. That means if it's cow bones you are using then they are grass fed, and organic. If you are using chicken bones the chickens should be free to graze, eating insects and foraging. There are many farms where you can get these "pastured" chickens. "Free range" or "cage free" does not necessarily mean that these chickens are out foraging. The important thing is that they are free to eat their traditional diet. If they do then they are packing their tissues with the nutrients that are best for them and for you, and not just with the limited nutrients that come in their feed. If you are using other bones such as fish, lamb, or game, again look for animals that are living as close to their natural life and diet as possible for the sake of your health (and their happiness). Look for the bones with lots of tendon and ligament attached. That will increase the amount of proline and glycine in the final product. Often these bones are labeled as dog bones. Don't be shy, those are usually the best ones. In my area we have a great local grocer, Central Market they have a lot of grass fed cow bones available. Look at your local store, or ask the butcher if you don't see them available. It's possible they just don't know the demand is there. Usually they are happy to find another item to sell to their customers.

Use organic vegetables as well, and the fresher the better. Clean, pure water from a well is ideal. If you are on city water then make sure you are filtering the water.

Here's the recipe:
Equipment:
-Large stock pot or crockpot
-Baking sheet pan
-Strainer

Ingredients:

-A pile of bones: 
4 or 5 large cow bones, a whole chicken carcass, or several fish heads and spines. There isn't an exact amount here. I keep a ziplock bag in the freezer and add bones to it as we eat then once I've accumulated enough I'll make another batch of bone broth. The amount of bones you use will depend on the size of your stock pot or crockpot.

-Mirepoix: 
Named for an 18th century French general, a mirepoix is a mixture of vegetables for making a flavorful stock. Traditionally this means onion, celery, and carrots. I use roughly equal parts each by volume. For one batch I typically use one large onion, one whole head of celery and 5 or 6 large carrots. In terms of volume I usually have about as large a pile of veggies as I have of bones.

-Tomato Paste (a small can)
-1 T grass fed butter, tallow, olive oil, ghee, or bacon fat
-Lots of cold pure water
-Various fresh herbs such as parsley, thyme, oregano, lavender, rosemary, a single bay leaf
-5 garlic cloves, eat cut in quarters
-A dozen or so peppercorns
-Dash Sea salt
-1/3 cup red wine
-1/8 cup vinegar (apple cider, or red wine vinegar)

Instructions:
1. Throw the bones on a baking sheet, slather them with a little bit of tomato paste and put them under the broiler. Broil till slightly browned, turning over periodically, usually about 20 minutes.
2. While the bones are broiling chop the veggies roughly into medium a dice.
3. In your large stock pot add the olive oil butter, tallow, bacon fat, ghee or other source of fat. Saute the veggies over low to medium heat for about 30 minutes, until they are all softened and taking on just a very slight caramelization. Be careful not to over brown them as they can impart a burnt flavor into the broth.
4. Add the red wine to the pot and deglaze the bottom. Allow the red wine to reduce down for a few minutes.
5. Add the bones to the pot and fill with as much water as it can safely hold.
6. Add all the remaining ingredients. There is no need to chop the herbs. The larger cut of the garlic keeps that flavor from becoming sharp and makes the garlic flavor more mellow. The vinegar is added to create a slight acidity that pulls some of the other nutrients (like magnesium and calcium) out of the bones.
7. Simmer over a low heat for 8-24 hours until it has reduced down to about 1/3 its original volume.
8. Taste it periodically. Adjust the flavor as needed with some salt, pepper, or more herbs. When its flavor is sufficiently concentrated for your taste it's done. You know that you did a really good job if when you put a small cup of it in the fridge it comes out set, like jello.
9. Strain out the veggies and bones. Store the broth in (glass) jars in the fridge and freezer. As I strain the broth out I reserve the pieces of meat and tendon that have been softened for so many hours of cooking. They go great into soups. Sometimes I'll just eat them straight, or add them to a bolognese.

To warm the broth you can pour a 1/4 cup into a coffee cup and set the cup into an inch or so of water in a pot on the stove and warm it on low. I prefer not to microwave my broth. Ideally this broth should be consumed twice daily for those healing, resting gut integrity or in the case of post partum women. In the rest of us, just trying to stay as healthy as possible, I'd recommend it daily or every other day.

For more information take a look at Mark's Daily Apple, he wrote a great segment on Bone broth a while back.

The basics of healthy diet choices: Eat close to the ground.

Some subjects are just plain contentious; rife with conflict, prone to disagreement and likely to result in argument. Religion, and politics for example are two things you tend to try to steer away from at the Thanksgiving table. I'd add a third to that list: diet. There are many different approaches to diet: low fat, high fat, low carb, vegetarian, paleo, high protein, vegan, macrobiotic and so on. The proponents of each pontificate on the virtues of their diet, and hold firm that theirs is the one true healthy diet, and all the rest are sure to result in ruinous disastrous health.

The idea that there is any one true and only healthy diet is an obviously ridiculous concept. It is pretty clearly disproved by looking around the world at our few remaining indigenous cultures. Groups of isolated peoples that continue to eat their traditional foods remain free of the sort of disease that are becoming rampant in today's society. Yet each of these cultures eat wildly different diets. Some, like the Masai tribe of Eastern Africa consume more than 50% of their calories from saturated fat, yet are rail thin and have much lower rates of heart disease than we do. Other indigenous cultures, such as the Kitavans in the Pacific islands consume more than 70% of their calories from carbohydrates, yet have no problem with diabetes or obesity. As we go through the list of remaining authentic indigenous cultures we see diets all over the board, with varying amounts of carbohydrates, protein and fat, yet despite their differences, they all have similarly low levels of disease and low BMIs.

All of these cultures do have one thing in common: the fact that their foods are procured and prepared without the tools of industrialized society. A phrase I have adopted to describe this is that they eat "close to the ground." When we walk into the store in our country and examine our food options many of them are several steps removed from their initial sources. They may have many ingredients and each of those ingredients likely passed through numerous steps of processing before finally being combined together into a "food product." The more removed from its natural state a food is the more of a mismatch it is with our physiology and ultimately the more problematic it is for our health.

This model of evaluating food choices takes a more realistic view of the health value of different food choices. For a lot of diets, food choices are very black and white. For instance with the paleo diet a food is either allowed or it isn't. With vegetarian diets the division is even more black and white. But few things in life, and even fewer things in biology are that black and white. Rather foods exist on a spectrum from healthy to unhealthy. When you evaluate a food choice, consider how far from the ground it is, ie, how many steps removed it is from it's natural state and you can take that into consideration as you prepare your meals. A few grains, or bread products within an otherwise unprocessed diet can be acceptable. On the other hand, eating a strict diet based on dogmatic following of a fad diet is not only unnecessary, in some cases it may even result in poorer health outcomes.

Our diet guide, "The Essential Health Diet*," is built on this premise that foods can be placed on a spectrum from healthy to not so healthy. It offers three basic tiers for addressing different levels of health or goals. You can choose a level that is right for you and your current health state. This becomes your core diet. In addition to those foods, additional food recommendations may be added to personalize the diet for your personal health goals or challenges. But the plan itself is very flexible, there are no calorie restrictions and you don't need to count calories. Rather foods are grouped into different levels of health value and servings are chosen in amounts based on the health of those foods. It keeps you accountable to eating in moderation, without chaining you to a strict dogmatic diet that is impossible to stick to, or too difficult to cook for.


*The Essential Health Diet is available to current patients at no additional charge and includes a 30 minute nutritional counseling session.  

How does acupuncture work?

Despite being one of the fastest growing medical modalities in the western world, the medical system of acupuncture remains surrounded by a certain mystic. That's understandable given that it originated in a culture and belief system very different from our own. However, acupuncture is a very logical and organized practice. A practitioner takes clear, logical steps to identify the cause of illness in a patient and then similarly follows established logical steps in selecting of the points for treatment. If you have a clear understanding of how an acupuncturist diagnoses illness and decides on a treatment a lot of the mystic and skepticism about acupuncture may prove unwarranted.

Over the past several thousand years this system of medicine has been developed mainly through clinical experience. That means treating patient after patient and watching the results. The points have been mapped on the body and their functions established and elaborated on through thousands of medical texts written by acclaimed doctors over the centuries. Over time the number of identified points grew to what we have today, over two thousand specific acupuncture points on the body.

"Point" is the word that is most accepted in the west to describe these locations on the body, however the actual Chinese character, 腧穴, "shu xue" actually translates to "flowing hole." This is a powerful concept. Think of walking along an iced over river, and periodically there are holes through the ice where the water flowing underneath is exposed. This is the concept of shu xue. Acupuncture points are holes where you can exert influence on the regulation functions in the body. Each of these different points have specific functions inside the body. For instance there is a point on the shin, Zu San Li, that we know increases the rate of digestion. It moves the contents of our stomachs through the intestines more quickly. It also increases gastric acid secretion, treats infections in the breast, reduces abdominal pain, treats pain in the knee, and increases energy.

If it sounds to you like that's a lot for a single point to do, you're right, and that's typical for acupuncture points. Each single point has multiple functions in the body. Knowing that, now imagine seeing an acupuncturist for low back pain. With two thousand points on the body and each point having multiple functions, you may imagine there are a lot of possible points for your complaint, and you'd be right. There are a few dozen points just in the region where you are having pain. There are also several dozen points on the arms, legs, hands, feet, ears and scalp that can treat low back pain. All told, there are maybe 100 different points on the body that can be used to treat the pain in your low back. Fortunately for you, you do not have to put needles in all of these points to effectively treat your back pain. In fact several of these points won't have any effect for you, because they aren't the right points for your back pain. (because not just every type of back pain, but also every type of patient is different.) In order to figure out which points will be effective for you, your acupuncturist needs to investigate deeper. They may ask you a lot of questions about your pain: when does it occur, what sort of pain is it, is it better with heat or cold, is it worse with stress, or activity, or rest, and so on. They'll do a physical exam, just like your doctor does, to identify the structures involved-discs, muscles, nerves, bones. They also need to understand the context in which your back pain is occurring. That means they need to understand you and your health. They will set aside your chief complaint for a moment and ask questions ranging your entire life, even your family history, different illnesses, the various functions of your body outside of your back pain-digestion, skin, sleep, emotions, thirst, and so on. Those questions are all vitally important as they create a richly textured understanding of the context in which your symptoms occur, the landscape against which your symptoms are presenting. Once that rich texture has been created the acupuncturist returns to those hundred or so points for your back pain, and out of those points identifies which points also treat all the other areas of your health that appeared through the course of your conversation. Those are the points, or "flowing holes" that are active in your case, and where they will be able to influence your health and restore function and comfort. Because Chinese Medicine is a truly holistic medicine, it doesn't necessarily just treat your back pain. What it does is treat your back pain within the context of you as a whole person.

Safe, honest health information for the public.

Welcome to our first post!

The Healing Jones blog is a resource for our patients to get access to deeper explanations of what we talk about in the clinic. There are a lot of subjects where it just isn't possible to give the full story on different lifestyle suggestions, diet recommendations, and current health information.

This blog serves as a venue to direct patients to in order to facilitate the education that must come if health is to truly transform.

We look forward to sharing our constant exploration of good health choices with you. Here are a few subjects that we are looking to cover in the next few weeks.
-How acupuncture works.
-The basics of good diet choices.
-How to get perfect sleep every night.
-How to pick a good supplement.
-Avoiding toxins in a chemical laden environment.
-How to support your liver.
...and more.

Keep an eye out, and better yet, make yourself a follower of this blog to get updates when new information is posted!

As always, if you are looking for an appointment there are multiple locations available, and multiple times. See our website for more information.

www.healingjones.com