Low Back Pain

You bend over to pick something up off the floor and suddenly feel a sharp pain in the low back.

You have a piece of furniture that REALLY belongs in the other corner of the room but you’re home alone.  It’s not that big, right?  I can move it myself.

You get home from work after 8 hours on your feet and think “I have to do something about my back.  I can’t handle another shift like that, the pain is too much.”

Do you have low back pain?  If so, you’re not alone.  Low back pain is one of the most common problems family doctors see.  From weekend warriors overdoing it at the gym, to sports injuries, to shoveling snow and pulling weeds and moving furniture, there are many ways to injure your back.

In fact, I’m having some trouble with MY low back this weekend!  Since yesterday afternoon I’ve had a sharp, aching pain in my right low back.  Standing up from sitting, rolling over in bed, picking things up off the floor and putting on my shoes have been an adventure today :-/

The most common cause of low back pain is a musculoskeletal injury.  For instance, you might slip on the ice and land on your back.  You also might lift something heavy or twist while carrying a baby. (That’s how I herniated a disc in my back over 10 years ago, bent over and twisted while putting my son in his crib.)

If you have low back pain, what do you do?  Well, of course the first thing to do is to see the doctor, especially if your pain is more than a simple “I overdid it” that goes away in a few days.  The doctor will ask questions about your pain, examine you, and may order tests and prescribe medicine to help you feel better.

When I see a patient with musculoskeletal back pain the first thing I do is to send them to physical therapy.  Most cases of low back pain are caused by two things: mechanical imbalance in the spine, and weak core support.  The therapists will help figure out what the patient is doing that might be making back pain worse (like bending and lifting improperly), teach strengthening exercises to address core weakness, and add treatments to relieve pain like traction, electrostim or ultrasound.

As I discussed in a previous post, chiropractic therapy is very helpful for low back pain as well.  Often manual therapy like massage and osteopathic or chiropractic adjustment can improve or relieve back pain very quickly.

If physical therapy and manual therapy don’t relieve symptoms in a few weeks we may discuss imaging like an Xray or MRI.  More serious problems may be present that need specialist care like injections or even surgery.

What are some of the danger signs that suggest low back pain is an urgent problem?  If you are having trouble emptying your bladder or controlling the bowels you need to see the doctor right away.  So-called “saddle anesthesia” which is numbness in the area between the legs (the part of you that would touch the saddle when riding horseback) may indicate damage to the spinal cord and should be checked out immediately.  Also, if you have a personal history of cancer then back pain could be a sign of a recurrence and should be reported to your doctor right away.

There are a few supplements that are helpful with musculoskeletal back pain.  Magnesium helps to relax muscles and can decrease pain from spasm.  Fish oil is helpful for painful conditions of all sorts, but you have to take a lot of it, as I wrote in a previous post.  Turmeric has anti-inflammatory properties.  (This is not an all-inclusive list, of course.)

Millions of people suffer with back pain every year.  Luckily most of the time it goes away without too much muss or fuss, with some simple strengthening exercises and pain-relieving medicines.  Most patients also benefit from some education on how to take good care of their back so the pain doesn’t come back.

Low back pain doesn’t have to take over your life!  It takes some time, work and patience, but straightening out the problems with your back is so worth the effort!

QUESTION: Do you have low back pain?  What have you found that helps?

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Multivitamin Benefits: Are They Good For You?

What do YOU think?

Anyone who knows me knows what my opinion is, but it’s been awhile since I sat down to review what the scientific research says about multivitamin benefits.

Many people believe that if they just eat healthy they will get all the nutrition they need.  Worse, health professionals like doctors and dietitians perpetuate this myth.  The research is very clear that people do NOT get all the nutrition they need from the food they eat.  Whether or not they SHOULD, they DON’T.

So if people are going around deficient in one or more nutrient every day, does supplementation help?  Can you get the nutrition you need from pills?

vitaminbottlesIn a word, no.  You can’t get all the nutrition you need from pills.  You need to eat healthy.  This is basically because we need to know that you need a nutrient before we can put it into a pill.  And whole-foods supplements (where they basically juice a food and dehydrate it and package what’s left into a pill) aren’t adequate because you’d have to take huge numbers of pills daily in order to get the content of a single piece of fruit or a vegetable.  You still need to eat healthy balanced meals and sensible portions of food.

So what’s a person to do?  The short answer is to eat healthy AND take a high-quality supplement.  I did a literature review and here are five studies from the 1980s to today.

1.  In 1985, a study was published examining blood nutrient levels in female college students living on-campus and eating a diet specifically designed for them by the college dietician.  These young women’s blood nutrient levels were significantly improved by taking a multivitamin.

2.  A study of healthy adults over age 60 showed that those who took a multivitamin-mineral supplement spent one-third as many days sick with infection-related illness as those who did not take the supplement.  (My friend Amanda knows this is true.  Her kids don’t share nearly as many colds with her since she started taking Shaklee supplements!)

3.  Calcium and vitamin D supplementation have been shown to decrease the rate of bone loss in postmenopausal women (many studies demonstrate this).

4.  Use of an herbal supplement (marketed by the Shaklee Corporation under the trade name NutriFeron) was associated with  significantly decreased menopausal symptoms, systolic and diastolic blood pressure, and plasma triglycerides and LDL-cholesterol.  Researchers also found lower plasma hepatitis C viral levels in patients with chronic active hepatitis C and improved symptoms as well in study participants who used NutriFeron.

5.  Long-term users of a number of supplements produced by the Shaklee Corporation were shown to have lower blood pressure, better cholesterol profiles, lower levels of certain inflammatory markers, lower risk of diabetes and were more likely to rate their health as “good” or “excellent.”  Here is the study link.

There are many more studies I can cite, but I think you’ll agree that the evidence is clear that taking a carefully designed program of supplements including a high-quality multivitamin is an important ingredient in a healthy lifestyle.

I should add that all the research I discussed above was supported and published by Shaklee.  There are over 100 research studies published in peer-reviewed journals supported by Shaklee, which you can check out at the Shaklee Health Resource.  How many studies has your supplement company published?

If you’d like more information about what supplements would be appropriate for you, please fill out a HealthPrint assessment or email me at drjen@jenniferwurstmd.com.

Question:  Do you take a multivitamin?  Do you think it makes you healthier?

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Fish Oil Is Good For Body And Mind

What if I told you there was a supplement that has proven to be good for your heart, your mind, your brain, your immune system, your joints, your digestive system AND improves women’s health?  There is!

It’s fish oil.  Yep, the lowly fish oil capsule can help ALL these parts of your body.

As you know, I’m very interested in nutrition and supplementation and their role in health.  It’s been fascinating to read research supporting the role of fish oil in general health.

I’m beginning to think EVERYONE from birth to death should take fish oil.

First let’s talk about all the physical and mental benefits of fish oil supplementation.  I’ll try to be brief!

HEART HEALTH

  • Reduces the risk of atrial fibrillation after heart attack
  • Reduces blood pressure
  • Eliminates aspirin resistance
  • Helps keep grafts open after bypass surgery
  • Decreases triglyceride levels
  • Improves heart function and decreases hospitalizations in heart failure patients
  • Inconclusive evidence about preventing both first and subsequent heart attacks

MENTAL HEALTH

  • Reduces anxiety symptoms by 20%
  • Prolongs remission and decreases depression symptoms in patients with bipolar disorder
  • Decreases depression symptoms and aggression in patients with borderline personality disorder
  • Decreases symptoms and promotes remission in major depression
  • Decreases psychotic symptoms in schizophrenia

BRAIN HEALTH

  • Improves cognition and behavior in children with developmental disorders
  • Inconsistent benefit in Alzheimer’s patients (some studies show benefit, some don’t)

IMMUNE RESPONSE / PAIN

  • Decreases pain and stiffness in rheumatoid arthritis
  • Decreases symptoms in systemic lupus
  • Decreases pain and the need for pain medication in patients with nonsurgical neck and back pain
  • Decreases need for rescue inhaler in exercise-induced asthma

DIABETES

  • Decreases risk of type I diabetes in children
  • Decreases insulin resistance in type II diabetes

WOMEN’S HEALTH

  • Significantly reduces menstrual symptoms in women
  • Reduces the frequency of menopausal hot flushes (but not their severity, unfortunately)
  • Decreases testosterone levels in women with PCOS
  • Decreases the rate of preterm birth when used in pregnancy

Wow, fish oil is good for such a long list of conditions and problems!  So how much fish oil is the right amount?  It depends on why you’re taking it, and what your diet is like.

In the USA we eat a LOT of omega-6 fatty acids.  They are found in nearly every oil used in cooking.  Omega-3 fatty acids are harder to get.  They are in flaxseeds, hemp seeds, purslane and walnuts as well as in fatty fish.

The best and safest sources of fish oil are small oily fish (like anchovies, sardines and herring) found low down on the food chain.  Fish high on the food chain (like tuna, mackerel and shark) tend to store up toxins from fish they’ve eaten, a phenomenon called bioaccumulation.

Recommended dosages vary based on why you’re taking it.  For general health purposes it’s reasonable to take 500-1000 mg daily.  Those with heart or vascular disease (including high cholesterol) should consider 1-3 gm daily.  Much higher doses are needed for those with autoimmune disease, neurological or psychiatric problems, or chronic pain.  A therapeutic trial of 5-10 gm daily is reasonable for these conditions.

Be careful which fish oil products you buy, some are not labeled accurately according to a review I found at ConsumerLab.com.  (I subscribe to this website because it gives me third-party testing results for all sorts of supplements.)

Want to know what fish oil my family and I take?  (Bet you can guess, if you’ve been reading this blog for awhile.)

OmegaGuard from the Shaklee Corporation is ultrapurified fish oil made from sardines.  Two capsules gives 1200 mg fish oil, free of mercury and other contaminants.

And no fish burps!  Yay!

Here’s a link to more information about OmegaGuard.  You can order it through this link.

QUESTION:  I was surprised to learn that fish oil was so effective in controlling chronic pain.  Was there one use for fish oil that surprised you?

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Reduce Colds And Flu With Vitamin D

How many colds and bouts of bronchitis do you have in any given winter?  Two?  Three?  Or are you one of those people who gets over one cold just to come down with the next?

Are you envious of those who don’t ever seem to get sick?  What if I told you the difference could be in your blood?  AND that it’s something EASY to change?

Turns out taking a vitamin D supplement reduces the risk of acute respiratory infections!  I’ve written about vitamin D before.  This nutrient has a lot of health benefits that we’re just starting to understand.  It helps keep bones strong.  It has mental health benefits.  Vitamin D levels are linked to the risk for multiple sclerosis.  We really don’t understand everything about how vitamin D works.

Credit: https://www.humnutrition.com/

Researchers in the UK wanted to know if there was a link between vitamin D levels and risk of colds and flu.  Specifically, they wanted to know if vitamin D supplements helped prevent respiratory infections.

Last year their study was published in the British Medical Journal.  They analyzed 25 other papers involving over 11,000 people to see if there was evidence that vitamin D supplements protect against respiratory infection.

They found that people who took vitamin D supplements did have a lower risk of acute respiratory infection, but the effect was pretty modest.  Overall, those who took vitamin D supplements had a 40.3% risk of acute respiratory infection, while those who didn’t had a 42.2% risk.  That means you have to treat 53 people to keep one person URI-free.  (The rest either would have been URI free without the supplement, or would have still gotten respiratory infections in spite of the supplement.)

Not a big effect, right?  Well let’s look deeper, OK?  The authors looked at those who were deficient to begin with, having a blood level less than 25 nmol/L, and found that with supplementation the risk dropped from 55% to 40.5%.  Your number needed to treat dropped from 53 to 7!

The authors also wanted to know if it mattered how you took your vitamin D.  In Europe apparently it’s common to give a huge dose (>30,000 IU) every once in awhile, called bolus dosing.  In the US we usually dose daily or weekly instead.

The study found that bolus dosing was NOT effective, and if you just looked at the studies that gave the vitamin D supplements on a daily or weekly schedule the effect was quite dramatic.

Those who started with low vitamin D levels saw their risk of upper respiratory infections drop from 59.8% to 31.5%.  (NNT=3.5)  That is a huge impact!  The fact that correcting deficiency had such a big effect is good evidence that this is real and not just statistical fancy footwork or a coincidence.

They also found a big drop, 46.2% to 33.6%, in children aged 1-16 years who were supplemented with vitamin D.  (NNT=8)  Since kids in school are exposed to germs all the time, this reduction is very important.

How can we use this information?  If you live in northern Ohio (or anywhere north of 40 degrees north latitude) you ARE vitamin D deficient unless you are taking a supplement.  So everyone in Cleveland needs to take a supplement all year ’round.  You also should have your levels checked periodically by your doctor or health practitioner to make sure you’re taking enough of a supplement, because some people need more than others.

I prefer to have my patients take their vitamin D every day rather than once per week.  It is easier to remember to take something every day, just make it part of your morning routine.  The best dose I’ve found is 2000-3000 units daily.  What is in your multivitamin is NOT enough.

While taking a vitamin D supplement is helpful, there’s more to staying healthy and warding off colds and flu than taking vitamins.  Make sure you’re washing your hands regularly.  Drink plenty of fresh clean water, get enough sleep, and watch your stress levels.  Stress depresses the immune system so if you’re feeling overwhelmed make sure to beef up your self-care routine!

If you’re wondering how to get enough vitamin D, please check out Shaklee’s Vita D3.  It’s an inexpensive way to add insurance for heart, bone AND immune health!  If you’re not already a Shaklee family member, why not click this link to get your personalized health assessment?  There’s no cost and no commitment, just individual recommendations for diet and lifestyle changes (and smart supplementation of course) to meet your health goals.

I have so many friends and patients suffering cold after cold this winter.  Now you have one more tool in the toolbox to keep you well!

QUESTION: Do you take vitamin D every day?

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Preventing Falls And Fractures

With the Snowpocalypse on its way this weekend I’ve been thinking about the rash of injuries that result from snow and ice every winter. Wrist fractures, back injuries, and the dreaded hip fracture happen when older adults slip and fall on snow and ice. What are some ways we have of preventing falls?

It’s obvious that preventing falls is much better than treating injuries when they happen. About 20% of hip fracture patients won’t leave the nursing home afterwards. Prevention strategies can be broadly divided into two categories: environmental measures and personal factors.

Environmental Measures

What can we do to make the environment safer and prevent falls? Snow removal and preventing the formation of ice (where possible) are obvious steps to take. Less obvious are installing railings on stairs, improving lighting, and placing awnings to prevent accumulation of snow and ice on landings and access points.

Personal Factors

Let’s face it, we live in northern Ohio. Snow and ice happen for about half the year. We can’t avoid it altogether and we can’t remove it all. So improving each person’s ability to avoid falls and avoid injury if they DO fall is critically important.

If you’re faced with ice and more snow than you’re comfortable with, stay home if possible. If you must go out, keeping one hand on something stable like a railing is smart when navigating stairs or other risky places. Using a cane if you have one can help.

Exercise, particularly Tai Chi, has been shown to reduce the risk of falls in senior adults. Better body awareness, better muscle strength and tone, and better balance are some of the benefits offered by regular exercise and Tai Chi in particular.

For the more adventurous, martial arts like jiu jitsu teach the student how to fall safely and reduce the risk of injuries in a fall. I myself have avoided serious injury in a fall not long ago, due to my training.

If you’re a woman over 60, make sure you’ve had a bone density (DEXA) test. This is a simple Xray that measures the strength of your bones. Using your bone density and other risk factors like age, gender and medical history, your doctor can estimate your fracture risk. If your fracture risk is high, you should discuss with your doctor what you can do to reduce your risk.

One important thing to do to keep your bones strong is to take vitamin D and a bone health supplement daily. Here in northern Ohio adults need 2000-3000 units of vitamin D every day, all year around. A lot of doctors tell patients to take calcium but bones need calcium, magnesium and vitamin D to be healthy. I recommend Shaklee’s OsteoMatrix which provides SMALL coated caplets proven to be well absorbed to support bone health.

Avoiding falls and avoiding injury from falls is very important. First, you have to stay on your feet. If a fall does happen, being able to fall safely and having strong bones to prevent fractures is critical.

QUESTION: Are you afraid of falls? What do you do to avoid them and stay safe?

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Just What Are Supplements FOR?

My new student and I were talking in the office the other day.  She was surprised (and all my students are, actually) at how often I talk to patients about nutrition.  Usually without my patients really WANTING to hear my opinions about nutrition, LOL!

So we got to talking about the question, “What are supplements for?”  This is something I don’t think I’ve ever put in so many words before.

We know our diets stink.  People eat too much meat, too much junk food, too much sugar.  We don’t get enough whole fresh foods.  Even if we did get all our servings of fruits and veggies (and I try really hard) our foods aren’t as nutritious as they were in the past.

This decrease in the nutrition content of food is generally because of changes in farming practices and because we tend to get our food from far away.  We get peaches from Chile instead of from Georgia.  We get apples from Washington State instead of from local orchards.  And we want to eat apples in June when they haven’t been harvested in over 6 months.

So one of the main reasons I advocate supplementation is to make up for gaps in our diet.  A good quality, comprehensive multivitamin (and yes, Shaklee’s Vita Lea is the best on the market, the one I use and recommend) goes a long way to filling in for days when our diets aren’t the best, or when the food we eat has lost nutrition due to storage and processing.

Other than a multivitamin, what other supplements do we take to make up gaps in our diet?  People under stress tend to use up the B vitamins more quickly.  People who suffer with migraines tend to have gene mutations which make them need more B vitamins.  More than half of us don’t get enough magnesium in the diet.  We eat way too much omega 6 oil, so omega 3 fats from fish oil supplements can help correct that.  And of course nearly everyone needs a vitamin D supplement especially in winter.

These supplements as mentioned above are used from a Functional Medicine approach.  This means we give the body what it needs to function properly, and avoid poisoning it!  Supplements used in this way are generally very safe, and very few side effects.

Giving the body what it needs doesn’t just refer to food.  This includes fresh clean water, plenty of rest and quality sleep.  Practicing our faith and getting fresh air and sunshine, exercise, and time with those we love are “nutrients” as well.  The word “nutrient” comes from the same root as “nurture.”  When we nourish ourselves properly we will be healthier!

And poisons or toxins include pesticides, alcohol and excess sugar but can also include excess stress.  Negative self-talk is toxic.  Smoking, recreational drugs and artificial food ingredients are other examples of things we should avoid in order for our bodies, minds and spirits to be as healthy as possible.

How else can supplements be used?  Supplements can also be used as drugs.  Some examples are St. John’s wort for depression, milk thistle for liver disorders, and red yeast rice for high cholesterol.  These supplements are considered botanical drugs.  They have risks just like pharmaceutical drugs do.  The risks tend to be lower, but the effectiveness is lower as well.  Some supplements can be used either way.  For instance, magnesium in high doses is a very effective laxative and is used for bowel prep before colonoscopy.

How can you tell the difference between a supplement used for a functional medicine purpose and one used as a drug?  It’s pretty simple actually.  Is the nutrient or supplement found in food, and can one be deficient in it?  One can be deficient in magnesium, but there’s no such thing as a milk thistle or St. John’s wort deficiency.

I’d like to use a very current controversy to illustrate the difference.  Right now there are a lot of supplement companies starting to market krill oil as a “better fish oil.”  Early research suggests that the main omega 3 fatty acids in both krill oil and fish oil are better absorbed from krill oil and may influence cholesterol and glucose metabolism in favorable ways when compared to fish oil.

The problem is that krill isn’t food for humans.  We have little or no idea what a safe dose of krill oil would be, or what the long-term effect may be.  There are no studies showing how krill oil supplements affect heart risk or any other health risk in humans.  Fish oil supplements are generally made from edible fish like sardines, tuna or salmon.

So fish oil is a functional medicine supplement, made from a human food that most of us don’t get enough of to balance out the oodles of omega-6 fatty acids in our diets.  Krill oil is not a human food, containing a form of omega-3 fatty acids not clearly understood.  I would therefore classify krill oil as a drug, one that’s not well understood.  Certainly not well enough to recommend regular use.

Before someone recommends a supplement to you, think to yourself whether that supplement is meant to fill a gap in your diet and provide nutrients your body needs to function well.  If not, it is a drug.  Make sure you understand the risks and benefits, because there are always risks with drugs, whether they come from nature or from a factory.  Often the ones that come from the factory are safer because they’re better understood and better studied.

QUESTION: Have you ever thought before about the question “What are supplements for?”  What do you think now?

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The Danger Of Adulterated Supplements

When swimmer Jessica Hardy set two world records in 2008 and was getting ready to compete in the Olympics in Beijing, she had no idea her world was about to come crashing down.  She tested positive for a banned substance right before the Olympics.

Turns out she had taken adulterated supplements that contained the banned substance, undisclosed by the supplement company.  Because she was able to prove the supplement she took contained the substance, her suspension was reduced to one year instead of two.  Still, she missed the Beijing Olympics.

Given the danger of adulteration, why would ANYONE risk taking supplements?  In the United States the supplement industry is only lightly regulated so companies are free to make all sorts of outlandish claims about their products.  My personal feeling is that people are so desperate for a “quick fix” they’re susceptible to too-good-to-be-true product claims for weight loss and other problems.

A report was recently published in JAMA about adulterated supplements.  Turns out almost 800 supplements have been found to have drugs in them, including sildenafil (Viagra), sibutramine (Meridia) and anabolic steroids.  The adulterated supplements are most often marketed for – unsurprisingly – sexual enhancement, weight loss and muscle building.  You can access the database yourself here at the FDA website.

Whether you’re an Olympic swimmer like Jessica Hardy, a world-class wrestler like Narsingh Yadav or Vinod Kumar, or a runner looking to PR your next half marathon, SHOULD you use nutritional supplements?  Which ones should you choose?

If you’ve been following my blog for awhile you probably know my answers to these questions 😉  Good nutrition improves athletic performance, that much is very clear.  And supplements are an efficient way to make sure the body’s nutritional needs (for vitamins, minerals, electrolytes, carbohydrates and protein) are optimally met.

So given this information, taking supplements make sense.  But before choosing a nutritional supplement, you have to ask yourself some questions.  If you have access to a representative for the company (especially if it’s a direct sales company) here are some good questions to get answered.

  • Does the company sponsor Olympic athletes?  How many medals have the sponsored athletes won?  If there are no Olympic athletes, do they sponsor athletes competing in “clean” events – i.e. subject to drug testing?  If not, steer clear.  Many sports supplements have disclaimers in the product literature stating they are not meant for athletes subject to drug testing.  Don’t take those!
  • What research has been done with the company’s products?  Ask to see the publications.  Are they peer reviewed?  You can search in the NIH’s research database to see if it’s a “legit” research article or not.
  • What are the company’s quality procedures?  Is there a money-back guarantee?  How are recalls handled?  Who do you call with a problem?

Ultimately, with supplements the reality in the United States is “let the buyer beware.”  Customers are responsible for doing their own research because the industry isn’t well regulated.  If the product is advertised to produce results that seem too good to be true, they probably are.  Do NOT buy products advertised to improve sexual performance.  No supplement has ever been shown effective for that problem – only pharmaceuticals work.

If you aren’t aware of the company I chose to partner with, I have easy and transparent answers to these questions.

  • Yes, Shaklee sponsors Olympic athletes.  We have nearly 100 athletes and a total of 144 medals to our team’s credit.  That’s a lot of hard work (and a lot of supplements)!  Learn more about the Shaklee Pure Performance Team at this link.  No athlete ever has, or ever will, fail a drug test due to a Shaklee product.
  • Over 100 publications is a LOT of science to Shaklee’s credit.  Published in respected journals like Nutrition, Journal of Clinical Endocrinology and Metabolism, and Journal of Gastroenterology.  You can check out research Shaklee has sponsored about athletic performance, weight management, blood sugar support and other topics at this link.
  • Every lot of raw materials is tested for 350 different contaminants like pesticides, molds, heavy metals and other toxins before it is accepted to make Shaklee products.  Shaklee is BETTER than organic, since organic products can still become contaminated in many ways.  In addition, over 100,000 quality tests are done every year on finished products before they head out to customers.  Shaklee has never had a recall.  They don’t need to!  And if you have a problem, everything is guaranteed, even if you just don’t like a flavor.  You call me, or your distributor if it’s not me, and it gets fixed.  Period.

Again and again, we see in the news reports that supplements aren’t safe, that supplements don’t work, that supplements are at best a waste of money or at worst dangerous to your health.  This isn’t true.  Nutritional supplements are a vital part of supporting health and optimizing outcomes for athletes as well as for the rest of us.  It’s just important to make sure you know what you’re buying!

QUESTION:  Do you take supplements?  Why or why not?  Is this information surprising to you?

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Wound Healing And Nutrition

One of the most devastating complications of diabetes is chronic nonhealing foot wounds.  I’ve had many patients in the hospital for chronic wounds that become infected.  Unfortunately many of them are unable to heal their wounds and wind up with partial or complete amputations of their foot and lower leg.

Diabetics and other chronically ill older patients often have diets that aren’t healthy.  They don’t get enough healthy fats, protein and micronutrients from the food they eat.  These problems contribute to ill health and complications like poor wound healing.

Vitamin deficiencies are more common in older adults, especially those who don’t have a varied, healthy diet.  Inadequate intake, decreased absorption and use of medications  are among the causes of nutrient deficiencies.  Protein, vitamin D, folic acid, vitamin B12 and water are examples of nutrients that older adults may not get in adequate amounts.

In the case of diabetics, elevated levels of blood sugar over time result in the formation of advanced glycation end products (AGEs) which damage proteins and increase levels of inflammation in the cells and tissues.  This is one of the main ways diabetes contributes to end organ damage in just about every organ in the body.  AGEs are thought to contribute to a number of diseases, from Alzheimer’s disease to end stage kidney failure to cataracts to atherosclerotic cardiovascular disease.

If someone develops a chronic wound, what nutrients are needed to help in healing?  Protein, carbohydrate, fat, vitamins and minerals are all needed.  The best sources of these nutrients come from a healthy balanced diet of course.  However, studies have shown that 95% of Americans are not getting enough of one or more vitamins or minerals in their diet.  Especially if someone is trying to heal a wound, getting enough nutrients is critical and the patient likely will benefit from a supplement.

Protein

People who are sick or have a wound to heal need extra protein.  Estimates are that such people need about 1.5 grams per kilogram of body weight.  So a woman who weighs 70 kg (155 pounds) would need about 105 grams of protein per day.  One ounce of animal flesh (beef, poultry, pork or fish), one cup of dairy milk or one ounce of cheese contains about 8 grams protein.  One egg contains 6 grams, 8 ounces of Greek yogurt contains 23 grams, one cup of navy beans contains 20 grams and 4 ounces of tofu contain 16 grams of protein.

Fat

Getting extra fat in the diet helps provide energy and calories for healing and also provides building blocks for making new cells.  Omega 3 fats help mute inflammation and encourage healing, and omega 6 fats balance things out.  Fish oil has been shown to be helpful in patients with pressure ulcers in the ICU setting.

Carbohydrates

Complex carbohydrates provide fiber which feeds the healthy bacteria in the gut, as well as calories for energy.  Our gut bacteria help support a healthy immune system.  Healing wounds and getting well is hard work!  Depends on how malnourished someone is (and how sick they are) a patient may need up to 40 calories per kilogram of body weight.  That 70-kilogram woman above would need up to 2800 calories per day, plus more if she is doing more than just lying in bed.

It’s important that these carbohydrates should be whole-food complex carbohydrates like fresh fruits and vegetables, beans and whole grains like oatmeal.  Refined carbohydrates like white bread, bagels, bakery and the like are NOT helpful and increase the production of AGEs.

Vitamins and Minerals

Vitamin A, vitamin C, vitamin D, zinc, selenium and antioxidants have been investigated as being helpful in wound healing.  While supplementation with high doses of single nutrients has not been shown to help, using a good quality well-balanced multivitamin is smart.  After all, if only 5% of Americans get all the nutrients they need from their diet, who doesn’t need a multivitamin?  And if deficiencies slow down wound healing, those with slow-healing wounds would benefit even more!

Unfortunately many Americans are badly malnourished.  Those with very low or very high body mass index (BMI) are most at risk of significant malnutrition.

How do you know if someone is malnourished?  They may or may not lose a lot of weight, especially if they were obese to start with.  Low blood albumin levels are a clue, as is swelling (edema).  The edema may be mostly in the legs, but the arms and abdomen may be puffy and swollen too.  They are weak, and there may be a big change in their strength and ability to take care of themselves.

People who are malnourished will have loss of muscle and fat tissue.  A good place to look is at the temples.  If the temples look bony and it’s easy to feel the skull bones and see the bones of the eye sockets, it is suggestive of malnutrition.

If you know anyone with a chronic wound, especially if they are diabetic, encourage them to see their doctor and work hard to get their blood sugar under control.  Good blood sugar control slows the production of AGEs and decreases inflammation.

Also, make sure they are getting plenty of protein and taking a high-quality multivitamin.  Antioxidants and fish oil may be helpful as well.  If your doctor isn’t able to make recommendations about specific supplements, you’re welcome to reach out to me or get a quick assessment at jenniferwurstmd.com/healthprint.

Chronic wounds are tough to heal.  In addition to careful wound care and avoiding pressure on the wound, attention to a healthy diet and smart supplementation are practical steps you can take to speed up the healing process.

QUESTION: Have you known anyone with a chronic wound?  What did it take to heal it?

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Update From Shaklee Global Conference

Hello Shaklee family!  This week I’m in Las Vegas for our annual Shaklee Global Conference.  Three days of training, team-building and renewing connections with others who care just as much about health and wellness as I do 🙂

August also marks my sixth anniversary of this website!  I started blogging and wrote my first post in August 2012.  Interestingly enough, that year’s Shaklee Global Conference was in Las Vegas as well.  The more things change, the more they stay the same!

Product Changes

There are big changes to a few of Shaklee’s key product lines this year.  The first one is a reformulation of Shaklee’s Life Shake.  It has always been an effective protein supplement and central to the Shaklee 180 weight loss program.  Shaklee is always working on improving products though, and they have been hearing feedback that our customers feel the shake has too much sugar.

Not anymore!  The new Life Shake has ZERO added sugar and less than 1 gram of carbohydrate per serving.  It is a great choice for those on the ketogenic diet and all of our Paleo friends.  Shaklee has stopped adding probiotics to the shake (more on probiotics later) but it has a new ancient-grain-based prebiotic fiber blend to continue to support gut health.  In addition, there are digestive enzymes added to also support healthy and comfortable digestion.

The Life Shake is still gluten free (all the weight loss products are) and now is completely plant based, because Shaklee was able to find a plant source of the amino acid leucine which is critical to protecting muscle mass during weight loss.  It is available in soy and non-soy-based versions, four delicious flavors, and was taste-tested against the leading retail brand of protein shake, and WON.  9 out of 10 tasters in a blind taste test preferred the taste of the new Shaklee Life Shake 🙂

Several of the people who have been secretly testing the newly formulated Life Shake said they had less bloating and lost inches around their waist without really trying.  One man WAS trying and lost 36 pounds in 9 weeks!  Wow!

We also have four new additions to the YOUTH skin care line.  I had a number of customers try the YOUTH Anti-Aging Regimen and have to stop because it irritated their skin.  Shaklee has unveiled the YOUTH Hydrating Collection for those who have sensitive or dry skin or who aren’t as interested in anti-aging products!  These products are also available as a package to start and as individual items to replace as you use them up.

Clinical testing is part of how Shaklee rolls, and the Hydrating products are no difference.  Women had a tripling of the measurable hydration of their skin after one application of YOUTH Moisture Activating Serum.  There is also a new YOUTH Moisture Lock Day Cream to lock in the moisturizing effects.  Want to try it yourself?  I’ll be hosting after-conference events, watch your email for your invitation!  The first one will be Sunday, 8/26 at 9 AM at the Coffee Club on Broadview Road in Broadview Hts, OH.

If you enjoy pampering yourself with a facial every now and then, you’ll love these next two products.  The YOUTH Hydrating Gel Mask applies soothing deep hydration, and the YOUTH Purifying Clay Mask removes impurities to reveal healthy skin.  I haven’t used them myself, I’ll be able to try them when I get home.  Can’t wait!

As always, Shaklee’s products are backed by an unconditional guarantee.  Also, our skin care products are free of 2500 harmful or questionable ingredients so you can be confident our products are safe for your skin, responsibly sourced, and gentle for our environment.

One last product to tell you about, and that’s Shaklee’s new Optiflora DI.  This is a brand new probiotic supplement that has grown out of the explosion of recent research on the effect of our microbiome on our health.  Our microbiome consists of the trillions of bacteria that live in our digestive tract, oral cavity, genital tracts and on our skin.  They outnumber our own cells ten-to-one and influence our health in countless ways.  The research is moving FAST and it’s clear that just about every system from our digestion to our brain is affected by the health of our microbiome.

Optiflora DI contains healthy bacteria proven to support healthy digestion AND healthy immunity.  With 70% of our immune system living in our gut, a healthy population of microorganisms helps keep our immune system healthy.

Business Changes

Shaklee has also has made big improvements to our business support that will help business people like me keep connected to our customers while on the go.  Better follow up will help keep my customers supported in meeting their health goals!

If you’re one of the over 50% of people age 21 to 65 who would like to work to build your own dream instead of someone else’s, who want more time freedom or just want a side gig to earn extra income, please let me know.  Shaklee’s business opportunity may very well not be right for you, it’s not right for everyone!  But we won’t know until we talk it over 🙂

QUESTION: Which of Shaklee’s new products is most interesting to you?  Are you interested in learning more about Shaklee’s business opportunity?

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The Best Way To Control Your Blood Sugar

Don’t eat fruit.  Don’t eat meat.  Don’t eat sugar.  Eat before exercising.  Exercise while fasting.  Don’t eat after 7 PM.

If you read books by the popular health gurus or look at Facebook posts you can get completely confused by all the conflicting advice offered for diabetics.  What is the best way for a diabetic to control their blood sugar?

Get To And Maintain A Healthy Weight

The most important thing to do to get blood sugar under control is to achieve and maintain a healthy weight.  Just that one thing will get most of our diabetics to good blood sugar control, even without medication.

It isn’t even all that critical to get to a “normal” weight for blood sugar to improve.  Even losing just 5% of body fat (10 pounds for those starting at 200 pounds) has been shown to improve glycemic control.

I have a lot of patients who ask me what they SHOULD weigh.  I tell them I’m not sure, but let’s start with 5 pounds.  The same skills that get rid of the first 5 pounds will get rid of the first 100 pounds, you just have to stick with it!

For those who are looking for a healthy, effective, simple weight loss program, I always recommend the Shaklee 180 program.  If you’re interested in more information, please click this link to check it out.  If you like to watch videos, here’s one on my YouTube channel that’s very informative.

Eat Real Food

A lot of people are afraid of eating carbohydrates.  So many people want to eat Paleo, keto, low-carb…  The list goes on!  There are a lot of problems with trying so desperately to avoid carbs that you swing the pendulum WAY in the other direction and eat more meat and dairy.  Any diet that gets you to avoid eating processed food is a step in the right direction, but plant foods are much healthier than animal based foods.

The only diet that has been shown to improve health in diabetics (blood sugar control AND heart and vascular health) is the plant-based diet.  That means fruits and veggies, root vegetables, beans, nuts, seeds and whole unprocessed grains.

I always laugh when keto and Paleo people try to say fruit is unhealthy.  Come on, now.  Anyone who tells you steak, bacon, sausage and cheese are healthy but apples will make you fat is either misinformed or outright lying to you!

A word on sweeteners.  Be aware that artificial sweeteners are not a good choice, and all sweeteners that contain calories are pretty much the same.  For instance, high-fructose corn syrup, table sugar, agave syrup and honey all impact the body about the same.  You should reduce ALL of them, and avoid artificial sweeteners altogether.

Smart Supplementation

There are a few nutrients that are helpful for maintaining blood sugar control.  For instance, chromium supplementation is well-known for helping to improve glycemic control.  In fact, there was a smallish study published out of Iran that found about 1/3 of diabetics actually have deficiencies in chromium.  (I think I might have to start testing my patients and prescribing a supplement!)

Other nutrients are helpful for diabetics, like vanadium and zinc.  The amino acid taurine also is protective and improves blood sugar control.  Magnesium is important for everybody but especially those with diabetes, high blood pressure, and increased cardiovascular risk.

Shaklee’s Glucose Regulation Complex is based on solid scientific research and formulated to promote healthy blood sugar levels.  If you’re interested, you can check this link to learn more about it.

Diabetes is getting more and more prevalent.  Two-thirds of Americans are overweight or obese, which seriously increases their risk of diabetes.  Losing weight, eating real food and smart supplementation are things you can do to improve blood sugar control.

QUESTION: Are you diabetic? What do you find helpful in controlling your blood sugar?

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