Natural Supplements- Am I flushing my money down the toilet?

vitamins

So, I walk into the exam room to see my sweet, 78 year old patient holding a shopping bag full of vitamins and supplements in her lap.  She laid them out on the counter, a collection of colorful bottles at least 10, promising good health and vitality.

So how many of you can relate to having a cabinet full of supplements at home? Ever wonder if they are any good?

The majority of adults in the United States take one or more dietary supplements either every day or occasionally.  It can be a wonderful thing to supplement one’s health but it can also be elusive in creating unrealistic expectations. The words, ‘natural’ and ‘holistic’ with a promise of health benefits can sell quickly to the eager consumer. But all that glitters is not gold.

Here is what you need to know before buying a supplement:

  1. Check the OTHER Ingredients! Look for fillers (magnesium stearate), binders (gluten), flow agents, coating and glazes, gelatin, carrageenan, artificial flavors and colors, sugar, high fructose corn syrup, sweeteners, preservatives (parabens, benzoates, sorbates, sulfites), titanium dioxide and more.
  2. Use Evidence-Based Resources for Dietary Supplements. How do you know your product is legit? ‘Buyer Beware” – there are a few checks and balances. Look for this seal: 
    Good manufacturing practices (GMPs) for dietary supplements established by the FDA help ensure the product’s identity, purity, strength, and composition. These GMPs are designed to prevent the inclusion of the wrong ingredient, the addition of too much or too little of an ingredient, the possibility of contamination, and the improper packaging and labeling of a product. Facilities that manufacture dietary supplements are periodically by the FDA.
  3. Look for the USP SEAL of APPROVAL from independent organizations that offer quality testing. These seals of approval provide assurance that the product was properly manufactured, contains the ingredients listed on the label, and does not contain harmful levels of contaminants. These seals of approval do not guarantee that a product is safe or effective. Organizations that offer this quality testing include:
    1. U.S. Pharmacopeia- http://www.usp.org/
    2. http://www.ConsumerLab.com
    3. NSF International- http://www.nsf.org
    4. http://www.Labdoor.com
  4. Always be alert to the possibility of unexpected side effects, especially when taking a new supplement. The POTENTIAL for interactions is huge. It can interact with your current medications, increase risk of bleeding or affect your response to anesthesia in surgery. Just as you would not start a new prescription without expert advice, do the same for any vitamin or supplement.
  5. You might be over-dosing on the same vitamins. It is possible to have too of a good thing. For example, you may be taking Vitamin D3 in your multi-vitamin, your calcium supplement and a separate Vit D3 tablet, all causing toxicity from a fat-soluble vitamin. Supplements often have combinations of vitamins listed, look for overlap of the same vitamins in all your bottles. It’s important not to exceed the RDA without checking with your healthcare provider.
  6. The term “natural” doesn’t always mean safe. A supplement’s safety depends on many things, such as its chemical makeup, how it works in the body, how it is prepared, and the dose used. Dietary supplements do not require pre-market review or approval by the FDA. Different brands may have a different concentration or constitution of the same supplement making the effects less predictable and may increase risk of drug interactions. When making health claims, supplements are required to have this : “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.” Please ask your doctor if it’s is right for you.

Talk with Your Health Care Provider

I ask our patients to bring all their dietary supplements, teas, tinctures and medication bottles to their visit. Make this your practice going forward. Have an open conversation with your doctor and ask them to help you determine which supplements, if any, might be valuable for you.

Supplements can’t take the place of the variety of foods that are important to a healthy diet but the right ones can help augment your deficiencies and optimize your health. Consider a micro-nutrient test like Spectracell or Genova Labs to identify your nutritional deficiencies. A targeted laboratory approach may prevent unnecessary supplements and help your wallet and health in the end!

The light in me, bows to the light in you~ Namaste

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Dr. Patel was named one of the TOP DOCS in Phoenix Magazine 2009, 2016 and Internist of the Year 2011 by the American College of Physicians Arizona Chapter. She is uniquely trained, board-certified and practices both Pediatrics and Internal Medicine in Fountain Hills, Arizona. She is additionally fellowship trained in Integrative Medicine. 

She has a passion for teaching medicine and acts as a preceptor for both medical residents and providers in training. Dr. Patel has a special interest in Integrative Medicine, Women’s health, Pediatric & Adolescent care, Nutrition and Medical Cosmetics.

How to Shop Healthy on a Tight Budget?

farmers market

In clinic, I was discussing with a young mother the struggles of affording healthy food. She had two little kids under the age of 5 and had a tight budget. She said that breakfast was typically a fruit-colored or sugary cereal bought in bulk, they made lots of pasta, sauce from jars, mac & cheese and frozen processed meats and pizzas. Often they made trips to a local fast food restaurant, usually more than once a week. She mentioned that snacks were typically packaged cookies and chips, usually brand names.

So, frequently patients will share the misconception that it is too expensive to eat healthy. Unfortunately, the price to pay will be later in healthcare bills and prescriptions. Stretching your dollars to feed a family can be difficult. Just a few savvy shopping tips may help your wallet and your health!

  1. Farmer’s Markets! Weekend trips to a farmers market can yield the freshest, locally grown, in season produce that is dirt cheap. (I personally love Singh Farms in my area). Organic produce that is locally grown is not only amazingly healthy but also inexpensive compared to supermarkets. Remember, you are paying less for a fruit or vegetable that hasn’t traveled half way around the world. To find a farmer’s market closest to you visit  the USDA site.  https://www.ams.usda.gov/local-food-directories/farmersmarkets
  2. Cook in Bulk! Plan your meals in advance. A meal can stretch to two or three meals when you make large stews, soups, lasagna, chili, casseroles, stir-fry, burritos or salads. Rather than buying pre-cut veggies, buy in bulk and cut them up yourself- much cheaper! Better yet, make it a family activity and divide up the prep work. Families that cook together, eat together 🙂
  3. Buy Less Processed Junk Foods!  Despite this big misconception, boxes of processed cereal, cookies, chips, fruit snacks, shredded cheese, frozen waffles, soda and juice will rack up quickly at the register.  Not only do these foods have no nutritional value,  they add chemicals and sugar to your body and they kill your budget. A more frugal option is to buy in whole oats, millet, barley, lentils, nuts, brown rice, frozen fruit and vegetables, canned beans and whole grain flour. You can buy them in larger quantities, they keep for long time and they are a much cheaper option.
  4. Replace your Meat! The biggest ticket items are usually meat, dairy and grains. Try protein alternatives once or twice a week. Add in canned fish, eggs, beans, legumes and whole organic tofu to your dishes.
  5. Don’t Buy Brand & Get Coupons! Marketing ads has programmed us for brand recognition. We seek the familiar brands and pay the extra price. Read labels, compare, download coupons and become a savvy shopper. Buy things in season and look for sales. Buy your favorite items in bulk when they are on sale and freeze them.
  6. Frozen is Good! Vegetables and fruit in the freezer section maintain their nutrient value so if you can’t buy fresh, buy frozen. It’s great for cooking, smoothies, topping on your oatmeal or yogurt. And you can buy them in bulk!
  7. Pack Your Lunch! Lead by example! Encourage your co-workers to bring sack lunches. Cook at home too, skip the trips through the drive-through and eating out. Eating out is very expensive. If you cook in bulk, left overs are a great way to save money and stay healthy and make great lunches. Set an example for your kids and pack your lunch starting today.
  8. Grow your Own Food! Okay, so you knew I would recommend you grow your own food 🙂 Home grown food tastes so much better and seeds are cheap. A great activity with your kids and teaching them where food comes from and building good habits. Small indoor pots are affordable and rewarding if you lack outdoor space!
  9. Make a List! Impulsive buys can add up quickly. Plan your meals and stick to your list. Stay on the perimeter of the store, buy whole and fresh. Stay away from the middle aisles which will tempt you to buy processed, pre-packaged expensive items.

Often I hear the same excuses, “the kids won’t eat it”, “my husband needs his treats”, “it’s easier to eat out”. If saving money is a priority in your household and improving the health of your loved ones, convince your family to try the above recommendations. Bad food leads to bad health, foul mood, weight gain, low energy and bigger medical bills. Your health is worth investing in!

The light in me, bows to the light in you~ Namaste

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Dr. Patel was named one of the TOP DOCS in Phoenix Magazine 2009, 2016 and Internist of the Year 2011 by the American College of Physicians Arizona Chapter. She is uniquely trained, board-certified and practices both Pediatrics and Internal Medicine in Fountain Hills, Arizona. She is additionally fellowship trained in Integrative Medicine. 

She has a passion for teaching medicine and acts as a preceptor for both medical residents and providers in training. Dr. Patel has a special interest in Integrative Medicine, Women’s health, Pediatric & Adolescent care, Nutrition and Medical Cosmetics.

Increased Suicidal Risk Associated with Childhood Bullying

A recent study showed that children who were exposed to the most persistent bullying were associated with 2 to 3 fold increase in risk for suicidal behaviors.

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Last week in clinic, a young patient explained how they were being bullied in school playground by other kids who would harass, point and laugh. It broke my heart to hear this story and others who are silently suffering from these despicable acts.

Bullying is not just for playgrounds anymore, social media has become an active, virtual playground for children to vent their frustrations and project their anger onto others. Though, Cyberbullying may seem harmless and can be a form of entertainment, it can create lasting harm in the person it is inflicted upon.  Ongoing cyberbullying is a threat to both victims and bullies in creating greater risk for anxiety, depression, and other stress-related disorders.

“Cyberbullying” is when a child, preteen or teen is tormented, threatened, harassed, humiliated, embarrassed or otherwise targeted by another child, preteen or teen using the Internet, interactive and digital technologies or mobile phones.

A recent published study, showed that children who were exposed to the most persistent bullying were associated with 2 to 3 fold increase in risk for suicidal behaviors. Associations of childhood bullying victimization with lifetime suicidal behaviors among new U.S. Army soldiers. – Depress Anxiety. 2017 Apr 3. doi: 10.1002/da.22621.)

As parents, what can you do?

  1. Watch for signs to see if your child is being bullied:
  • being emotionally upset during or after using the Internet or the phone
  • being very secretive or protective of one’s digital life
  • withdrawal from family members, friends, and activities
  • avoiding school or group gatherings
  • slipping grades and “acting out” in anger at home
  • changes in mood, behavior, sleep, or appetite
  • wanting to stop using the computer or cellphone
  • being nervous or jumpy when getting an instant message, text, or email
  • avoiding discussions about computer or cellphone activities

2.  Show compassion and listen to your child. Share stories about your childhood experiences. Tell them you are proud of them for coming forward and that it is not their fault and they are not alone. Encourage them not to engage with the bully but keep a record of all online activities for future evidence. Let your child know that you plan to bring it up to the school i.e head of school, teachers, counselor.

3. Set Limits. You can set online parameters to block the bully, limit tech time for your child and know your child’s online world by ‘friending them’ or following them on social sites. Set them up with counseling so they can receive help for the stress they have encountered.

4. Keep evidence of cyberbullying. Record the dates, times, and descriptions of instances when cyberbullying has occurred. Save and print screenshots, emails, and text messages. Use this evidence to report cyberbullying to web and cell phone service providers. Report cyberbullying to the social media site so they can take action against users abusing the terms of service.

5. Report cyberbullying. When cyberbullying involves threats of violence, child pornography or sending sexually explicit messages or photos, taking a photo or video or someone in a place where he or she would expect privacy, stalking and hate crime it is considered a crime and should be reported to law enforcement.

6. Set a good example yourself.  Model good online habits to help your kids understand the benefits and the dangers of life in the digital world. Once adults become involved, it is considered cyber-harassment or cyberstalking, a crime that can have legal consequences and involve jail time.

7. Make sure your child is not a Bully. Bullying in any form is unacceptable.  Severe, long-term, or frequent cyberbullying can leave both victims and bullies at greater risk for anxiety, depression, and other stress-related disorders. Unfortunately, these kids are at a higher risk for suicidal thoughts, attempts, and completed suicides.

8. Get Help. If you know of anyone who is feeling hopeless or thinking of suicide, contact the National Suicide Prevention Lifeline online or at 1-800-273-TALK (8255). The toll-free call goes to the nearest crisis center in our national network. These centers provide 24-hour crisis counseling and mental health referrals.

The light in me, bows to the light in you~ Namaste

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Dr. Patel was named one of the TOP DOCS in Phoenix Magazine 2009, 2016 and Internist of the Year 2011 by the American College of Physicians Arizona Chapter. She is uniquely trained, board-certified and practices both Pediatrics and Internal Medicine in Fountain Hills, Arizona. She is additionally fellowship trained in Integrative Medicine. 

She has a passion for teaching medicine and acts as a preceptor for both medical residents and providers in training. Dr. Patel has a special interest in Integrative Medicine, Women’s health, Pediatric & Adolescent care, Nutrition and Medical Cosmetics.

Can Food Be Medicine?

In clinic, I saw a young teenage girl suffering from chronic abdominal pain, bloating, gas and alternating explosive diarrhea, urgency and constipation. It had been going on for months. It was affecting her school work, energy levels, focus, and mood. Her check up and the blood tests were normal. Parents are told everything is normal?

Young woman in pain

I see this many times in the clinic. A young patient has gastrointestinal symptoms and the full medical work up does not reveal any pathologic findings. She gets labeled with IBS (irritable bowel syndrome). This leaves a frustrated and discouraged family to carry on their lives with no valuable treatment solutions. So why is food not considered medicine when we seek medical treatment? Why have we become so dependent on a pill, an antibiotic or a procedure as the only medical solution.  Food is Medicine. It’s time to change that mindset!

So my simple solutions:

  1. Find the ROOT CAUSE- sometimes it is as simple as being Sherlock Holmes. Elimination diets are great and cost nothing. Start a food log and eliminate one food at a time. Common triggers are gluten, dairy, sugar, processed foods, artificial sweeteners, fruit juices, dyes, preservatives, and prepackaged meals. If you can’t pronounce it or find it in your pantry, don’t eat it or drink it. Cleaning the gut can take months so be patient, one week isn’t enough to give up!
  2. Choose GUT FRIENDLY FOODS- high fiber foods, pre-biotics and probiotics when the bowel is acutely inflamed can be rough on the stomach and can make gas, bloating, cramping and diarrhea worse. Especially if there is inflammation, malabsorption and dysbiosis. Start with a gentle gut healing diet like a low FODMAP diet. (fructose (when in excess of glucose), fructans, galacto-oligosaccharides (GOS), lactose and polyols (eg. sorbitol and mannitol). It makes it easier for the bowels to heal without the additional stress.
  3. Avoid certain MEDICATIONS -common side effect of some medications can be abdominal pain, diarrhea or constipation (antibiotics, narcotics, antacids). Even natural supplements like Vitamin C, aloe and magnesium can cause diarrhea.
  4. Manage STRESS- the mind and body are connected as one. Every illness can be traced to an initial stress. As long as the mind is not at rest, the gut may not heal. Work towards breath work, meditation, guided imagery, exercise, connecting with friends and having fun.
  5. Work towards a HEALTHY DIET- once the gut has calmed down, adding in more fruits and vegetables, pre and probiotics via foods is a great idea. If symptoms reappear, then step back and reassess potential triggers. Eat natural, whole and organic when possible. Eat a more plant based diet. Red meat and processed meats like hot dogs, sausages and cold cuts have been classified by the World Health Organization as a Class 2 Carcinogen, same as cigarettes. So rethink your sandwich meats and school lunches!
  6. Additional WORKUPS that may help- allergy and food sensitivity/gluten testing, SIBO or small bowel overgrowth testing, Comprehensive Stool Analysis for malabsorption, dysbiosis or infection. Micronutrient testing for deficiencies like ZINC can be the cause. These can be outside of insurance coverage and expensive at times. So do 1-5 first!

The gut is a wonderful, tropical rainforest with lots of species of bacteria living in a nutrient rich environment sharing a symbiotic relationship with us. Just like the outside world, if we pollute the space they live in, poison the cells and food supply, these bacteria die and become sick which in turn makes us sick. Teach your kids to nourish their bodies with good, healthy, whole food so they can remain healthy inside and out. Food is Medicine!

The light in me, bows to the light in you~ Namaste

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Dr. Patel was named one of the TOP DOCS in Phoenix Magazine 2009, 2016 and Internist of the Year 2011 by the American College of Physicians Arizona Chapter. She is uniquely trained, board-certified and practices both Pediatrics and Internal Medicine in Fountain Hills, Arizona. She is additionally fellowship trained in Integrative Medicine. 

She has a passion for teaching medicine and acts as a preceptor for both medical residents and providers in training. Dr. Patel has a special interest in Integrative Medicine, Women’s health, Pediatric & Adolescent care, Nutrition and Medical Cosmetics.

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How do I optimize my own Healing?

So as a busy mom and physician, my day starts in a whirlwind of making breakfasts, packing lunches, drop offs at multiple schools, busy office work, stressed to stay on time in a dimly lit florescent office with little or no time to slow down, ending my day with more charts, homework, dinner and bedtime routines to only start it all over again.

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Over the last two years, as I journeyed through an Integrative Medicine Fellowship… I learned to change my approach to optimize my own healing and I am now sharing this wisdom in the hopes that it would help others.

  1. Care starts with ourselves. Sounds simple. But we rarely believe in this idea as we find excuses to put ourselves last. So  start your day by setting an intention to eat, breath, move and wind down between crazy, busy moments.
  2. Health is a balance of the mind, body and spirit. Explore and understand how to positively balance all three. Meditate daily. Exercise when you can. Nourish your body with real food. Embrace the imperfections of your day and move forward.
  3. Be Mindful. Laugh, sing, dance and enjoy the company of those who lift you up. Savor the good moments and etch them in your memory so you can draw from them all day.
  4. Work to create healing spaces with nature, color, light, fresh air, music, art and scents. Change your screen saver to your favorite scenery, keep a plant on your desk, step outside, massage your hands with fragrant essential oils. You set the stage for a beautiful day!
  5. Rest well. Sleep is not a place you go to. Being less awake is the key. Get comfortable and relax!

How do we solve the problem of a fast-moving culture, driven by success and pressured to perform? We start with ourselves. ‘Be the change you wish to see in the world’. Movements start with one person setting an intention, touching the lives of people around them. Sending a ripple effect through the universe, turning the tide in how we live, love and breathe. My intention is to move people in a direction of mindfulness, what is your intention?

The light in me, bows to the light in you~ Namaste

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Dr. Patel was named one of the TOP DOCS in Phoenix Magazine 2009, 2016 and Internist of the Year 2011 by the American College of Physicians Arizona Chapter. She is uniquely trained, board-certified and practices both Pediatrics and Internal Medicine in Fountain Hills, Arizona. She is additionally fellowship trained in Integrative Medicine. 

She has a passion for teaching medicine and acts as a preceptor for both medical residents and providers in training. Dr. Patel has a special interest in Integrative Medicine, Women’s health, Pediatric & Adolescent care, Nutrition and Medical Cosmetics.

 

Suffer from Flying Anxiety? Take these easy steps on your next flight……

  Many people suffer from flying anxiety. A fierce sensation of feeling warm, nausea, heart palpitations, and feelings of doom, that can be overwhelming. The solution is simple, quick, requires no equipment and you can do it anywhere. A relaxation exercise called 4-7-8 taught by Dr. Andrew Weil. Sit with your back straight. Exhale completely […]

 

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Many people suffer from flying anxiety. A fierce sensation of feeling warm, nausea, heart palpitations, and feelings of doom, that can be overwhelming. The solution is simple, quick, requires no equipment and you can do it anywhere. A relaxation exercise called 4-7-8 taught by Dr. Andrew Weil.

Sit with your back straight. Exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of 4. Hold your breath for a count of 7. Exhale completely through your mouth, making a whoosh sound to a count of 8. This is one breath. Now repeat this cycle for a total of  four to six times.

This exercise is a natural tranquilizer for the nervous system. Use this new skill whenever anything upsetting happens before you react. Use it whenever you are aware of internal tension. Use it to help you fall asleep and on your next flight.  Happy Travels!

Is My Child Autistic?

April-2nd-Is-World-Autism-Awareness-Day1

A mom sits in my exam room frantic with questions about her daughter. She is overwhelmed after searching every internet site and getting multiple opinions from friends and family. Her 20 month daughter doesn’t behave like her cousins. She prefers to play alone. She doesn’t respond to her name when called. She has few to no words.  She is clingy and has difficulty with loud places and resistant to changing her routine. Having her later in life, mom had been very protective and accepted her tantrums and behavior as being different. She asks, ‘Is my child autistic?’ 

These are difficult discussions with parents that require more time than a blog can do justice. Families have mixed feelings of sadness and relief with a diagnosis as it validates their concerns. The process of finding a cause, diagnosis and treatment can be frustrating since there is no blood test or scan. But here are some guidelines that may help parents decide if they should broach the topic with their doctor. The DSM-5 describes Autism Spectrum of Disorders (ASD) as a group of neuro-developmental disorders that include Aspergers, autism, childhood disintegrative disorder and pervasive developmental disorder not due to another condition.

What to look for?

  1. Usually symptoms appear before the age of 3.
  2. There can be poor social interaction and loss of social cues- does he or she make poor eye contact, have you noticed he or she doesn’t smile, they cannot recognize facial expressions or emotions and he or she has trouble making friends
  3. Have you noticed a regression of milestones and speech, impaired communication- he or she doesn’t babble, doesn’t point, seems to ignore you when you call his or her name, was saying words now has lost those words, keeps repeating words or phrases, trouble with communication that leads to aggressive behavior and tantrums.
  4. Often a child may resist change or engage in repetitive behavior- this may be hand flapping, head rolling, or body rocking. They may be hyper-fixed on one toy, game or show for an extended time. You have to manage your day around their insistence of daily routine as they have difficulty with change. There can also be self-harming behavior, self-biting, or hitting their head.

Children on the spectrum are unique and have their own special gifts. It is important to not only look for problems but to focus on their strengths as well. These strengths can lead to abilities that foster long term success like seeing and hearing things in concrete terms, content with being alone, they can focus for a long period of time on the same task, and may be good with computers and technology.

Why is a diagnosis important? A thorough and detailed evaluation can identify challenges and direct effective intervention from school programs, Early Intervention and Special Education services. A multi-disciplinary approach with your developmental pediatrician, neurologist, psychiatrist, psychologist, physical/occupational therapist and speech therapist is essential in early identification of strengths and needs. Remember you are not alone, start with a conversation with your pediatrician and love your child and all their gifts.

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Resources:

http://www.nationalautismcenter.org/resources/for-families/

https://www.autismspeaks.org/family-services/resource-library/websites-families

http://www.autisable.com/

http://www.autismasperger.net/