Low Dose Naltrexone (LDN): The New Treatment You've Never Heard of...

Low Dose Naltrexone (LDN):  The treatment you've never heard of...

Why haven't you heard about this amazing new breakthrough for conditions ranging from autoimmunity to cancer?  Perhaps because as of yet no company has stepped forward with the billions of dollars needed to do a large-scale study on low-dose naltrexone (LDN).  Unfortunately getting FDA-approval for use is not a straightforward process.  With the patent expired, no drug company has been willing to pay such a large sum when they cannot sell the drug exclusively.

However, if you check PubMed, there are currently over 90 studies published on the various uses of LDN, from pain relief, fibromyalgia, Crohn's disease, multiple sclerosis, systemic sclerosis and even cancer.  I have been using this drug in clinical practice with great results for the past several years and I want to tell you about it...

So how does LDN work?

Researchers at The Pennsylvania State University College of Medicine, Hershey, Pennsylvania have discovered the mechanism by which a low dose of the opioid antagonist naltrexone, an agent used clinically (off-label) to treat cancer and autoimmune diseases, exerts a profound inhibitory effect on cell proliferation. We believe that opioid receptor blockade by LDN provokes a compensatory elevation in endogenous opioids and opioid receptors that can function even after LDN is no longer available.

These papers revealed that a short-term opioid receptor blockade with naltrexone (LDN), a general opioid receptor antagonist devoid of intrinsic activity, results in an elevation in production of your own opioids and in response to the blockade. Interference of opioid peptide–opioid receptor interactions for a short time each day (from 4-6 hours) with LDN provided a subsequent window of time (18–20 hours) for the increased levels of endogenous opioids and opioid receptors to elicit a robust functional response: the inhibition of cell proliferation.  In addition many patient report an improved sense of well-being and decrease in overall pain, as one might expect with higher levels of opioid production in the body.

Preliminary Research Abounds for cancer and autoimmune disease

Low dose of the opioid antagonist naltrexone (LDN) is being used clinically off-label to treat cancer and autoimmune diseases, by exerting a profound inhibitory effect on cell proliferation.  LDN is an oral medication, generic, inexpensive, and non-toxic, and has been documented to alter the course of both neoplasias and autoimmune diseases such as Crohn's and multiple sclerosis, making this drug especially attractive as a therapeutic agent.

According to this study in Clinical Rheumatology, Low Dose Naltrexone(LDN) has been demonstrated to reduce symptom severity in conditions such as fibromyalgia, Crohn's disease, multiple sclerosis, and complex regional pain syndrome. They suggest that LDN may operate as a novel anti-inflammatory agent in the central nervous system, via action on microglial cells. These effects may be unique to low dosages of naltrexone and appear to be entirely independent from naltrexone's better-known activity on opioid receptors. As a daily oral therapy, LDN is inexpensive and well-tolerated.

A study published online in the Cochraine Library in February 2014 discusses using low-dose naltrexone to induce remission in Crohn's Disease.  Although the author conclude there is insufficient evidence to recommend and further research is needed, data from one small study suggests that LDN may provide a benefit in terms of clinical and endoscopic response in adult patients with active Crohn’s disease. Data from two small studies suggest that LDN does not increase the rate of specific adverse events relative to placebo.

In the Journal of Clinical Gastroenterology April 2013, Naltrexone therapy appears safe with limited toxicity when given to children with Crohn’s disease and may even reduce disease activity.

Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome involves glial activation and central sensitization in the central nervous system. This can be a difficult disease to treat and patients suffer greatly with severe chronic pain.   An article in the Journal of Neuroimmune Pharmacology showed positive outcomes of two CRPS patients, after they were treated with low-dose naltrexone, in combination with other CRPS therapies.  Perhaps this is because Low Dose Naltrexone (LDN) is known to antagonize the Toll-like Receptor 4 (TLR4) pathway and attenuate activated microglia.

Link to Fibromyalgia and Autism?

Another article posted online in Discovery Medicine came to the following conclusions:

1. Patients on chronic opioids relate autistically.
2. Autism is a hyperopioidergic disorder.
3. Fibromylagia is a hypoopioidergic disorder.
4. Low opioid tone caused by opioid maintenance or fibromyalgia can usually be reversed with low-dose naltrexone.
5. The increase in the incidence of autism may have been caused by the increase in use of opioids for analgesia during childbirth.

The bottom line is that for disorders that involve low endogenous opioid production, like fibromyalgia and chronic fatigue syndrome, Low Dose Naltrexone may prove to be profoundly beneficial.

A January 2013 article written in Arthritis and Rheumatology concluded that evidence continues to show that low dose naltrexone has a specific and clinically beneficial impact on fibromyalgia pain. The medication is widely available, inexpensive, safe, and well-tolerated.

Motility Agent for Small Intestinal Bacterial Overgrowth (SIBO)

Another novel use of Low Dose Naltrexone has been for aiding motility in SIBO (small intestinal bacterial overgrowth).  Ploesser et al described the use of LDN for aiding the migrating motor complex (MMC) in cleansing the small bowel.  His small study use 2.5mg twice daily in patients with IBS and evidence of SIBO and 4.5mg daily in patients with inflammatory bowel disease.  Approximately 68% of the study patients had improvement in symptoms taking LDN.  According to other research, LDN may have effects on the gut to decrease inflammation, decrease intestinal permeability and stabilize toll like receptors, in addition to aiding motility.

Experimental and Off-label but well tolerated and promising

The use of LDN for chronic disorders is still experimental and considered off-label.  This doesn't stop progressive doctors from prescribing it due to it's safety profile.  The typical dose of LDN is a compounded immediate release tablet from 1.5 to 4.5mg taken at bedtime.   The few reported side effects may be related to opioid blockade at night.  Occasionally patients report anxiety, insomnia, vivid dreaming or nightmares.  There are a portion of patients who already have elevated opioids that may not tolerate the drug. To avoid side effects, I generally start patients on half of intended dose and increase after 7-10 days.  If they still report symptoms, we move the dosing earlier in the day and may still get a beneficial effect.

Low Dose Naltrexone is an oral medication, generic, inexpensive, and non-toxic, and has been documented to alter the course of both neoplasias and autoimmune diseases such as Crohn's and multiple sclerosis, making it an attractive and effective therapeutic agent.

For more on LDN watch my recent interview with Dr. Alex Vasquez ...

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More References:

1. Low Dose Naltrexone Research Trust
2. LDN Clinical Trials 

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Glyphosate Toxicity: What you don't know might kill you!

Glyphosate is the active ingredient in the popular herbicide, Roundup.  Glyphosate toxicity is a big deal and what you don't know just might kill you!  Many people routinely spray their lawns with this chemical unaware of the toxicity.   In the United States, farmer's are applying ever increasing amounts to their crops before harvest. According the the World Health Organization, glyphosate is now declared a "probable carcinogen" which means is may cause cancer.  The industry still asserts that it is totally safe for humans, however, one only needs to look at the data to know that is not the case.  Ignorance may be bliss but I believe we may be on the verge of one of the most toxic man made environmental disasters in history... and unfortunately this chemical is persistent in the environment and human body and not easy to clean up.   France's highest court found Monsanto guilty of lying as far back as 2008 about the toxicity it's popular weedkiller, Roundup.  "The court confirmed an earlier judgment that Monsanto had falsely advertised its herbicide as "biodegradable" and claimed it "left the soil clean" (Read more here)

According to an Article in Nature published March 24, 2015:

Glyphosate is the world’s most widely produced herbicide, by volume. It is used extensively in agriculture and is also found in garden products in many countries. The chemical is an ingredient in Monsanto's weedkiller product Roundup, and glyphosate has become more popular with the increasing market share of crops that are genetically engineered to be tolerant to the herbicide.

California recently became the first state to issue plans to list glyphosate as a chemical known to cause cancer according to EcoWatch.  This is big news and we need to pay attention... the use of glyphosate has nearly doubled from 95 million pounds in 2001 to nearly 185million pounds in 2007, according to the latest  released report form the EPA and who knows how much it's increased sine 2007!  This is likely in part due to the increase usage of Round-up Ready genetically modified crops during that time period.

Dr. Anthony Samsel and Dr. Stephanie Seneff state in their recent article published August 2015:

Glyphosate has a large number of tumorigenic [cancer-causing] effects on biological systems, including direct damage to DNA in sensitive cells, disruption of glycine homeostasis, succinate dehydrogenase inhibition, chelation of [minerals such as] manganese, modification to more carcinogenic molecules, such as N-nitrosoglyphosate and glyoxylate, disruption of fructose metabolism, etc...

Sadly epidemiological evidence supports a strong correlation between the dramatic rise in use of glyphosate on crops and the multitude of cancers reaching epidemic proportions, such as breast, pancreatic, kidney, thyroid, bladder, and liver cancers.

In perhaps the most ironic twist of all, glyphosate has proven highly toxic to the basic phase one detoxification of the liver, the cytochrome pathways.  I find it incredibly alarming that one of the most toxic chemicals known to mankind also exerts it's influence by impairing human detoxification.  Here is an excerpt from  Entropy 2013, Glyphosate's Suppression of Cytochrome P450 enzymes and amino acid biosynthesis by the gut microbe:

Glyphosate's inhibition of cytochrome P450 (CYP) enzymes is an overlooked component of its toxicity to mammals. CYP enzymes play crucial roles in biology, one of which is to detoxify xenobiotics. Thus, glyphosate enhances the damaging effects of other food borne chemical residues and environmental toxins. Negative impact on the body is insidious and manifests slowly over time as inflammation damages cellular systems throughout the body.

Harvesting wheat after glyphosate application

Glyphosate may trigger autoimmunity, such as celiac disease by the following mechanisms:

• Spraying of wheat before harvest with glyphosate, a common practice in North America allows for a large exposure to glyphosate in wheat.
• Wheat may be the most common ingredient in all processed foods.
• Glyphosate also damages the microvilli in gut reducing ability to absorb vitamins and minerals
• Wheat contains gliadin, which is difficult for genetically susceptible individuals to break down.
• Glyphosate may attach to the gliadin as a consequence of a chemical interaction between the chemical make it even harder to break down this large protein molecule.
• It may not be recognized by the body or able to be broken down, making even more likely to induce an immunological response in susceptible individuals, contributing to development of celiac disease

In addition to celiac disease, researchers now believe that glyphosate may be linked to the following diseases:

1. Autism
2. Autoimmune diseases
3. Cancer
4. Parkinson's
5. Alzheimer's disease
6. Inflammatory bowel diseases (Crohn's and Ulcerative Colitis)
7. Cardiovascular disease
8. Depression
9. Infertility

Glyphosate is also toxic to our gut microbiome

Glyphosate is toxic to many of our benetifical gut microbes.  It may preferentially kill off species, like lactobacillus while leaving potential pathogens, like clostridia to run wild.  Glyphosate also chelates essential minerals, such as manganese, iron, cobalt, molybdenum, and copper so that the gut microbes do not have access to them.  This leads to chronic inflammatory states in the gut as well as increased intestinal permeability, a mechanism at the core of many chronic illnesses, including inflammatory bowel disease, depression, and autoimmunity.

If you are eating processed food, you are eating glyphosate...

Residues of glyphosate are commonly found in the most common foods in the American Diet, including

1. Corn
2. Soy
3. Sugar Beets (sugar)
4. Canola
5. Cotton (not food but in clothing, sanitary napkins and many products we use daily)

Nearly one billion pounds of glyphosate are doused on both conventional and genetically modified crops world-wide each year but GMO crops receive the largest amounts.  Processed foods undoubtable expose you to this toxic contamination, courtesy of wheat, corn, soy and the vegetable oil used.  And the meats from conventionally raised animals in confined feed lots are given fed that most likely contains glyphosate-laden corn and soy.

And finally... it gets personal

You may know that I grew up on a farm in Central Illinois.  My Dad and brothers still farm corn and soybeans there and I couldn't be more proud that they have recently switched over to non-GMO versions of these crops.  My brothers have started a few fields of organic crops as well.  Due to my own history of breast cancer and Crohn's disease, I have followed at 100% organic diet for at least the past 10-15 years.  Recently I realized just how pervasive this glyphosate exposure is in our environment when I sent out my urine to test my own glyphosate level.  I was shocked to get the results back (below) showing that my level was higher than the "Farmer" study, which tested farm workers on application day!  This made me realize how pervasive this dangerous chemical is in our environment and how important it is to remain vigilant to decrease exposure and work to get it banned.

Dr. Jill glyphosate levels

Ok, so what can I do about it?!

The most important thing to realize is that you cannot wash glyphosate off food since it is incorporated into each cell of plant.

Here are some tips to keep your diet free of glyphosate:

• Only way to 100% eliminate from your diet is to avoid conventionally grown and processed foods 
• Glyphosate accumulates in animal tissues, so make sure your meat was not fed GMO grains and your butter and dairy is organic
• Switch over to a 100% organic diet
• Take activated charcoal, clay or rice bran powder in aiding elimination of organophosphates and glyphosate after exposure
• Maintain adequate mineral status by taking a multi-mineral supplement that includes trace minerals
• Support glutathione production with N-acetylcysteine, glycine and glutamine or oral liposomal glutathione
• Support phase 1 and phase 2 liver detoxification by avoiding alcohol and taking liver support, like silymarin, lipoid acid
• It is much harder to reverse damage once it's done, so best to avoid glyphosate from the start—especially in children!

So go to it...  It's worth every penny to grown your own food or buy organic and begin to detox your body of this dangerous chemical!

Drinking Pure Water: A Overlooked Key to Optimal Health!

Talking about pure drinking water may seem a bit boring but making sure that you are adequately hydrated and that the water you drink is free of chemicals and toxins is paramount to your health.  Perhaps nothing is more basic but more important!

Did you know that blood is 92% water,  brain is 75% water, and muscles are 75% water?

Getting enough pure clean water is key in achieving optimal health.  Water makes up two thirds of the body and helps maintain blood volume, which maintains your energy. Proper hydration improves your concentration and reaction time.  It allows the body to remove toxic waste and keeps your skin looking supple and healthy.  In fact, dehydration may be a hidden factor in many types of illness.

Do you have any of these symptoms?  If so, you may be dehydrated...

• Feeling sleepy or tired for no reason
• Dry sticky roof of your mouth
• Craving sweets or hunger after just having eaten
• Low blood pressure
• Throbbing headaches
• Dry, scaly skin, rashes or eczema
• Constipation or pellet-like stools
• Dizziness upon standing
• Confusion or irritability
• Infrequent urination
• Muscle cramping
• Rapid heartrate

Fun Facts about water:

• It is responsible for carrying food and oxygen to our cells and carrying away waste.
• It is the biggest playing in our blood and lymphatic drainage systems
• It helps flush out our kidneys to get rid of toxic substances.
• It moistens our eyes, mouth, and nasal passages.
• It controls the balance of electrolytes in our cells and body and regulates blood pressure
• It allows the body to cool when it is hot and insulates the body from cold.
• It cushion the body’s organs, acting like a shock absorber
• It provide many of the trace minerals we need if drinking spring or non-RO filtered water
• It assists joints with lubrication and is part of your sweat, tears, and saliva.

Most important, though, is that you  have a clean source of drinking water.  Whole house filters are wonderful for those who can afford them but reverse osmosis also pulls the essential minerals from your water leaving it quite acidic.  It is essential to use a quality filter that gets all impurities, chemicals and toxins out!  You can read articles all over the internet on the contamination of our water supply, like arsenic in well water here.  In fact, a recent EPA study  shows there is alarming contamination of our water supply with pharmaceutical drugs... and no one is doing anything about it. Here is the Consumer Report  and the WHO report regarding prescription drugs in your drinking water.   One of my favorite handouts to give patients on the topic of clean water is the EWG's Guide to Safe Drinking Water.

So, in order to practice what I preach to patients, I recently revisited the importance of clean drinking water myself and did my homework.  I did researched and decided against an RO system and instead purchased my first Big Berkley (see photo below)  Best. Purchase. Ever!

Dr. Jill's New Big Berkey Water Filter

Berkey water filters produce purified drinking water, surpassing standards set by the military in order to be able to differentiate between water filters of different abilities. They set the bar high so that very few are able to achieve this classification. Berkey water filters not only meet this standard but surpasses it.  The technology that Berkey uses to purify water is able to handle the very smallest of water contaminants, even viruses, making it on of the most powerful water filtering systems available.  Better yet, you can even get a travel version!   This ability is all possible using the most simple, foolproof methods, starting with micro-filtration with a pore structure so small that minute organisms are not physically able to pass through the filtration medium.  For more answers to frequently asked questions, read this.  If you know me well, I only tell you about things that I use myself and have found profoundly beneficial in my own healing journey.  Berkey water filters are one of them ;-) So here's to all of use having healthy clean drinking water!

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If you know me well, you know one of the highlights of my week is the Farmer's Market in Boulder, Colorado.  Getting my weekly supply of seasonal dark leafy greens and fresh vegetables from local farmer's like Red Wagon Organics for my smoothies and juices and occasionally some of Plowshares organic bacon for my husband is an adventure and something we enjoy doing together on Saturday mornings!

A couple of weeks ago, I ran into Jake Burgart with Olea Estates olive oil, one of my favorite new finds at the local Boulder Farmer's Market.  I bought a bottle right away and was back for more the very next week!  (Yes, I eat that much olive oil!)  Not only was it absolutely pure and delicious but organic extra virgin olive oil is loaded with health benefits!

You can read all about the Chronis family tradition in Greece here.  Even now, they are one of the only few producers that certify our olive oil every year with both the European Regulations for Biological Products and with the USDA for Organic Products. You can taste and see the quality of pure first press olive oil, when you open a bottle of Olea. The deep green color, the thick consistency, the pure aroma, the exquisite taste, all contribute to separate Olea from other olive oils that I've tried.

Jake Burgart and friend at the Olea Estates Olive oil booth in Boulder on Saturday

"At Olea we do not produce anything but only our extra-virgin olive oil obtained by first press of our ripe and selected olives at temperatures under 27C. We do not blend refined oils and we use no other method of altering our olive quality, taste or color. We do not filter our olive oil, but we do guarantee uniform clarity and no cloudiness. See how we do it. Olea Olive Oil has the true, rich flavor of olive oil and all associated nutrients and is obtained by a strictly controlled and long lasting process, especially for the food connoisseur."

But perhaps the best thing is you can enjoy it freely with a guilt-free conscious as there are so many health effects of a Mediterranean diet rich in olive oil!

Here's just a few of the latest studies on health benefits of olive oil:

• A Mediterranean diet rich in virgin olive oil is associated with reduced weight gain.

• Mediterranean Meal with Olive Oil Keeps Blood Sugar Levels Lower than with Corn Oil

• Consumption of olive Oil Polyphenols Decrease LDL Concentrations in healthy men.

• Consumption of olive oil may decrease breast cancer risk.

• Olive Oil Polyphenols Reduce Bad Cholesterol and Plaque Formation

• Mediterranean diet rich in olive oil may reduce risk of metabolic syndrome.

• Dietary unsaponifiable fraction from extra virgin olive oil supplementation heals ulcerative colitis in mice.

• The Protective Effect of the Mediterranean Diet: Focus on Cancer and Cardiovascular Risk

• Antioxidant and anti-atherogenic activities of olive oil phenolics.

• Mediterranean Diet rich in olive oil may have protective effect in multiple sclerosis.

• A mixture of honey, olive oil, and beeswax for the management of hemorrhoids and anal fissures.

So be sure to stop by and tell Jake "hello" from Dr. Jill and get some of this new delicious crop of olives.  Who knows?  You just might run into me there next weekend ;-)

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Diet-induced Changes in the Gut Micro-biome

Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease

Read full article HERE

Kirsty Brown  †, Daniella DeCoffe  †, Erin Molcan and Deanna L. Gibson  *

Department of Biology, University of British Columbia Okanagan, Kelowna, BC V1V 1V7, Canada;

Abstract

The gastrointestinal (GI) microbiota is the collection of microbes which reside in the GI tract and represents the largest source of non-self antigens in the human body. The GI tract functions as a major immunological organ as it must maintain tolerance to commensal and dietary antigens while remaining responsive to pathogenic stimuli. If this balance is disrupted, inappropriate inflammatory processes can result, leading to host cell damage and/or autoimmunity. Evidence suggests that the composition of the intestinal microbiota can influence susceptibility to chronic disease of the intestinal tract including ulcerative colitis, Crohn’s disease, celiac disease and irritable bowel syndrome, as well as more systemic diseases such as obesity, type 1 diabetes and type 2 diabetes. Interestingly, a considerable shift in diet has coincided with increased incidence of many of these inflammatory diseases. It was originally believed that the composition of the intestinal microbiota was relatively stable from early childhood; however, recent evidence suggests that diet can cause dysbiosis, an alteration in the composition of the microbiota, which could lead to aberrant immune responses. The role of the microbiota and the potential for diet-induced dysbiosis in inflammatory conditions of the GI tract and systemic diseases will be discussed.

Microbial changes in the GI tract have profound effects on host inflammatory and metabolic responses. For example, protein-rich diets increase the activity of bacterial enzymes such as β-glucuronidase, azoreductase and nitroreductase, which produce toxic metabolites that trigger inflammatory responses. Because of the intricate balance that exists within the microbiota, alterations in one group or species may not only affect the host directly, but can also disrupt the entire microbial community. For example, members from the phyla Firmicutes, Actinobacteria, Verrucomicrobium and Bacteroidetes can degrade complex carbohydrates not absorbed by the host and can also inhibit the growth of opportunistic pathogens such as Clostridium spp. and members of Enterobacteriaceae like E. coli . Dysbiosis can also alter the metabolic activity of other members of the microbiota in the gut. Thus, it is conceivable that some diets promote the growth of microbes that could have detrimental effects on their host while other dietary factors could promote beneficial microbes. It is unknown whether diet-induced dysbiosis is a transient or long-term event. If dysbiosis is a long-term event, then postnatal nutrition could be used to promote changes in the microbiota early in life during the development of a more stable microbiota. In support of this, consumption of formula supplemented with fish oil has the capacity to alter the microbial composition in the infant; however, it is unknown if these microbial changes would be long lasting or transient. Although this study did not identify the specific microbes that changed, nor did it examine the effect on intestinal immunity, it does suggest that the microbiota could be modified through dietary factors to enrich beneficial microbes and prevent diseases associated with dysbiosis.

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Dr. Jill's Summer Reading List

Top 10 Inspirational/Motivational

1. Love Does
2. Better Than Before
3. Circle Maker
4. Unexplainable, Pursuing a Life only God can make possible
5. The Life Changing Magic of Tidying Up
6. Quiet, The Power of Introverts in a World that Can't Stop Talking
7. Crazy Love
8. The Rise of Superman
9. The Gift of Imperfections
10. Love, Medicine and Miracles

Top 10 Healthy Living/Functional Medicine

1. Tox-Sick
2. Brain Maker
3. Missing Microbes
4. The Good Gut
5. Gut Balance Revolution
6. Why We Get Fat .... and What to Do About It
7. Why Can't I Get Better? Solving the Mystery of Lyme and Chronic Disease
8. Gluten Freedom
9. Wheat Belly
10. Autoimmune Solution

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Natural Treatments for Adrenal Fatigue

Symptoms that indicate you may have Adrenal Fatigue...

Click here to take the QUIZ:  Do you have Adrenal Fatigue?  

• Morning fatigue -- it's hard to "wake up" until 10 a.m., even if you've been awake since 7 a.m.
• Afternoon feeling of sleepiness or brain fog from 2 to 4 p.m.
• You may have a burst of energy at 6 pm
• Sleepiness at 9 to 10 pm but often you resist going to sleep and get a "second wind" at 11 p.m. that lasts until about 1 a.m., when you finally go to sleep.
• Cravings for foods high in salt
• Increased PMS or menopausal symptoms
• Mild depression or anxiety
• Lack of energy, fatigue
• Decreased ability to handle stress,
• Feeling easily overwhelmed
• Increased allergies
• Lightheadedness when getting up from a sitting or laying down position
• Decreased libido
• Frequent sighing or air hunger
• Inability to handle foods high in potassium or carbohydrates unless they're combined with fats and protein

 Dr. Jill's Top Treatment Strategies for Adrenal Fatigue

 "Optimal adrenal health is one of the major keys to the enjoyment of life" If you have adrenal fatigue take these simple steps of necessary lifestyle and dietary changes to revive your adrenals and begin to enjoy life again!

 

LIFESTYLE TIPS

• Identify and remove stressors - this is the most important step. Emotional stressors such as relationships or financial problems needs to be dealt with and normalized.  It might require a change in hours, who you spend time with, or even occupation.  Make the necessary changes to restore your health.
• Go to sleep by by 10pm.  You may need to set an alarm and begin getting ready for bed by 9pm.
• Whenever possible get rest in the morning from 7-9am, the optimal hours to restore adrenal function.
• Include something you enjoy every day, a leisurely walk, 30min of reading a great book, weekly massage, etc...  Schedule these necessities into your calendar so that you are sure to carve out time for self-care.
• Incorporate humor into your day, laugh at comics, watch a funny video or just belly laugh about something funny with your spouse.
• Avoid becoming over-tired, by ensuring proper bedtime and avoiding activities that cut into your time for restful restorative sleep.  Try red light at night and avoid computer screens, iPads or stimulating blue light after 7pm.
• Consider a melatonin supplement 3-6mg at bedtime to help regular cortisol before bed.
• Exercise gently at least 5 days per week, preferably morning and not late in the day.  Try swimming, gentle bike rides, walking, yoga, stretching, or any restorative activity that incorporates breathing.  Avoid high adrenaline activities, like kayaking, competitive sports, running, cross fit or high intensity training until you are well on your way to healing.
• Drink high quality, purified water with added minerals.  Natural mineral waters, like San Pellegrino are also helpful to restore the missing minerals, like magnesium and have the added benefit of sulfur.
• Avoid negative people who drain your energy and instead make time for friends and family who lift you up, support you and encourage you.  Life is too short to waste time on those who steal your joy.
• Consider taking specific adrenal-supportive nutrients with your doctor:   Some of my favorites are Vitamin C, B complex, pantothenic acid, magnesium, and vitamin E.
• Consider adaptogenic herbs, like ashwaganda, rhodiola, ginseng, and licorice.
  • You can order either of my favorite formulas Adrenal Manager or Adrenal Essence  direct from Xymogen using code: DrJill and last name: Carnahan

DIETARY TIPS

• A poor unhealthy diet is a key causes of Adrenal Fatigue
• Always eat breakfast before 10am. The body's glycogen supply needs to be replenished after going through the night. Try to eat your lunch before noon and evening meal before 6 p.m.
• Avoid coffee or other caffeinated beverages. Coffee and tea act as stimulants and interrupt sleep pattern. Herbal tea is acceptable because it does not contain caffeine.
• Eat within one hour of waking.  Fasting is hard on the adrenal glands so minimize time overnight fasting.  Never skip breakfast and be sure your first meal contains high quality protein and no refined carbohydrates or sugar.  Eat your starches in the evening and never in the morning.
• Drink a large glass of water in the morning immediately upon waking with 1 teaspoon of Redmond real sea salt and 1/2 squeezed lemon.  You can also use 1 scoop of my favorite adrenal supportive electrolytes in water:  Thorne Catalyte (Order online using code: HCP1004064)
• Sprinkle sea salt liberally on food to taste provided blood pressure is normal. Foods high in potassium such as banana can make the adrenals worse and should be avoided.
• Adopt a whole food organic diet, devoid refined grains and all processed food, such as breads, pastas, and rice cakes and crackers.
• Eat 5-7 servings of organic veggies daily
• Avoid high starchy foods, such as white rice and white potatoes.  Some people do better with a serving of complex starch, like brown rice, quinoa or sweet potato in the evening to lower cortisol and help them sleep.
• Avoid high sugar fruits and all juices, especially at breakfast.
• Eliminate trans fats (we all should do this anyway!)
• Eat wild-caught seafood at least 3X weekly or taking a high quality mercury-free fish oil supplement.
• Eat foods rich in adrenal-supportive nutrients, such as Organic 85% dark chocolate, leafy greens, nuts, sunflower or pumpkin seeds, flax and chia seeds, and organic grass-fed animal proteins.
• Combine protein and fat at every meal and snack. This will ensure sustained energy is available at and between meals.  Avoid eating only fruit or carbohydrates alone as this may cause blood sugar instability.  Upping your total fat intake with olive oil, coconut, and avocado may also help.
• Whole fruits may be eaten later in the day at lunch and dinner except banana, fig, melons, or dried fruits.  Berries and apples are wonderful low-glycemic options.
• Take small amounts of protein and fat such as nuts, cheese or nut butter before bed if you have difficulty falling asleep or awaken frequently between 2-3am.

Follow these easy tips and before long your adrenals will be recovering and you'll be on your way to feeling fabulous!

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DID YOU MISS PART I?  Read it here: Could You Have Adrenal Fatigue?

Quiz: Could you be suffering from Adrenal Fatigue?!

Take this simple quiz to find out if you might have Adrenal Fatigue or Adrenal Dysfunction...

1. Do you have difficulty awakening from sleep in the morning, often hitting the snooze button multiple times?
2. Do you need coffee to get going in the morning?
3. Have you recently gained weight, especially around the middle?
4. Do you feel like you get every cold and flu bug that is going around, that your immune system is shot?
5. Do you have more difficulty dealing with stress and deadline pressure than you used to?
6. Do you have a lack of interest in sex?
7. Do you frequently feel lightheaded upon standing quickly?
8. Do you struggle with poor memory or "brain fog"?
9. Do you feel especially tired in the mornings and afternoons between 3-5pm?
10. Do you feel the need to snack or eat frequently to maintain a normal blood sugar?
11. Do you crave salty foods?
12. Do you feel extremely tired between 7-10pm but get a second wind if you stay up later?
13. If you are female do you struggle with PMS:  heavy bleeding, moodiness, fatigue during menstrual cycle?  If you are male, do you feel like you stamina, energy and ability to maintain muscle are decreased?
14. Do you frequently have pain in the upper back or neck with no apparent reason?
15. Do you notice improvement of symptoms stress levels are lower, such as during a vacation or time away from work?

If you answered more than 10 of the questions above "yes",  you may have a condition of adrenal dysfunction often referred to as Adrenal Fatigue.

The adrenal glands sit over the kidneys, where they play a significant role in the body, secreting more than 50 hormones necessary for life, including epinephrine, cortisol, DHEA, progesterone and testosterone.
Since they produce so many essential hormones, the adrenal glands are responsible for many of the functions we need to stay alive and healthy, including:

• Energy production - carbohydrate, protein and fat conversion to blood glucose for energy
• Fluid and electrolyte balance
• Fat storage

One hormone in particular, cortisol, is extremely important for keeping our body systems in balance, as well as protecting our cells. For example:

• It controls the strength of the immune system: Too much cortisol weakens the immune system, setting the motions for increased susceptibility to infections and cancer, while too little leads to an overactive immune system and autoimmune disease.
• It normalizes blood sugar.
• It regulates blood pressure and electrolyte balance

As the manufacturer of adrenaline, they are the "glands of stress," but are also the first glands to fail during prolonged or intense periods of stress. The problem with stressors is that they are "cumulative," in the sense that their impact tends to add up in the body over time until your adrenal glands just can't take anymore. Adrenal "fatigue" or dysfunction used to be rare, but is now all too common because of our lack of relaxation and other lifestyle factors, such as smoking, sleep deprivation, poor eating habits and excessive caffeine intake, as well as exposure to environmental toxins and allergens.
Adrenal fatigue should not be confused with another medical condition called Addison's disease where the adrenal glands are not functioning at all. While Addison's disease is often caused by autoimmunity, Adrenal Fatigue is largely caused by stress along with a host of other factors, like accumulation of toxic exposures, hidden infections, hormone imbalance, or even nutritional deficiencies.

More signs and symptoms of Adrenal Fatigue include:

• Mild depression or anxiety
• Multiple food and or inhalant allergies
• Lethargy and lack of energy
• Increased effort to perform daily tasks
• Decreased ability to handle stress
• Dry and thin skin
• Low blood sugar
• Low body temperature
• Palpitation
• Unexplained hair loss
• Alternating diarrhea or constipation

The ability to handle stress, physical or emotional, is a cornerstone to human survival. Our body has a complete set of stress modulation systems in place, and the control center is the adrenal glands. When these glands become dysfunctional, our body's ability to handle stress and fight infections is decreased.

Causes of Adrenal Fatigue Include:

Excessive stress can be from many sources. Chemical toxicity and nutritional depletion are among the physical causes. Mental, emotional or spiritual stress may be a major factor, too. Financial, family or other stress may also contribute to burnout. Even infections can play a role.

STRESS

Any excessive stress can deplete the adrenals. Excessive workload, long hours, lack of sleep, or emotional stress are common.  Other stressors in cities are noise and electromagnetic pollution. Cell phones, microwave towers and appliances like televisions, cell phones, wearable electronics,  microwave ovens and computers give off strong EMF fields that can be stressful to our bodies

NUTRITIONAL DEFICIENCIES

Many people today have subclinical deficiencies of essential nutrients, like B vitamins, Vitamins A, C and E, Magnesium, Zinc,  and other trace elements.  When under stress, the need for nutrients is even greater. Refined carbohydrates stress the adrenals as well. Diets low in protein may also create deficiencies.   The Standard American Diet is both high in processed carbs and sugar and lower in quality fats and protein and many times lacking in micronutrients.

Inadequate or poor quality water affects oxygenation of the tissues. Most diets are low in nutrients required by the adrenals. These include  The reasons for this begin with how food is grown. Most food is grown on depleted soils.  Our soils of today contain a fraction of the magnesium as soils hundreds of years ago did.  Processing and refining further deplete nutrients. Habits such as eating in the car or while on the run further diminish the value derived from food and our ability to digest it.  Allergic reactions to foods such as wheat and dairy products can damage the intestines and reduce the absorption of nutrients as well.

ENVIRONMENTAL TOXINS

Toxic chemicals often play a large role in adrenal burnout. Everyone is exposed to thousands of chemicals in the air, the water and the food. Sources may also include dental materials or beauty products, such as shampoo, lotions, make-up.   Cleaning our home with toxic chemicals may also take it's toll.  Over-the-counter and prescribed medications also add to the body’s toxic load.   Check out these 10 Tips to decrease your exposure. Toxins may also be generated internally due to microbial imbalances in the gut and impaired digestion. When food is not properly digested, it may ferment in the intestines, producing many harmful substances that are absorbed through the intestinal lining. A healthy body has the ability to eliminate many toxins on a daily basis. However, as adrenal weakness develops, the body’s ability to eliminate all toxins decreases. This produces a vicious cycle in which weaker adrenals impairs the elimination of all poisons, which then further weakens the adrenals.

CHRONIC INFECTIONS

Chronic infections may originate in infected teeth or gums, though they can be located anywhere in the body. They contribute greatly to the toxic load of the body. Infections also cause inflammation and stress that must be countered using the adrenal hormones such as cortisol and cortisone.

One of the most commonly overlooked causes of Adrenal Fatigue is intestinal infections that gives rise to an inflammatory response. Such infection can occur sub-clinically with no obvious signs at all. Infections in the gut, including giardia, SIBO (small intestinal bacterial overgrowth), fungal dysbiosis, and h. pylori infection are just a few that may contribute to adrenal dysfunction.

STIMULANTS OR EXCESSIVE EXERCISE

Stimulants damage the adrenal glands by pushing the secretion of stress hormones and adrenaline and over time depleting the body of essential neurotransmitters. Caffeine, sugar and alcohol are among the most common culprits.

Less obvious but no less important stimulants may include anger, rage, arguments, hatred, unforgiveness, loud music, tragic news, and even movies with suspense or excessive violence. Other activities that may act as stimulants  include vigorous exercise or recreational drug use.  Even high risk sports, like surfing, diving, or extreme climbing if done in excess may deplete the adrenals.  Most of these activities provide a temporary “high”, which is caused in part by the secretion of high amounts of adrenal hormones. Over time, however, this weakens the adrenals and can eventually lead to adrenal depletion and insufficiency.  

TOXIC EMOTIONS

Uncontrolled emotions are another cause of adrenal burnout. These include habits of worrying, or becoming angry or afraid. Don’t worry, be happy is a great prescription for adrenal burnout. This applies particularly to high strung, Type A, nervous individuals as they are especially prone to adrenal burnout.  Prayer and meditation release calming neurotransmitters and take the body from a state of fight and flight into the parasympathetic mode of relaxation and can be extremely helpful in healing adrenal fatigue.  In addition, cultivating an attitude of gratitude can do wonders for you adrenals.

More stressors that can lead to Adrenal Fatigue:

• Emotions, like anger, fear, guilt
• Chronic illness
• Chronic infections
• Chronic pain
• Depression
• Excessive exercise
• Gluten intolerance
• Malabsorption and poor digestion
• Toxic exposure
• Severe or chronic stress
• Surgery
• Sleep deprivation
• Excessive sugar in diet
• Excessive caffeine intake
• Processed foods, additives, chemicals and genetically modified ingredients, like corn, soy, canola.
• Infected teeth, gums or root canal

Chronic stress is very common in western society. The most common causes of stress are work pressure, changing jobs, death of a loved one, moving homes, illness, and marital disruption. Adrenal fatigue occurs when the amount of stress overextends the capacity of the body to compensate and recover.   But there is hope...  stay tuned for my next article on how to treat adrenal fatigue

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Be sure to read PART II:  TREATMENTS FOR ADRENAL FATIGUE...

Mind Altering Microbes: How your gut microbiome may influence your mood

"I've got a gut feeling about this"

While we have certainly heard that appetite and digestion are controlled by the enteric nervous system  (also known as "the master control panel in your gut"), who would've thought that the gut might also control your emotions and mood?  It's no wonder the old sayings, like "I've got a gut feeling about this", "That movie was gut-wrenching", or  "Come on, gut it out!" ring so true.  In fact I'd venture to say when we are trusting our intuition we associate it with having a "gut feeling" about something.

From the research it is now clear that gut microbes have an affect on inflammation, pain, eating behaviors, food cravings, mood and other seemingly unrelated symptoms, such as depression or uncontrolled anxiety.  In addition, it is common for depression and anxiety to co-exsist with disorders such as IBS (irritable bowel disorder).

It goes both ways...

Yes, it's true!  Did you know the gut-brain axis provides a way of communicating both directions using signals, such as neurotransmitters, hormones and cytokines?  This means that your gut bugs actually talk to your brain to influence emotions.  Equally important the emotions you feel and neurotransmitters produced by the brain have a profound effect on the gut as well.  We know that dysfunction in this communication between gut and brain can lead to various diseases, including depression and anxiety.  Who knew that the composition of your gut microbes could play such a great role in your mood?  The next time you get angry at your spouse or are overcome with sadness making you want to curl up in bed you can simply say, "Don't blame me...It's my gut microbes's fault!"  and you may be right on target!

The human gut is populated by more than 100 trillion microbes, which means there is more bugs in your gut than cells in your body.   And the genetic material contained by microbes in your gut is 150X that of the genetic material from human origin.  Most experts agree we have more than 1000 different species in our gut and over 7000 different strains.  We know that as we are exposed to stress, chemicals, antibiotics, and toxins, the diversity of the microbiome decreases and we know that the less diverse or microbiome, the more susceptible we are to illness and disease.

A baby's colonization of the gut first occurs at birth with vaginal exposure to the mother's microflora.  Did you know that c-section baby's have gut microbes more akin to skin flora than gut flora after birth?  And some studies show that throughout the entirety of life, they may never regain the normal diversity of vaginally delivered infants.

These are just a few of the functions of these bugs residing in your gut:

• Development of your immune system function
• Assisting with bowel movements and gut motility
• Maintaining intestinal cell barrier integrity (keeping the the good stuff in and the bad stuff out)
• Aiding in digestion and absorption of specific vitamins and minerals
• Controlling fat absorption and distribution

Pathways involved in communication between the gut microbes and brain.

Microbes and Stress

What is increasingly clear is that there is bi-directional communication between our gut microbes influencing the central nervous system and brain... and the reverse; communication between our brain influencing microbial composition.   Did you know that stress affects the gut microbes, too?

These are the top 3 ways that chronic stress affects the gut:

1. Increases the levels of inflammatory cytokines (IL-6, TNF-alpha) which can changes gut microbe populations.
2. Increases permeability of the gut lining, which is linked to many autoimmune diseases  (Hashimoto's thyroiditis, lupus, rheumatoid arthritis, multiple sclerosis and many others).
3. Allows bacteria to cross over into the bloodstream where the bacterial coating (LPS) can trigger an intense inflammatory response in the body.

So how do the gut microbes contribute to anxiety and depression?

Here are some of the mechanisms by which the gut microbes influence the brain and emotions:

• Altered microbial composition: Both probiotic ("good guys") administration and harmful infectious bacteria ("bad guys") have both shown to have an effect on the brain and emotions.  One study showed supplementation with probiotics decreased anxiety.
• Immune Activation:  Bacteria in the gut have been shown to activate the immune system and increase production of harmful pro-inflammatory cytokines.   There are many studies showing a link between increase in certain cytokines and depression (see below if you want to read more)
• Vagus nerve:  This is one of the main controls of the parasympathetic system that calms our fight or flight response and allows our body to relax and feel calm.  Activation of the vagus nerve and release of acetyl-choline has been shown to have a profoundly calming and anti-inflammatory effect on the body.  Most of the effects of gut microbes on the brain and body have been shown to be dependent on vagal nerve activation.
• Tryptophan metabolism:  Tryptophan is an extremely important amino acid and the raw material needed to make serotonin (think "the happy neurotransmitter") by the body.  There is a pathway, called the kynurinine pathway that involves metabolism of tryptophan and accounts for nearly 95% of the stores of tryptophan in the body.  In the case of pathogenic microbial infections in the gut (bacteria, yeast, or parasites) this pathway may be activated and "steal" from your body's tryptophan stores.  This leads to depletion of serotonin stores and may result in insomnia and depression.
• Microbial metabolites:  Bacteria in the gut help produce bile acids and short chain fatty acids (SCFAs) which are essential for human physical and mental health.
• Neurometabolites: Crazy but true... bacteria have the ability to produce many neurotransmitters and metabolites that have direct action on brain and thought.   Did you know studies show microbes can even influence your food cravings?!
• Bacterial cell wall sugars:  Perhaps most fascinating of all, the outer coatings of bacteria contain sugar molecules that can directly signal immune and hormonal systems into action.  This is the mechanism thought to be responsible for the healthy effects of probiotics on the gut and brain.

The bottom line is there is a growing body of evidence that suggests gut microbes play a large role in regulation in behavior and brain chemistry and are relevant to development of depression and anxiety.

So perhaps the best antidepressant is a healthy whole food diet and a high potency probiotic to fuel a healthy gut microbiome!

Check out Part II - Six Simple Steps to Treat Depression

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Further Reading:

• Psychoneuroimmunology Meets Neuropsychopharmacology: Translational Implications of the Impact of Inflammation on Behavior
• Inflammatory Cytokines in Depression: Neurobiological Mechanisms and Therapeutic Implications
• Cytokine variations and mood disorders: influence of social stressors and social support
• Increased IgA and IgM responses against gut commensals in chronic depression: Further evidence for increased bacterial translocation or leaky gut
• Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour
• Stress and the Gut