Anemia may be the root cause of many chronic conditions such as headache, migraine, mood disorders, and fatigue.  Getting assessed by a functional medicine provider trained in the diagnosis and treatment of anemia may be the missing link towards optimal health.  In this blog post I will be focusing on iron deficiency anemia as it is the most prevalent in our clinical practice.  While both males and females can be affected by anemia, females are affected at a much higher rate.  

What is anemia?

Anemia is defined as a low red blood cell count (RBC), low hemoglobin (Hgb), and a low hematocrit (red blood cell concentration in whole blood). Iron deficiency anemia, or IDA, is defined as a microcytic, hypochromic anemia, where the red blood cells are small in size and pale in color due to poor hemoglobin concentration. These red blood cells do not carry oxygen as efficiently, and your tissues can become hypoxic or starved of oxygen. As a result, your heart pumps faster to try and bring more oxygen to the tissues. Additionally, your brain gets less oxygen which causes headaches and mental fatigue.  Symptoms of anemia include fatigue, cold hands/feet, rapid or irregular heart rate, headaches, dizziness and lightheadedness, pale or yellow skin, and shortness of breath. When iron status is addressed, we have seen issues like anxiety, depression, and insomnia improve drastically in our patients. 

There are many types of anemias that can affect the body. For instance, Vitamin B12 (cobalamin) and Vitamin B9 (folate) deficiencies can cause anemia.  These anemias will present as a ‘macrocytic’ anemia where red blood count is low and the red blood cells actually become larger as part of the deficiency.  When assessing your bloodwork for anemia and any other condition, make sure to consult with a physician trained in functional medicine.

How do you measure it?

To assess iron status, we order a simple test called plasma ferritin. Ferritin is your body’s storage form of iron and is in largest concentration in your liver, spleen, and bone marrow. Small amounts of ferritin circulate in your bloodstream in direct proportion to the amount of ferritin stored in tissues. Normal values for ferritin vary with age and sex, and good laboratories will provide age and sex specific reference ranges. The lab reference ranges for ferritin are typically quite large, e.g. 16-154 ng/ mL for a 40 year old female, meaning stricter ‘functional ranges’ need to be used for clinical decision making. Using functional medicine standards, we prefer to see ferritin levels above 100 ng/ mL. It’s important to note too much iron is also a problem, and can cause conditions such as iron overload or hemochromatosis.  

What to do: 

If your ferritin levels are low, look to optimize digestion of iron by taking a hydrochloric acid supplement which will help increase the acidity of your gut. Having an appropriately low stomach pH (more acidic) is necessary for the proper digestion of iron, vitamin B12, calcium, and magnesium among other vital nutrients. For more information, refer to my blog post on stomach acid and digestion here.  

To improve iron status it’s important to consume foods high in iron. Animal protein is one of the best ways to get iron. Red meat, organ meats, shellfish, and turkey are excellent ways to increase iron status when paired with optimal digestion. Cooking daily with a cast iron skillet is another easy way to improve iron status. One of my favorite iron and vitamin B12 rich meals is a grass fed ribeye steak cooked with butter or coconut oil in a cast iron skillet. Another option is to use an ‘iron fish’ which can be dropped into warm beverages and will safely release iron into your drink. Consider using an iron fish in hot water with honey and apple cider vinegar. The apple cider vinegar will help increase gut acidity and improve iron absorption.  

Take action!

If you can relate to the symptoms described above, make sure to get a ferritin and complete blood count (CBC) test as soon as possible from your doctor. It’s always better to ‘test rather than guess’ because too much iron can also be problematic. The tests are simple and inexpensive so don’t hesitate to ask your doctor to order it for you. Having healthy red blood cells is essential for optimal health, and a CBC test looking at iron levels will help determine what steps you may need to take to improve your overall well-being. 

Post written by Dr. Riley Kulm, DC.  Check out his bio here.

When I am performing needling on a patient for the first time, I am regularly asked what the difference is between acupuncture and dry needling.  For many, these two treatments are one and the same, but despite their similarities, they also have their differences. 

Acupuncture

Acupuncture is one branch of Traditional Chinese Medicine (TCM), the others being herbal medicine, nutrition, movement (Qi gong), and manual therapy (cupping, tui na massage, and gua sha).  Acupuncture involves inserting needles at specific points and utilizes the ‘meridian theory’ as its basis for treatment. On an acupuncture chart you will notice lines, or meridians, drawn throughout a person’s body.  A meridian may travel from the hand to the head, the foot to the abdomen, or from one end of the spine to the other. Meridians connect different parts of the body to each other. Each meridian is linked to an internal organ, such as your liver, lung, or heart. There are 12 primary meridians, one for each organ, along with 2 ‘extraordinary’ meridians, which are commonly used in practice.

Based on the theories of TCM there is an energy force called ‘Qi’ flowing along the meridians. Qi is responsible for keeping our tissues healthy, youthful, and disease free. The smooth flow of Qi along the meridians is imperative for optimal health. When Qi does not flow well or is stagnate, pain, injury, and disease can arise. When a needle is used to stimulate an acupuncture point in clinical practice, the goal is to restore the flow of Qi along the meridian. When Qi is flowing freely throughout your body, you will feel vital and energized.  

Dry Needling

The origins of dry needling and trigger point theory are closely related. Trigger point theory refers to the idea that pressing on a tight, tender band of muscle tissue will often refer pain to a different area of the body. For instance, stimulating a trigger point in the upper trapezius muscle of the shoulder may cause pain in the temporal region of the skull. Researchers began mapping these ‘referral patterns,’ which appeared to be consistent from person to person. Janet Travell and David Simons are arguably the two most influential contributors to trigger point theory and their pain referral charts are still widely used today.  Early researchers of the trigger point theory used needle injections of local anesthetics to map the associated referral areas for each trigger point. Interestingly, the treatment benefit would often outlast the anesthetics known treatment time. It was at this point researchers realized it was actually the needle insertion into the trigger point, rather than the anesthetic itself, providing the therapeutic effect.  Dry needling is referred to as ‘dry’ because there is no anesthetic or saline injection used during the needling treatment.

Similarities Between the Two

In general, the local effect of the needle is the same whether you are performing acupuncture or dry needling. At a microscopic level, the needle is causing a local micro-trauma or small injury to the tissues, which stimulates the body to send blood and healing products to the area.  Needling is a viable treatment for areas receiving poor blood flow, such as tendons, ligaments, and the periosteum of bone.  By stimulating blood flow to these traditionally ‘avascular’ or low blood flow areas, the patient’s recovery from tendinous and ligamentous injuries can be accelerated.  

In my practice I use a combination of acupuncture and dry needling. I often do dry needling at the site of pain, and then utilize local, adjacent, and distant Chinese medicine acupuncture points to help move Qi and blood throughout the body. As a chiropractor, I utilize many spinal points to help with painful conditions of the neck and low back. Combining a spinal chiropractic adjustment with needling in the same area is extremely helpful for patients. Acupuncture and chiropractic care complement each other wonderfully. Chiropractic care helps the neurologic and orthopedic systems function better, while acupuncture helps with systemic health by improving the flow of Qi and blood throughout the body.  Combining a Western orthopedic approach with an Eastern Chinese medicine approach is an excellent way to help patients achieve optimal health.  

Post Written by Dr. Riley Kulm DC.  Check out his bio here.

People are often told in order to meet their weight loss goals they need to eat clean, work out consistently, and limit the number of calories in versus calories out. Unfortunately, despite working these modifications into their daily lives, they still find their weight loss goals unachieved. I’ve worked with numerous frustrated patients who work out strenuously 5 to 6 times per week, yet are not seeing the results they would like. The overlooked missing piece to weight loss is hormonal imbalances. These imbalances may be preventing you from reaching your weight loss goals.   

The two hormones I will focus on for weight loss are cortisol and melatonin. Please note, hormones such as grehlin and leptin (hunger and satiety), testosterone and estrogen (male and female sex hormones), and insulin and glucagon (energy storage and utilization hormones), are all intimately involved in weight loss, but cortisol and melatonin are a simple and effective place to start.  

Cortisol often gets a bad rep as our body’s ‘stress hormone’. Cortisol is a primary hormone involved in the body’s stress response, however, cortisol is more appropriately defined as our ‘awake’ hormone. Cortisol is released in the morning and helps us get out of bed, use the bathroom, and provide us with the stimulation to start our day. In a normal functioning endocrine system, cortisol release is high in the morning and then tapers off in the afternoon to allow our sleep hormone, melatonin, the chance to take over.   

Melatonin is our ‘sleep’ or ‘darkness’ hormone and it’s release is inhibited with exposure to light. Melatonin helps us wind down in the evening and prepare the mind and body for sleep. Melatonin and cortisol work in opposition to each other. Having one with high levels means the other is not fully expressed. With this in mind, if cortisol levels are abnormally elevated in the afternoon and evening, the normal release of melatonin around lunch time is inhibited, therefore impairing our ability to fall asleep. The entire system is regulated by our circadian rhythm which responds directly to light exposure on the eyeballs. Bright light in the morning stimulates cortisol release, the dimming of light in the evening stimulates melatonin release.  

Cortisol becomes a stress hormone when levels remain elevated in the afternoon and early evening.  When cortisol release is improperly timed and is still high in the afternoon, we feel anxious and crave sugary, fried, and fatty foods. If our ‘awake’ hormone is elevated in the evening when we are trying to prepare for sleep, we will feel uneasy and distressed. The combination of excess calories from sugary, fried, fatty foods and poor sleep due to excess cortisol and deficient melatonin is what leads to weight gain and the inability to lose weight. Even if you eat a clean diet excess cortisol in the evening will create a stress response causing systemic inflammation. Systemic inflammation and insulin resistance each make weight loss more difficult to achieve and maintain.  

The best way to normalize your cortisol/melatonin system is with direct sunlight exposure within 30 minutes of waking. Dr. Andrew Huberman, neurobiologist from Stanford, was recently interviewed on The Tim Ferriss Show Podcast where he suggests everyone get 2-10 minutes of direct sunlight exposure on their eyes first thing in the morning.  By stimulating photoreceptors in the eyes, cortisol release is amplified.  Going outside for an additional 2-10 minutes in the evening, when the sun is at a low angle, will help to stimulate melatonin and prepare us for sleep. Start your weight loss journey by normalizing your circadian rhythm using direct sunlight exposure in the morning and again in the evening.  

Post written by Dr. Riley Kulm, DC.  Check out his bio here.  

The standard lipid panel consists of four different numbers – total cholesterol, LDL, HDL, and triglycerides. LDL and HDL refer to ‘low density lipoprotein’ and ‘high density lipoprotein’ respectively. LDL and HDL are the carrier proteins for cholesterol in the body and help to make sure the fat from our diets ends up in the cells needing the energy. Triglycerides are fat molecules circulating in the bloodstream. When triglycerides in the bloodstream are abnormally elevated due to poor diet, obesity, or type 2 diabetes, there is more deposition of fat in the tissues leading to weight gain. Total cholesterol is the sum of LDL, HDL and 20% of your triglyceride level. Looking at the values of these different numbers can give valuable clues into heart disease risk and overall metabolic health.  

When assessing a lipid panel, I like to use the numbers offered by functional medicine practitioner, Dr. Catherine Shanahan, M.D. in her excellent book, Deep Nutrition: Why Your Genes Need Traditional Foods. She suggests the following optimal lab values for the standard lipid panel: 

-Triglycerides less than 150. 

-HDL greater than 45 in men and greater than 50 in women. 

-LDL: HDL ratio less than 3 to 1. 

A high total cholesterol is not concerning if the ratio of LDL to HDL is maintained below 3.  Likewise, a high LDL number does not necessarily indicate an increased risk of heart disease if the ratio is maintained. It’s important to remember the gold standard test to determine the health of your lipid cycle is the LDL particle size count. The test assesses for damage to LDL particles – a damaged LDL particle is a smaller one. Damaged LDL particles are more likely to cause inflammatory reactions in the arterial walls leading to plaque formation and atherosclerosis. The LDL particle size count is rarely ordered by physicians due to the cost, however it remains the best test for assessing heart disease risk. 

Many physicians put their patients on a class of drugs called a statin which decreases the body’s natural production of cholesterol, especially the type of cholesterol bound to LDL particles. The problem with this is cholesterol is an important building block for many cells in the body including our steroid hormones which include testosterone, estrogen, and cortisol among others. Additionally, the brain contains the highest amount of cholesterol on the body, meaning lowering cholesterol with a statin drug may impair brain function and induce cognitive decline.  Statins come with a host of side effects including muscle aches and pains, altered liver enzymes due to liver damage, and increased risk of developing type 2 diabetes. This is why it is so important to match your most recent lipid panel up with the numbers I give above before agreeing to start taking a statin drug. In future posts I will explain some of the diet and lifestyle factors you can adopt to help normalize the levels in your lipid panel without having to take a statin drug.  

Post written by Dr. Riley Kulm, DC.  Check out his bio here

Sleep is the most important cornerstone for optimal health. Without the foundation of a healthy night of sleep, all other health interventions, such as nutrition and exercise, will fall short. Our memory, cognition, and ability to learn new tasks all depend on healthy sleep. ‘Sleep hygiene’ refers to the quality and quantity of sleep you are getting each night. I recommend my patients get 7 to 9 hours of sleep each night, depending on activity level, as well as season. During the winter months, you should opt for close to 9 hours of sleep. During the summer months, 7 hours of sleep may be adequate since days are longer and the nights are shorter. Additionally, more sleep is needed the more active you are as it is important to allow your body adequate time to recover after difficult workouts. When helping patients improve their sleep hygiene, there are three interventions I use most frequently, outlined below. 

 

First morning sunshine

Going outside first thing in the morning with as much skin exposed as possible stimulates the body’s release of the hormone cortisol. Cortisol is known as our ‘awake hormone’ and gives us the energy to start our day. Cortisol naturally starts to decline around lunch time, and by the evening levels should be low as it starts to get dark and we prepare for sleep. Cortisol becomes problematic when levels remain high in the afternoon. When cortisol levels remain elevated, it becomes a stress hormone and causes us to crave sugary and fatty foods. Additionally, high levels of our ‘awake hormone’ in the evening work against us falling and staying asleep. The best way to ensure cortisol levels are low in the evening is to secrete as much as possible in the morning. Sunshine stimulates cortisol secretion, meaning it is optimal to get plenty of sunshine in the first half of the day.

Turn off electronics at least 90 minutes before bed

Blue light exposure tricks your brain into thinking it is still light outside, decreasing the release of your sleep hormone, melatonin. I recommend turning off all electronics 90 minutes before bedtime. Not only does blue light manipulate our brain into thinking it’s light outside, but often the things we are looking at on our screens, such as social media feeds or work emails, stimulate our brain in a way making sleep difficult. Scrolling through your social media feed causes a release of the neurotransmitter, dopamine, which plays a role in the brain’s reward system. When dopamine is released, the brain is stimulated and there are feelings of pleasure. While satisfying at the moment, excessive release of dopamine prior to sleeping will make it harder to fall asleep and stay asleep. Therefore, put those phones away before bed time!

Read fiction before bed

Reading before bed is one of the best ways to prepare our brains for sleep. Giving the brain a singular point of focus, such as a captivating fictional story, will allow you to stop thinking about the stresses of work and life and prepare your brain for sleep. With this in mind, reading materials related to work or checking emails will continue to stimulate our minds and keep us thinking about the day. Consequently, I recommend reading fiction. It is a better way to take your mind away from the pressures of the day. If you are a fan of historical fiction like myself, check out Ken Follet’s new novel, Pillars of the Earth.

 

Post written by Dr. Riley Kulm, DC.  Check out his bio here

Goal setting has been touted as the most effective way to achieve success in life.  We’ve been told to write them down, stick them to our refrigerator door and even to write them on our bathroom mirror.  You’ve heard that goals should be SMART – specific, measurable, attainable, realistic, and time oriented.  I even wrote a blog post on effective goal setting.  Recently, I’ve moved away from goal setting with both myself and my patients, focusing instead on daily habit formation and the implementation of routines that set you up for success now and in the future.  The inspiration for this change came after listening to the Atomic Habits audiobook by James Clear.  Clear argues that goals are easily procrastinated upon, and can often be too daunting to even get started in the right direction.  By focusing on daily habits and routines, you will improve yourself each day, setting yourself up to achieve success and ultimately to conquer even the loftiest of goals. 

The problem with goal setting

One of the main problems I see with goal setting is that time oriented goals are susceptible to procrastination.  If my goal is to lose 20 lbs. by the end of the year, it’s very easy to let myself wait until 6 or even 3 months are left in the year to start working towards the goal.  Why start now when I have an entire year to accomplish my goal?  A goal that is set out over a year may lose steam after a couple of months, which is what I commonly see with patients looking to make health changes at the beginning of the New Year.  Everyone knows that you will see more people out walking in your neighborhood or exercising at the gym in January, February and March only for it to taper off as the year progresses.  Rather than setting a time oriented goal, instead pick daily habits that will incrementally help you achieve whatever you envision for yourself.

Define your ideal self

Before completely throwing away your list of goals, make sure you have a clear idea in your mind of what you want for yourself.  Envision your ideal job, body composition, and skill set.  Where do you see yourself in 5 or 10 years?  Where do you want to be financially?  How do you define your ideal self?  Once you’ve established these parameters, you are better suited to implementing daily habits that align with this vision.  If you envision yourself as having a fit and healthy body, implementing a daily habit that helps you save money or be more organized doesn’t necessarily bring you closer to your vision.  Instead, for weight loss, pick habits such as a consistent gym routine, a healthy breakfast at the same time each morning, or reading a book before bed to help promote optimal sleep and recovery.  

Do this instead

As stated previously, the alternative to goal setting is the implementation of daily habits and routines.  Habit formation is beneficial because it focuses on daily growth.  If we aim to grow and improve ourselves little by little each day, the culmination of consistent work will be incredible in the long term.  We may not notice the improvements on a day to day, micro level, however, if we step back after a year and look at the macro improvement the results are substantial.  True growth and change does not come with drastic lifestyle changes such as an extreme 10 day fast or juice cleanse but rather with small steps each day in the right direction.  

 

Next, I show you how to reframe your goals into daily habit formation.

Goal #1: ‘I want to lose 20 lbs. before summer’

Habit: I will work to implement a habit where I do 3 sets x 15 push-ups in the morning followed by drinking a 16 ounce glass of water.  

Habit: Weather permitting, I will go outside in the morning for a 10 minute walk in the sunshine before work.

(First morning exercise and sunshine stimulates cortisol release and helps to regulate our circadian rhythm.  Sufficient cortisol release in the AM will decrease cravings for fried and sugary foods in the evening which occurs if cortisol levels remain high.)

Habit: I will place a pan, plate, and eating utensils out in my kitchen before I go to bed each night.  Already having the pan on the stove increases the likelihood that I will cook a homemade breakfast and adopt a more consistent eating schedule that includes breakfast each day.

 

Goal #2: ‘I want to increase my sales at work by 15% this year’

Habit: I will wake up at the same time every day to ensure a consistent sleep schedule and to increase my productivity at work. 

Habit: I will call 2 potential new clients each day prior to leaving for lunch.

Habit: I will send a thank you card to 2 existing clients each week thanking them for their business.  

For work related goals, consider setting up a daily, weekly, and monthly checklist in a binder or whiteboard to track progress of tasks to be completed.  Make these tasks part of your habits at work and you will see your productivity increase.

 

Goal #3: ‘I want to improve my relationship with my parents’ 

Habit: Each morning I will practice gratitude by writing down 3 things in my life that I am grateful as part of a journaling routine. 

Habit: I will call one of my parents every Friday after work to check in.

 

Goal #4: ‘I want to be more organized’

Habit: Each morning I will make my bed as the first task to be completed in my day.  Making your bed each morning sets yourself up for success throughout the rest of your day and helps you to establish a task completion mindset.

Habit: Each morning when my coffee is brewing I will take 5 minutes to tidy up my living room so I leave for work with an organized living space. 

 

Goal #5: ‘I want to get better sleep this year’

Habit: I will develop a habit where I turn off all electronics at least 1 hour before bed time.  Blue light exposure stimulates cortisol release at the wrong time of day and will make falling and staying asleep more difficult. 

Habit: Prior to going to bed I will write out tomorrow’s ‘To Do’ list in a journal that I keep by my night stand.  Getting tomorrow’s tasks written down will give you peace of mind and allow your brain to turn off before going to sleep.

Habit: I will read for 20 minutes before bed.  Reading, especially fiction, gives your brain a singular point of focus, and helps you get your mind off of the day’s stresses.  

 

I hope this article gives you valuable insight into daily habit formation and the power it can have.  I finish with a quote from W.H. Auden – ‘Routine, in an intelligent man (or woman), is a sign of ambition.’

Post written by Dr. Riley Kulm, DC.  Check out his bio here

With the recent passing of Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020), the cost of using tobacco products in the state of Colorado is higher than ever. For smokers in Colorado, the estimated increase in taxes will be $222 in the state budget year 2021-22, increasing to $291 by state budget year 2027-28¹. The minimum price for a pack of cigarettes will be $7 in 2021, and will increase to $7.50 by 2024². Tobacco products will see the current 40% tax rate increase to 62% by 2027, and the new nicotine tax aimed at e-cigarettes will be applied at 30% starting in 2021 and go up to 56% starting in July 2024. These taxes are mainly incurred on Coloradans in lower income brackets. Of the 14 percent of Coloradans who use tobacco products, 80% of those individuals make less than $40,000 per year.  Financial incentives aside, smoking is the leading cause of preventable death in the US, accounting for 1 out of every 5 deaths in the US each year or 480,000 deaths³.  For context, the covid-19 pandemic has taken the lives of 269,763 Americans in approximately the last year⁴, many of whom were significantly immunocompromised and suffering from two or more comorbidities. These statistics beg an important question – why is smoking cessation not a greater public health concern?

Why you should quit smoking

Smoking is strongly linked to chronic diseases such as cancer, heart disease, and stroke. Smoking damages your hair, skin, and nails leading to premature aging on the inside and out. Smoking eats away at the cartilaginous cushioning between our joints and promotes arthritis and joint pain.  Smoking promotes a chronic chest and neck dominant breathing pattern leading to headaches and muscle tightness in the upper shoulders and neck. Second hand smoke exposure can create these problems for family members and friends.  

The detrimental effects of smoking are related to oxidative stress, which occurs when the delicate balance between pro-oxidant and antioxidant systems in our bodies can no longer be maintained. Regular smoking increases the amount of reactive oxygen species (free radicals) in the body, overwhelming the antioxidant defense systems in the body.  Free radicals are circulating molecules that have an unpaired electron. In an attempt to bind the unpaired electron, free radicals steal electrons from normal, healthy cells in the body and alter their structure and function. Damaged cells do not function properly and are flagged by the immune system for destruction resulting in widespread inflammation. Damaged cells can also become cancerous as normal cell replication processes are disrupted. The cell walls of our arteries and veins are damaged by smoking, increasing the likelihood of artheroscletoric plaque formation and subsequent heart disease and stroke. The good news? Your body starts healing within one day of quitting smoking. 

How does acupuncture help you stop smoking?

Acupuncture helps you quit smoking by decreasing the mental and physical stress involved with quitting, as well as helping to diminish cravings. The most powerful detox points for alcohol abuse, drug addiction, and nicotine are located on the ear. The treatment of these areas is referred to as auricular acupuncture, and the protocol I use is based on the National Acupuncture Detoxification Association (NADA) nicotine cessation protocol. I also incorporate specific body points which help improve blood flow, decrease stress, and increase the likelihood of successfully quitting. Additionally, we use semi permanent acupuncture needles (seeds) which are implanted into the ear like a small piercing and stay there for 3-5 days providing constant stimulation of the acupuncture point. I use seeds at the designated nicotine point which is located on the lower tragus and can be manually stimulated by the patient when a craving is felt.  

Combining acupuncture with patient education seems to be more effective than acupuncture or education alone⁵. I encourage my patients to adopt some of the strategies found on state sponsored quitting websites, like Colorado QuitLine. Beneficial strategies I’ve used with patients include telling loved ones when and why you are going to quit, making a list of all of the items or experiences you can buy with the money normally spent on tobacco, disposing of all tobacco or tobacco related products at the house or in the car, setting a strict quit date instead of trying to slowly wean yourself off, and to write out a daily health journal to track improvements in energy, mood, and pain levels.

Case Study 

I recently treated a patient at the clinic for smoking cessation. For this case study, we will refer to the patient as Laura. Laura is a middle aged female who has been a pack a day smoker for 20 years. She was spending upwards of $1,000 per month on tobacco products. Laura came to me wanting more than anything to quit smoking. She had tried everything from nicorette to patches, and had even tried hypnosis. However, nothing seemed to work and the nicorette made her nauseous. She was open to the idea of acupuncture because it had been a helpful treatment for a low back injury I was seeing her for.  We settled on a treatment plan of 8, 30 minute visits over a 4 week period. Laura set her quit date in conjunction with her first day of acupuncture. 

Within a week, the immediate improvements in her health were palpable. Her skin was clearer and was less red and inflamed. Her stiff and leathery muscles felt relaxed and pliable. Her breathing was slower, deeper, and less labored. She seemed less stressed, and had a calm nature about her. The acupuncture helped her deal with the day to day stress of quitting, and also mitigated cravings and withdrawal symptoms. On top of this, the chronic low back pain she was experiencing dramatically improved as her body’s internal healing mechanisms were better allowed to do their job. Overall, her transformation was inspirational. It motivated me to want to help more people struggling with nicotine addiction create lasting change in their lives. I’m happy to report it is now 3 months since her quit date and she has not had a cigarette since.

If you or someone you know smokes and wants to quit but doesn’t know where to start, please direct them to this article or me personally. It would be a privilege to assist you or a loved one quit for good and to help you realize the immense financial and health benefits of quitting today.  

Post Written by Dr. Riley Kulm, DC.  Check out his bio here

Sources and References 

  1. Colorado Proposition EE, Tobacco and E-Cigarette Tax Increase for Health and Education Programs Measure (2020)
  2. Proposition EE: Taxes On Nicotine Products, Explained
  3. Centers for Disease Control and Prevention, Current Cigarette Smoking Among Adults in the United States.
  4. CDC COVID Data Tracker
  5. Auricular Acupuncture, Education, and Smoking Cessation: A Randomized, Sham-Controlled Trial

You’ve heard the stories, watched the YouTube videos, and maybe even experienced it yourself.  The ‘pop’ or ‘crack’ made during a chiropractic adjustment is a mystery to most people. Are the bones cracking? The joints popping? The ligaments snapping? Where is the noise actually coming from? When a chiropractor delivers a high velocity, low amplitude thrust (HVLA) to a specific joint, there is often an audible sound associated with the adjustment.  What is really causing this noise? Read on to find out more! 

Cavitation 

To understand where the noise in a chiropractic adjustment comes from, it’s important to first define the engineering phenomenon called ‘cavitation.’ Cavitation refers to air pockets or bubbles formed in response to a rapid change in the pressure of a liquid. Cavitation is often seen with underwater propellers, where bubbles are formed in response to the rapid change in water pressure caused by the spinning propeller. As pressure increases, these bubbles can burst, releasing a shockwave of energy. The field of engineering views the cavitation as a negative phenomenon to be avoided, because the energy released by the bursting bubbles can damage the propeller by subjecting it to uneven stress. 

Synovial Joints 

A joint is formed when two bones come together or ‘articulate.’ The surface of a bone comprising one half of a joint is called an articulating surface and is aligned with the articulating surface of another bone. Joints in the spine and extremities are referred to as synovial joints. There are several types of synovial joints in the body such as the ball-and-socket joint (hip joint, shoulder joint), hinge joint (elbow), and the pivot joint (between C1 and C2 vertebrae), among others. Despite having different shapes and planes of movement, all synovial joints share some common characteristics. Synovial joints are encased in a fibrous joint capsule called the articular capsule. Within the articular capsule is viscous liquid called synovial fluid. Synovial fluid is the consistency of egg-whites and its main purpose is to lubricate the joint, reducing friction and stress between the two surfaces of the joint. Healthy levels of synovial fluid help keep our joints moving freely and prevent the formation of arthritis.  

Putting it all together 

The phenomenon of cavitation is observed in the human body. When a chiropractor delivers an adjustment, the therapeutic goal is to gap or widen the two joint surfaces, resulting in a decrease in pressure within the joint capsule.  The pressure decrease occurs within the synovial fluid, and bubbles are formed in response to this change in pressure. The bubbles rapidly collapse on themselves, releasing a shockwave of energy. The collapse of the bubbles and subsequent release of energy is believed to cause the audible pop or crack caused by the chiropractic adjustment. The noise made during a chiropractic adjustment is caused by the bursting of small bubbles within the synovial fluid of a joint in response to a rapid change in fluid pressure. Damage to the joint does not occur like it does to the propeller. The cavitation associated with the propeller takes place thousands of times per minute, whereas most patients get adjusted twice per week at the most. As such, regularly self adjusting your spine can lead to an array of negative outcomes. For more information, please reference my blog post, The Dangers of Self Adjusting.  Lastly, to determine how frequently you should get adjusted, review my blog post, How Often Should I Get Adjusted?


Post written by Dr. Riley Kulm, DC.  Check out his bio here.

As we move into summer and start spending more time outdoors, it’s important to educate yourself on proper sunscreen usage, as well as the health benefits from sensible sun exposure. It is important to find a balance between harnessing the health benefits of sunshine while protecting your skin and body from UV radiation damage. Excessive sun exposure is linked to multiple forms of cancers including basal cell carcinoma, squamous cell carcinoma, and melanoma. To help prevent these skin cancers, the American Academy of Dermatology (AAD) suggests applying sunscreen of SPF 30 or higher 30 minutes before going outside and then reapplying every 2 hours while outside. Sunscreen is to be applied to all areas of the skin not covered by clothing. While these guidelines from the AAD should not be ignored, it is critical to address the consequences of effectively eliminating all sun exposure, such as vitamin D deficiency. The goal of this article is to move away from the ‘sun is dangerous’ paradigm which is promoted by the AAD.  While excessive sun exposure may cause skin damage, the negative health consequences with avoiding sunshine are much more concerning for our overall health.  

Vitamin D deficiency and cancer

It is estimated that upwards of 40% of American adults are vitamin D deficient, which is defined as having a serum level below 20 ng/mL 4.  Using 30 ng/mL as the cutoff for vitamin D insufficiency, it is estimated 75% of American adults and teens do not meet this mark.  Most functional medicine doctors recommend an optimal range of 60-80 ng/mL, which would place more than 90% of Americans in the sub-optimal category for vitamin D levels. Optimal vitamin D levels are protective against many forms of disease including cancer, heart disease, infection, autoimmune diseases like lupus, celiacs, multiple sclerosis, and neurodegenerative diseases such as Parkinson’s, Alzheimer’s, and ALS.  Research shows breast cancer and vitamin D deficiency are closely associated, and one study showed women with a vitamin D level higher than 60 ng/mL were 83% less likely to develop the disease 9. Vitamin D is one of the body’s most potent anti-cancer fighting compounds. With most of America already vitamin D deficient or insufficient, and spending much more time indoors compared to our ancestors, it is dangerous to completely cover our skin with sunscreen.  In effect, we are blocking the production of one of our most potent anti-cancer fighting compounds by wearing sunscreen every day, placing us at an even greater risk of developing all forms of cancer, including skin cancer. Individuals with darker skin need even more exposure to sunshine because the increased melanin content in the skin slows the rate of vitamin D production. 

Nutrition and skin cancer

One of the best ways to protect our bodies from skin cancer is to make sure we are eating a diet rich in the antioxidants designed to protect us from cancer cell growth and proliferation. Excessive exposure to UV radiation can lead to free radical formation which damage all cell types and cause inflammation and the potential for cancer. Firstly, foods with high concentrations of the flavonoid proanthocyanidin are particularly useful in protecting our body from UV radiation damage and skin cancer 2.  Proanthocyanidins act in the body as an antioxidant, anticancer, antidiabetic, and antimicrobial compound 6. Foods highest in proanthocyanidins include blackberries, blueberries, marionberries, huckleberries, grape seeds, hawthorn berries, rose hips, and pine bark.  

Another food compound which is effective at preventing skin cancer is the flavonoid apigenin 1Apigenin also acts as an antioxidant and anti-inflammatory compound and specifically protects our skin from UV radiation damage.  The best food sources of apigenins include chamomile, apples, oranges, celery, onions, and endive. Opt for a bottle of iced chamomile tea during your next day out in the sun!  

The last compound to mention is resveratrol.  Made popular for the health benefits associated with drinking red wine, resveratrol is a potent anti-oxidant and anti-cancer fighting compound.  Resveratrol promotes healthy cell differentiation, and being that abnormal cell division is one of the bases for tumor formation, resveratrol is exceedingly important for protecting ourselves from all types of cancer. The best dietary sources of resveratrol include grapes, cranberries, blueberries, red and white wine, peanuts, and cocoa.  If individuals make a conscious effort to increase the consumption of these foods, skin damage and the potential for developing cancer will significantly be reduced. 

Benefits of sunshine

There are many health benefits from regular, sensible sunshine exposure. In addition to vitamin D production, UV rays from the sun stimulate the production of melanocyte stimulating hormone (MSH) which increases skin pigmentation and sexual arousal, as well as suppresses appetite 1.  For patients looking to lose weight, 10 minutes of direct sunlight exposure first thing in the morning assists hormone production and Circadian rhythm.  Additionally, UV rays produce beta-endorphins and natural opiates which help decrease pain and inflammation, and promote relaxation in the body 1.  Natural opiates and beta-endorphins produced within the body are stronger and more effective than pharmaceutical pain killers that often come with a host of side effects and risk of dependency.  Finally, UV rays help our body produce calcitonin, a vasodilatory peptide which helps protect the body’s cardiovascular system from problems such as high blood pressure (hypertension) and cardiovascular disease (CVD) 1.  With the multitude of drugs aimed at weight loss, sexual dysfunction, hypertension, CVD and chronic pain, more attention should be paid to direct sun exposure as a clinically viable intervention for these conditions. 

Avoid oxybenzone 

When purchasing a sunscreen, make sure to avoid products containing oxybenzone. Research shows that oxybenzone is an endocrine disruptor, meaning it alters your body’s hormonal system. Alterations in the hormonal system can lead to an array of detrimental health conditions including weight gain, chronic fatigue, altered pregnancy, sexual dysfunction and cancer among others 8.  Not only does oxybenzone act as an endocrine disruptor itself, it also enhances your body’s absorption of other hormone disrupting chemicals such as toxic herbicides, pesticides, and insect repellants 5.  Oxybenzone can damage our hormonal system and increase the risk of all kinds of cancer including skin cancer.  Other active ingredients highly absorbable into the bloodstream that can potentially pose a threat to your health include avobenzone, octocrylene, and ecamsule 10.

What should I use? 

After reading this article, you may want to throw away your sunscreen and lay in the sun for hours on end with minimal clothing. Do not do this!  While the benefits of sun exposure are immense, the potential for skin damage is still prevalent.  If you are planning to spend more than 20 minutes in direct sunlight, make sure to apply non-nanoscale zinc oxide or titanium dioxide. Non-nanoscale means the sunscreen will not easily absorb through your skin and into your bloodstream like traditional sunscreens with microscopic particles that easily cross the skin barrier.  If kept on the surface, zinc oxide and titanium dioxide are safe on your endocrine system.  That being said, if absorbed into your bloodstream, both compounds can have similar detrimental effects as oxybenzone, so make sure to buy the non-nanoscale version!  Pay special attention to areas like the nose, top of the ears, shoulders, and back of the neck, because these areas are often exposed to more sun.  We recommend the sun care products from the company Badger Healthy Body Care due to their high quality and avoidance of toxic chemicals like oxybenzone.  

Post written by Dr. Riley Kulm, DC.  Check out his bio here

References

  1. Greenfield, B. (N.d.) Is the Sun the Ultimate Source of Health and Vitality or just a Giant Orange Cancer Circle in the Sky?  Ben Greenfield Fitness.  Retrieved from: https://bengreenfieldfitness.com/article/lifestyle-articles/natural-sun-protection-foods/
  1. Katiyar, S.K. (2015).  Proanthocyanidins from grape seeds inhibit UV-radiation-induced immune suppression in mice: detection and analysis of molecular and cellular targets.  Photochemistry.  Photobiology., 91 (2015), pp/ 156-162. 
  1. Mercola, J. (2020). Sunscreen Safety Questioned Yet Again.  Mercola.  Retrieved from https://articles.mercola.com/sites/articles/archive/2020/02/05/oxybenzone-sunscreen.aspx
  1. Mercola, J. (2019).  Top 5 Signs of Vitamin D Deficiency.  Mercola.  Retrieved from https://articles.mercola.com/sites/articles/archive/2019/01/01/signs-of-vitamin-d-deficiency.aspx
  1. Pont AR, Charron AR, Brand RM. Active ingredients in sunscreens act as topical penetration enhancers for the herbicide 2,4-dichlorophenoxyacetic acid. Toxicol Appl Pharmacol. 2004;195(3):348‐354. doi:10.1016/j.taap.2003.09.021
  1. Rauf, A. Et al. (2019).  Proanthocyanidins: A Comprehensive Review.  Biomedicine & Pharmacology. Vol. 116. August 2019, 108999
  1. Sunscreen FAQs. (n.d.). American Academy of Dermatology.  Retrieved from: https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs
  1. The Trouble With Ingredients in Sunscreen. (N.d.).  Environmental Working Group (EWG).  Retrieved from: https://www.ewg.org/sunscreen/report/the-trouble-with-sunscreen-chemicals/
  1. McDonnell SL, Baggerly CA, French CB, Baggerly LL, Garland CF, et al. (2018) Breast cancer risk markedly lower with serum 25-hydroxyvitamin D concentrations ≥60 vs <20 ng/ml (150 vs 50 nmol/L): Pooled analysis of two randomized trials and a prospective cohort. PLOS ONE 13(6): e0199265. https://doi.org/10.1371/journal.pone.0199265
  2. Matta MK, Zusterzeel R, Pilli NR, et al. Effect of Sunscreen Application Under Maximal Use Conditions on Plasma Concentration of Sunscreen Active Ingredients: A Randomized Clinical Trial. JAMA. 2019;321(21):2082–2091. doi:10.1001/jama.2019.5586

It’s no secret we are living in unprecedented times with the COVID-19 pandemic. Now more than ever, individuals need to take every possible measure to ensure the health of themselves and their loved ones. This post will focus on the steps you can take to stay healthy by boosting your immune system with diet and supplementation, sunlight exposure, exercise, and staying connected socially without in-person contact. 

Double Down on Vitamin C

Vitamin C (ascorbic acid) acts in a multitude of ways in the body. Firstly, vitamin C is required for the manufacture of collagen, a protein which is responsible for holding body tissues together such as cartilage, connective tissue, ligaments, tendons, skin, hair, and nails. Additionally, vitamin C is exceedingly important for wound healing, healthy teeth and gums, immune function, and it also acts as a nutritional antioxidant. With specific focus on the immune system, vitamin C has been shown to improve white blood cell function and increase the body’s antibody response. It also increases interferon, which acts as the body’s natural antiviral and anticancer compound. In fact, interferon gets its name from its ability to interfere with viral replication. 

Foods highest in vitamin C include fruits such as guava, persimmons, strawberries, papaya, oranges, and grapefruit. Vegetables rich in vitamin C include red chili and red sweet peppers, dark leafy greens like kale, collared greens, and spinach, parsley, broccoli, Brussels sprouts, cauliflower, and cabbage². The food with the absolute highest vitamin C content is the Acerola cherry, which is often sold in powder or supplement form. The vitamin C content in fruits and vegetables is markedly decreased with exposure to air, so eating fresh fruits and vegetables is essential.

During times of extreme stress and risk of infection, dietary sources of vitamin C may not be adequate. When choosing a supplemental form of vitamin C, make sure to use ‘liposomal’ vitamin C. The bioavailability, or the amount of a supplement your body actually absorbs, may be 20% or lower for traditional vitamin C supplements. GI upset and diarrhea is associated with consumption of high doses of traditional vitamin C.  When liposomal vitamin C is ingested, a phospholipid coating surrounds the vitamin in the GI tract. The effect of the protective coating is a much higher percentage of vitamin C absorbed, as well as less GI upset. Here’s a link to our online supplement dispensary where you can purchase the liposomal vitamin C supplement I suggest to my patients. Our favorite product is the one made by Dr. Mercola. As you might imagine, quality vitamin C supplements are in high demand right now. Even if the product is back ordered, I recommend ordering the supplement now as suppliers are promising to get new product out within the upcoming weeks.

Get More Sunlight

Getting direct sunlight is an excellent way to naturally boost your immune system. Vitamin D is more accurately defined as a hormone rather than a vitamin, since it is produced by our body in response to direct sun exposure on our skin, and has various signaling effects on many cell types in the body. The vitamin D hormone is most commonly associated with upregulating calcium absorption in the small intestine, thereby increasing the strength of our bones.  However, the vitamin D hormone has a wide array of positive benefits elsewhere in the body, as a result of cells in our bone marrow, brain, colon, breast tissue, and immune system all expressing the vitamin D receptor (VDR). Specifically, B and T cells (the two major components of our adaptive immune response) directly respond to vitamin D and upregulate our body’s ability to fight off all forms of disease¹. Not only does vitamin D help protect us from viruses, it can also halt the progression of autoimmune diseases including multiple sclerosis, rheumatoid arthritis, diabetes mellitus, inflammatory bowel disease, and systemic lupus. Additionally, the sun’s energy produces beta-endorphins, neuropeptides and natural opiates that regulate pain, decrease inflammation, and promote relaxation – all positive changes that strengthen our immune system and help our body combat infection. Opt for 15-20 minutes of direct sunlight exposure on as much exposed skin as possible.

Cut Out Refined Sugar

Refined sugar has a host of negative effects on the body, perhaps the most important being damage to our mitochondria and the associated oxidative damage that occurs with overloading of the electron transport chain. Oxidative damage or ‘oxidative stress’ is the result of increased free radical production in the body. Free radicals are molecules with an unpaired electron. They attack and damage healthy cells in our body, creating a state of chronic inflammation. When our body is in a constant state of low level inflammation from excessive sugar consumption, our ability to combat disease and heal wounds is significantly impaired. In fact, research suggests after consuming sucrose (white table sugar), our immune system is inhibited for six hours. Additionally, the only viable fuel source for pathogenic viruses and bacteria is sugar. Viruses and bacteria feed on sugar and multiply when placed in a high sugar environment. One of the best ways to combat viruses and bacteria is to remove their food source!  

Eat More Fermented Foods

Fermented foods are rich in natural probiotics and help replenish the beneficial bacteria that line or GI tract. The beneficial bacterial lining, also known as GI flora in our digestive tract acts as a natural barrier between the foods we eat and the insides of our body. The healthier and thicker the GI flora, the less likely pathogenic substances can enter our body and cause disease.  Naturally occurring probiotics are produced during the fermentation process in foods such as kefir, miso, kimchi, yogurt, sauerkraut, kombucha, and raw, grass-fed organic milk. Load up on these probiotic rich foods and your immune system will thank you!

Eat Garlic

Garlic is a potent antiviral, anti-bacterial, and antifungal. According to The Encyclopedia of Healing Foods, garlic is rich in vitamin B6, manganese, selenium, vitamin C, phosphorous, calcium, potassium, iron, and copper – all of which are needed for a healthy immune system.  Many of garlic’s benefits are associated with a sulfur-containing compound called allicin, which is a powerful anti-microbial. In fact, garlic has been called ‘Russian Penicillin’ due to its strong anti-microbial activity. Make sure to chop or crush the garlic and let it sit for 10 minutes before eating or cooking. Letting the chopped garlic sit for 10 minutes helps trigger the enzymatic process that transforms alliin into its active and beneficial form, allicin. 

Connect with Others 

One clear benefit of modern technology is our ability to connect socially with friends and family without having to see them in person. Utilize apps like Skype and Zoom to stay in communication with your friends and loved ones during these trying times. Staying connected socially is very important not only to the health of the body, but also the mind. Human beings crave connection, social interaction, and a sense of community. Consequently, the health of our body’s will suffer if we cannot maintain these connections. There are positive, simple ways you can stay connected with society, such as offering to do a grocery run for an elderly or at risk individual. When at the grocery store, purchase only what you need and avoid buying in excess. The next customer (and your wallet!) will thank you. Take a moment to say a prayer or perform a moment of silence for all those affected directly and indirectly by the virus. Performing small acts of kindness will keep you connected socially and add positivity to a society that desperately needs it right now. 

References 

  1. Aranow, C. (2011).  Vitamin D and the Immune System.  J Investig Med. 59(6): 881-886.
  2. Aschan, S. (2006).  Sugar: The Real Deal.  ABC News.
  3. Murray, M. T., Pizzorno, J. E., & Pizzorno, L. (2006). The encyclopedia of healing foods. Pages 112-114.

Post written by Dr. Riley Kulm, DC. Check out his bio here.