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.
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.
For years it was thought the cause of indigestion, stomach ulcers, and gastric reflux was the presence of too much acid in the stomach. However, research shows the cause of these issues is actually too little stomach acid. Stomach acid, or hydrochloric acid (HCL), is necessary to ensure the proper digestion of your food, protect you from pathogenic bacteria, and prevent the backflow of food into your esophagus and throat. If our stomach is not acidic enough, our gastro-esophageal sphincter will not close and we can get back flow of acid into our throat (esophagus) which causes heartburn (gerd). Without adequate stomach acid, vitamins and minerals such as calcium, magnesium, iron, and vitamin B12, are not fully absorbed into the body. For example, if you are supplementing with calcium and magnesium in an effort to improve the strength of your bones but do not have enough stomach acid, the supplements will not be effective.
To determine whether you have adequate stomach acid, your doctor will have you perform one of the two tests below:
- First thing in the morning, before eating or drinking anything, mix ¼ tsp baking soda in 4 to 6 ounces of cold water. Drink the baking soda solution and set a timer for 5 minutes. Record and note the time anything happens over the next five minutes and bring the results to your doctor at your next visit.
- The betaine HCL test requires some trial and error, but you will finish the test with an exact dosage for how much HCL you need supplementally. For this test you will start by taking one betaine HCL pill right before eat. If you do not feel a “burn”, you will then take two pills right before your next meal. You will continue to up the pills one by one for each meal until you feel a burning sensation. Once you feel a burn, you will take one pill off and this will become your dosage. Once you begin to feel a burn at this dosage, you will again drop by one pill. This is not a long-term solution for lack of stomach acid, but it is a good way to kick start your digestion. It will also aid in vitamin and mineral adsorption so you have the energy and motivation to improve stomach acid naturally through weight-bearing exercise, improved posture, and stress management strategies. When dosing the supplement if you have an uncomfortable burn you can drink some baking soda in water to neutralize the acid. Make sure to lower the dosage at the next meal.
If your doctor determines your stomach acid levels are too low, here are some natural ways to boost HCL production in the stomach and ensure healthier digestion:
- Consume apple cider vinegar. Put ½ tablespoon up to 2 tablespoons in 8-12 ounces of water. Drink this solution first thing in the morning and before bed. If apple cider vinegar makes you nauseous, start with ½ tbsp and slowly build up to 2 tbsp.
- If you don’t struggle with heartburn add fresh squeezed lemon or lime juice to your water and drink throughout the day.
- Eat grapefruit and fermented foods (sauerkraut, kombucha, pickled foods (pickled beets, etc) to help stimulate HCL production. Eat pineapple and papaya to increase digestive enzymes.
- Use vinegars (red wine, white wine, balsamic, etc.) as a salad dressing or marinade.
- Drink celery or cabbage juice.
- Chew on celery, pumpkin seeds, or beeswax throughout the day. In addition to stimulating HCL production, this will also help heal your stomach lining, and boost metabolism for fat loss.
- Mindfully chew your food. The physical act of chewing will stimulate HCL production and help digest your food via adequate release of salivary enzymes triggered in the mouth by chewing.
- Limit fluid intake with meals as it dilutes your stomach acid. Drink your fluids in between meals.
- ONE glass of wine with a meal can help add some acidity to your stomach to aid with digestion
- To improve digestion after meals limit sitting and laying down, go for light walks, perform light chores, stand, etc.
Finally, make sure you are in a calm and relaxed state before eating your meals. When you are in a stressed state (sympathetics), your body does not produce stomach acid or digest your food. Take 4 deep, slow breaths prior to eating, reflecting on how lucky you are to have an abundance of healthy food to fuel your body. Gratitude is excellent for your brain and digestive health!
If you have sensitivities or allergies to any of the suggested foods on the list please continue to avoid them and consume the ones you can tolerate. Food allergies and sensitivities start because of increased sympathetics and therefore decreased stomach acid. As we repair your gut, increase stomach acid, and decrease sympathetics you will begin to tolerate foods you couldn’t tolerate prior.
If you struggle with heartburn (GERD) it is best to avoid citrus, caffeine, alcohol, spicy foods, peppermint, and eating after 7pm as we repair your stomach. These foods and activities can cause relaxation of your stomach valve which can cause regurgitation of acid into your throat/chest.
Last weekend I had the pleasure of attending the annual Colorado Chiropractic Association (CCA) Conference. Each year chiropractors from across Colorado gather to enjoy a weekend of educational speakers, networking, and discussion of the future of the chiropractic profession in Colorado. The CCA conference offers a unique opportunity for doctors of differing experience levels, techniques, and chiropractic universities to connect with a common goal – the advancement of the chiropractic profession in Colorado.
Since there has been a scarcity of in-person continuing education opportunities over the last two years, the phenomenal speakers at this year’s conference were a breath of fresh air for the doctors in attendance. As a clinician, it’s important to regularly learn new treatments and methodologies, staying up to date with the most current research available. I truly love continuing education courses because you come back to work with a renewed sense of vigor, and are eager to try new treatments and methods to help your patients. There were many fantastic speakers at this year’s conference, including Dr. Mike Hall, DC, Dr. Alicia Yochum DC, and Del Bigtree.
Dr. Hall spoke extensively on the importance of maintaining a healthy cervical lordosis. The cervical lordosis is the natural C-shaped curvature your neck should display. Many patients present with a flattened cervical spine which may be due to prior motor vehicle accident (MVA), prolonged poor posture, or genetic predisposition. Dr. Hall spoke about how the cervical lordosis acts as an indicator of the orthopedic health and fitness of the rest of the body. Patients with good strength in their hips and legs, shoulders and arms, often present with a healthy cervical lordosis. Conversely, individuals with poor strength in the lower body and who sit at a computer all day, often have a flattening of the cervical curve. Patients dealing with chronic stress and anxiety often present with head tilts and a poor cervical curve, indicating that the emotional and physical health of the brain is represented in the health of the cervical curve. The cervical curve is a window into the neurologic and orthopedic health of the entire body.
Dr. Alicia Yochum, daughter of Terry Yochum, who is co-author of Essentials of Skeletal Radiology, a textbook universally used in chiropractic and medical radiology programs, spoke about clinical radiology cases. For each case, she asked the audience to identify the pathology and then decide the appropriate course of action in terms of treatment or external referral. Dr. Yochum also spoke extensively on the benefits of musculoskeletal (MSK) ultrasound which is a cost effective diagnostic tool for soft tissue injuries. She provided an excellent review of how to distinguish T1, T2, and STIR sequence MRI’s. As a talented presenter, she made her radiology course engaging for all attendees.
To round out an exceptional group of speakers was Del Bigtree, former Hollywood producer of ABC’s The Doctors, who now uses his production skills to educate the public on the danger of vaccines, medical misinformation, and the pursuit of health care freedom in the US. His highly acclaimed internet show, The Highwire, is watched by millions of Americans who seek unbiased information when it comes to health related topics in the US. Bigtree spoke at length on the dangers of global vaccination for Sars-cov-2, which has a 0.26% mortality rate worldwide. Noting Dr. Robert Malone, inventor of mRNA vaccines, has even publicly spoken out about the dangers of global vaccination and has urged the medical community to stop. The mRNA vaccines use a new form of technology where vaccine adjuvants can turn off the ‘toll like receptors (TLR’s) of the patient’s innate immune system. Turning off the TLR’s allow the mRNA gene therapy to quickly bypass the innate immune system and enter the patient’s cells with the goal of stimulating an immune response and subsequent antibody formation. The overlooked issue is TLR’s are an extremely vital component of our immune system and shutting them off may have deleterious effects. Bigtree noted many oncologists have contacted him saying they’ve never seen new cancer rates this high in the US, and one plausible explanation is widespread vaccination with the mRNA gene therapies. Bigtree is a prominent advocate for the health freedoms of all Americans and I am grateful to have heard him speak on such a divisive and important topic.
The 2021 conference was my second CCA conference and I left feeling refreshed, excited about chiropractic, and with a wealth of new information to share with my patients. Whether you’ve been in practice for 3 years or 30, chiropractors share a kinship with each other and treat each other with respect. I enjoyed getting to know other Colorado chiropractors such as Dr. Roman, Dr. Pearson, Dr. Starling, and Dr. Birdsall just to name a few. My deepest thanks goes out to the staff of the CCA and all those involved in orchestrating a truly fantastic weekend.
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.
Many people experience popping in their hips. Most patients come to the clinic complaining of back or knee pain, and a popping hip may be a secondary complaint. Although typically not a significant pain generator, popping in the hip is a sign of an underlying dysfunction in the hip needing to be addressed. If the popping in the hip is not attended to, more serious orthopedic issues may arise down the road.
There are three main causes of a popping hip – external, internal, and intra-articular. External is most frequent and refers to the iliotibial (IT) band snapping over the greater trochanter of the femur. Internal is also common and refers to the iliopsoas (hip flexor) tendon snapping over a bony prominence on the pelvis or at the lesser trochanter of the femur. Intra-articular is least common and refers to a floating loose body within the joint such as a torn labrum. External and internal variations are often due to gradual onset, whereas an intra-articular loose body is often due to trauma. There is a higher incidence of hip popping in females, especially those who perform sports requiring repetitive flexion and extension of the hip such as gymnastics, dance, soccer, and running.
How to fix it
Popping in the hip is often related to a stability issue in the hip or the core. To address this, work to improve your hip stability in all three planes of motion. Train slowly, controlling the motion to avoid the pop. Train only through ranges of motion where you can avoid the pop, and gradually increase the range of motion as your stability improves. The external hip pop (ITB over greater trochanter) is often related to poor hip stability in the frontal plane (abduction/adduction), and increasing strength of muscles such as the gluteus medius will be helpful in decreasing the external hip pop. The internal hip pop relates to the iliopsoas muscle. The iliopsoas muscle has shared attachments with the diaphragm. If the diaphragm is not providing a solid anchor point for the iliopsoas muscle, function of the hip flexor will be impaired increasing the likelihood of an internal hip pop. For this, focus working on diaphragmatic breathing to create better stability patterns in your core. Intra-articular hip popping requires an in-depth examination to determine which structures may be injured and to determine the best course of care.
To know exactly which exercises and treatments are best for you, it is important to seek out a therapist who understands hip biomechanics and can help you address the specific stability limitations causing the pop. Whatever the cause, popping in the hip should not be ignored. Even if caused by mild muscle imbalance, a popping hip can worsen over time if not addressed early.
Post written by Dr. Riley Kulm. 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.
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!
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.
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 1. Apigenin 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.
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.
- 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/
- 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.
- Mercola, J. (2020). Sunscreen Safety Questioned Yet Again. Mercola. Retrieved from https://articles.mercola.com/sites/articles/archive/2020/02/05/oxybenzone-sunscreen.aspx
- 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
- 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
- Rauf, A. Et al. (2019). Proanthocyanidins: A Comprehensive Review. Biomedicine & Pharmacology. Vol. 116. August 2019, 108999
- Sunscreen FAQs. (n.d.). American Academy of Dermatology. Retrieved from: https://www.aad.org/public/everyday-care/sun-protection/sunscreen-patients/sunscreen-faqs
- 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/
- 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
- 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