Many of us have issues that we’ve been dealing with for a long time, and we’ve gotten used to them, to the extent that we don’t even notice them or pay attention to them on a regular basis.  As a practicing physician I see many patients who tell me they are fine and healthy, but when questioned admit to having headaches and migraines, joint or back pain, heartburn, skin rashes, or diarrhea among other things.  These things are not healthy, we’ve just gotten used to having them, and often take them for granted as “normal”.

Therefore it’s important to back up and take an inventory of your health and disease before you begin the ECD, so you can truly get a sense of how much benefit you’ve received from doing it.

I recommend creating an inventory of your health and disease.  Below I have provided you with a template that lets you rate your general health and well-being.  Answer each of the following categories from 1-10, with 1 being lowest/worst and 10 being highest/best, and answer yes or no to the sub-questions.  If you have specific issues you can add descriptions or notes afterward.

1. Sleep 1 – 10
2. Are you waking up feeling rested?
3. Energy 1 – 10
4. Do you have any energy crashes throughout the day?
5. Digestion 1 – 10
6. How often are you having a bowel movement? (1 per day, 1 per week, etc.)
7. Are you constipated?
8. Do you have diarrhea?
9. Gas or bloating?
10. Flatulence?
11. Mood 1 – 10
12. Anxiety?
13. Depression?
14. Menses (your period; for women only) 1 – 10
15. PMS?
16. Painful period?
17. Musculo-Skeletal 1 – 10
18. Joint pain?
19. Muscle pain?
20. Back pain?
21. Skin 1 – 10
22. Rashes?
23. Overall sense of well-being 1 – 10

After having taken an inventory, set it aside in a safe place.  Once you finish the elimination portion of the diet, you’ll fill out a second copy of the above questions which you’ll compare to the first to help solidify the benefit you’ve seen from the ECD.

What are your thoughts?  Feel free to share them with us in the comments section below.

Because it seems to cause the most negative reactions of any type of food and because it is hidden in EVERYTHING.

What is Wheat/Gluten intolerance?

Wheat or gluten intolerance is a broad category of NON-autoimmune problems brought on by the consumption of wheat or gluten.  People with wheat intolerance experience a variety of health conditions/symptoms from eating wheat but do NOT test positive for celiac disease.

What is Celiac Disease (CD)?

Celiac disease is an autoimmune disease (where the body attacks itself) that is triggered by the consumption of gluten (a protein that is contained in wheat).  This results in damage to the intestines (where food is absorbed) and also to other areas of the body such as the nerves, skin, bones, and thyroid.  People with CD test positive on blood and genetic testing for the disease.

Tests for Wheat/Gluten Intolerance

1. Elimination and Challenge Diet – Remove gluten STRICTLY from the diet for 3-4 weeks and note any change or improvement.  Then challenge yourself by having gluten and note any changes or worsening/return of symptoms.
2. IgG Food “Allergy” testing – this testing is done by drawing blood and is NOT done by conventional doctors.  It measures antibody reactions to various foods and can show a reaction to wheat (as well as other foods)

Tests for Celiac Disease

1. Antibody testing – this is the most common form of testing and is done by drawing blood.  The tests that you can ask your doctor for are:
   1. Total IgA
   2. IgA and IgG anti-gliadin antibodies
   3. IgA and IgG anti-endomysial antibodies
   4. IgA and IgG anti-tissue transglutaminase antibodies
2. Genetic testing – While anyone can have wheat intolerance, Celiac disease only seems to affect people with a genetic predisposition towards it.  Genetic testing can tell you if you have the potential to get Celiac disease (you have the genes) but NOT whether you actually have celiac disease or not.
3. Biopsy – reserved as a follow up to antibody testing where a colonoscopy is performed and a biopsy of the damaged tissue is taken to confirm the diagnosis of CD

Who should be tested for Celiac Disease (CD)?

What foods contain gluten?

When in doubt, ALL processed foods contain gluten unless they are labeled certified gluten free.

The short, short list

1.  Wheat, flour (bleached, unbleached, bread, bran), bulghur, wheat germ

2.  Barley, barley grass, barley malt

3.  Spelt

4.  Beer

5.  Cakes

6.  Cereals

7.  Cookies, cookie dough

8.  Crackers

9.  Einkorn

10.  Emmer

11.  Hydrolyzed wheat gluten, protein, or starch

12.  Kamut

13.  Soy Sauce

14.  Malted barley flour, milk, extract, syrup, or flavoring

15.  Malt vinegar

16.  Pasta

17.  Rye

18.  Semolina

Gluten is often but not always in products containing:

Artificial colorings, artificial flavorings, natural flavors, natural flavorings, vegetable broth, vegetable gum, vegetable protein, and vegetable starches

Gluten IS in vitamins (unless they are labeled gluten free) and can also be found in prescription medications!

For a more comprehensive list of where gluten can be found, go here.

What are your thoughts?  Share them with us in the comments section below.

The first step here is getting a handle on what you regularly eat.  Let me use myself as an example.  Before the ECD we ate fairly well; a low wheat diet without much added sugar.

A typical day looked something like this for me:

• Breakfast:  A smoothie made in my blender (3 raw eggs, ½ cup of whole milk unflavored yogurt, ½ cup of frozen blueberries, stevia to taste, added water to thin the consistency)
• Snack:  None
• Lunch:  Salad greens with roast chicken, peppers, avocado, and grated parmesan cheese.  Dressing typically either balsamic vinegar and olive oil or a prepared garlic-parmesan dressing.
• Snack:  An apple, or a piece of cheese.  Sometimes both.   Often a small handful of dark chocolate chips.
• Dinner:  A protein portion (chicken, protein, beef, fish) and a side of vegetables topped with butter, a sweet potato a couple of times per week.  A side salad with bleu cheese crumbles, balsamic and olive oil.
• Snack:  A coconut ice cream bar
• Fluids:  Mostly water, green tea, glass of kombucha with a few ounces of pomegranate juice added.

As you can see my standard diet was low in wheat and high in dairy.  Before you think I’m anywhere near perfect, we tended to eat out 1-2 times per week depending on the week.  This could range from relatively healthy food to pretty “junky” food like pizza, burritos, hamburgers, and ice cream cones.  I admit to a special fondness for donuts (about once per month; I highly recommend Top Pot donuts here in Seattle, if you’re going to eat a donut make it a good one) but I did draw the line at sodas, Twinkies, Slurpies, and potato chips.

So looking over my average day, it’s important to see what’s going to have to come out.  The biggest thing coming out for me are eggs for breakfast, and dairy in general.  It’s important to see what needs to come out and then even more importantly what is going to replace it.  Some people who aren’t prepared for an ECD do a kind of hunger strike for 2-3 days where they simply abstain from eating reactive foods but don’t put anything in its place.  This is a recipe for disaster.  One suggestion is to find two new foods to take the place of every food that is going to come out.  This may seem like a lot of work, but the effort you put in on the front end is going to make a huge amount of difference in the 3-4 weeks you are on the ECD.

I recommend you come up with 2 options for breakfast, 2-3 options for lunch, and 5-7 options for dinner, then plan to repeat these options for the 3-4 weeks of the ECD.  I used the Garden of Eating, a wonderful, highly recommended cookbook to plan out most of the recipes we’ll be using.

If at all possible, I highly recommend staying away from ‘faux’ foods.  That is, don’t replace milk with almond milk, cheese with a processed “no cheese” cheese, bread with rice bread, etc.  Simply removing the reactive foods will give you a huge boost in your health and well-being, but I recommend taking it a step farther, and at least for 3-4 weeks, purge fake food from your diet entirely.  I recommend you focus on: Meat, Fish, Fowl, Natural fats, Vegetables, Fruits & Nuts.

What are your thoughts?  Feel free to share them with us in the comments section below.

We’d love to have you join us.

This is not a pretty story, prepare yourself…

Excluding gluten from your diet unfortunately is much easier said than done however.

Here is how you go about it:

1. Remove bread, pasta, and baked goods.  Most people think this means they’ve gone gluten-free, sadly it doesn’t.
2. Then you must also a label reader.  Many prepared foods (in boxes, bags, or cans) contain gluten in them.  A list like this will help you keep an eye out for gluten containing ingredients.
3. Sadly, you’re still not done.  Next you must check your medications and supplements as many contain gluten as a filler ingredient.  If your supplements do not say they are free from gluten you must assume they contain it.
4. Do NOT buy from the bulk aisle of grocery stores (bummer).  They keep wheat flour at one end, and by pouring it into the bucket, and people scooping it out, it gets all over the other bins and food in the other bins.  You must assume these foods are contaminated with gluten.
5. Rice is often contaminated with gluten, so just switching to rice is often not sufficient.

Even more.  Depending on your sensitivity to gluten you must go further.

1. Unless the product says CERTIFIED gluten free, you cannot assume that it is gluten free.  McCann’s steel cut oats for example, a staple many health conscious folks buy, was shown to be contaminated with wheat.  This is not unusual, MANY foods either contain or are contaminated with wheat.  It is everywhere in our society!
2. If wheat and gluten are used in your household you should have a separate set of pans, plates, bowels, and utensils that are kept strictly gluten free.  Does this sound utterly ridiculous?  Yes it does.  It sounds obsessive, and it is, but it can be necessary.  Even the tiny bit of contamination on a cutting board used to cut bread, wiped off and then used to prepare a gluten-free meal has been shown to activate immune reactions to gluten.  It is THAT significant.

Here are a few cases given at the conference.

1. A young woman had been vomiting for two weeks anytime she ate food.  She was diagnosed with an eating disorder before seeking alternative care.  After an extensive workup it was found that the gluten in her chewing gum (the white powder that is used to keep the gum sticking to its wrapper) was causing the reaction.  She went completely gluten free and the vomiting stopped.
2. A young boy with autism was put on a gluten free, dairy free diet and had a remarkably positive reaction.  Three months later the boy put on lip balm and had a strong return of symptoms.  It was found the lip balm contained gluten (not listed anywhere on the label) and when he licked his lips the tiny bit he ingested was enough to trigger a return of symptoms.  After going back to the gluten free, dairy free diet his symptoms disappeared.
3. An older man with ulcerative colitis had the disease in remission using a gluten free diet.  Suddenly he started having 16 bowel movements per day.  After a workup it was found that he had started eating non-breaded roasted chicken at Kentucky Fried Chicken.  Some research found that although the chicken was unbreaded, it was marinated with soy sauce.  Soy sauces are made with wheat and do contain gluten.  When he discontinued the food and went back to a gluten free diet his symptoms disappeared.

Unfortunately, no good news for wheat and gluten.  Gluten, yes, it’s that bad.

More posts will be upcoming on gluten in the future.

What are your thoughts?  Have you tried a gluten free diet?  Share your thoughts in the comments section below.

If you don’t feel like you have strong willpower be sure you have eaten before going anywhere there is going to be food, and try to cancel out of all the obligations you can for the 3-4 weeks you are on the ECD.  When you’re on the ECD is not a good time to have business lunches, dinners, parties or other celebrations.  DON’T plan on doing the ECD around birthdays or the holidays.

More on the ECD coming soon.

What are your thoughts?  We’d love to hear them.  Please post them in the comments section below.

Let me give you an example.  A woman had severe seasonal allergies, she dreaded pollen season with a passion.  She was on the maximum doses of all the allergy medications and was still barely keeping her allergies under control.  Blood allergy testing showed that she was very reactive to wheat, dairy, and eggs (the big 3).  She cried a little bit at hearing this because it meant that virtually everything she ate on a regular basis was out.  But she took to the challenge with relish, and decided that this was going to be her chance to get back into the kitchen and experiment, finding tasty foods that she could eat and enjoy.  Within a few weeks her allergies were gone completely.  She stopped all of her allergy medication and has had no sign of her allergies, unless she eats some dairy, wheat, or eggs.  She is thrilled with her results and couldn’t be happier she took the plunge and did an elimination diet.  And for those who worry about giving up groups of foods forever, I expect over time as her gut heals and her immune system normalizes she will be able to reintroduce most of those foods back into her diet.

Before undertaking an ECD it’s important to determine your motivation.  What is going to give you the drive to persist through the early cravings?  What is going to allow you to say no when you get in situations where it would be so much easier to simply say yes?  Unless you plan to be a hermit for the 3-4 week duration of the elimination part of the diet, you need to have motivation.  One strong source of motivation is others.  Most of us don’t tell anyone about any diet or lifestyle changes we’re trying to make, that way if we fail, no one knows.  Turn that around, and tell all your friends, tell your co-workers.  Enlist their help and let them hold you accountable.  That way when you are tempted to reach for that food you know you others are going to know.

For me, I have three sources of motivation.  The first is simply curiosity.  As mentioned in my previous post when we saw the changes a change in diet caused in our pets, I became curious.  What changes would I see in myself if I did the same?  So this is an experiment to see what happens.  The second source of motivation is my desire to have experienced the therapies I ask my patients to go through.  It is a belief of mine to, whenever possible, try the therapies out on myself that I recommend to my patients.  That way I know what the therapies feel like, and it helps me understand what my patients are going through.  The ECD is one that I have held out on, because without any major health problems I simply did not want to give up the foods that I enjoy.  The third source of motivation is others, when my wife and I first came up with the idea, the first thing I did was quickly post the idea to my blog and to my mailing list.  That way, many people know about this, and are going to hold me accountable for completing it.

If possible, get your friends or family to join you on the ECD (often easier said than done).  It’s especially important to have the help of people you are living with.  If you can all go on the diet together it creates a shared camaraderie and helps to keep the foods that have been removed out of the house.

Stay tuned as this series on the ECD will continue.

Do you have any thoughts on the ECD?  Have you tried one?  We’d love to hear your comments, please post them in the comments section below.

With reasonable precautions ear candling is generally safe.  Years ago I had it done to me and did it to a few others.  None of us had any problems.  That’s not to say it’s totally safe however.  The most obvious issue is you have fire inches above the side of your head.  Reported injuries with ear candling include:  hair catching on fire, burns to the side of the head, ear, and ear canal, blockage of the ear canal with wax and rupture of the ear drum.

So ear candling is not an exceptionally dangerous nor especially safe procedure.  If you’re determined to use an ear candle it’s important to take the proper precautions to protect yourself.  But the real question is, does it work?  To the best of my knowledge there are no published studies on ear candling.  An informal poll of my Naturopathic colleagues representing several hundred years of combined practice says no.  A number of doctors have looked in the ears with an otoscope (the device doctors use to look in your ears) before and after patients have done ear candles and reported no change in the amount of wax.  Others have burned the candles without putting them in an ear, cut them open and found the same wax in the stub.  All evidence points to the fact that the wax in the stub is from the candle itself, not from anyone’s ear.

The bottom line is: ear candling presents too much risk for not enough benefit.  It does not seem to clear the ears of wax and occasionally people get hurt.  As one of my colleagues said, having to dig candle wax out of someone’s ear is no fun.

If ear wax build-up is a problem for you, it’s best to let a physician clean it out professionally.  If your situation doesn’t allow you the opportunity to have a professional do it, I would much rather see someone do a proper ear rinse than an ear candle.  If you feel you must do it yourself (and I am not recommending you do) the safest way to rinse your ears out is to start by piercing a capsule of docusate sodium (stool softener available in any pharmacy that works exceptionally well on ear wax) and squeeze the liquid inside into the ear (throw the capsule away).  Keep your head tilted to keep the solution in your ear for 10-15 minutes, then using a large syringe or bulb GENTLY squeeze warm water into the ear with that ear facing toward the ground to flush out the docusate and wax.  You may need to repeat several times over the course of a few days to clear the wax out.

What are your thoughts?  We’d love to hear them, please share them in the comments below.

The quickest way to be labeled a quack is to openly admit that you practice homeopathy.

So what is homeopathy?

Homeopathy is a system of medicine developed in the 18^th century by a medical doctor named Samuel Hahnemann who was so disgusted by the practice of medicine in his day that he set out to find a better way to practice.  What he created was a system of medicine founded on completely different principles from our modern conventional one.  It is so different in fact that it seems to make no sense.

1. That a substance that causes symptoms when given to a healthy person can cure those same symptoms in a sick person.  This runs counter to our conventional system of medicine which uses primarily anti- medicines (antibiotics, antihistamines, anti-inflammatories, etc.) and doesn’t seem to make much sense.
   1. Homeopathy doesn’t determine how medicines work by analyzing their molecular structures or testing them on animals but by giving them to healthy people.  These healthy people are monitored for what symptoms they develop.  For instance, taking a substance may produce a dry, irritating cough.
   2. This substance is then given medicinally to people with a dry, irritating cough in order to help the person resolve the cough.
2. That a substance can be diluted to a level where statistically no molecules of that substance remain and yet still have an effect.  While the first principle is strange this is the one that gets everyone in an uproar. This runs counter to the conventional system of medicine which is organized around biochemistry.  If there are no molecules of the substance left, how can it have an effect?

Let me say this right now.  We have no idea how homeopathy works.  There are many theories; Hahnemann proposed some back in the 18^th century, as have many people since then, but no one knows how it works.  But there is a critically important difference between saying we don’t know how it works, and that it CAN’T work.

No true scientist will say that something CANNOT work, they might say they believe that it won’t work, or that there is no evidence that it does work.  But the statement it cannot work is a belief not science.  After all everyone knew the Earth was flat until we discovered it wasn’t, and the Sun went around the Earth, until we discovered it didn’t.  The Church members refused to look through Galileo’s telescope because they knew without looking that what he said could not possibly be true.

Statements that there are no scientific studies showing homeopathy works are false.  Studies on homeopathy are mixed.  Some show that it is no better than placebo, others that it is.  Could it be placebo (work only through the power of the mind)?  Possibly.  But we also thought arthroscopic knee surgery really worked until we discovered the effects were merely placebo.  Figures I have seen quoted suggest 30% or more of the medicines we use everyday are placebo.  Many of the positive effects we believe come from our medicines (conventional and alternative) are the result of the placebo effect.  But homeopathy has also been used effectively on pets (dogs and cats) and livestock (horses, pigs and cows) which makes it much harder to argue the only effect happening is from placebo.  Homeopathy has also been used on babies and comatose patients (a real stretch to say that there is any placebo effect on someone in a coma).

Why do I use homeopathy? Because in my clinical practice I have seen it work.  I have seen it work on small things and I have seen it work “miracles.”  Does it always work?  No, nothing always works.  If it is just a placebo, I don’t care.  It is cheap, it has few side effects (things that cannot be said about most conventional medicines), and my primary concern is to see people get better, and I am less concerned with how they get better.  I use homeopathy as one of the tools in my medical practice to help people live a high quality life.

For an entertaining, easily readable short work published in 1896 on why an MD became a homeopath, download this free book here.  J Compton Burnett was a medical doctor who, frustrated with his inability to help people get better turned to homeopathy.  Despite tremendous skepticism he was so impressed with his experiments in homeopathy that he became a homeopath.  Challenged by one of his conventional peers to state why he used homeopathy, he wrote this little book of his 50 reasons.

What are your thoughts?  We’d love to hear them?  Have you ever used homeopathy and did it help you?  Share your comments below.

Part II here

In part I of this series we answered the basic question, what is evidence based medicine (EBM) with the definition:  EBM is the equal use of clinical experience and external evidence to make the best decisions about the care of patients.

In part II we saw how this definition is often discarded for the much more stringent and less useful definition of EBM as the selection of therapies according to the evidence presented in the scientific literature.  This evidence is ranked with double blind, placebo controlled studies at the top (considered most authoritative) and clinical experience at the bottom (considered least reliable).

In part III, my intention is to outline how I use EBM in my practice.  Alternative or natural practitioners are often dismissed by conventional practitioners with the refrain “not enough evidence” or “hasn’t been proven to work”.  This is true only under the strict definition of EBM we talked about in part II but as I will show I base my practice on a great deal of evidence, much of which is not given significant value by the conventional community.

In my practice of medicine, I break evidence down into four quadrants.

Quadrant I – Tradition

The use of food and plants as medicines dates back to the beginnings of humanity and is found in every culture around the globe.  The most widely known traditional medical systems are Chinese medicine and Indian (Ayurvedic) medicine which have experience spanning several thousand years, and many generations of healers.

There is a tendency in modern culture to view our predecessors as ignorant or at the very least to think, “they were doing the best they could, but we’re clearly so much smarter and better than they are, after all we have iPods and electricity…” and to discount their knowledge and wisdom.  I think this is an arrogant and prideful view.  Our ancestors faced many of the same health problems we face today and generations of experience helped them to accumulate a wealth of wisdom about what heals and what doesn’t.

This is not to say that tradition has all of the answers, it doesn’t.  Superstition pervades this quadrant, some of the therapies our ancestors used were ineffective and some were downright harmful, and the conditions of our modern lives are uniquely different from those of our ancestors.  But to throw out this quadrant of evidence because of these flaws is to “throw the baby out with the bathwater.”  We have much to learn from our ancestors, and in my opinion, evidence based medicine starts here.  I look at how my Naturopathic predecessors treated disease and restored health, and how traditional cultures around the world used food, plants and other medicines.  To this base I add…

Quadrant II – Scientific literature

Because I am a Naturopathic doctor (ND) and not a medical doctor (MD) I have been called anti-science.  Let me be clear, I am NOT anti-science.  I value and use science, but I also do not revere science.  For me it is one of four quadrants of evidence, not the only quadrant.

Science is incredibly valuable.  At its best it helps us to uncover mechanisms of action so we can more deeply understand how diseases and medicines work, and how to better use our medicines.  It also helps us strip superstition and bias out of tradition and our own personal experiences.  But science is also a human endeavor and not something passed on down from ‘on high’.  Recent exposés have shown the bad side of science, manipulated for monetary gain: some scientific studies are ghost written by marketing people looking to influence the prescribing habits of doctors, some pharmaceutical companies hold back scientific data that would make their drug look worse, and that studies are manipulated from the very beginning to give the results that are being looked for.

Scientific studies are not gospel, and in my opinion, need to be taken in the context of other quadrants of information.  So to them we add…

Quadrant III – Personal clinical experience

Nothing can replace a doctor’s experience with their patients and their medicine, which is why we all value a doctor with years of experience.  A doctor’s experience working with their therapies, seeing what works and what doesn’t on real people in front of them, gives personal knowledge of that therapy that cannot be learned from tradition or the scientific literature.

This is not to say we should rely only on clinical experience because we are all subject to our biases and the biases of our patients and the population that we serve.  But by placing it in the context of the other quadrants we gain irreplaceable knowledge.  The last quadrant is…

Quadrant IV – Non-rational or intuitive

This is the hardest category to explain, and as such is often just ignored and swept under the rug.  Medicine is not just a science, it is also an art.  Hunches, gut feelings and intuitive leaps of thought play a vital part in the practice of medicine, even for the staunchest scientific practitioners.  Sometimes we choose therapies because it simply feels right.

Each of the four quadrants provides valuable evidence that I feel is, in and of itself, insufficient for the practice of EBM.   Conventional medicine, I believe, makes the mistake of discarding quadrant I (tradition) and IV (intuition), minimizing quadrant III (clinical experience), and attempting to rely almost exclusively on quadrant II (scientific literature).  Alternative medicine, I believe, also makes the same mistakes by rejecting quadrant II (scientific literature)  attempting to rely almost exclusively on quadrant I (tradition) and III (clinical experience), while some alternative practitioners think quadrant IV (intuition) by itself is enough.

I value each quadrant equally, and do not rely on any one to provide all the evidence for my treatments.  The strongest evidence is where each quadrant converges with the others; where a traditional use is verified by modern scientific studies, the clinical experience of the doctor and their peers, and by the practitioners and patients non-logical intuition.   This I believe is truly comprehensive, holistic EBM and best serves patients.

What are your thoughts?  We’d love to hear them, please post your comments below.