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Non-toxic Skincare - The Why, What and How.  
Part two:  The WHAT

This month we are highlighting healthy skin, including skincare basics, healthy skin care products, food and skin and more. This is part two of a three-part series going in-depth on the topic of toxic skincare products, including why it’s important to choose healthy skincare products, ingredients to be aware of, and resources to help you choose safe, healthy skin care products for you and your family.


PART TWO: THE WHAT

As explained in my previous blog, your skin absorbs up to 60% of what you apply to it, and serves in some cases as a direct route to your blood. Chemicals in skin care products can bioaccumulate, or store and accumulate in your body over time, potentially causing hormone disruption, inflammation, weight gain and increased cancer risk. Unfortunately, the FDA does not require proof of safety before cosmetics and other skincare products reach the market, so you need to be your own advocate to protect yourself and your family!

There are so many potentially toxic ingredients in skin care products that I had trouble choosing which ones to feature! I’ve chosen three of the most pervasive, and potentially most dangerous chemicals for today’s blog, and I provide links to articles I used in my research with more extensive information should you choose to read more!


b2ap3_thumbnail_natural-shampoo-label.jpgPARABENS

Parabens serve as preservatives in a wide variety of skincare products. Parabens are everywhere, and it’s likely that most of us have been exposed to Parabens through a number of different products throughout our lifetime. Some researchers have estimated that some 90 percent of typical grocery items contain measurable amounts of parabens. Scary!

The main concern with Parabens is that they have hormone-mimicking and estrogenic properties. This means that they can act like estrogen in the body, competing with naturally-produced estrogen and binding to estrogen receptors on cells. This can potentially create an “estrogen overload” effect in the body, which may increase the risk of hormonally-driven cancers like Breast Cancer and fuel other hormone-mediated conditions such as endometriosis.

Ingredient Keywords: methylparaben, ethylparaben, propylparaben, butylparaben, and isobutylparaben


b2ap3_thumbnail_makeup__large.jpgPHTHALATES 

Phthalates serve as plasticizers They are used to make skincare products flexible and better able to hold color and scent.

The concern with Phthalates is that they belong to a group of chemicals referred to as endocrine disrupters, which means they have the potential to disrupt your hormones. Phthalates have been shown to reduce fertility in both men and women, reduce testosterone production in men, reduce egg quality and quantity in women, and are associated with endometriosis.

How to find them? You can look for phthalates on labels, but unfortunately, you won't always find them. The FDA does not require manufacturers to list every ingredient in proprietary fragrances, so they may be hidden in the term ‘fragrance/parfum’.


b2ap3_thumbnail_Triclosan.jpgTRICLOSAN

Triclosan is added to a variety of skin care products to reduce or prevent bacterial contamination. Exposure to Triclosan is so pervasive that the U.S. Centers for Disease Control and Prevention reports that it can be found in the urine of 75 percent of all U.S. residents, as well as in plasma and breast milk.

There are a variety of concerns with Triclosan. Not only does it function as an endocrine disruptor (like phthalates), it also promotes antibiotic resistance, has been shown to be a skin irritant, and is considered to be carcinogenic, increasing the risk of certain cancers. In addition, Triclosan has been shown to have a negative environmental impact, most notably in aquatic ecosystems.

While the FDA banned the use of Triclosan in over-the-counter antiseptic soaps, gels and wipes ion 2016, it is still in widespread use in personal care products like toothpastes, shampoos, and deodorants.

Look for “Triclosan” directly on your label.

Looking for more information? Check out these resources:

Sara Gottfried, MD: Ten Toxic Ingredients That Might Be in Your Skin Care (And What to Use Instead).

MindBodyGreen: 12 Toxic Ingredients to AVOID in Cosmetics & Skin Care Products

Andrew Weil, MD: What's Wrong With Triclosan?

Scientific American: Should People be Concerned about Parabens in Beauty Products?



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and provide treatment options that go beyond the prescription pad. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Alpha-hydroxyl Acids (AHAs)


HOW AHAs WORK

Our skin has a natural ability to exfoliate dead skin cells and does so daily. Unfortunately, this process slows down with age, which can lead to an accumulation of dead skin cells, leaving skin appearing dull and uneven.

AHAs dissolve the upper layer of skin cells by weakening the cellular “glue” that holds dead skin cells together, encouraging exfoliation and triggering skin repair.


HOW AHAs IMPROVE YOUR SKIN.

AHAs have a number of proven skin benefits.

AHAs remove dead skin cells, revealing healthy, younger skin cells, resulting in a brighter complexion and more even skin tone. This increase in cell turnover is also effective in treating sun-damaged skin, hyperpigmentation, and melasma.

AHAs trigger collagen regeneration, thickening the outer skin layers. This works to firm and tighten skin. minimize fine lines/wrinkles, and fade blotches. (When combined with a retinol, these results can be even more dramatic, but we’ll save that for another blog...)


AHAs AND DRY OR SENSITIVE SKIN.  

Many of my clients with dry or sensitive skin get nervous when they hear the word “acid“. Have no fear! Even those with dry or sensitive skin can benefit from regular use of a quality AHA product with proper pH balance.

AHAs may actually be a better choice to exfoliate sensitive skin because they are less likely to irritate then manual exfoliation. AHAs are gently applied to the skin, no need to scrub. AHAs can also be effective for dry skin. By removing the outer layer of dead skin cells, healthy skin cells become more receptive to the skin care products you apply. Regular AHA use, combined with appropriate product, can significantly increase your skin’s moisture factor.


GETTING STARTED WITH AHAs. 
While there are a number of AHAs, the two most commonly used in skin care are Glycolic Acid and Lactic Acid. Glycolic Acid is considered to be the most powerful because it has the smallest molecular size of all AHAs. The smaller the molecule, the deeper it is able to penetrate skin layers.

When beginning an AHA regimen, it is important to “start low and go slow”.
Start low - choose a product with a lower concentration of acid to start. Over time, and under the supervision of your skin care provider, you can gradually increase the concentration of your product for added benefits.

Go slow - don’t overdo it! Start your AHA routine only 1-2 times per week, giving your skin plenty of time in between treatments to rest and repair. You can gradually work up two more frequent use. I typically recommend an every other day regimen for my patients, using AHAs twice daily on “active“ days, with “rest“ days in between.

You can add an AHA right into your regular skincare routine. Apply your AHA after cleansing, and follow with serum and/or moisturizer. Don’t forget sun protection! Use of AHAs can make your skin more susceptible to sun damage, so don’t forget your daily sunblock!

b2ap3_thumbnail_BL_Sanitas3.jpg

RECOMMENDED PRODUCTS FROM OUR SANITAS SKINCARE LINE:   

Glycosolution 5% 
The perfect starting point. Removes spent skin cells and helps stimulate skin renewal. An amino acid complex, blended with glycolic acid, helps smooth the appearance of wrinkles, boost moisture retention and brighten dark spots. (also included in all Sanitas System Kits)

Brightening Peel Pads 
Instant results! These pads contain a triple acid blend to brighten, tone and reveal clear, radiant skin. Follow with 3 drops of Vita C Serum for an instant glow.

Solar Block 
A natural, non-toxic broad-spectrum sunscreen for daily use. Contains a blend of zinc oxide and antioxidants. Absorbs quickly and will not clog pores.

All Sanitas products are cruelty-free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and providing treatment options that go beyond the prescription pad. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Non-Toxic Skincare - The Why, What and How
Part One:  The WHY

This month we are highlighting healthy skin, including skincare basics, healthy skin care products, food and skin, and more. This is part one in a series of three blogs going in-depth on the topic of toxic skincare products, including why it’s important to choose healthy skincare products, ingredients to be aware of, and resources to help you choose safe, healthy skin care products for you and your family.

PART ONE: THE WHY

Our skin is our largest organ! The average adult has about 8 pounds, or 22 square feet of skin. That is a lot of surface! Not only is that a large area that requires care and protection, but it’s also like a big sponge. What we put on our skin can be absorbed by the body and enter our blood. In fact, we absorb up to 60 percent of what we put on our skin, even more through delicate areas such as the face and armpits.
b2ap3_thumbnail_SKIN2.jpg

So WHY care about the safety of your skincare products? Because what you put on your skin can go directly into your blood.

Toxic ingredients in your skincare products can be sneaky. While you generally won’t notice a problem right away, many toxic ingredients bioaccumulate in the body, meaning they store in the body and build up over time. When it comes to toxic skincare chemicals, this can lead, over time, to hormone disruption, inflammation, weight gain and increased risk of certain cancers.

Bioaccumulation = The accumulation of a substance, such as a toxic chemical, in various tissues of a living organism.

“The FDA protects me from potentially harmful chemicals, right?”

Absolutely not! The FDA does not require proof of safety before cosmetics and other skincare products reach the market. In addition, there is no skincare industry standard for claims like “natural,” “organic,” “green,” “clean”, or “non-toxic.” Buyer beware! You have to do your own research and be your own advocate.

The FDA is not protecting you against potentially harmful chemicals in your skincare products.

Stay tuned…next up we’ll be reviewing a few of the toxic chemicals that you need to be aware of in your skincare products.




Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, as well as general wellness and healthy aging. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances, and going beyond the prescription pad for true health and wellness. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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FOOD SENSITIVITY TESTING and
The FIT Test by KBMO Diagnostics


In my medical practice, we look for root causes of symptoms and chronic disease, rather than focusing on simply treating symptoms with prescriptions. This is what sets Integrative and Functional Medicine apart from traditional Western Medicine. 

b2ap3_thumbnail_inflammation.jpg Inflammation is one of the main root causes of nearly everything I see wrong with my patients.  Food is a primary trigger for inflammation and should be considered as playing a large role in most symptoms, chronic disease, and autoimmune disease.  Like I often say to my patients:

Every time that you eat, you are making a decision to either
increase or decrease inflammation in your body.


FOOD SENSITIVITIES & SYMPTOMS
First things first, we are not talking about food allergies.  Food allergies are mediated by an IgE immune system reaction, which produces immediate and often serious or life-threatening symptoms that require immediate medical attention.  In contrast, food sensitivities (also referred to as food intolerances) are mediated by an IgG immune system reaction that is more delayed and generally less serious. Reactions may take up to 3 days to develop, and the IgG antibodies can remain in your body for up to three weeks.
Click here to read more about Food Allergy vs. Food Sensitivity

With food being a primary driver of inflammation, and inflammation underlying most symptoms, the argument could be made that food may be a trigger of nearly any symptom in the body!  The most common symptoms that I see in my practice that have a strong association with food include:

  • b2ap3_thumbnail_Abdominal-Pain-Is-It-Appendicitis_article_main.jpgRashes, Acne, Eczema and other Skin Conditions
  • Joint Pain
  • Digestive Issues, including IBS
  • Headaches
  • Fatigue/Energy and "Brain Fog"
  • Autoimmunity of any kind
  • Hormone Imbalance
  • Weight Gain
  • Mood Disorders, including Depression, Anxiety and more

 

DETERMINING FOOD SENSITIVITIES
Traditionally, the Comprehensive Elimination Diet has been considered the “gold standard” for determining food sensitivities. The Comprehensive Elimination Diet involves removing the food, drink, and additives that are most commonly associated with inflammation and symptoms, including:

  • b2ap3_thumbnail_Donuts.jpgGluten/Wheat
  • Dairy
  • Sugar
  • Eggs
  • Soy 
  • Corn
  • Peanuts
  • Nightshade Vegetables
  • Citrus Fruits
  • Caffeine 
  • Alcohol

The Comprehensive Elimination Diet needs to be done for at least three weeks (if you recall from above, the IgG antibodies associated with food sensitivities can remain in the body for three weeks, this allows time for them to "flush out").  After this time foods may be re-introduced one at a time while monitoring for an increase in symptoms.  For those patients who are able to complete a Comprehensive Elimination Diet, the process can be life-changing.  In my patients who complete this process, I frequently see a dramatic reduction in symptoms, improved energy and mental clarity, and better sleep. However, for many others, this process can be difficult or nearly impossible.


FOOD SENSITIVITY TESTING and the FIT TEST
One of the most common Food Sensitivity laboratory tests (and the one I have previously used) involves measuring IgG antibodies in the blood to a variety of foods.  The presence of these IgG antibodies indicates an immune system reaction to that food.  While the information on an IgG food sensitivity test can be useful, I have found several problems associated with this testing:

  • Some patients have so many IgG food reactions that they could not possibly remove these many foods from their diet.
  • We cannot always correlate a positive IgG food reaction directly to inflammation or a patient's symptoms.
  • These tests can be expensive!

FIT = FOOD AND INFLAMMATION TEST
b2ap3_thumbnail_KBMO.jpgThe FIT Test by KBMO Diagnostics is, in my opinion, the next generation in Food Sensitivity Testing.  Rather than simply measuring IgG antibody reactions, the FIT Test measures IgG and Complement-mediated Immune Complexes.  Translation = by adding the measurement of immune complexes the FIT test may more accurately identify the foods that are actually causing inflammation in the body.  

Other benefits of the FIT Test:
  • The FIT Test measures sensitivities to up to 132 different foods,  as well as coloring and additives.
  • The FIT Test can diagnose increased intestinal permeability, or "Leaky Gut", through the identification of a positive Candida immune-complex response.
  • There are less positive reactions to work with, allowing patients to more easily remove inflammation and symptom-triggering foods.
  • In addition to the 132 item option (currently $275), the FIT Test offers a more-affordable 22 item option which includes the most commonly identified food and antigen triggers (currently $100).*
Click here to learn more about the FIT test, see a list of the foods tested, and view a sample report.

Are you interested in the FIT Food Sensitivity Testing?  Do you have questions?  Feel free to send me an email at This email address is being protected from spambots. You need JavaScript enabled to view it. or contact our office 231-638-5585.

*I do not make any profit of the FIT Test, or any other laboratory test offered in my practice. Any costs associated with laboratory testing are related to the laboratories themselves.



Carin Nielsen, MD Integrative MedicineLooking for a personalized approach to your healthcare? I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms and chronic disease simply by prescribing medication doesn't address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface" to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

 
 
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FEMALE HORMONE TESTING 101

Which test is right for you?


Achieving Hormone Balance in women starts with evaluating your hormone levels. While symptoms can often suggest hormonal patterns, I use laboratory data to confirm these patterns, and also to evaluate the safety and effectiveness of prescribed hormones, supplements and lifestyle recommendations.


WHICH HORMONES DO WE TEST?
The term “hormone balance” refers to the interaction and balance of a variety of hormones in the body, therefore when evaluating hormones we need to do so BY keeping all of these interactions in mind. While there are many hormones we are able to test, the hormones I most routinely test in my patients include:
  • Adrenal (stress hormones) - cortisol, DHEA-S
  • Sex-steroid hormones- estrogen, progesterone, testosterone, DHEA
  • Thyroid - TSH and free thyroid hormone levels
  • Other - insulin (think blood sugar regulation), pregnenolone (a hormone precursor often referred to as “the mother of all hormones”)
b2ap3_thumbnail_TESTTUBES.pngThere is no perfect hormone test for everyone.

Hormone levels can be measured in blood, urine or saliva. There are many factors taken into consideration when choosing which test is appropriate for each patient, including:
  • patient age
  • type of hormone(s) being measured
  • the number of samples needed to test
  • pre-, peri- or post-menopausal
  • whether the patient is currently on hormone therapy
  • cost of test

So which test is right for you?

Below I’ve broken down the pros and cons of each test and provided information on the tests I most often order in my practice.


HORMONE TESTING 101

BLOOD
Pros: Blood testing is simple and cost-effective (covered by most commercial insurance policies as well as Medicare and Medicaid).

I routinely use blood testing for thyroid hormones and fasting insulin regardless of age. Blood testing of DHEA and pregnenolone is useful for both baseline levels and to monitor when supplementing these hormone precursors. For sex-steroid hormones (estrogen, progesterone, testosterone), blood testing can be useful in the following situations:
  • Pre-menopause - an early-cycle draw (around day 5) can help evaluate for PCOS (polycystic ovarian syndrome).
  • Peri-menopause - a luteal phase draw (day 22-24) helps to evaluate PMS imbalances and estrogen: progesterone balance.
  • Post-menopause - blood hormone levels can be used to confirm menopause and also to monitor hormone levels while on hormone therapy.
Cons: Blood hormone testing gives us information on one moment in time. It is not practical to use blood for multiple-day specimens, or for several samples in one day. Blood measurements are also limited in their ability to provide information on hormone metabolites. Hormone metabolites give valuable insight info which “pathways” hormones take in your body, some of which are healthier than others, and can help stratify risk for hormone-related cancers.

Click HERE to read my previous blog on estrogen metabolite testing.


SALIVA
Pros: Saliva tests can be performed and shipped from anywhere, bypassing a trip to the laboratory. Saliva tests are convenient when multiple specimens are needed and can be kept in your freezer if testing over a month cycle.
I routinely use saliva hormone testing to test adrenal hormones. I also use saliva sex-steroid hormone testing in pre- or peri-menopause to look at cyclical trends and hormone fluctuations, testing anywhere from 5-28 day periods.

Cons: While Medicare covers saliva hormone testing, most commercial insurance companies do not. Saliva hormone testing does not provide hormone metabolite information. While saliva testing can be useful for adrenal and sex-steroid hormones, it is not used to measure thyroid hormones or insulin. Some patients have trouble producing enough saliva for testing, especially if they have chronic dry mouth or are on medications that reduce saliva production.

MY MOST ORDERED SALIVA HORMONE TESTS BY GENOVA DIAGNOSTICS:

URINE

Pros: Urine hormone testing can be done and shipped from home, bypassing a trip to the laboratory. One of the biggest benefits of urine hormone testing is the ability to get an abundance of information on hormone metabolites (see above and my prior blog). Hormone metabolites are especially useful in stratifying risk for hormone-related cancers and also in evaluating the efficacy and safety of hormone replacement therapy.

Cons: Most commercial insurance companies do not cover the cost of urine hormone testing. Some urine hormone tests in postmenopausal women require a 24-hour urine collection, which can be cumbersome for patients. While I use urine hormone testing to measure adrenal and sex-steroid hormones, I do not use urine to measure thyroid hormone or insulin.


b2ap3_thumbnail_DUTCHwheel.pngMY MOST ORDERED URINE HORMONE TEST BY GENOVA DIAGNOSTICS:
Complete Hormones (either 24-hour or first-morning urine, depending upon patient age)

MY NEW FAVORITE TEST BY PRECISION ANALYTICAL INC. COMBINES BOTH SALIVA AND URINE:
DUTCH Complete and DUTCH Plus testing




Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy hormone imbalance. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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ADVANCED LABORATORY SPOTLIGHT:

THE NutraEval PLASMA ® TEST

A Comprehensive Test for Identifying Nutritional Deficiencies, Toxicities, Gut Imbalances, and More

by Genova Diagnostics


b2ap3_thumbnail_nutreval-fm-nutritional-test-blood-urine-small-1.pngThe NutrEval® laboratory test by Genova Diagnostics is one of the most commonly ordered specialty laboratory tests in my practice. This test serves as an excellent starting point for evaluating nutritional status and investigating the root causes of chronic illness, as well as a useful follow-up tool to measure how well lifestyle changes and supplement regimens are working.


OVERVIEW

The NutrEval® test is an advanced nutritional analysis designed to reveal nutritional imbalances or inadequacies. NutrEval Plasma® evaluates the functional need for antioxidants, B-vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients. The test also provides insight into gut health, heavy metal toxicity, mitochondrial function and more.


YOUR REPORT INCLUDES:

Metabolic Analysis (urine organic acids)
Urine organic acids are not something I learned about in Medical School. This analysis, often utilized by Naturopathic Physicians, measures metabolites in the urine that reflect processes going on in your body. This analysis provides insight into:
  • Digestion
  • Bacteria and/or Fungal Overgrowth in the Gut
  • Mitochondrial Function (cellular energy production/Krebs Cycle)
  • Neurotransmitter Balance (stress/mood)
  • Functional B-vitamin Need (not measured values in your body but rather a measurement of how your body is utilizing these vitamins)
  • Need for Detoxification Support
Plasma Amino Acid Analysis (essential and non-essential amino acids, plus intermediary metabolites)
The Amino Acid Analysis represents a 21-day “window” into your protein intake and amino acid balance. I use this section most often to:
  • Evaluate protein intake, digestion and absorption.
  • Evaluate amino acid balance in relationship to mood disorders.

Essential and Metabolic Fatty Acids (red blood cell essential and non-essential fatty acids, including Omega-3 and Omega-6 fatty acids) The Fatty Acid Analysis is a red blood cell measurement, representing approximately 100-120 days prior to testing. When interpreting these results with patients, I am able to accurately identify what type of diet they are following, which types of oils they are cooking with, and whether or not they are supplementing with fatty acids. This section can provide valuable insight insight for diet and supplement recommendations for:
  • General Wellness
  • Inflammatory Disorders
  • Cardiovascular Risk
  • Mood and Brain Disorders

Oxidative Stress Analysis (blood and urine biomarkers indicative of oxidative stress) Oxidative Stress represents the balance of antioxidants and free radical damage in the body. When describing Oxidative Stress to patients, I often describe it as “rusting” on your cells and DNA. This analysis measures markers of this “rusting”, as well as levels of Glutathione, a powerful antioxidant that plays key roles in healthy aging and detoxification (learn more here). Our levels of Glutathione are determined by both our genes and our lifestyle, so if low levels are detected, we can implement protocols for improvement.

Learn more about Glutathione HERE.

Elemental Markers (both mineral nutrients and toxic metals in red blood cells or plasma) This section provides direct measurements of minerals and heavy metals. Mineral results can be used to identify mineral deficiencies or excess. Heavy Metal results can be a useful screening tool, if elevated levels are identified, provoked urine heavy metal testing is often recommended. Analyses measured include:
  • Copper
  • Lead
  • Magnesium
  • Mercury
  • Manganese
  • Antimony
  • Potassium
  • Arsenic
  • Selenium
  • Cadmium
  • Zinc
  • Tin
  • Mood and Brain Disorders
b2ap3_thumbnail_LabTesting.jpg


SPECIMENS:

First-morning urine and a blood draw at a participating laboratory.

COST:
  • Varies per insurance.
  • Covered completely by many Medicare plans.
  • Commercial plans require and out-of-pocket co-pay of $200-300.
  • Not covered by Medicaid.

Note: I do not profit off of ordering this (or any other) laboratory test. Any co-pay goes directly to Genova Diagnostics.

Visit the Genova Diagnostics Website and view a Sample Report HERE.  



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like advanced laboratory testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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The holiday season can be full of excitement, family, friends, and...busy-ness. Before your season becomes a blur of things to do and places to go, take some time to create intentional practices to help you slow down and appreciate the inspiration of the season. Here are five ideas to get you started.


1. CHOOSE AN INTENTION
Use a word, image, or memory to guide your holiday season. Take some time to think about what you truly want from your experience this year, then allow that idea to become a touchstone for your time and energy. For example, if your guiding word this year is gratitude, think about how you can enliven that word in your life, perhaps through journaling, writing a holiday letter of thanks to your friends and family, or finding opportunities to express gratitude within your community.


2. GO OUTSIDE
Getting outside, away from technology, is one of the best ways to slow down and appreciate the here and now. Being in nature calms the body, mind, and spirit, and beneficially affects the nervous system and immune system. Take time to walk in the woods. While you're there, stop to take notice of what you see, hear, and smell. Feel the ground beneath your feet. Plant yourself firmly and remind yourself that you, too, are part of the natural world.


3. BREATHE!
When we become busy and stressed, we change our breathing patterns, taking shorter breaths out of the chest rather than the relaxed, deep breaths that help us feel calm and balanced. Breath awareness techniques can help your mind and body establish a state of relaxation in which you can operate from a state of intentional response rather than stressful reaction. Here's a quick breath awareness tool you might try when you notice yourself feeling rushed and stressed:
  • Close your eyes if you can.
  • Breathe in and feel a touch of cool air at the tip of your nose.
  • Breathe out and feel a touch of warm air.
  • Notice how in each moment of breath awareness you are just here, just now, in the present moment.

4. CREATE AND ENJOY A HOMEMADE MEAL

In our focus on "getting it all done," we can forget to nourish ourselves. Whole, minimally processed food can reduce our stress levels, provide the energy we need to stay balanced, and remind us of the comfort of a good, healthy meal. Choose colorful veggies and fruits, savor the smells and sights of your meal, and enjoy it mindfully, one bite at a time.


5. BECOME DELIBERATE WITH YOUR BEDTIME
Nothing can take away from enjoying the season like sleep deprivation. Sleep is the time when our bodies rest, restore, and gather the resources necessary to wake up focused and ready for an intentional day. Especially during the busy holiday season, your body needs this time to reset. Adequate sleep helps the body to recover from stress, fight off illnesses, balance hormone levels associated with appetite and food cravings, and improve mood, just to name a few of the benefits of healthy sleep. If you are not waking up feeling rested, consider changing your bedtime routine to help you establish a calm state before bed. A few ideas include creating a consistent bedtime, turning off all technology at least one hour before bed, and avoiding substances that interfere with sleep (alcohol, sugar, caffeine, etc.). Treat yourself to a relaxing warm bath or cup of herbal tea and notice how your body can begin to relax and become calm before you get into bed.

Give yourself and those around you the gift of mindful presence this holiday season. Slow down and create a season of intention. Notice that you can find a moment of peace and joy, and take the time to absorb and extend that sensation.


Many Blessings to you all this holiday season,
Katie Winnell RN, BSN, NC-BC



b2ap3_thumbnail_katiewinnell_thumbnail.jpgKatie Winnell is a Registered Nurse and Board Certified Nurse Coach with Credentialing in Clinical Meditation and Imagery and Health Education. She helps clients reveal and activate a lifestyle of wellness though Integrative Nurse Coaching and Clinical Meditation, Mindfulness and Imagery techniques. Katie is now seeing clients through the Integrative Medicine Office of Dr. Carin Nielsen.

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Book Review

FOOD: WHAT THE HECK SHOULD I EAT? 
Dr. Mark Hyman

b2ap3_thumbnail_MARKHYMAN.jpgFROM THE PUBLISHER: When it comes to diet, there's so much changing and conflicting information flying around that it's impossible to know where to look for sound advice. Decades of misguided "common sense," food-industry lobbying, bad science, and corrupt food policies and guidelines have only deepened our crisis of nutritional confusion, leaving us overwhelmed and anxious when we head to the grocery store.

Bestselling author Dr. Mark Hyman is here to set the record straight. In Food: What the Heck Should I Eat? -- his most comprehensive book yet -- he takes a close look at every food group and explains what we've gotten wrong, revealing which foods nurture our health and which pose a threat. From grains to legumes, meat to dairy, fats to artificial sweeteners, and beyond, Dr. Hyman debunks misconceptions and breaks down the fascinating science in his signature accessible style. He also explains food's role as powerful medicine capable of reversing chronic disease and shows how our food system and policies impact the environment, the economy, social justice, and personal health, painting a holistic picture of growing, cooking, and eating food in ways that nourish our bodies and the earth while creating a healthy society.

With myth-busting insights, easy-to-understand science, and delicious, wholesome recipes, Food: What the Heck Should I Eat? is a no-nonsense guide to achieving optimal weight and lifelong health.

MY THOUGHTS: This book is a MUST READ, and will forever change the way you think about food. When I began reading this book I set aside a notebook, thinking that I would take brief notes of information “pearls” to share with my patients - I stopped after 2 chapters because there was so much relevant and useful information on EVERY PAGE I couldn’t possibly write it all down!

In this book, Dr. Mark Hyman acknowledges that there is no one “perfect” diet for everybody, instead of focusing on basic dietary principles that simply make sense. He breaks down macronutrients (carbohydrates, proteins, and fats), providing education on each group’s benefits, as well as information on how to make safe, quality food choices. For example, not only will you learn more about why protein is important for our health, but also which sources of protein provide the most benefit and the “dos and don’ts” of choosing quality sources of protein for you and your family.

The book is packed with information, yet easy to read, and each recommendation is backed by sound research, not simply opinion. I found this book to be eye-opening, thought-compelling, and forever life-changing when it comes to thinking about the food that we eat. Consider adding this book to your Summer reading list!

Carin Nielsen, MD



Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, and using a "Food First" approach is a common theme in our office. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_SupplementSwap3.jpgIf you take nutritional supplements, the changing of seasons is a great time to clean and organize your supplement cupboard and re-think your routine. The demands on your mind and body vary with the seasons, and adjusting your supplements to meet seasonal needs can help you to look and feel your best all year long!

Check out these “Summer Supplement Swaps” from my personal routine to help you get started:

SWAP OUT IMMUNE SUPPORT FOR ANTIOXIDANTS

During Winter months I take Vira-Resist herbal immune support daily to fight off coughs, colds, and flu. In the Summer months, I take a break from my immune support and tighten the cap and store the bottle in a cool, dark cupboard.

Summer months bring the potential for increased oxidative stress from sun exposure, summer cocktails and restaurant meals. To fight the effects of oxidative stress I increase my antioxidant routine, adding extra Antioxidant Support Formula, which contains the powerful antioxidants Selenium, Alpha-Lipoic Acid, and N-Acetyl Cysteine, as well as Milk Thistle, which helps to protect my liver from potentially damaging effects of summer cocktails. I also add extra antioxidant-rich Vitamin C in the form of Buffered Vitamin C (which is more gentle on the stomach) to help protect my skin from sun damage and boost collagen synthesis.

ADD EXTRA MINERALS

Summer = Sweat. Combining the increased perspiration of summer with regular infrared sauna use puts me at risk for excess mineral loss, so I add extra Zinc and Magnesium to my routine to replenish losses. In addition, I am liberal with my use of sea salt to replenish minerals and stay hydrated.

KEEP YOUR VITAMIN D DOSE IN CHECK

For myself and many of my patients, a hefty dose of Vitamin D is recommended during Fall and Winter months. During Summer months, with increased sun exposure, this may not be necessary. I check my 25, OH Vitamin D levels and adjust my dose of Vitamin D3 as necessary. Why is this important? You can overdose on Vitamin D! Vitamin D is one of four fat-soluble vitamins (along with Vitamins A, E, and K), so levels can build up in your system and become toxic. It’s important to know your number!

Here’s to a happy, healthy Summer!

Carin Nielsen, MD


Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed to your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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CAN JOURNALING HELP YOU EXERCISE SMARTER?

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Spring has sprung in Northern Michigan, finally! More sun and warmer temps beckon us outdoors and inspire us to get out and move. Spring is a great time to enter into or return to your exercise routine*. But just like any other healthy habit, it can be hard to find the motivation to stay committed to moving our bodies. 

Instead of plodding through an exercise routine using highly over-rated willpower to push through motivation obstacles, how about taking a step back to look honestly at those obstacles, as well as your hopes and goals? Observing our strengths and struggles nonjudgmentally allows us to view and explore them without falling into sabotaging self-criticism. Once we are clear on where we are, strengths, struggles, and all, then we can plan the path forward with a clear vision based in reality and inspiration.


So, try taking a step inward to notice the story you may be telling yourself about exercising, a story which may color and shape your motivation and commitment to this healthy habit.  Journaling is a great way to begin this practice. Here are 3 journaling prompts to help you get started:

1) Get clear on where you are right now. Why do you want to exercise? It seems like an easy question, but we exercise for different reasons, some for specific health-related outcomes, some to meet athletic goals, and others to get out and feel better emotionally. Knowing why you want to exercise can help you choose a routine and set goals that will be effective and enjoyable. It can also help you remain realistic about your exercise routine, which helps you to set specific, achievable goals that honor your motivation and path, not someone else's. 

2) Take a peek at your future self. Close your eyes, take a deep breath, imagine walking a path. Ahead you see yourself 3 months from now. What do you see from a whole, integrated perspective? Not just your physical self, but what do hope for in terms of your emotional, spiritual, and relational self? Now, what strengths do you hold that can get you further along your path? Perseverance? Positive attitude? Enjoyment of the outdoors? And what obstacles might get in your way? Lack of social support? Time limitations? Self-criticism? How can you problem solve those obstacles now, so when they pop up, you have a plan to overcome them? Keep this picture (make sure it is realistic!) close, and revisit and revise when it's helpful. 

3) Maximize the benefits. Take a moment at the end of each exercise session to journal about how you feel, physically, emotionally, and spiritually. Our human brains spend lots of time ruminating on the negative aspects of new habits (no, it’s not just you, we all do it!), and it is more difficult to hard-wire in the positive. So take a minute to revel in your accomplishment and the state you are in after you exercise. What do you feel? Name how your body feels. Name the emotions you experienced while exercising and post-exercise...joy, positivity, pride? Revisit this positive physical and emotional state when you are low in motivation, remind yourself of what is to come (no worries if you aren't feeling those good vibes, journal about the obstacles you noticed and spend a minute problem solving those struggles).  

Journaling can be an effective awareness practice to help you uncover the stories that either limit you or motivate you. Give it a try, you might surprise and inspire yourself! Most of all, use exercise journaling as a method to explore, not critique. Everything you uncover is more information, neither good nor bad, just more self-knowledge to work with to fine tune your motivation. 

So, explore, journal, and MOVE!

*As always, if you have a specific health condition or are new to exercise, have a conversation with your health care provider regarding your exercise routine. 

Katie Winnell, Board Certified Nurse Coach, Health Educator, and Clinical Mediation and Imagery Specialist, can help you with your wellness plan using coaching, behavioral change, and self-awareness tools. You can make an appointment by calling 231.638.5585.


b2ap3_thumbnail_katiewinnell_thumbnail.jpgKatie Winnell, Board Certified Nurse Coach, Health Educator, and Clinical Mediation and Imagery Specialist, can help you with your wellness plan using coaching, behavioral change, and self-awareness tools. You can make an appointment by calling 231.638.5585.This email address is being protected from spambots. You need JavaScript enabled to view it.">

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BACKGROUND
b2ap3_thumbnail_Abdominal-Pain-Is-It-Appendicitis_article_main.jpgI first met Todd* with his wife in October 2016. He had been diagnosed with Crohn's disease (an autoimmune inflammatory bowel disorder) three years prior.  His symptoms included abdominal pain and loose stools with blood and mucous.

During our first visit, I learned that during the time his symptoms began Todd had been under increased stress with an upcoming wedding, a change in employment, and home renovations.

He had originally been treated with sulfasalazine, a common prescription medication for Crohn's, however, the medication made him nauseated and his symptoms were not well controlled. He had been unable to increase the dose as recommended due to side effects.

Todd continued to have frequent loose bowel movements within 15 minutes of eating, often associated with mucus and blood. He was experiencing sharp localized abdominal pain with activity, and the pain was limiting his ability to perform his physically strenuous job as an electrical lineman.

Prior to our first visit, Todd and his wife had already explored holistic options for his treatment. He had tried digestive enzymes, probiotics, and homeopathic remedies without relief. He had also completed a two month trial of a gluten-free diet but was unsure if that made any difference.


INITIAL WORK UP
At our first visit, I ordered a comprehensive laboratory evaluation to screen for:
  • Inflammation
  • Nutritional deficiencies
  • Anemia
  • Hormone balance
  • Candida/Yeast
  • Celiac disease
I also ordered Functional Stool Testing.

While waiting for results, I recommended that Todd begin a four-week Comprehensive Elimination Diet, and provided educational materials and book recommendations for support with this.

Blood testing revealed low levels of zinc, and significant vitamin D deficiency, but was otherwise normal. Functional stool testing indicated significant intestinal inflammation and low levels of "good" gut bacteria.

Recommendations were customized for Todd based on his laboratory results (no more “guessing game” when it comes to supplements):
  • Vitamin D (which supports the immune system response)
  • Zinc carnosine (a key factor in the health of the intestinal lining)
  • Fish Oil (a natural anti-inflammatory)
  • Immunoglobulin powder (derived from colostrum)
  • VSL#3 - A high-dose prescription-grade probiotic (this brand has solid evidence supporting its use in the treatment of Crohn’s)
I also prescribed Low-Dose Naltrexone (LDN), an opioid antagonist that has an outstanding safety profile and has shown promise in the treatment of Crohn’s in both adults and children with minimal side effects.


TWO MONTHS LATER–IMPROVEMENT!
Two months after initiating diet changes, LDN and targeted supplementation, Todd reported his pain improved by at least 50% with some pain-free days and improved energy. While still experiencing blood in his stools, he described it as much less than before.

I recommended he add a glutamine/aloe combination to promote further healing of the intestinal lining.


SIX MONTHS LATER–MORE IMPROVEMENT!
b2ap3_thumbnail_intestines.jpgAt six months Todd reported that he continued to experience significant improvement and was very pleased with his progress. He described his pain as minimal, with only minor flares "nothing like it was before”. He had good energy and stamina and was no longer having any work pain. He had become a “believer” in his regimen of supplements and LDN, having forgotten them on two nights, each time with a symptom flare.

While bowel movements had earlier been improved, he had since noticed increased blood and mucus in his stools, so a low dose of Sulfasalazine had been restarted.

He continued to cautiously experiment with his diet, determining his “trigger foods”.


ONE YEAR LATER
This past fall I was able to meet with Todd and his wife for his one-year follow-up. He reported great energy and stamina, no work pain, and no blood in his stools.

While still on the low dose of Sulfasalazine, it was a dose that did not give him side effects and his symptoms as a whole were nearly resolved. Follow up laboratory testing showed normalized levels of iron, zinc and Vitamin D.

I ordered comprehensive nutritional testing at this visit, which allowed us to customize Todd’s diet and supplement needs. His testing showed a need for B-vitamins, as well as magnesium and enhanced antioxidant support to reduce oxidative stress in the intestinal lining. Based on this testing, I also recommended he begin to reduce the amount of animal protein in his diet, transitioning to plant-based proteins.

In just one year, Todd was able to get much better control of his Crohn’s disease through changes in diet, targeted supplementation, and lower-doses of prescription medications without side effects. He had normalized bowel movements, no blood in his stool, minimal pain and improved energy. I look forward to continuing to work with Todd and his wife to optimize his nutrition, simplify his regimen as he continues to heal, and achieve further success!

*Patient names are changed to protect privacy

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many autoimmune conditions. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” (using assessments like estrogen metabolite testing) to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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THREE REASONS TO CHOOSE SANITAS:


1. MAKE YOUR SKIN WORK FOR YOU
Sanitas products give skin everything it needs to do what it already does best: repair and strengthen itself.

The human skin has miraculous built-in mechanisms for constant repair and renewal of its surface. Unfortunately, the combined assaults of lifestyle, environment and time can compromise the body’s ability to keep up – which is why every technology, ingredient, and dosage in every Sanitas product is selected to foster and improve your skin’s own natural processes to regenerate and protect itself.


2. “EXERCISE & REST” - YOUR NEW SKINCARE ROUTINE
The heart of Sanitas’ tested and proven skincare routines lies in the concept of “exercise and rest.”

A resting phase and strengthening phase are both necessary to build continuous skin strength. “Exercising” products utilize alpha hydroxy acids to encourage skin renewal and strengthen the skin’s barrier. On resting days, exercising products are eliminated and only pH neutral products are used to keep the skin’s barrier intact. Limiting the use of exercising products to three to four days per week allows the skin to recover and regenerate.


3. CLEAN, SAFE INGREDIENTS
All Sanitas products are cruelty-free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.

Sanitas Skincare pharmaceutical-grade ingredients are obtained from fair trade, earth conscious, sustainable suppliers. All Sanitas facial care products that remain on the skin are completely fragrance-free and only essential oils that are medicinal in purpose are used.

Want to learn more? Stop by our Downtown Petoskey office to sample or browse products online.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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Your skin has the amazing ability to repair and regenerate itself, especially when you treat it with the right balance of stimulation and nourishment. This simple truth is the foundation of the Sanitas Skin Care line.

I have been using products from this Boulder, Colorado based company for years and am excited to share them with my clients.  All Sanitas products are cruelty free and contain no parabens, phthalates, dyes, harsh preservatives or gluten.


b2ap3_thumbnail_SAN_CURRENT-PHOTO-groupsm.jpgPROGENERATE • ACTIVATE • OPTIMIZE

AN OVERVIEW OF THE SANITAS SKIN CARE SYSTEM
 

PROGENERATE
The foundation for healthy skin starts here.
Start with daily essentials: Cleanser - Serum - Moisturizer

Looking to change up your skin care routine? This is the place to start. This collection features customized, daily essentials that are specially formulated for various skin types. A simple daily regimen of cleanser, serum, and moisturizer will help strengthen and prepare your skin to progress to the Activate and Optimize categories for rapid results.  Formulas available for all skin types.
Dr. Nielsen's favorites: The Lemon Cream Cleanser is addictive - one smell and you will be hooked! I alternate between the Vita Rich Serum (very hydrating and packed with antioxidants) and the Weightless Serum (more of a matte finish) depending on the time of year.

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ACTIVATE
Looking to take your skin care routine up a notch?
Integrate one or more of the Active skin care products into your routine. 

Designed to activate skin rejuvenation levels and elevate results, this collection of products integrates powerful technologies for progressing the health of the skin. Activate products include alpha-hydroxy acids, retinols, high-potency topical Vitamin C and more. Product concentrations may increase over time to prevent your progress from plateauing.
Dr. Nielsen's favorites: I'm obsessed with the Vitamin C Lactic cleanser (used 2-3 days per week).  I use the Vita C Serum at night - this high-potency Vitamin C serum is rich in antioxidants and essential fatty acids.  

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OPTIMIZE
Have a specific need?
Try these targeted, therapeutic products.

Whether you are looking to reduce blemishes, brighten, hydrate, or reverse the effects of aging, this collection of targeted, therapeutic products is designed to help rehabilitate challenged skin. When combined with the proper Progenerate and Activate programs, the correct selection of Optimize products will advance skin to its most healthy, optimal state.
Dr. Nielsen's favorites: I LOVE the Brightening Peel Pads - these pads can be used 2-3 times per week for an instant glow. The Hyaluronic Concentrate is combined with your usual moisturizer to boost hydration and reduce the appearance of fine lines - instant results!

Want to learn more? Stop by our Downtown Petoskey office to sample or browse products online.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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In our fast-paced, on-the-go culture, a meditation practice can offer moments of calm amidst the chaos, moments which can grow into a lifestyle of greater attention, awareness, and peacefulness. As stressful lives have led to an increase in stress-related illness, the healthcare industry has gravitated toward integrating contemplative practices such as meditation into care plans for those with new or chronic illness. This occurrence is supported by years of research into the effectiveness of using meditation as a tool for stress reduction, chronic illness risk reduction, and for balanced emotional and spiritual health. As western medicine becomes better at understanding the gifts of meditation, it is clear that meditation is an effective adjunct therapy for many physical, emotional, and spiritual illness states. 

In using meditation as an aspect of integrated medical care, however, we must be careful to match the meditation style to both the personality and the symptom set of the client. Though meditation skills, in general, are appropriate for almost all populations, using meditation clinically involves more than a one-size-fits-all approach. Using an evidence-based scientific approach to meditation has taught us that meditation changes the neurophysiology of the brain, changes the parts of the brain that are "on-line" and functioning, and changes brain wave activity in the brain. These changes, of course, are reflected in the body. So, how these practices are taught and applied, among other factors, can determine the outcome. This is important in setting where a particular outcome is desired, where others may not be. Different goals require different techniques. 

Fortunately, we know a lot about how different meditation techniques affect the body and the brain. And we know a lot about how different symptoms and illnesses present in the body and the brain. With the combination of clinician experience, medical history, and the client's own wisdom, specific meditation techniques can be matched to best meet the needs and goals of the client. Mindfulness Meditation may be the right fit for one client, Focused Awareness Meditation more effective for another, while Open Heart Meditation best matches the needs of yet a different client.

Research does indeed suggest that even relatively brief and general meditation training can have an impact, but this same research indicates that the popular impression that "meditation" or "mindfulness" is good for everything or everyone is a bit of a fallacy, especially when used in clinical settings. Clinically, meditation should not be guesswork. Rather, it should be used with specificity regarding the client's own goals, their physiology, and how different meditative techniques impact the brain and body. When meditation training is matched to the individual client, it has the potential to reduce stress, reduce chronic illness symptoms, and open the door to experiences of joy, wonder, curiosity, and peace.



b2ap3_thumbnail_katiewinnell_thumbnail.jpgIf you are interested in learning about how meditation can be effective for your life and health goals, you can make an appointment to begin your journey with Katie Winnell RN, BSN, NC. Katie is a licensed RN, Nurse-Coach and Health Educator with credentials in Clinical Meditation and Imagery. The upcoming Spring 2018 Foundations of Meditation Session, an introductory 4-week class which sets the foundations for your meditation practice, begins April 17th at 6:30 pm at Dr. Nielsen’s office, 413 Waukazoo Ave., in Petoskey. Call 231.638.5585 to pre-register or schedule an appointment.This email address is being protected from spambots. You need JavaScript enabled to view it.">

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b2ap3_thumbnail_HealingArthritis.jpgIn Healing Arthritis, Dr. Susan Blum, author of the bestselling The Immune System Recovery Plan shares her science-based, drug-free treatment plan for the almost fifty million people who suffer from arthritis.

FROM THE PUBLISHER:
Arthritis is the most common cause of disability in the world—greater than both back pain and heart disease. One example, Rheumatoid Arthritis (RA), is the most common autoimmune disease, affecting 1% of the US population, and almost 68 million people worldwide. Conventional medicine tends to treat arthritis with strong, gut-damaging, immune-suppressing pain medications, temporarily relieving the symptoms of the disease without addressing its root causes. Now, in her groundbreaking new book, Dr. Susan Blum, a leading expert in functional medicine, offers a better approach to healing arthritis permanently.

MY THOUGHTS:
This book is a must-read for anyone suffering from joint pain or arthritis. While I’ve been recommending Dr. Blum’s first book The Immune System Recovery Plan to my patients for years, I find Healing Arthritis easier to read and more user-friendly for my patients to navigate. The book provides an overview of the root causes of inflammation/arthritis, focusing on:
  • inflammatory foods
  • gut health
  • the role of stress/trauma
Dr. Blum includes a straightforward two-week plan to quickly reduce pain through anti-inflammatory foods and supplements; followed by an intensive gut repair program. Once through this initial phase, her plan addresses the emotional issues that contribute to inflammation and outlines a simple, Mediterranean inspired diet to maintain a healthy gut.

I was pleased to see that the diet and supplement recommendations are given are the same available to patients in my office! This book will serve as a useful companion for patients navigating the world of Functional Medicine in treating arthritis and controlling inflammation.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including arthritis. Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. When treating arthritis and autoimmune disease, my approach involves treating root causes such as toxicity, food allergy/sensitivity, stress/trauma and underlying infection. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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In one year, this 10-year-old has made significant behavioral improvements, has stopped two of three medications, is no longer experiencing insomnia or constipation, and is thriving at school.  Read today's blog to hear his story!

BACKGROUND

I first met nine-year-old Luke* and his mother in late 2016. Luke had been diagnosed with a variety of psychological and neurological disorders, including ADHD, PDD-NOS (pervasive developmental disorder-not otherwise specified), Anxiety, OCD (obsessive-compulsive disorder), ODD (oppositional defiant disorder), and a sensory processing disorder.

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Since the age of five, Luke had been evaluated and treated by a variety of psychologists, psychiatrists, neuropsychologists, and pediatricians, as well as a number of occupational and physical therapists. By age nine he was on three different prescription medications for mood and attention.

At that first visit, Luke’s mom described him as "consistently inconsistent". She illustrated a child who on one day would appear happy, calm and content, while the next day appeared ”tormented" by irritability, anger, hyperactivity, impulsiveness, and anxiety.

I also learned that Luke had suffered from both chronic interrupted sleep and lifelong constipation. At times he would go 5–7 days without a bowel movement, and his mother would notice worsening behavior during these times. Complicating matters, his multiple psychiatric medications only seemed to worsen both his sleep and constipation.

INITIAL WORKUP AND RECOMMENDATIONS 
After hearing Luke’s story and performing an examination, a comprehensive laboratory evaluation was ordered which included testing for:
  • nutritional deficiencies
  • inflammation
  • blood levels of heavy metals
  • thyroid function
  • food allergies and sensitivities
  • micronutrient testing
  • functional stool testing
Prior to our first visit, Luke's parents had already implemented changes to his diet by eliminating additives and preservatives, most processed foods, sugar, soy, and conventional dairy products. I asked them to expand upon this and completely remove gluten from his diet.

FOLLOW UP AND PLAN 
I met again with Luke and his mother in early March 2017 to review the results of his testing. With the exception of low Vitamin D, Luke’s blood lab results were overwhelmingly normal. His stool testing, however, was not.

Luke’s functional stool testing revealed several abnormalities, including:
  • poor digestion, with evidence of high levels of protein and fat in his stool
  • bacterial dysbiosis, an overgrowth of “bad” bacteria in the gut
  • low microbial diversity
I recommended they add both fish oil and vitamin D with specific dosing recommendations given. We also initiated a protocol to rebalance his gut which included:
  • continued food restriction, avoiding gluten and other inflammatory foods
  • chewable digestive enzymes with meals
  • pharmaceutical-grade probiotics
  • an herbal blend to reduce the overgrowth of “bad” gut bacteria while still promoting the growth of “good” gut bacteria
TWO MONTHS LATER - PROGRESS! 
Off one medication and behavior improved!

Luke’s mother and I followed up via email in May after completing the herbal gut protocol. I was thrilled to learn of the progress that Luke had made! He had been off of Concerta (a medicine for hyperactivity and attention) for 2 months and was experiencing less behavioral problems. I advised them to continue the probiotics, enzymes, fish oil and vitamin D, and we added magnesium.

A FEW MORE MONTHS - MORE PROGRESS!
Off two medications, sleeping well and regular bowel movements!

b2ap3_thumbnail_GUT.jpgBy August 2017 Luke was down from three to only one medication. His mother reported that he was sleeping well and was having daily well-formed bowel movements! While Luke was still often impulsive and defiant, overall significant behavior improvement had continued since his initial visit.

In November Luke’s mother and I touched base after he had been back in school. She reported that he was “loving school” and was excited to report that he had not had any behavioral or academic problems. His anxiety and impulsiveness had improved. and his mother commented that “he looks really healthy”.

ONE YEAR LATER 
To follow up our gut protocol, we repeated Luke’s Functional Stool Testing, as well as a Urine Organic Acid Panel (which can give us a wealth of information without another blood draw). His stool testing had significantly improved, with better microbial diversity however he continued to show signs of poor digestion and bacterial levels, while much better, were still trending toward imbalance.

Using this follow up information we were able to “tweak” his current program, adding back digestive enzymes (which had been phased out), and repeating a one-month herbal program to further balance gut bacteria. We also added back L-glutamine to further heal and strengthen his small intestinal lining.

His diet restrictions have loosened slightly, but key concepts remain in place, including a whole food diet, and keeping sugar and processed foods to a minimum. They have identified significant gluten intolerance with increased anxiety and agitation, as well as a slightly less pronounced sugar intolerance.

Through the use of a thorough history, appropriate laboratory testing, and evidence-based Functional Medicine protocols, Luke has made significant behavioral improvements, has stopped two of three medications, is sleeping well, having regular bowel movements and thriving at school. I look forward to seeing his progress continue over the years to come!

*patient name has been changed to protect privacy

Carin Nielsen, MD Integrative MedicineI use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including both adult and childhood mood and behavior disorders. Rather than focusing solely on the use of prescription medication, consider addressing potential "root causes" of you or your loved one's symptoms, such as nutrition, gut health, toxicities/impaired detoxification, hormone imbalance, deficiencies and more. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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What is the best way to keep your New Year’s resolution for better health?

Make it something easy and enjoyable that you actually want to do.

A key part of weight management, healthy blood pressure, hormone balance, and overall better health is stress reduction.

Exercise and acupuncture are both excellent ways to reduce stress. In a research article on acupuncture’s physiologic effects on the body, researchers in Stockholm Sweden stated “Both exercise and acupuncture . . . cause the release of endogenous opioids and oxytocin essential to the induction of functional changes in different organ systems. Beta-endorphin levels, important in pain control, . . . have been observed to rise in the brain tissue of animals after both acupuncture and strong exercise.”

The release of these ‘feel good’ substances helps us to feel less stress (and less pain). Evidence also shows that the elevated levels of endorphins and oxytocin after acupuncture can remain long after the acupuncture treatment has ended.

The exercise part of the equation is up to you, but monthly, bi-monthly, or even seasonal acupuncture treatments can do wonders for your health. And, if you have pain issues or a lack of energy, acupuncture can help with those too.

Resolving to improve your health could be the best choice you will ever make, but only if you actually follow through on it. Why not make it easy on yourself? A relaxing hour, or half hour, break in your day for an acupuncture treatment could make the difference.



b2ap3_thumbnail_katiewinslow_thumbnail.jpgRegardless of your health history and physical background, almost anyone is a candidate for acupuncture. If you have an ailment, acupuncture can help relieve it. If you feel well, acupuncture can help you maintain wellness, boost immunity, and manage stress. At Integrative Medicine, practitioners provide acupuncture in collaboration with Dr. Nielsen’s recommendations. Patients very often see greater improvement in their condition when treated by both an MD and an acupuncturist. If you are interested in a consultation or appointment, contact our office at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

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b2ap3_thumbnail_Shop_17FiberCapsules.jpgGlucomannan is a “Super Fiber” that has been shown to reduce appetite, aid in weight loss, lower cholesterol and blood sugars, and relieve constipation.*

Glucomannan is an ancient fiber that comes from the Asian elephant yam, also known as Amorphophallus konjac. This soluble fiber is one of the most viscous dietary fibers known - it can absorb up to 50 times its weight in water.

APPETITE AND WEIGHT LOSS

When combined with water, glucomannan forms a viscous gel-like substance that slows digestion, delays the emptying of food from the stomach into the small intestine, slows down the influx of carbohydrates and fats into the bloodstream, binds to bile acids, and impedes dietary fat absorption.* [1,2]  Studies suggest that glucomannan supplementation significantly reduces weight at doses of 3 g/d to 4 g/d when compared to placebo. [1-7]

Bottom line: When combined with water, Glucomannan expands in your stomach, helping to reduce hunger and promote weight loss.*

GLUCOSE AND LIPID METABOLISM

Soluble fiber slows the absorption of carbohydrates, which influences the release of insulin and the rate of fat storage. Glucomannan studies have not only demonstrated a positive impact on postprandial glucose handling and glucose metabolism but also on cholesterol metabolism.* [1-4,7-9]

Bottom line: When combined with food, studies show that Glucommanan can lower blood sugars and cholesterol.*

HEALTHY BOWEL FUNCTION, PREBIOTIC

Glucomannan not only allows more water to remain in the stool, thereby making waste softer, larger, and easier to pass through the intestines, but it is also an excellent prebiotic. In a placebo-controlled, randomized, parallel, double-blind, crossover trial, doses of 3 g/d and 4 g/d of glucomannan had a positive impact on bowel regularity when compared to placebo. [10] Glucomannan has also been shown to increased the fecal concentration of lactobacilli as well as the daily output of bifidobacteria, lactobacilli, and total bacteria. In addition, fermentation of glucomannan resulted in greater fecal concentrations of short-chain fatty acids and lower fecal pH.*[11]

Bottom line: Glucomannan promotes regular bowel movements and the growth of more "good bacteria" in your gut.*


FIBER LEAN

b2ap3_thumbnail_Shop_17FiberLean.jpgFIBER LEAN
features Shimizu Propol® A propolmannan - a konjac-derived glucomannan using proprietary processing techniques that allow the fiber to maintain high viscosity yet remain stable through the digestive tract.
  • Supports Appetite and Weight Control* 
  • Supports Glucose and Cholesterol Metabolism* 
  • Supports Healthy Bowel Movements* 
  • Serves as a Prebiotic for Intestinal Bacteria* 
When taken with adequate amounts of water, Fiber Lean expands in the stomach, creating a viscous “gel-like” substance which promotes a sense of fullness, slows the rate at which food enters your bloodstream and increases the speed at which food exits the body through the digestive tract (pushing more calories out through the colon, rather than letting them be absorbed). Fiber Lean binds and quickly eliminates toxins from the gut.*
  • Take 30-60 minutes before a meal to feel full with reduced portion sizes*
  • Take prior to heading out to a party/event to reduce cravings and temptation*

Fiber Lean comes in both powder and capsule form.  
Visit our Downtown Petoskey office for a free Fiber Lean sample, 

or visit our online store to buy online.


1. Walsh DE, Yaghoubian V, Behforooz A. Effect of glucomannan on obese patients: a clinical study. Int J Obes. 1984;8(4):289-93. [PMID: 6096282]
2. Doi K, Nakamura T, Aoyama N, et al. Metabolic and nutritional effects of long- term use of glucomannan in the treatment of obese diabetics. In: Oomura Y, Tarue S, Inoue S, Shimazu T, eds. Progress in Obesity Research 1990. London: John Libbey; 1991:507-14. [on file]
3. Kaats GR, Bagchi D, Preuss HG. Konjac glucomannan dietary supplementation causes significant fat loss in compliant overweight adults. J Am Coll Nutr. 2015 Oct 22:1-7. [PMID: 26492494] 4. Biancardi G, Palmiero L, Ghirardi PE. Glucomannan in the treatment of overweight patients with osteoarthritis. Curr Ther Res. 1989;46:908-12. [on file]
5. Reffo GC, Ghirardi PE, Foranttini C. Glucomannan in hypertensive outpatients: pilot clinical trial. Curr Ther Res. 1988;44(1):22-27. [on file]
6. Salvatoni A, Bosetti G, Gambarini G. Lipid pro le and excess body weight in obese children: effect of a dietary drug supplement (glucomannan vs detastranum). Ped Oggi. 1991;11:243-45. [on file]
7. Kraemer WJ, Vingren JL, Silvestre R, et al. Effect of adding exercise to a diet containing glucomannan. Metabolism. 2007 Aug; 56(8):1149-58. [PMID: 17618964]
8. Hopman WP, Houben PG, Speth PA, et al. Glucomannan prevents postprandial hypoglycaemia in patients with previous gastric surgery. Gut. 1988;29(7):930- 34. [PMID: 2840365]
9. Vita PM, Restelli A, Caspani P, et al. Chronic use of glucomannan in the dietary treatment of severe obesity [in Italian]. Minerva Med. 1992 Mar;83(3):135-39. [PMID: 1313163]
10. Marsicano LJ, Berrizbeitia ML, Mondelo A. Use of glucomannan dietary ber in changes in intestinal habit [in Spanish]. G E N. 1995 Jan-Mar;49(1):7-14. [PMID: 8566676]
11. Chen HL, Cheng HC, Wu WT, et al. Supplementation of konjac glucomannan into a low- ber Chinese diet promoted bowel movement and improved colonic ecology in constipated adults: a placebo-controlled, diet-controlled trial. J Am Coll Nutr. 2008 Feb;27(1):102-08. [PMID: 18460488]

Consult your healthcare practitioner prior to use. Individuals taking medication, especially hypoglycemic agents, should discuss potential interactions with their healthcare practitioner. Do not take Fiber Lean at the same time as medication as it may reduce medication absorption.

*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

Carin Nielsen, MD Integrative Medicine I use an Integrative/Functional Medicine approach with my patients to treat a variety of chronic medical conditions, including many that are linked to unhealthy eating habits and lifestyle patterns Treating symptoms simply by prescribing medication as a “band-aid” does not address the underlying factors that contributed your problems in the first place, and is not likely to provide lasting results. My approach involves getting "under the surface” to find and correct underlying imbalances. If you are interested in learning more or if you would like to schedule a consultation, please contact our office This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.
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b2ap3_thumbnail_lotus-2436937_1920.jpgRegardless of who you are, where you live, or what you do, chances are you’ve experienced the stress and anxiety life can bring. The fact of the matter is, we live in uncertain times. As a human species, we always have. Intellectually we know there are no guarantees that come with being alive. Our evolutionary development demands that we stay alert to threats and potential danger so that we can stay alive. While we no longer find ourselves on the look-out for the proverbial lion outside the cave door, potential threats and turmoil abound, for some of us more than others. This can leave us feeling stressed, anxious, uncertain, and vulnerable.

Every day we absorb, integrate, and react to countless stressful stimuli from our external environment as well as the emotions and thoughts that these stimuli bring up within ourselves. Our brains have literally been designed to scan for these stimuli and attach emotion and memory to them (termed the negativity bias) (1). In this sometimes constant state of vigilance, we may find ourselves further and further away from a state of calm, a state of peace. This distancing from inner peace can lead to increased chronic stress and multiple stress related illnesses (2). Now we have added another layer of dis-ease to our uncertain lives.

And yet, amidst all of this turmoil, we live, we trust, we love, we look forward to tomorrow. How is it that we hold these two dichotomies within the same brain, the same heart, the same spirit? This is the essence of being human. It is in human vulnerability that we often locate both our desire for and our capacity to experience the state of peace which allows us to trust, to love, to find the meaning and purpose that see us through to tomorrow. And these potentials exist within each and every one of us. They are not mysterious or magical, they are the result of the intermingling and reorganization of the myriad functions of the human brain (3). This physiological fact, however, does not diminish the beauty and freedom experienced with unlocking these potentials. We all have access to these resources, sometimes we just need the guidance and support of others to nudge open the door within ourselves behind which they are waiting.

So how do we nudge this door within ourselves open? One inch at a time. The field of neuroplasticity has shown us we can “turn down” the negativity bias wired into our brains through evolution and “turn up” our capacity to scan and experience beauty, contentment, and peace (1). Doing this, however, takes a dedicated practice which guides us to a state of inner awareness, then gently turns this inner awareness to a more active state of focused attention to the experience of peace. This quite literally changes the activity of the brain biochemically and energetically, priming us to absorb and experience calm peacefulness. From this state we can access our own wisdom, our purpose in life, softening the vulnerability of uncertainty (4).

We can exist in peace, even in the tumultuous world in which we live. But this is a practice. And as in any practice, we need guidance and support. Join me at Dr. Nielsen’s office for one or both of these offerings as we explore the human potentials of peace, wisdom, purpose, and oneness through the practice of Clinical Meditation and Imagery.


FOUNDATIONS OF MEDITATION
Four-week session: When: Monday evenings November 6th, 13th, 20th, 27th, 2017, 6:30pm.
$140. Pre-registration required.


EXPLORATIONS IN MEDITATION AND IMAGERY
Drop-In sessions: When: first and third Tuesdays of each month** starting September 5th 2017, 6:30pm.
$15 drop-in fee. No registration required.
**please note: October 2017 offerings will be the first and fourth Tuesday, Oct. 3rd and 24th, 2017**

Sources:
1. Hanson, Rick. Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence. Harmony Books, NY, New York.
2. Sapolsky, R. (2004). Why Zebras Don’t Get Ulcers. Sapolosky, NY, New York.
3. Schaub, Bonnie, and Schaub, Richard. (2014). Dante’s Path: Vulnerability and the Spiritual Journey. Florence Press, NY, New York.
4. Austin, James. (2000). Zen and the Brain. First MIT Press, Cambridge, Massachusetts.



b2ap3_thumbnail_katiewinnell_thumbnail.jpgIf you are interested in learning how I can help you manage chronic illness risk factors and access your own unique lifestyle of wellness through wellness management, health education, health coaching, workshops, and clinical meditation instruction or if you would like to schedule a consultation, please contact the office of Integrative Medicine - Carin Nielsen, MD at This email address is being protected from spambots. You need JavaScript enabled to view it. or 231-638-5585.

 
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THE THREE BOOKS I MOST OFTEN RECOMMEND TO PATIENTS

Summer is a great time to relax in the hammock or on the beach with a good book.  Below are three books I frequently recommend to patients.  Each is the type of book that you can come back to over time, re-reading chapters and absorbing more information.  Happy reading!


b2ap3_thumbnail_ImmuneSystemRecovery.jpg THE IMMUNE SYSTEM RECOVERY PLAN: A DOCTOR'S 4-STEP PROGRAM TO TREAT AUTOIMMUNE DISEASE

By Susan Blum, MD, MPH

A must-read for anyone seeking a Functional Medicine approach to Autoimmune Disease, and a great companion to my office protocols.

This book provides:

 -A basic science “primer” of the immune system and its dysfunction in Autoimmune Disease (you can skip ahead if it’s too much).
- An overview of a Functional Medicine approach to Autoimmune Disease.
- Sep-by-step protocols for managing stress, cleaning up the gut and optimizing detoxification.


b2ap3_thumbnail_HormoneCure.jpg THE HORMONE CURE:
RECLAIM BALANCE, SLEEP, AND SEX DRIVE; LOSE WEIGHT; FEEL FOCUSED, VITAL, AND ENERGIZED NATURALLY WITH THE GOTTFRIED PROTOCOL

by Sara Gottfried, MD

If you are a female between the ages of 35-65, you should read this book!

Harvard-trained physician Dr. Sara Gottfried provides an easy-to-read, well-organized summary of a Functional Medicine approach to hormone balance, including:
  • - Adrenal dysfunction
  • - Thyroid disorders
  • - Peri-menopause and Menopause
Dr. Gottfried explains how stress impacts hormones at many levels and provides evidence-based protocols to get you started on the path to hormone balance.


b2ap3_thumbnail_GrainBrain.jpg GRAIN BRAIN:
THE SURPRISING TRUTH ABOUT WHEAT, CARBS, AND SUGAR--YOUR BRAIN'S SILENT KILLERS

by David Perlmutter, MD

Looking to learn more about gluten and its potentially damaging effects on the body? Considering a more “Paleo” diet? This best-selling book by board-certified Neurologist David Perlmutter is thought-provocative and research-oriented, and will certainly cause you to pause before you put that bagel in your mouth! Included is a practical four-week plan to get you started on a grain-free lifestyle, including gluten-free recipes.

Want to learn more? Consider a few of Dr. Perlmutter’s other books:
  • “The Grain Brain Cookbook” and “The Grain Brain Whole Life Plan” offer even more practical, day-to-day applications.
  • “Brain Maker” a compelling read that describes the relationship between gut health and brain function.
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