 A crucial goal of meditation is to quiet the mind.
But what if you spend hours each day sitting at your desk, and you can’t imagine taking even more time just to sit still? What if, after a long commute, seated meditation simply doesn’t appeal to you? Fortunately, you aren’t limited to seated meditation. Walking meditation is an increasingly popular alternative. How does walking meditation work? Also known as mindful walking, walking meditation involves moving slowly and steadily in your environment. It’s a simple form of meditation that incorporates physical activity and entails directing and responding to the movements of your body. In this way of meditating, the very act of moving is essential. Rather than walking to a specific destination or to achieve a particular goal, practitioners strive to focus on the present. Most choose a specific lane composed of 10 to 20 paces in one direction, and then 10 to 20 paces back—over and over until the session is complete.1 By adding just 10 minutes of walking meditation to your daily routine, you can enjoy a greater sense of calm, improved psychological balance, and better overall health.2 Paired with the benefits of walking—which include a reduced risk of heart disease and diabetes, as well as enhanced cardiovascular health—this form of meditation is a multifaceted approach to strengthen your well being 3 How can I get started with walking meditation? Allowing the mind time to rest will help it function more smoothly. To get started with walking meditation, wear comfortable clothes and shoes and begin your practice with an open mind. In addition, consider the five following tips:
Walking meditation is designed to restore a sense of calm. When it’s time to end your session, pause and stand still before calling it a day. Take a few deep breaths, and then dive back into your routine. Submitted by the Metagenics Marketing Team References:
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 Contrary to what you might think, “exercise snacking” doesn’t involve grabbing a bite to eat between workout intervals.
It’s a little more nuanced than that—but still highly effective, and well within reach for people looking to get in shape or maintain their fitness. The practice breaks exercise up into bite-size, digestible pieces that even those with the greatest time constraints can enjoy. An antidote to lack of physical activity Currently, roughly half of American adults face one or more preventable chronic health issues. Seven of the 10 most common chronic conditions can be addressed—at least to a certain extent—with consistent physical activity. However, only 50% of adults are getting the suggested amount of aerobic exercise.1 That’s a gap that needs filling, and research indicates that exercise snacking could be the answer.2 National guidelines recommend at least 150 minutes of moderate-intensity aerobic exercise each week, or no fewer than 75 minutes of intense exercise. For additional health benefits, adults should engage in 300 or more minutes of aerobic exercise per week, or the equivalent of five hours of physical activity.1 This may sound like a substantial time commitment, and you might not have a consecutive hour or two to spare each day. It turns out, though, that you can break a sweat in just a short time every few hours, with expansive results.2 Short bouts of exercise can be highly effective You might not be able to fit a 90-minute yoga class into your busy schedule, and on a workday, hitting your local trail for a long run or hike might not be in the cards. Though there are so many workout options available, it still sometimes feels like we don’t have the bandwidth for any of them. Fortunately, you have time for exercise snacking. The term was coined in a 2014 study conducted by exercise physiologist Monique Francois, who determined that six minute-long intervals of vigorous exercise before breakfast, lunch, and dinner could help insulin-resistant people manage their blood sugar levels more effectively.3 The concept has come a long way in the last five years. Many recent studies have found that short bursts of exercise feature powerful results for cardio-respiratory and cognitive health.4 Take one study from January 2019, which found that even a few minutes of stair climbing spread throughout the day can have a significant impact. Researchers from Hamilton University in Ontario, Canada, divided 24 sedentary adults into two groups of 12, with one group vigorously climbing three flights of stairs three times each day. They would wait one to four hours between each climb and engage in this activity three times weekly throughout the six-week study.5 The remaining 12 participants served as the control group and did not exercise. The study ultimately found that the stair climbers were not only stronger, but also had better heart and lung fitness by the end of the study.5 Sounds appealing, right? If you live or work in a multistory building, you can engage in exercise snacking on your own time, without having to go anywhere but up or down the steps. And if you don’t have easy access to several flights of stairs, there’s no need to worry—exercise snacking is versatile, and you can take it elsewhere if needed. A sample exercise snack regimen In England, the University of Bath defines exercise snacking as a form of structured exercise broken up into brief stints, performed twice daily with five minutes of activity and one minute of rest between each exercise.6 The University’s Department of Health has also published a short exercise snacking routine that you can perform at home, without any need for special equipment or a lengthy warm-up.6 In fact, all you need to complete these five exercises is a kitchen chair:
Each exercise should be repeated for one minute before moving on to the next one. And while they’ll certainly get you moving, you may want to engage in more vigorous activities. It’s important to note that exercises like jumping jacks, sprints, burpees, mountain climbers, and squat jumps are fair game as well. You can incorporate these high-intensity movements into your own exercise snacking regimen at your leisure and work out in 5-, 10-, or 15-minute “snack” intervals two or three times each day. You might perform an activity for 30 seconds and then engage in 30 seconds of rest before moving on to the next one. No matter how you go about exercise snacking, it’s a great way to be productive before and after work, between meetings and appointments, during your lunch break, or even while the kids are napping. That’s the beauty of the practice—exercise snacking is good for you, and it’s inherently flexible. All you need to enjoy a great workout is a small chunk of uninterrupted time. References
Submitted by the Metagenics Marketing Team  Q&A: What Should I Look for in a Hemp Oil?
It seems like hemp products are everywhere you look. With so many options to choose from, it’s more important than ever to ask the right questions when seeking a hemp product. Q. What is the composition of the product? A. The Cannabis sativa plant contains more than 80 different phytocannabinoids, which are naturally occurring plant-based bioactive compounds that can support and influence the body’s endocannabinoid system (ECS). The ECS promotes biological balance in many cells and tissues throughout the body. While certain phytocannabinoid compounds may be more well-known, research has indicated that several of the phytocannabinoids found in hemp may work together to produce synergistic effects on the body’s ECS. Terpenes, a group of compounds naturally present in all plants and spices including pepper, cloves, and cinnamon, are also thought to carry a wide array of health supportive properties. Terpenes work together with phytocannabinoids to enhance the overall benefit of hemp oil and support physiological health.This synergy is known in the research community as the entourage effect. Ultimately, healthcare practitioners can best advise on which compounds people might seek for their personal support needs. Q. How much information does the manufacturer provide on the product? A. This is where manufacturing transparency comes in. It’s vitally important to purchase any product from a trusted source. If you can access data from testing conducted on the product, it will provide added peace of mind. Q. What extraction methods were applied? A. Did you know there are multiple ways extracts can be obtained from plants? Conventional methods commonly using alcohol or solvents are generally more cost-effective and rapid from a manufacturing standpoint. Other more costly and time-consuming methods can include supercritical extraction. Supercritical extraction uses pressure to extract the desired compounds from a plant. The most well-known form of supercritical extraction utilizes carbon dioxide and is termed “supercritical CO2 extraction.” Unlike many conventional extraction methods, the supercritical CO2 extraction process is free of any harsh chemical solvents. CO2 extraction is also thought to be a more environmentally friendly method as compared to conventional methods. References available Submitted by the Metagenics Marketing Team  Vitamin D deficiency and the need for practitioner intervention by Sara Gottfried, MD and Lewis Chang, PhD Introduction When I finished my medical training in 1998 at the University of California at San Francisco, I thought I knew everything about vitamin D, particularly vitamin D deficiency and insufficiency. I understood vitamin D was important for the efficient trafficking of calcium in the body, and that helps to keep bones strong, which was important for women’s health over the age of thirty when bone density begins to decline. What I learned in the subsequent twenty years is that vitamin D is both a hormone and a vitamin, and an essential nutrient for more than 400 biochemical jobs in the body. And I learned that what I knew in residency was the tip of the iceberg. Further, I discovered that I inherited a gene for a faulty vitamin D receptor (VDR), which means my body doesn’t absorb and transport vitamin D well, so I tend to have low levels of vitamin D in my blood. This potentially puts me at greater risk for accelerated bone loss, osteopenia, osteoporosis, multiple sclerosis, and certain malignancies such as colorectal cancer. I’m not that unique in carrying the risky gene, but I’m getting ahead of myself. More later on the gene/environment interactions as they relate to vitamin D status, and whether you should be checking your patients for them. As I continue to identify my own knowledge gaps regarding vitamin D, I have become obsessed with teaching other practitioners and my patients about how persistent vitamin D deficiency and insufficiency continue to be despite the public initiatives to raise awareness. In this series on vitamin D, I want to share with you the importance of vitamin D to your health and that of your patients, starting first in this article with how vitamin D status is determined, how prevalent vitamin D insufficiency and deficiency have been in our population, what factors can affect circulating vitamin D levels, recommendations for your female patients since they are at greater risk of problems, and what proven actions to take to help improve your patients’ vitamin D status. How is vitamin D deficiency defined? Serum 25-hydroxyvitamin D [25(OH)D] level is widely used as a bio marker of a person’s vitamin D status, for it is the main circulating form of vitamin D and the best estimator of both endogenous vitamin D synthesis in the skin upon exposure to UV-B light and dietary intake of foods and supplements containing vitamin D.1 Therefore, the diagnosis of vitamin D deficiency is based on the measurement of circulating 25(OH)D levels. However, there is no consensus among key opinion leaders for what is considered an appropriate cutoff for normal, desirable, and optimal serum 25(OH)D concentrations. As a result, different cut-off points have been used to define hypovitaminosis D (deficiency of vitamin D), ranging from 10 ng/mL (25 nmol/L) to 30 ng/mL (75 nmol/L).2-6 There is no consensus among professional societies, either. In 2010, Institute of Medicine (IOM)—renamed in 2016 as the National Academy of Medicine (NAM)—suggested that circulating 25(OH)D levels need to be at least 20 ng/mL (50 nmol/L) to prevent osteomalacia and maintain bone health in at least 97.5% of the population. Therefore, levels at or higher than 20 ng/mL (>50 nmol/L) are defined as vitamin D sufficient. Levels lower than 20 ng/mL (<50 nmol/L) but above 12 ng/mL (>30 nmol/L) are considered vitamin D insufficient and are inadequate for bone and overall health. Levels below 12 ng/mL (<30 nmol/L) are vitamin D deficient which can cause rickets in infants and children and osteomalacia in adults (Figure 1).7 Conversely, believing the IOM recommendations to be too conservative, the Endocrine Society released its clinical practice guidelines in 2011 in which vitamin D sufficiency, insufficiency and deficiency was defined as circulating 25(OH) levels above 30 ng/mL (>75 nmol/L), between 20-30 ng/mL (50-75 nmol/L), and below 20 ng/mL (<50 nmol/L), respectively (Figure 1).8 These recommended cut-off points are similar to the guidelines released by the Central European Scientific Committee on Vitamin D.9 The Endocrine Society also argued that, since any methodology for 25(OH)D measurement is subject to assay variability, targeting a higher 25(OH)D cut-off value may ensure that an individual meets the requirement for sufficient vitamin D levels with only minimal risk of vitamin D toxicity.8 These conflicting professional recommendations result in constant debate among researchers and confusion among clinicians about where the optimal 25(OH)D levels fall. Nevertheless, it is at least agreed upon that serum vitamin D levels less than 30 ng/mL are definitely insufficient and probably deficient for most people. I advise 50-75 ng/mL.  Figure 1. 25(OH)D recommendations by the Institute of Medicine (IOM) and the Endocrine Society. How prevalent is vitamin D insufficiency and deficiency? The prevalence varies depending on how vitamin D insufficiency and deficiency is defined. Another important factor that needs to be considered is how 25(OH)D is measured and how differences in the assay methodology (such as assay sensitivity and analytical variability) confound prevalence estimation.  Figure 2. Prevalence of vitamin D insufficiency and deficiency (%) from 1988 to 2010 in the U.S. using standardized serum concentrations of 25(OH)D.10Since 1988, the National Health and Nutrition Examination Surveys (NHANES) have periodically tracked nutrition status of adults and children in the U.S. via examining a nationally representative sample population. These estimates are highly valuable in assessing the trends of vitamin D status over time. However, different assays have been used to determine 25(OH)D levels between 1988 and 2010, from DiaSorin radioimmunoassay to reformulated radioimmunoassay to the more accurate chromatography-based assays. To minimize laboratory method bias and imprecision in these different assays, the Vitamin D Standardization Program—initiated by the US Office of Dietary Supplements in the National Institutes of Health in collaboration with the National Institute of Standards and Technology, Centers for Disease Control and Prevention, and Ghent University—was organized in 2010 to promote standardize 25(OH)D measurement using liquid chromatography-tandem mass spectrometry (LC-MS/MS).11 Also, equations were developed to help standardize data from older radioimmunoassays to LC-MS/MS-equivalent data. The first paper that reported the temporal trends of vitamin D status in the U.S. using standardized 25(OH)D measurement was published in American Journal of Clinical Nutrition (AJCN) in 2016. They found that the prevalence of IOM-defined vitamin D insufficiency and deficiency (together as one category) was 30-32 percent from 1988 to 2006 and 26 percent from 2007 to 2010 (Figure 2; left). The prevalence was even higher when the Endocrine Society recommended cut-off point was used: 70-77 percent from 1988 to 2006, dropping slightly to 64-65 percent from 2007 to 2010 (Figure 2; right). Also, non-Hispanic blacks and Mexican Americans had much higher prevalence of vitamin D insufficiency and deficiency than non-Hispanic whites.10 Prior to the development of standardizing 25(OH) measurements, an earlier study also had tracked the prevalence trend in the same NHANES cohort and found an increase in vitamin D deficiency over time.1 Now, from the standardized data, we know the prevalence of vitamin D insufficiency and deficiency has been relatively stable. This discrepancy illustrates the importance of method standardization and having data expressed in LC-MS/MS equivalents for the most accurate interpretation of the prevalence trends. This AJCN report also reported a small increase in vitamin D supplement use (≥ 600 IU/day) among women over time: 2.1% during 1998-1994, increasing to 19% during 2009-2010. Vitamin D supplement users tend to be older (≥40 y/o) and non-Hispanic whites, Still, the majority remained to be non-users; at 70% during 1988-1994 and at 57% during 2009-2010.10 What are the recommended dietary intakes of vitamin D for women? The recommended dietary intakes of vitamin D for women from the IOM and the Endocrine Society are compared in Table 1. IOM recommends 600 IU/day for those who are 9-70 y/o and 800 IU/day for those more than 70 y/o to maintain bone health in at least 97.5% of the population in those age groups. Pregnant and lactating women have the same requirement of 600 IU/day. The intake levels recommended by the Endocrine Society are higher than IOM’s. For those who are 9-18 y/o, at least 600 IU/day is needed. However, in order to consistently achieve 25(OH)D of 30 ng/mL (75 nmol/L) preferred by the Endocrine Society, 1000 IU/day may be required. For those who are 19 y/o and older, including pregnant and lactating women, at least 1500-2000 IU/day may be required to maintain the blood levels of 25(OH)D to above 30 ng/mL (75 nmol/L). Table 1. The recommended dietary intakes of vitamin D for women from IOM and the Endocrine Society.  *RDA (Recommended Dietary Allowance): the average daily dietary intake level that is sufficient to meet the nutrient requirement of 97.5% of healthy individuals in a group. **UL (Tolerable Upper Intake Level): the highest level of daily nutrient intake that is likely to pose no risk of adverse health effects to almost all individuals in the general population. Are dietary intakes of vitamin D sufficient in women in the U.S.? Overall no. Even among supplement users, the majority of women have insufficient intakes of vitamin D. Read more in this additional article debunking the myths of vitamin D. The first study that presented national estimates of vitamin D intakes was conducted by the Office of Dietary Supplements and the National Institutes of Health based on NHANES 2005-2006 data. The average vitamin D intake from diet alone was low in every age group (Table 2); the lowest being those 19-30 y/o (144 IU/day) and the highest 9-13 y/o (212 IU/day). When including vitamin D-containing supplement, vitamin D intakes somewhat increased, particularly among those 51 y/o and older (to approximately 400 IU/day).12 Even so, the intake still fell short of the RDA (600-800 IU/day) and way below the levels recommended by the Endocrine Society (1,500-2,000 IU/day). Table 2. Mean vitamin D intake from the diet and from diet plus dietary supplements in women based on NHANES 2005-2006 data.12  *40 IU/day = 1 µg/day The low vitamin D intake seen during 2005-2006 was not a single event. A subsequent study that examined data from NHANES 2001-2002, 2003-2004, 2005-2006, and 2007-2008 confirmed the previous pattern: vitamin D intake from diet only remained extremely low across all populations and age groups, falling short of the RDA even when dietary supplement use was included.13
Further, this study identified certain sub populations that were at greater risks of insufficient vitamin D intakes. When comparing mean intakes by race, African Americans and Mexican Americans had even lower intakes than non-Hispanic whites. When stratifying by annual house income levels, low income was linked to lower vitamin D intakes. Further, those who were affected by obesity had the lowest intake levels compared with those who had normal body weight.13 What about dietary intakes of vitamin D in other countries? Insufficient intakes of vitamin D is not just a phenomenon in the U.S. In fact, it is a global issue. For example, a study involving populations in representative Western countries (Germany, U.K., and the Netherlands) concluded that vitamin D intakes are below recommendations in a significant part of the population in these countries.14 A more recent overview of vitamin D status globally found that vitamin D deficiency occurred all over the world such as in the Middle East, China, Mongolia, and India.15 How much vitamin D intake is needed to improve vitamin D status in women? The Women’s Health Initiative Observational Study (WHI-OS), one of the largest cohorts of postmenopausal women in the U.S., has detailed data on vitamin D intake and serum 25(OH)D level, which has allowed the investigators to address this question. Analysis of the data identified a more or less linear relationship between vitamin D intake and serum vitamin D status: every 100 IU increase in total vitamin D intake (diet and supplement combined) was associated with approximately 0.83 ng/mL (2.08 nmol/L) higher serum 25(OH)D levels. Also, total vitamin D intake was the main factor that determined vitamin D status.16 This dose-response observation is consistent with findings from VIDOS (Vitamin D Supplementation in Older Subjects) study, a 1-year randomized trial that investigated vitamin D intakes and serum 25(OH)D levels in healthy postmenopausal women.17 VIDOS study also found that vitamin D intake at 1,600 IU/day could achieve serum 25(OH)D of 30 ng/mL (75 nmol/L) in 97.5% of the participating women. This dosage level is in line with the recommendations from the Endocrine Society. Is increasing sun exposure alone able to optimize vitamin D status? Some insights can be gained from a study which investigated serum 25(OH)D levels in a group of healthy men who had just completed a summer season of extended outdoor activity such as landscaping, construction work, farming, or recreation. Compared with the general population, these were people who received some of the highest sun exposure—and with sufficient body surface area exposed and without sunscreen—during the season when UV-B radiation was the strongest. The study found that median serum 25(OH)D concentration in these subjects at late summer reached 48.8 ng/mL (122 nmol/L). However, even with ample summer sun exposure, the median serum 25(OH)D dropped to 29.6 ng/mL (74 nmol/L) by late winter, barely meeting vitamin D sufficiency (30 ng/mL) defined by the Endocrine Society.18 Latitude also determines whether one may obtain sufficient levels of vitamin D via sun exposure. One study compared sun exposure in two different cities, Miami (latitude 26 degrees N) and Boston (latitude 42 degrees N), and found that it’s possible to synthesize vitamin D via skin in all months in Miami but it’s very difficult to do so during winter in Boston.19 Therefore, for a very specific group of people such as landscapers, construction workers and farmers who don’t live in high latitude and don’t use sunscreen, their vitamin D level during summer would be sufficient even without dietary intakes of vitamin D. However, their healthy vitamin D status is not sustainable by end of winter if they don’t have additional sources of vitamin D. For the majority of the population—those who spend most of their daylight hours indoors (e.g., office workers), use sunscreen, have their body surface area covered up (e.g., hat, long-sleeve shirt and pants), or live a sedentary lifestyle, etc.—it is highly unlikely that sun exposure alone can increase serum 25(OH)D to sufficient levels even during summer, let alone the rest of the year. What are other important factors affecting vitamin D status? Key non-modifiable factors include age, sex, and race/ethnicity. Although the IOM, the Endocrine Society, and many other professional organizations around the world recommend intake levels based on age and sex, it does not mean that age and sex are the most impactful factors of vitamin D status. Race/ethnicity is another factor that one cannot change, either. However, many factors (besides vitamin D intake) that affect vitamin D status are behavior- and lifestyle-related and therefore modifiable. A 2018 analysis based on NHANES 2001-2010 data has identified several factors and calculated adjusted prevalence ratios of vitamin D deficiency (<20 ng/mL or 50 nmol/L) and insufficiency (20-30 ng/mL or 50-75 nmol/L) in the general population:20
The link between heavier body weight and poorer vitamin D status is a more recent discovery but from the public health viewpoint its impact can be significant, especially when the obesity epidemic has shown no sign of slowing. Due to higher fat mass, a larger individual may simply need more ingestion or internal synthesis of vitamin D to reach the same concentration as a smaller individual.21 This hypothesis is strengthened by findings from a weight loss intervention trial involving postmenopausal women which demonstrated an increase in serum 25(OH)D levels after weight loss.22 The link between physical activity and vitamin D status may be related to other factors. Decreased physical activity level, especially outdoor types, is associated with reduced sunlight exposure which limits vitamin D synthesis from the skin.8Lower physical activity may also contribute to weight gain leading to lower serum 25(OH)D levels due to the effect of dilution. Therefore, increasing outdoor physical activity can improve vitamin D status via increased sunlight exposure and improved body weight. Do genetic factors play an important role in determining vitamin D status? Several genes encode proteins and enzymes that are involved in vitamin D metabolism. Understandably, genetic variations such as single nucleotide polymorphisms (SNPs) of these genes may influence vitamin D status. The first genome-wide association study (GWAS) to identify common genetic variants that influence serum 25(OH)D levels was conducted in 2010 by the SUNLIGHT Consortium involving approximately 30,000 Caucasians from Europe, Canada and the U.S.23 This study identified four SNPs that were associated with lower 25(OH)D levels:
In 2018, the consortium was expanded to nearly 80,000 individuals (all Caucasians) from 31 epidemiological cohorts.28The study confirmed the previous four genetic loci and identified two novel loci for serum 25(OH)D levels:
However, this is an area of active research, and different genetic variations associated with vitamin D status are being discovered in other studies involving other study populations.32-36 Further, little is yet known on how genetic variants interact with other non-genetic factors. For example, one cohort study involving 1,200 postmenopausal women of European descent found that the association between 25(OH)D levels and certain SNPs in GC and CYP2R1 genes were stronger in summer months but not winter months, or in individuals with dietary intakes of vitamin D above 400 IU/day but not below.37 Also, a randomized controlled trial involving nearly 1,800 adults demonstrated that the increase in 25(OH)D after consumption of 1,000 IU/day vitamin D for 1 year was modified by certain SNPs in CYP2R1, CYP24A1, and VDRgene.38 These gene-environmental interactions and associations, once repeated in larger epidemiological studies and confirmed in large clinical trials, will have important public health implications. It will help determine whether individuals with certain genetic risk factors may indeed require higher amounts of vitamin D to achieve sufficient levels of 25(OH). Institute of Medicine miscalculation leads to the wrong recommendation of 600 IU/day As we wrap up, I would like to share with you an interesting article, published in 2014, which was titled “A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D.” (I have included the hyperlink here in case you are interested in reading the whole open-access article.) In brief, researchers from School of Public Health, University of Alberta (Canada) described how IOM’s RDA for vitamin D was underestimated due to a calculation error. IOM estimated that 600 IU/day of vitamin D would achieve serum 25(OH)D above 20 ng/mL (50 nmol/L) for 97.5% of the population, but the authors re-examined the data and estimated that 600 IU/day of vitamin D would only achieve 10.7 ng/mL (26.8 nmol/L) in 97.5% of the population.39 This means that the dose needed to achieve 20 ng/mL (50 nmol/L) in the majority of the population would have been significantly much higher than 600 IU/day. Following the publication, another group of researchers verified in another publication that IOM indeed had made a calculation error.40 Miscalculated RDA for vitamin D can have serious public health and clinical implications as the true vitamin D insufficiency and deficiency would have been severely underestimated based on the IOM definition. Many researchers are now calling for the IOM and public health authorities to redefine RDA for vitamin D (closer to what the Endocrine Society has proposed) to allow for appropriate public health and clinical decision-making. In the meantime, I recommend dosing vitamin D to achieve serum sufficiency by starting with the Endocrine Society guidelines, not IOM. In the next series of articles, I will discuss how vitamin D status is related to women’s health, including current scientific data on the genetic influence of different disease outcomes, as well as common clinical issues we face as clinicians on the front lines. References
Sara Gottfried, MD is a board-certified gynecologist and physician scientist. She graduated from Harvard Medical School and the Massachusetts Institute of Technology and completed residency at the University of California at San Francisco. Over the past two decades, Dr. Gottfried has seen more than 25,000 patients and specializes in identifying the underlying cause of her patients’ conditions to achieve true and lasting health transformations, not just symptom management. Dr. Gottfried is the President of Metagenics Institute, which is dedicated to transforming healthcare by educating, inspiring, and mobilizing practitioners and patients to learn about and adopt personalized lifestyle medicine. Dr. Gottfried is a global keynote speaker who practices evidence-based integrative, precision, and Functional Medicine. She recently published a new book, Brain Body Diet and has also authored three New York Times bestselling books: The Hormone Cure, The Hormone Reset Diet, and Younger. Lewis Chang, PhD is Scientific Editorial Manager of R&D at Metagenics. Dr. Chang received his PhD in Nutritional Sciences at University of Washington, along with his MS in Nutrition and Public Health from Teachers College, Columbia University and BS in Pharmacy from National Taiwan University. Prior to joining Metagenics, he conducted dissertation research and completed a research assistantship and postdoctoral fellowship at the Fred Hutchinson Cancer Research Center in Seattle, WA. Dr. Chang has authored or co-authored and managed the publication of over 30 peer-reviewed journal articles and numerous scientific abstracts and posters. He has quite a green thumb, enjoys opera, theater and jazz, and loves cooking, collecting art, and learning to play gypsy jazz guitar.  Gut health is important for overall health, and there are many wide-ranging causes that can change and affect gut health. These changes can be from acute causes, such as gastrointestinal surgeries, to others, such as the normal aging process, which may affect gastrointestinal motility. Regardless of the cause, the intestines usually experience changes during the healing or aging process.1
That said, despite any shifts, it’s important to get back on track as soon as possible and make the gut the best it can be.1 Here are a few things to consider. What are the implications of changes in the gut? The gut has trillions of bacteria that help to digest food, absorb nutrients, and manage our wellbeing.Many of these bacteria are beneficial, and evidence has shown that good gut health is linked to supporting general health, including the immune system and brain. However, certain gastrointestinal conditions can lead to changes in the gut’s microbial environment and result in poor health and wellness.2 Common sources of gut-health changes include shifts in gut immunity, stomach acid, and gastrointestinal flora (that is, the ecosystem of over 400 bacterial species that make up the microbiome).2,3 Some digestive changes—including compromised gut function—are simply caused by the aging process.3This is because our natural metabolic processes slow as we grow older. Are there ways to support common gastrointestinal changes? You’ve probably heard the expression, “prevention is the best form of medicine.” Prevention is admittedly king in a healthcare setting, but it also involves hard work and dedication. So how can we avoid intestinal changes that may affect gut health? Here are some preventive strategies that may help keep your gastrointestinal health in check:4
Which ingredients can enhance gut health?Many foods and supplements are connected to a healthy gut and a strong digestive tract.4 Some options to explore include: 1. Probiotics Probiotics are “live microorganisms that, when administered in adequate amounts, confer a health benefit on the host.”6,7 They offer a number of benefits, including supporting digestion, and data suggests a gut-brain connection exists.8 While only strain-identified probiotics have been researched extensively for specific health benefits, fermented foods, such as kimchi, miso soup, kombucha, and kefir are popular dietary sources of probiotics. Most probiotics come from one of the following genera of bacteria:8
2. Prebiotics Prebiotics are fibrous carbs the human body cannot digest (but certain bacteria in the gut can). They serve as food for probiotics and include oats, garlic, onions, apple skin, beans, and chicory root.5 Much like probiotics, prebiotics encourage healthy digestion.8 3. Fiber When it comes to improving our digestive health, fiber—also known as roughage—is crucial.13 It cannot be digested by the body; rather, it passes through the stomach, small intestine, and colon more or less intact.9 Fruits and vegetable, whole grains, beans, and legumes are all rich in fiber.14 Fibrous ingredients are generally full of nutrients as well, which may enhance our absorption abilities.13 There are two types of fiber, one of which is more closely linked to the digestive system:13
Be sure to discuss your fiber intake with your healthcare practitioner to minimize chances of discomfort.13 4. Glutamine This amino acid provides both a source of fuel and precursors for growth to the rapidly dividing cells of the intestinal lining.15 5. Inner-leaf aloe Sourced from the aloe vera plant, inner-leaf aloe has been shown in studies to support temporary digestive symptoms such as cramping, bloating, and flatulence.16 It has also been shown to a support a healthy intestinal lining.17 6. Zinc-carnosine Ideal for gastric comfort, zinc-carnosine works by supporting the healthy ecology and integrity of the stomach lining.18,19 Always consult your healthcare practitioner before making any adjustments to your diet or adding any supplements. For more information on nutrition and gut health, please visit the Metagenics blog. References
 Have you ever stood before the wall of vitamins at the drugstore or your healthcare practitioner’s office, wondering what you should take? Choosing supplements can be a daunting experience: Some boxes are orange. Some bottles are silver. Some contain iron, while others do not. Which one is right for you?
Start the selection process by getting specific about your particular stage of life. From young adulthood to the childbearing years and into menopause, each life stage may require greater emphasis on different nutrients to help your body get what it needs for optimal wellness. Young, ambitious, and carefree! Does this ring true for you? Women in their late teens or early 20s are going off to college, choosing a career path, and just beginning to explore adulthood. This is a time to be mindful of getting the appropriate nutrients you need to create a healthy foundation for the years ahead. Calcium. This mineral is important for women of all ages, but especially so in your 20s when bone mass reaches its peak. After this time, the risk of losing bone mass increases as a woman moves into her 30s and beyond.1 Taking a calcium supplement can help the body build bone, especially when paired with vitamin D3, which is known to enhance absorption of this vital mineral.2 Iron. Iron is important for young ladies, as menstruation is one of the ways this mineral is depleted from the body. In fact, menstruation increases the average daily iron loss to about 2 mg per day in premenopausal female adults,3 with excessive menstrual blood loss as the most common cause of iron deficiency in women.3 Baby, it’s you!The time of a woman’s life when she can become pregnant and have a baby is very special. It is also especially important to consider which nutrients are needed before conceiving and to ensure a smooth pregnancy and delivery. Folic acid. This vitamin (known as folate in its natural form) is needed before and during pregnancy. If you are considering getting pregnant, it is smart to increase folic acid intake before conceiving—there is strong evidence that taking folic acid prior to conception and during the first trimester of pregnancy can reduce the risk of neural tube defects of the brain, spine, or spinal cord by up to 70%.4Additionally, folic acid requirements are 5- to 10-fold higher in pregnant women than nonpregnant women,5 so get your folic acid going! Iron. Iron supplementation in pregnancy is often recommended. During pregnancy, the body’s iron requirements progressively increase until the third month.6 This is because more iron is needed for the growing fetus and placenta, as well as to increase your red blood cells.7 Calcium. Calcium is essential for fetal development, and this requirement increases during pregnancy (from 50 mg/day at the halfway point up to 330 mg/day at the end) and lactation.6 Iodine. During pregnancy, iodine is needed in the production of fetal thyroid hormones (the fetus’ thyroid begins functioning as early as 12 weeks in the womb!) and should be increased by about 50%.6 Vitamin D. Vitamin D (mostly vitamin D3, as it’s the predominant form in mom’s blood) is needed in the first stage of pregnancy, as it contributes to embryo implantation and the regulation of several hormones.6 Choline. Choline is an important nutrient for the health of women throughout their lifetime, and in particular during pregnancy. Choline is also vital for early brain development.8 The change of lifeAs your body progresses toward menopause, it produces less estrogen, opening up a world of change. It is during this time that certain nutrients can help support you in the management of symptoms like hot flashes and mood fluctuations, as well as help stave off concerns about bone mass loss. Calcium and vitamin D. In menopause, calcium remains a top nutrient to support the maintenance of bone mass. Bone turnover increases at this time, while the creation of new bone does not, which can lead to bone mass loss. Along with calcium, vitamin D is an important factor in helping to support bone health, which has been shown to help prevent bone mass loss in perimenopausal and menopausal women.9 Vitamin K and vitamin D. It has been shown that Vitamin D and K are both important nutritional factors in supporting mineralization and healthy structure of bones.10 Vitamin B12. When it comes to menopause, the B’s have it! Vitamin B12 plays a key role in energy metabolism, something we all need more of during menopause.11 Where to begin?Your healthcare practitioner is the best person to ask about which nutrients you may need. So get out of the vitamin aisle and in to see your doctor! This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues. References:
 Fish and shellfish are full of healthy fats, vitamins, and minerals. Great for our physical and cognitive wellbeing, they’re a solid addition to a nutritious diet.1
That said, not all seafood is created equal. This post will outline the differences between farm-raised and wild-caught fish, including their impact on our health and the environment. What are the differences between farm-raised and wild-caught fish? Fishermen catch wild fish and shellfish in lakes, rivers, oceans, and other bodies of water. These fish eat a natural diet. Farmed fish are bred for human consumption through a process called aquaculture. This means they live outside their natural environment and are generally given processed feed.2 Specifically, farmed fish are placed in pens submerged in ponds, lakes, or even saltwater.1 Some pens are filled with water and kept on land. While this might not sound ideal, fish farming isn’t inherently bad. Sustainable farming practices have become more common than ever, as the World Bank estimates that almost two-thirds of seafood will be farm-raised by 2030. In Norway and Canada, for instance, most farmed salmon are cultivated through an eco-friendly recirculating aquaculture system.3 Here are some other items to consider:
Nutrition: Which fish variety is better for your health?Fish have been shown in clinical studies to display anti-inflammatory properties, not to mention being rich in heart-healthy omega-3 fatty acids.3 The overall quality of seafood, however, depends largely on what fish eat. Wild fish consume a natural diet lower in saturated fats.5 What does this mean? Let’s focus on salmon for a moment. In addition to being higher in saturated fat than wild salmon, farmed salmon contains more omega-3s and 46% more calories. The wild-caught stuff, however, is richer in minerals like potassium, zinc, and iron.4 Consider the following when evaluating both fish varieties for your health:
Most people consume too much omega-6, which may cause inflammation and other symptoms. And farm-raised salmon specifically—despite containing higher quantities of omega-3—has a significantly higher omega-3-to-omega-6 ratio.4 The ratio is still good enough, but it isn’t quite at the level you would find in wild seafood.
Of course, the trace metals found in fish aren’t limited to mercury. Farmed salmon contains higher arsenic levels, while wild salmon contains more cobalt, copper, and cadmium.7 Fortunately, levels of trace metals in both wild and farmed fish are usually so low they’re unlikely to harm the average person.4
Some studies indicate that farm-raised fish have higher levels of contaminants.4 Furthermore, seafood raised via aquaculture may have a higher rate of disease because of some of the farming practices and conditions.5
For example, approximately 530 grams of antibiotics were used per ton of harvested Chilean salmon in 2016. (In contrast, Norway used just 1 gram of antibiotics per ton of harvested salmon in 2008.)4As such, it’s essential that you understand where your fish is from before consumption. Sustainability: Which fish variety is better for the environment?Fish accounts for 17% of our global protein intake.8 For this reason, we can’t rely on wild-caught fish alone. There just isn’t enough wild seafood to keep up with the growing demand. Based on our current trajectory, there’s a global need for another 80 million tons of farmed fish per year by 2050.8 Yet aquaculture may be detrimental to the environment too. Use of antibiotics can cause damage to the environment and adversely affect human health as well.4 Moreover, when lots of fish are crammed together in a small space like a pen, they create a ton of waste that can pollute rivers, lakes, and oceans.8 And the environmental consequences of fish farming doesn’t end there, either. Some fish farms are disease-ridden, which can be toxic to the environment; in Indonesia, shrimp farming specifically has contributed to the decline of the nation’s mangrove forests.8 Since we don’t want to deplete what’s left of our wild fish resources, where does that leave us? Fortunately, some experts say that feeding farmed fish a higher-quality diet free from antibiotics can help address some of the problems described above. Similarly, as fish farmers gain efficiency, governments will be more likely to offer incentives for the adoption of sustainable practices.8 Ideally, the environment will become an even greater focus for everyone in the near future. The verdict on wild-caught vs. farm-raised fishWhile wild seafood is generally healthier than farmed fish and shellfish, sustainable methods make many farm-raised options completely viable. Both wild-caught and farm-raised fish varieties offer plenty of protein, the omega-3 Docosahexaenoic acid (DHA), and other essential nutrients.4 To make sure you’re eating top-quality seafood, be sure to look into where your seafood is from, and opt to eat local, low-mercury varieties when possible. For more information on nutrition and general wellness topics, please visit the Metagenics blog. References:
 There’s been plenty of buzz in recent years around the word “detox,” but your body is not the only thing that can be exposed to toxins. Your whole way of life might be exposing you to emotional toxicity, too.
We take the trash out from our homes on a regular basis. This allows us to discard what’s no longer useful and keep our living spaces clean and pleasant. If we neglect this responsibility, the consequences are hard to ignore: overflowing waste baskets, unpleasant odors, and possibly the invasion of pests! Unfortunately, emotional garbage is not so easy to detect. Bad habits, negative thoughts, toxic people, and unhealthy situations can overwhelm your personal space and accumulate clutter in your mind. Over time, both internal and external stressors cause your mental waste bin to become full. If you aren’t careful to filter out what you don’t need, that waste bin can overflow—and lead to a very unhealthy life! There are plenty of ways to minimize toxicity in your life. Consider these nine steps to start reducing stressors today. 1. Change your self-talk What are you thinking about right now? What did you think about when you first woke up? Believe it or not, your answers say a lot about you and your health.1 Your thought patterns are an integral part of your overall well being. Over time, repeated thought patterns influence behavior and beliefs.1 When your thoughts are mostly negative, it can feel like you’re stuck on a “not-so-merry”-go-round. Remind yourself, too, that you can’t always trust your own thoughts to be impartial. Sometimes you have to hit the pause button, take some deep breaths, and talk yourself off the ledge. And that’s okay. To break free from a negative thought spiral, try a relaxing, rejuvenating activity (e.g., read a book, practice yoga, tend to your garden, or listen to a favorite record) to lift your spirits and get your mind focused on something new. 2. Reevaluate your habits We all have bad habits. Some habits are relatively benign, like biting your nails or smacking your lips when you chew. But others, like hitting the snooze button, comparing yourself to other people, and picking fights with friends or partners, can actually be toxic to your well being. The first step toward improvement is self-awareness. To start, make a list of your habits and mark an X next to the not-so-good ones. As you build your self-discipline, remember to be patient with yourself. Studies say it can take about two months (not 21 days) to make or break a habit!2 3. Walk away from bad relationships Good friendships matter. In fact, research conducted over a ten-year period found that individuals with a stronger network of friends were 22% more likely to outlive their lonelier counterparts.3 But where good friendships can support your health, bad ones can do just the opposite. Pay attention to how you feel after hanging with certain people. If you’re always left feeling distressed in one way or another, it may be best to start distancing yourself from them. Don’t feel obligated to keep up friendships (or romantic partners) that cost you your mental and emotional sense of peace. 4. Disconnect from social media Social media is a double-edged sword. On one hand, it helps us stay connected with friends and family. On the other hand, it’s a hotbed of competition, comparison, and drama. Taking a break from social media can clear mental clutter and help you focus on the here and now. Evaluate your feelings after using Facebook, Instagram, or any other social network, then ask yourself why you feel this way. It’s a good idea to delete or un-follow highly negative people or those who stir up bad feelings whenever you visit their pages or see their posts. Doing this can spare you those negative emotions and allow you to focus your energy on more positive things. If nothing else, social media can be a real time killer. The time you save on scrolling could mean more time spent on hobbies or with loves ones. 5. Downsize your wardrobe Clothes are a necessity and a fun way to express personal style. Unfortunately, they are also an easy thing to hoard. Physical clutter can lead to mental clutter. If sartorial clutter has taken over your bedroom, you may be in need of a closet purge. The clothes you wear can affect your mood and your confidence, so it’s important that you feel good in them. Are any of your duds, well…a dud? Find out by doing a quick survey of every item in your wardrobe. Ask yourself: Would I feel good wearing this tomorrow or to an upcoming event? If the answer is no, it may be time to let it go. If you choose to donate, you can feel good knowing that your preloved apparel might work equally well for someone new. 6. Reorganize your work space While the importance of keeping a clean home seems like a no-brainer, your work area can be an easy thing to neglect—until you find it’s covered in “organized” piles of paper and old business cards. According to science, a clean, organized work space can boost productivity. In fact, a Harvard study found that students who worked in a tidier environment remained focused for 7 ½ minutes longer than messier students, who were more likely to experience frustration and weariness.4 Giving your desk or work space a weekly once-over means you are less likely to be invaded by dust bunnies and more likely to check items off your to-do list. 7. Turn off the TV It’s easier than ever to get hooked on television. The average American adult watches five hours of TV per day (wow!), and about 50 percent of Americans use some kind of streaming service—a number that’s been steadily rising.5 As statistics show, what we spend much of our free time doing is more passive than active, and that mindset may spill over into other areas of life. Although entertainment is not all bad, moderation may be the best approach to screen time. Increased television watching is associated with lower physical and mental vitality and may be linked to chronic health conditions.6,7 If this feels relevant for you, consider cutting your quality time with the tube by a small amount each day. Replace that time with a physical activity or creative hobby, which—according to research—can promote overall well being 8. 8. Reassess your diet The benefits of a balanced diet go beyond your physical body. It can also make you feel good mentally. Eating foods rich in vitamins, minerals, and antioxidants can protect your brain from oxidative stress, support brain function, and help stabilize your mood.9 There’s also plenty of evidence showing that when your body is low in certain essential nutrients, such as vitamin D and omega-3's, it can negatively impact mental health.10,11 If you’re stuck in a funk, your diet may be playing a role. To help combat those blues and support your health, start by incorporating wholesome snacks into your day, like nuts, fruit, or string cheese, and eat plenty of nutrient-dense greens whenever possible. Stock your fridge or pantry with things you enjoy that won’t make you feel guilty. And to set yourself up for success, rid your kitchen of sugary, greasy snack foods so you won’t be tempted to indulge. 9. Keep a journal Had a bad day? Feeling low but you don’t know why? Write about it! Reading what you wrote a few days later may give insights on things that can be reduced or eliminated to avoid future bad or unhappy days. Writing is one of the best ways to release bad feelings. Writing down your thoughts can feel just as good as venting to a friend. And because your thoughts are recorded in one place, it’s much easier to pick up on patterns in your thoughts and behavior—helping you prioritize problems, identify triggers, and work through anxious feelings.12 Anyone can do it! When life gets too complicated, well being silently suffers. And though we all have different thresholds for toxic overload, most of us could benefit from taking some steps to detox our lives as well. References:
 Inflammation is a popular buzzword these days. But what causes it exactly? How can you know you have it, and if it’s something your body does naturally to help you heal, then what’s the big deal?
We’ve all been there: It’s late, you’re tired, and you don’t feel like turning the lights on just to cross a room…then bam! Shin finds coffee table. The resulting egg-shaped lump is formed when blood flow increases to the area, bringing with it neutrophils and macrophages as part of the immune response. Symptoms of this acute inflammation are typical: redness, swelling, heat, and pain. The swelling that occurs as fluid collects in the area is also called “edema.” The symptoms last for a limited period of time—minutes to days—as the body heals itself. Acute inflammation vs. chronic inflammation When the body isn’t given enough time, or if the body is unable to resolve the immune response due to deficiency of certain nutrients, it can lead to chronic inflammation. This can also be caused by untreated infectious pathogens such as bacteria or viruses, as well as the adverse effects of long-term exposure to pollutants or chemicals, including smoking.1,2 Stress and obesity are also known factors that lead to chronic inflammation.3,4 Common symptoms of chronic inflammation include:
What can we do?While acute inflammation is one way your body can heal itself, chronic inflammation should be avoided, as a prolonged inflammatory response can cause damage to healthy cells and tissue. Consider adopting a few simple ways to decrease inflammation. If you have been experiencing the symptoms described herein and are concerned you may have chronic inflammation, make an appointment with your healthcare practitioner. This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues. References:
 By Robert Silverman, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR
Take a freelancer, an office worker, and an orthodontist; what do they all have in common? They spend the majority of their workday sitting. Worse, they all likely take part in sedentary out-of-office behaviors, too—like watching TV, playing video games, or scrolling through social media. According to the World Health Organization, physical inactivity ranks fourth on the list of leading preventable killers, with an estimated 3.2 million people dying each year as a result.1 The Centers for Disease Control reports that we spend 75 cents of every healthcare dollar on chronic conditions linked to sedentary behavior. Why? When we sit, muscles in our lower body turn off and automatically adopt positions that shut off our glutes as well as our trunk and spine muscles. As a result, we experience compromised body function, increased blood sugar levels, and joint and soft-tissue injuries; injuries can vary from neck and back muscle soreness all the way to chronic illness. Thankfully, there are a number of ways to prevent, and/or reduce, the adverse effects of sitting that almost every professional can start doing today. Take a stand Standing desks are becoming increasingly common in the workplace, and with good reason. Seated office workers have more musculoskeletal injuries than any other industry sector worker. Those who sit for more than nine hours each day are also prone to developing chronic diseases such as diabetes and heart disease.2 If acquiring a standing desk is not an option for you, there are inexpensive desktop converters that enable you to convert your current desk to a standing desk. Especially for those who aren’t sure if they can manage standing up all day, desktop converters are an easy way to try out this new way of working. Sit ergonomically While standing is better than sitting, if you have to sit, do so in an ergonomic manner. To start, practice good sitting habits. When sitting at a desk, your feet should be flat on the floor, and the height of the chair should allow your thighs to angle down slightly. This position allows you to place your weight through your “sitting bones,” rather than rounding your lower back and causing your shoulders to round and your posture to slump forward. As for your keyboard height, set the keyboard high enough so that your elbows are bent approximately 90 degrees. If the tray is too low and cannot be adjusted, place the keyboard on your desk. Finally, the mouse should be placed at the same level as the keyboard. A great way to improve your posture while sitting is swapping out your office chair for an exercise ball. While seated on an exercise ball, you engage your core muscles to support your back and maintain proper posture. Plus, it’s nearly impossible to slump forward into that slouching position without risking losing your balance. Schedule regular breaks In a recent study published in the journal Sports Medicine, researchers compared the effects of individuals sitting for prolonged periods with those who took breaks from sitting and engaged in light to moderate activity.3 The results of the study suggest that taking a break from sitting every 30 minutes and incorporating even light activity had significant effects. In those individuals who took breaks, physical activity of any intensity was shown to reduce their concentrations of glucose and insulin in the blood up to 9 hours after eating a meal. So whether you sit or stand, taking breaks from your desk every 30 minutes should become part of your normal routine. Remember, even a quick walk to the break room or bathroom will help. Better yet, a 20-minute walk around the office block promotes blood flow that brings important nutrients to all spinal structures and reduces blood glucose and insulin levels. If remembering to take twice hourly breaks seems unrealistic, put your smartphone to use. Download an app—such as Stand Up! or Sitting Timer—to remind yourself to take breaks from your desk. It may not be possible to get up every time the reminder goes off, but it will help you be more cognisant that you’ve been sitting for a while—and that your health depends on your taking sufficient breaks. Stretch at your desk If you don’t have time to leave the office on regular intervals, take your break at your desk and stretch. Depending on the amount of space you have in your work area, a variety of stretches, like ankle and wrist rolls, a hands-over-head stretch, head rolls, and shoulder rolls, can all help relieve the stress sitting causes your body. If you have room to move around a bit, try these stretches and exercises:
Those who want to reverse the negative effects of sitting should start right away. Switching to a standing desk, taking regular breaks, prioritising short busts of light activity, and stretching can all help expedite the body’s ability to recover from long hours spent sitting. Mild back and neck soreness may be just an inconvenience now, but sustained sitting habits can lead to chronic health problems down the road. The time to take a stand against the sitting epidemic is now. This content is not intended as a substitute for professional medical advice, diagnosis, or treatment. Individuals should always consult with their healthcare professional for advice on medical issues. References:
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