Cheat Clean with Delicious Keto Chocolate Lava Cakes

I've made these once before and they turned out great, so in preparation for some Sunday afternoon football I decided to give them another go and share the recipe with all of you. This recipe comes out great and takes less than 20 minutes from start to finish. Perfect dessert for those of you trying to keep the carbs low and the weight off!

I used a muffin tin and the easiest way to get these things out of there was right side up. So I guess that makes them upside down as far as lava cakes go. This recipe made 7 so you can adjust it to whatever suits your snacking needs:

Ingredients

6 tbsp unsweetened cocoa powder

3 tbsp xylitol

3 eggs

3 tbsp heavy cream (Substitute with coconut cream if dairy doesn't sit right with you)

1 1/2 tsp vanilla extract

3/4 tsp baking powder

3 pinches of salt

Instructions

Start by preheating your oven to 350 degrees celsius. 

Mix in the cocoa powder and xylitol together in a bowl. The better you combine them, the smoother your final product will be. In a separate bowl beat the eggs as the air will help with the rising of the cakes. Add the cream and vanilla extract to the eggs then combine with the cocoa powder/xylitol mixture. Lastly, add in the baking powder and salt and mix together until you get the mixture as smooth as possible. 

Pour your mixture into a muffin tin, filling each spot about 1/2 way. Now for the baking aspect, remember that the smaller you make these guys the less time they'll need to bake. You don't want to overcook them or you'll just have cake and no lava. For this batch I went for 12 minutes and it left me with a decently gooey centre. I'd suggest maybe 11 minutes if you really want the lava to flow. 

Try pairing these delicious cakes with some low carb ice cream right after they come out of the oven while they're still warm for some extra incredible, keto friendly, indulgent desserts! 

Nutritional Information (per lava cake)

Calories: 68cals

Fat: 4.7g

Carbs (total): 2.5g

Carbs (fiber): 1.7g

Net carbs: 0.8g

Protein: 3.5g

www.msknaturopathic.com

Guest Blog: Workout Circuit @ The Playground - Michelle Jackson, BMSc. (Hons), Clinic Intern

So I was invited to team up with some colleagues to come up with an easy and fun way to exercise at the park. The weather is still nice out and gym memberships are expensive. Finding a close by park can be a great way to get fit and stay active. Check out the exercise routine we came up with and give it a try!

Do you ever get bored of your work-out routine? I definitely do. That's why this week, I reached out to friends and colleagues, Rob and Ryan, and asked (very nicely) if they could put me through the ropes.

I chose the playground location mainly as an excuse to spend more time outside, but it also allows for functional types of exercise that challenge muscles in a different way compared to using machines at the gym. It also felt more like play than exercise.

These guys definitely know their stuff when it comes to exercise (see their bios below). This circuit that they created is fun and challenging. Head to the playground and give it a go! 

Playground Circuit: Repeat 2-3x. Take 10sec of rest between each exercise. 

Start with a 2 min light warm up - jumping jacks, high knees, butt kicks, and/or running on the spot. 

 1. Monkey Bar Pull-ups or Chin-ups 

|10-15 reps|

Pull-ups: Rob's grip (back of hands facing self)

Chin-ups: My grip (palm of hands facing self) 

Ryan's tip for beginners: If too difficult, begin by using platform on monkey bars (or get a boost from a spotter) and start in the top position of the chin up/pull up (as shown in                                                                                                        picture). Slowly lower yourself down with                                                                                                            control and repeat. 

2. Lunges    |10-15 reps each leg |

Tip: Don't let your forward knee go past your toes. 

3. Plank high-fives    |20 each side|

If by yourself, extend each arm out, one at a time, holding each for 1-2sec. 

Tip: Try to keep your body as straight as possible without rocking side to side.

(note Ryan's form!) 

4. Pole Climb - Up and down   |1-2 reps |

A.  Try using only your upper body to climb up and down, like Rob. (Trust me, easier said than done.)        

B. Using mostly your upper body, squeeze legs around the pole for added assistance. (My strategy) 

Tip: Unlike Rob, I started off with a little jump, so the momentum gave me a boost vs. just pulling myself up from the ground.

5. Push ups    |10-15 reps|

Keep your feet on an elevated platform (not pictured) for an extra challenge. 

Tip: Keep elbows tucked into sides to isolate more of your triceps. Pointing your elbows outwards will engage other muscles, like your pecs. 

6. Jump Squats     |15-20 reps|

Starting on the ground, jump up and land on a step or elevated platform. Step down and repeat. 

Tip: Try to land so that your knees don't go past your toes. 

For an added challenge, jump down into a squat vs. just stepping off. 

 7. Swing extension     |10 reps| 

This one is a major ab burner!

Fully extend body and hold for 1 sec before returning to starting position. 

Tip: The further you initially stand from the swing, the further you extend and the harder this exercise becomes.  

You can do this on your knees as a                                                                                                                        modification, but you may want a towel to                                                                                                          kneel on (the gravel in the sand really hurts!) 

That's 1 set! When you're finished, don't forget to stretch :)

More about the author:

Michelle Jackson is an intern at RSNC and BNTC. She is on the fibromyalgia/chronic fatigue focus shift and has a strong interest in fatigue and pain management. Check out her blog and website where she and 4 other interns post weekly articles and bi-weekly recipes! http://www.wholeandholistic.com

More about Ryan:

Ryan has experience in high performance sport, playing for both Toronto FC and the University of Toronto while studying Kinesiology. He went on to receive his Certified Strength and Conditioning Specialist (CSCS) designation from the NSCA and is currently working with clients at Physiomed Roytec. Check out his blog too! http://naturopathywithryan.blogspot.ca


Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com

Diets 101: Ketogenic Diet

The Ketogenic diet has been used primarily as a weight loss diet in the past (and a very effective one at that), however more recent research has surfaced showing great promise for it's use in various diseases such as epilepsy, Parkinson's disease, diabetes and even cancer.

So what is it?

The Keto diet follows the premise of consuming a high fat and low carbohydrate diet with adequate amounts of protein. The percentage of total caloric intake per day are as follows:
Calories from fat: 60-75%
Calories from protein: 15-30%
Calories from carbohydrates: 5-10%
Carbs are the primary energy source of the body. They are easily converted to glucose and used as energy, but excess amounts can just as easily be stored as fat. With the Keto diet, carbs are reduced to an amount that is not sufficient enough to sustain the energy needs of the body. Because of this, the body is forced to adapt. It is this adaptation which enables the previously mentioned benefits of this diet to occur.

Ketogenesis is the process of breaking down and converting stored fat into ketones for energy use. The brain can only use glucose and ketones as energy, so when there is no more glucose around, ketones become the primary source of fuel. This means that lowering the amount of carbs you consume and entering a state of ketosis allows you to burn fat without even having to think about it! This is the premise behind why the weight loss is so effective and the ketone bodies themselves seem to be where the health benefits arise from.

5 Health Benefits of the Ketogenic Diet

Following a Ketogenic diet is not something that should be tackled without seeking the advice of a professional, especially if the benefits being sought are for the aid of medical conditions. That being said, there is a lot benefit to be obtained and if weight loss or disease control is something that is of interest, book an appointment and consult a medical professional first.

1. Glycemic control
Following a Keto diet has been proven to significantly impact glycemic control, leading to a decrease in blood glucose. This makes sense considering the absence of carbohydrates and sugars in the diet, but it does warrant supervision in diabetic patients who are medicated since blood sugar may drop too low.

2. Anti-inflammatory
While not a heavily researched area of the Ketogenic diet, it is inherently effective as an anti-inflammatory diet due to the elimination of proteins like gluten, and refined sugars. Further modifications can easily be incorporated on a case by case basis in order to ensure specific intolerances are avoided.

3. Weight loss
Weight loss on a Ketogenic diet comes easy. You are literally burning fat while just sitting around. Now I wouldn't recommend relying on diet alone, exercise is very important for more than just weight loss purposes, but calories still do play a role in how much weight can be lost. This diet itself however, does not feel very restrictive when it comes to consumption of foods. Once your body adjusts to working off of fat, satiety is achieved and maintained for much longer than a carbohydrate heavy diet. This means without even realizing, you'll be consuming less calories.
Less calorie consumption + constant fat burning = weight loss
Weight loss on it's own has additional benefits including lowering blood pressure, decreasing pain associated with arthritis, improving diabetic control, and decreasing the risk of cardiovascular disease.

4. Energy
Who couldn't use more energy? While on the Ketogenic diet, there will be an initial drop in energy and increase in hunger as your body adapts to these changes that are occurring. I can tell you from personal experience that they are not great BUT they do pass. If you stick with the dietary changes, after a few days the hunger will decrease, the mental clarity will improve and you stop experiencing periods of grogginess and fatigue that typically accompany a crash in energy after a carbohydrate or sugar dense meal. These changes are quite noticeable and lasting. They are most definitely worth the first few days of unhappiness. The trade off is a much longer lasting increase in energy and mental clarity.

5. Performance
While specific research in the area of exercise performance is difficult to come by, the consensus of athletes who follow a Ketogenic diet seem to all be in favour of this way of eating. When you break it down it really just makes sense for a variety of athletes. First benefit, fat loss.. More lean muscle, less weight to carry around. That alone is beneficial for most. Next benefit, efficient use of fat as energy. This means fat burning fuel is the first and last energy source. There will be no crossover between carbohydrate stores to fat stores and a crash in energy. All you're left with is a consistent conversion of energy from fat. This is useful for the endurance athlete, who has to rely on fat as a fuel source during long bouts of exercise. With the great majority of endurance performance coming from fat burning anyway (pretty much anything after 20 minutes), having optimized this method of energy conversion prior to an event can only be beneficial.
I recently experienced this first hand and can attest to the claims made by others who follow this way of eating. Patience and timing are factors that need to be considered though, if performance enhancement is your goal. There is an adaptation period in which your performance (particularly endurance) will take a drastic hit. I learned this early on by attempting to go for a light jog within 5 days of starting my Keto diet experience. After about 1 minute of jogging I felt like I had run a full marathon (or at least what I might imagine that would feel like). I don't recommend doing that at all, instead, give it some time and try to save the more serious endurance events for closer to 1 month after starting. If you persevere, you will notice drastic changes in your performance.

What to eat?!

Avoiding carbs is not all that bad! At first it feels like a daunting task, especially if you are not prepared for it. My number one tip for being successful at following through with these dietary changes is to remove temptations from your eating space. Pick a day that you want to start. In the days leading up to this, either consume or throw out any and all sources of temptation! Eat up all that pasta, have a few cookies, dump that pop down the sink and don't pretend you forgot to clean out the freezer! Not having these foods around will make things a lot easier.

Once that's out of the way, make sure you stalk up so you don't go hungry. Start to replace those foods you've gotten rid of with Keto friendly options such as:

Nuts (Almond, Walnut, Cashew, Macadamia, Hazelnut, Brazil Nut, Peanut*)

Oils and Fats (Healthy oils - Olive oil, Coconut oil, Avocado oil, Walnut oil, Sesame oil) 

                      (Fats - Butter!, Ghee, Heavy cream, Cheese)

Meats (Chicken, Turkey, Beef, Pork, Lamb, Venison, Small birds, Large birds, Rabbit, Eggs)

Seafood (Crab, Lobster, Fish**, Shrimp, Calamari)

Veggies (Avocado, Spinach, Kale, Collards, Zucchini***, Broccoli, Cauliflower, Pumpkin, Lettuce)

Drinks (Coffee, Tea, Coconut milk, Almond Milk, Cashew Milk, Water!, Vodka if you must)

            - ensure all of these are unsweetened!

Dessert (Yes, you can still have dessert. You just have to get a little creative. I suggest looking up Keto friendly dessert recipes but anything made with coconut, cocoa, cinnamon or high fat dairy is perfectly fine)

*Peanuts - Some debate here but I love my peanut butter so you can't make me not include it! Just go for ones without anything added.
**Fish - Stick to smaller fish as the primary source here as larger fish like tuna and sword fish have higher amounts of bioaccumulated toxins like mercury. Sardines are the best bet but salmon and white fish sized fish are fine as well.
***Zucchini - Get your hands on a vegetable spiralizer and replace spaghetti with a zucchini imposter! Try butter and sage as the sauce.

The key to success and maximizing the benefits that can be obtained from following this diet is choosing foods that are good for you! Yes, it is a high fat diet, but that doesn't mean you should be deep frying everything you eat. Try as much as possible to bake, steam, boil and add the above mentioned oils raw as a drizzle on top of already cooked foods. If done correctly, this high fat diet can actually reduce triglycerides and LDL cholesterol (the bad one), and increase HDL cholesterol (the good one)!

Remember that starting a diet like this is not something you should tackle on your own. Always seek the assistance of a medical professional before tackling major voluntary dietary changes especially if you're seeking therapeutic results. That being said, if this fat burning, energy producing, glycemic stabilizing diet sounds like something that interests you, book an appointment and get the wheels in motion!

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com

References

Hussain, Talib A., et al. "Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes." Nutrition 28.10 (2012): 1016-1021.

Partsalaki, Ioanna, Alexia Karvela, and Bessie E. Spiliotis. "Metabolic impact of a ketogenic diet compared to a hypocaloric diet in obese children and adolescents." Journal of Pediatric Endocrinology and Metabolism 25.7-8 (2012): 697-704.

Yancy, William S., et al. "A randomized trial of a low-carbohydrate diet vs orlistat plus a low-fat diet for weight loss." Archives of internal medicine 170.2 (2010): 136-145.

Gibson, A. A., et al. "Do ketogenic diets really suppress appetite? A systematic review and meta‐analysis." Obesity Reviews 16.1 (2015): 64-76.

Zajac, Adam, et al. "The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists." Nutrients 6.7 (2014): 2493-2508.

Paoli, Antonio, et al. "Effects of n-3 polyunsaturated fatty acids (ω-3) supplementation on some cardiovascular risk factors with a ketogenic Mediterranean diet." Marine drugs 13.2 (2015): 996-1009.

Dashti, Hussein M., et al. "Beneficial effects of ketogenic diet in obese diabetic subjects." Molecular and cellular biochemistry 302.1-2 (2007): 249-256.

Diets 101: Intermittent Fasting

Okay, so maybe this first entry isn't exactly a diet, however it is a great place to start if you're someone who wants to make lifestyle changes that can alter the way you think and act with regards to food.

Enter Intermittent Fasting

Intermittent Fasting (IF) can be accomplished in a few different ways but the beauty of this dietary practice is in it's simplicity. There is no fancy food list to follow, no complicated recipes to cook up, and no consumption of time to do it... in fact, it gives you more free time in the day. All you need to do is not eat. No meal prep, no cook time, nothing complicated, just do no eat anything for a period of time. I'll admit that this doesn't sound too great, but I promise it gets better, just stick with me.

How long and how often you decide to fast is totally up to you and your comfort level with going for extended periods of time with no food.

The first method is fasting on alternate days. One day you eat, one day you don't. This method sounds a bit extreme to me personally and I don't know how realistic it would be to follow long term.

Another method is the 8 hour eating period per day. You basically allow yourself an 8 hour period each day where you are allowed to consume food, and once that time is up you fast for 16 hours until you've reached your next 8 hour period. An example of this would be only allowing yourself to eat between the hours of 10am-6pm each day. This method could be easier for some, and many people may actually already be doing this without knowing when they skip breakfast and don't eat until noon (mind you, coffee with a bunch of sugar and milk first thing in the morning is not consistent with IF!).

The final method may be the easiest of the three and will still offer tremendous benefits. The one day fast is all about selecting a day of the week where you will choose not to eat for a certain period of time. I like to aim for 18 hours, but this can range from 14-24 hours in length.

**During these times of fasting it is important and helpful to remember that you can drink as much water or tea as you desire. Coffee is acceptable as well as long as no sugars, milks or creams are added!

These all seem like very long times to go without food, but the trick is to time it out properly so that you hardly notice you've fasted. Let's say one night you finish dinner by 6pm and choose to begin your fast from this point on. You're in bed by 11pm and wake up for 7am the next day. At this point you've already made it 13 hours without having to do much at all. If you can just make it until noon you will have reached that 18 hour time and can start eating once again. And remember, this would only be one time a week. What is very important to remember when breaking the fast though, is to eat like you normally would at the time at which you decide to end it. The first few times you do this you will be very hungry and it will be extremely tempting to just eat everything you can get your hands on but you should just return back to eating normally. Have lunch if it's lunch time or a snack if you're somewhere in between meals, just remember to eat slowly and allow yourself some time to digest so that your brain can recognize that your stomach has received some food and you can avoid going overboard.

At this point you may be asking yourself, "But why?", and I do have reasons to back this up. IF has been shown to reduce oxidative damage and inflammation, protect cells from damage, and optimize energy metabolism. With that comes it's studied effects in chronic degenerative and inflammatory diseases. It's even been shown to reduce signals in the body that are associated with aging! There are proven studies on how IF is even being used in mood disorders with promising results. It's also a simple and effective way to lessen the calorie load for the day and makes maintaining weight that much easier.

The point about affecting moods is an intriguing one for me. My first attempt at IF was an interesting experience. I can tell you with confidence that my mood was not affected in a very positive way initially. At first, all I could do was think about food and fantasize about when I would be able to eat again. Following that came the fatigue which was quickly replaced by irritability. My first attempt at IF was definitely a mental battle, but after having made it through 18 hours without food I noticed a change in myself. I quickly realized how much of an affect food had on me. It seemed for a while that food was in charge, food dictated what I should be doing or how I should be feeling and this for me was the most positive outcome of beginning a weekly IF routine. Willingly being able to withhold yourself from food can change your relationship with it. You really start to be able to tell the difference between when you're actually hungry versus when you're just bored or giving in to cravings. All the scientific evidence aside, this is what I believe to be the most powerful outcome of challenging yourself to fast. You can begin to take control of your health through understanding the dynamic between yourself and what you are eating. You can control cravings and eat for healthy pleasure and not just indulge on pleasure alone. This is why I chose to start my diet series here, with a post about something that isn't quite a diet, but is a great stepping stone to making healthier lifestyle changes that will last and not simply be the next fad.

To summarize, IF is a great practice for your mind and body. Yes, you will be reducing calories because you are not eating so weight maintenance or loss is made easier from that point of view. There will be benefits in terms of decreased inflammation, decreased oxidative damage, improved insulin control and slowing of aging but most of all your relationship with food will change. It's not going to feel great at first, but each time you do it, it will get easier and easier. I challenge you to try it out for yourselves. Start with a shorter fast the first time and build from there. Once a week is my preferred method, but choose one that you think would work best for you. Just remember to consult with your doctor before beginning, especially if you have any illnesses that may affect your bodies ability to fast safely.

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com

Below are some references for those interested in reading more:

1. Longo, Valter D., and Mark P. Mattson. "Fasting: molecular mechanisms and clinical applications." Cell metabolism 19.2 (2014): 181-192.

2. Michalsen, Andreas, and Chenying Li. "Fasting therapy for treating and preventing disease-current state of evidence." Forschende Komplementärmedizin/Research in Complementary Medicine 20.6 (2013): 444-453.

3. Hussin, N. M., et al. "Efficacy of fasting and calorie restriction (FCR) on mood and depression among ageing men." The journal of nutrition, health & aging17.8 (2013): 674-680.

4. Klempel, Monica C., et al. "Intermittent fasting combined with calorie restriction is effective for weight loss and cardio-protection in obese women." Nutrition journal 11.1 (2012): 1.

5. Halberg, Nils, et al. "Effect of intermittent fasting and refeeding on insulin action in healthy men." Journal of Applied Physiology 99.6 (2005): 2128-2136.

The most common nutrient deficiencies in our population

Do you suffer from annoyingly recurring illnesses like the cold? Do you get headaches or feel tired all the time? Do you have trouble remembering things or staying focused? Believe it or not but a lot these symptoms may actually be due to nutrient deficiencies that are quite common even in developed countries such as those in North America. Now I'm not talking about frank deficiencies and the development of conditions such as scurvy, however suboptimal levels of important vitamins and minerals can leave us functioning..well, sub-optimally. So here are a few of the most common deficiencies we face, and some easy ways to better manage them.

Vitamin D

"The Sunshine Vitamin" actually acts more like a hormone than a vitamin, and is incredibly important in many aspects of how we function. Unfortunately, it is much more commonly deficient than most people think. We do have the ability to make this vitamin when sunlight comes into contact with our skin, however to achieve optimal levels we would need to be out in the sun far longer than what would be good for us. Those of us at a higher risk of having sub-optimal levels? - anyone who lives somewhere where winter is one of the seasons (less daylight, less time outside), individuals with darker skin (ability to synthesize Vit D is decreased in this population), and sedentary or overweight individuals (may be more due to decreased time spent outdoors). With low levels being linked to lowered immune function and increased risk of developing osteoporosis and even multiple sclerosis, this is one important vitamin. There are foods that contain higher amounts of Vit D, such as fish, cheese, egg yolk and liver, however supplementation may actually be the best bet. Doses vary depending on the preexisting status of the individual, so it is always best to visit your ND for help before considering supplementing on your own.

Magnesium

This little mineral is endlessly useful in the body and very commonly deficient in so many people. Some signs of inadequacy can include; fatigue, weakness, muscle twitching and cramping. Magnesium also plays a large role in decreasing blood pressure, making it very useful in the cardiovascular system. This is because magnesium is a widely used catalyst in the body which means it's presence is required for many chemical reactions to occur within us. So while we may be getting enough magnesium to avoid seeing signs of frank deficiency, not getting optimal amounts can also lead to the presentation of annoying symptoms. Where can we find magnesium? Good food sources would include nuts (almonds, cashews and peanuts), spinach, beans, avocado, potatoes, and brown rice. Those of us at risk for sub-optimal levels of this mineral would be anyone not eating much of the previously mentioned foods, anyone with gastrointestinal issues as absorption will be decreased, diabetics (excrete more magnesium in their urine), and the geriatric population due to a decrease in food intake and decreased absorption due to aging.

Omega 3 Fatty Acids

These are as good as "good fats" get. I don't even know where to begin or what studies to cite because the benefits of these fats are incredible and new research continues to come out on how useful they are in various conditions. Ideally, when consuming fats we would want to have a ratio of omega-3 to omega-6 at 1:1. That is ideal, however anything close to that would be beneficial. Unfortunately, a standard North American diet contains a ratio somewhere in the range of 1:20 or more. This supports an overall inflammatory state within the body and inflammation is bad. Low levels of omega-3 fatty acids can present as dry or flaky skin and hair, decreased ability to focus or remember and even increased aches and pains throughout the body. Achieving and maintaining an adequate amount of omega-3s may help improve all of those things and has also been linked to benefiting cardiovascular disease, cognition, diabetes, arthritis, Alzheimer's disease and even cancer. It has actually been shown in the research to decrease "all causes of mortality" which is kind of big deal since this includes literally any cause of death. So yeah, if you can achieve adequate amounts of omega-3's, statistically speaking you will decrease your chances of dying in a car accident. Pretty impressive. Where can we find more omega-3's? Rich sources are flax, fish, vegetable oils, and nuts. There is a kicker though. EPA and DHA are further components of omega-3's and the best benefits are seen when we get higher amounts of EPA than DHA. So when we look at our naturally occurring sources, fish constitutes the best available option as the vegetarian options are not easily converted in our bodies and yield lower amounts of useful EPA. Another problem... eating too much fish can be harmful for us because of the high levels of mercury often found within. Fortunately this can be avoided or at least minimized by choosing smaller fish (as the larger fish have higher amounts accumulated) or supplementing with fish oils (as the mercury is eliminated and EPA and DHA are all rigorously accounted for). As always, it is best to consult with an ND before deciding if supplementation is a good option for you as each person is unique and will require a unique prescription.

Iron

This one is much more prevalent in women but can be seen in men as well. Iron is a component of hemoglobin in our blood which is responsible for carrying oxygen throughout the body. Low iron can present as general fatigue, pale skin, feeling cold (especially hands and feet), brittle nails and even cravings to eat ice. Those at higher risk for iron deficiency are women of childbearing age (even more so in those who experience heavier menstrual cycles), vegetarians, or anyone who has lost a lot of blood for any reason (donating too frequently included). The best sources of iron are from meat as the iron contained within is in "heme" form which is the most absorbable form. Red meat, oysters, beef or chicken liver and sardines are great sources of heme iron. While legumes, nuts, grains and green veggies all contain fairly high amounts of iron, it is in the non heme form and only a fraction is absorbed when compared to the heme sources. For this reason it is important for vegetarians to watch their iron levels and ensure they are getting adequate amounts. A vegetarian friendly option would be the use of cast iron pans in cooking. Not only do these things make meals taste better (totally biased) but cooking in them can actually absorb some of the iron from the pan into your food. Additionally, if you are cooking up more acidic foods (something like tomatoes), the iron will actually be converted into a more active form, further increasing the ability of your body to absorb it. Supplementation with iron is always a viable option as well but it would be best to consult with an ND first as dose, duration, and form are all important factors that need to be considered before beginning any supplementation regime.

Vitamin B12

Ok, so this one isn't as common as those previously mentioned but definitely deserves a spot on the list because it can have some serious impacts to certain individuals. These individuals being vegetarian/vegans or anyone who does not consume a lot of meat. Vitamin B12 is responsible for the production of energy, and also for the formation of blood and myelin (this is the stuff that coats your nerves and helps with the transmission of signals from the brain). With these actions, it may be easy to guess what suboptimal levels can present as; fatigue, muscle weakness, and also mental fog and memory problems. What makes this more concerning is that in order for deficient signs to present themselves, the individual would have had to have been fairly deficient for many years. The main complication of this is the impact on the neurological system and that function of coating the nerves with myelin. If someone is left without Vitamin B12 for too long, they can have irreversible neurological damage which can impair their reflexes and sensations of touch. Now this is pretty rare but also quite severe and can be easily avoided. Extreme symptoms like this one are not very common but can be seen in a North American population where meat is excluded. More common however, are the suboptimal levels and their associated symptoms. In the case of Vitamin B12 deficiencies, meat is really the best way to go but for those who do no consume meat for any reason, supplementation of an active form of this vitamin is a must. Sublingual and injection form are the best approaches and the posology is best determined by your ND.


There we have it, a 5 item list of some common nutrient deficiencies that can be seen even in developed countries like Canada and the US. If you are experiencing some of these signs or symptoms, it could be attributed to one of the previously mentioned nutrients. Remember to always consult with a health care practitioner when experiencing any of these symptoms as deficiencies may not be the cause.


Comment, share and ask any questions you may have and I will do my best to answer them!

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com

Studies for those interested,

1. Wang, Thomas J., et al. "Vitamin D deficiency and risk of cardiovascular disease." Circulation 117.4 (2008): 503-511.

2. Holick, Michael F., and Tai C. Chen. "Vitamin D deficiency: a worldwide problem with health consequences." The American journal of clinical nutrition87.4 (2008): 1080S-1086S.

3. Munger, Kassandra L., et al. "Vitamin D intake and incidence of multiple sclerosis." Neurology 62.1 (2004): 60-65.

4. Al-Ghamdi, Saeed MG, Eugene C. Cameron, and Roger AL Sutton. "Magnesium deficiency: pathophysiologic and clinical overview." American Journal of Kidney Diseases 24.5 (1994): 737-752.

5. Kass, Lindsy, J. Weekes, and Lewis Carpenter. "Effect of magnesium supplementation on blood pressure: a meta-analysis." European journal of clinical nutrition 66.4 (2012): 411-418.

6. Delgado-Lista, Javier, et al. "Long chain omega-3 fatty acids and cardiovascular disease: a systematic review." British Journal of Nutrition107.S2 (2012): S201-S213.

7. Lee, Lai Kuan, et al. "Docosahexaenoic acid-concentrated fish oil supplementation in subjects with mild cognitive impairment (MCI): a 12-month randomised, double-blind, placebo-controlled trial." Psychopharmacology 225.3 (2013): 605-612.

8. Vaucher, Paul, et al. "Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial." Canadian Medical Association Journal 184.11 (2012): 1247-1254.

9. Stabler, Sally P. "Vitamin B12 deficiency." New England Journal of Medicine368.2 (2013): 149-160.

10. Moore, Eileen M., et al. "Among vitamin B12 deficient older people, high folate levels are associated with worse cognitive function: combined data from three cohorts." Journal of Alzheimer's Disease 39.3 (2014): 661-668. **Interesting study on relationship between B12 and folate in the elderly for those interested

11. Tayyebi, Ali, et al. "The effect of Vitamin B12 supplemention on fatigue in hemodialysis patients." Iran J Crit Care Nurs 6.1 (2013): 39-48.

How Sugar Can Help With Your Pain - Prolotherapy

What do arthritis, tendinitis/tendinosis, and low back pain have in common? Well aside from low back pain they can affect many different areas of the body and they are all quite difficult to effectively treat. Currently, the standard of care for most of these is a watch and wait approach (wait around and see if it gets better on it's own), corticosteroid injections (which effectively deal with pain management but little else), or physiotherapy (helpful, but has it's limitations). The majority of these approaches are effective at dealing with pain in these conditions but do not really help in the healing of the damaged tissues. Even the pain management seems to be somewhat short lived.

Enter prolotherapy. In short, it is an injection based therapy where a solution of sugar (hypertonic dextrose) is introduced into the area of pain. From here on out the exact reason for how this works is a bit unclear but the strongest theory is that this causes inflammation to the area which then in a way, forces the body to begin to heal a part of itself in which it essentially has forgotten about. Now this isn't the same type of inflammation you get during an allergic reaction or cut on your skin, rather it's quite mild and only serves to reactivate the healing process.

So here we have an alternative to the current standards of care but how does it stack up when compared against them? Quite well actually. Research has shown that not only is prolotherapy comparable to corticosteroid injections for reducing pain, but it can also return the individual to proper function and strength quicker. Additionally, the effects it has last over a longer period of time than any of the comparable treatments! So it works as effective or better than the current treatments, and it's effect lasts longer.. too good to be true? No, not really. I mean as long as you're ok with needles, the only side effect seen after treatment is some soreness at the site of injection. That's pretty incredible considering the alternatives. And just to be clear, I'm not against the standards of care in any way, they are the standards for a reason. I just think it's important to have choice and know all the options before receiving a treatment.

So why is prolotherapy not more widely known and used? Well, if you live in Ontario or many other provinces and states across North America, prolotherapy is not actually allowed to be practiced by Medical or Naturopathic doctors. Because the research coming out is so new and the participant sizes in the studies are relatively small, many governing bodies are hesitant to allow prolotherapy to flourish... for now. With a growing body of research supporting it's uses and relatively no negatives against it, it may only be a matter of time before it makes it's way into more of North America.

Who knew sugar could be so good?

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com


For those interested in learning more, feel free to read up on some of the research:

References

1. Rabago, David, et al. "Hypertonic dextrose and morrhuate sodium injections (prolotherapy) for lateral epicondylosis (tennis elbow): Results of a single-blind, pilot-level randomized controlled trial." American journal of physical medicine & rehabilitation/Association of Academic Physiatrists 92.7 (2013): 587. 
2. Bernard, BP. Musculoskeletal disorders and workplace fractures: a critical review of the epidemiological evidence for work-related musculoskeletal disorders of the neck, upper extremity and low back. National Institute for Occupational Safety and Health; Washington D.C.: 1997. NIOSH Publication 97-141 
3. Hudak PL, Cole D, Haines T. Understanding prognosis to improve rehabilitation: example of lateral elbow pain. Arch Phys Med Rehabil. 1996; 77:586–593. [PubMed: 8831477] 
4. Bisset L, Beller E, Jull G, et al. Mobilization with movement and exercise, corticosteroid injection or wait and see. BMJ. 2006; 333:939. [PubMed: 17012266] 
5. Maynard JA, Pedrini VA, Pedrini-Mille A, et al. Morphological and biochemical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research 1985;3:236–248. [PubMed: 3998899] 
6. Verhaar JA: Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop 1994, 18:263-267. 
 
7. Krogh, Thøger Persson, et al. "Comparative Effectiveness of Injection Therapies in Lateral Epicondylitis A Systematic Review and Network Meta-analysis of Randomized Controlled Trials." The American journal of sports medicine 41.6 (2013): 1435-1446. 
8. Petrella, Robert J., et al. "Management of tennis elbow with sodium hyaluronate periarticular injections." BMC Sports Science, Medicine and Rehabilitation 2.1 (2010): 4. 
9. Scarpone, Michael, et al. "The efficacy of prolotherapy for lateral epicondylosis: a pilot study." Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 18.3 (2008): 248. 
10. Rabago, David, et al. "A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma." British journal of sports medicine 43.7 (2009): 471-481. 
11. Prolotherapy for the treatment of lateral epicondylitis: A double-blind pilot study. North American Research Conference on Complementary and Integrative Medicine; Edmonton, Canada. 2006. Focus Altern Complement Ther 
12. Lyftogt, John. "Subcutaneous prolotherapy treatment of refractory knee, shoulder, and lateral elbow pain." (2007): 110. 
13. Coombes, Brooke K., Leanne Bisset, and Bill Vicenzino. "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials." The Lancet 376.9754 (2010): 1751-1767. 
14. Carayannopoulos, Alexios, et al. "Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial." PM&R 3.8 (2011): 706-715. 
15. Johnson, Greg W., et al. “Treatment of Lateral Epicondylitis.” Am Fam Physician. 2007 Sep 15;76(6):843-848. 
16. Smidt N, van der Windt DA, Assendelft WJ, Deville WL, Korthalsde Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002;359:657–62. 
17. Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, et al. Non-steroidal anti- inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2001;(4):CD003686. 
18. Smidt N, Assendelft WJ, van der Windt DA, Hay EM, Buchbinder R, Bouter LM. Corticosteroid injections for lateral epicondylitis: a systematic review. Pain. 2002;96:23–40. 
19. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39:411–22. 
20. Chang, Wen-Dien, Ping-Tung Lai, and Yung-An Tsou. "Analgesic Effect of Manual Acupuncture and Laser Acupuncture for Lateral Epicondylalgia: A Systematic Review and Meta-Analysis." The American journal of Chinese medicine 42.06 (2014): 1301-1314. 
21. Khan KM, Cook JL, Kannus P, et al. Time to abandon the ‘tendinitis’ myth. BMJ. 2002; 324:626– 627. [PubMed: 11895810] 
22. Røe, C., et al. "[No effect of supplement of essential fatty acids on lateral epicondylitis]." Tidsskrift for den Norske laegeforening: tidsskrift for praktisk medicin, ny raekke 125.19 (2005): 2615-2618. 
23. Chesterton, Linda S., et al. "Transcutaneous electrical nerve stimulation as adjunct to primary care management for tennis elbow: pragmatic randomised controlled trial (TATE trial)." BMJ 347 (2013): f5160. 
24. Buchbinder, Rachelle, et al. "Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain." The Journal of rheumatology 33.7 (2006): 1351-1363. 
25. Rabago, David, Andrew Slattengren, and Aleksandra Zgierska. "Prolotherapy in primary care practice." Primary Care: Clinics in Office Practice 37.1 (2010): 65-80. 
26. Maynard JA, Pedrini VA, Pedrini-Mille A, Romanus B, Ohlerking F. Morphological and biochemical effects of sodium morrhuate on tendons. Journal of Orthopaedic Research. 1985;3:236–248. 
27. Jensen, Kristina T., et al. "Response of knee ligaments to prolotherapy in a rat injury model." The American journal of sports medicine 36.7 (2008): 1347-1357. 
28. Rabago, D., J. J. Patterson, and M. Mundt. "Feature Article Prolotherapy: A nontraditional approach to knee osteoarthritis Dextrose injections into the knee can reduce pain and improve a patient’s quality of life. From The Journal of Family Practice. 2014; 63 (4): 206-208." The Journal of Family Practice 63.4 (2014): 206-208.

What is Naturopathic Medicine?

While it is a quickly growing field, there are still quite a few misconceptions about what it actually means to be a naturopathic doctor, or simply, ND. I personally see this every time I meet new people and tell them about what it is I do. Soon after informing them that I am studying to become an ND I am typically met with one of the following three responses;

1) They love it and proceed to having an entertainingly extensive conversation about what they take and who they've had visits with,

2) Disapproval or impartiality. Conversation doesn't usually last long, and

3) "Oh! Like homeopathy?"

Those last two responses (especially the third) are the reason I have decided to start my blog by clearing the air about what exactly naturopathic medicine is and what it is we do. 

So, who are these crazy individuals who decide to get into this field? Where did we come from and why this form of medicine? I can't speak for all of us, but I can tell you we are quite the diversified group of individuals united by the common goal of helping others, and I mean truly helping others in any and every way that we can. I can also tell you that to get where we are we are required to finish an undergraduate degree, complete all of the prerequisite university level science courses and then successfully complete another four year degree at an approved naturopathic college. So we also love to prolong that whole graduate and enter the work force thing. 

Enough of the backstory, let's get back on topic. What is naturopathic medicine? What it really all comes down to is treating the root cause of disease. We are trained to do a very thorough patient intake in which we attempt to obtain a complete history of factors that may have contributed to that specific individual's illness. Attention to detail, asking the right questions, obtaining lab tests and ensuring that each person is heard as their own unique case are all key factors into how an ND begins their approach to identify and then treat the root cause.

The simplest way I can explain what we do is by comparing ND's to mechanics and our patients to their cars. When a warning light shows up on your car dashboard, it's trying to tell you something is wrong even though you may have no idea what that light means (or is that just me?). Now you can do one of two things here; take your car to the mechanic where the problem will be diagnosed and fixed from the inside so the light turns off, or you can simply cover the warning light with a piece of tape and forget that it's there. Here we can see how simply treating the symptom (the warning light) is really not getting down to the real reason it came on in the first place. ND's are the mechanics who are going to use all of their tools to diagnose and fix the real problem. Instead of wrenches, ratchets and screwdrivers, ND's use nutrition, counselling, physical manipulation, acupuncture, supplements and yes, occasionally homeopathy to develop a treatment plan that is specific and realistic to the individual so that their illness can be addressed properly and thoroughly. While the results may take longer to achieve than a conventional medical treatment protocol , the overall results will be lifelong and with fewer complications.

I hope I have been able to clear the air on what naturopathic medicine is and I encourage any and all of you to continue to research more about it and comment or ask me any questions you may have.

Rob Raponi, CISSN, B.Kine,
Naturopathic Intern
www.msknaturopathic.com