Summer 2015 Health News

Michelle Crowder, ND - Licensed Naturopathic Physician

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En salud,

E V E N T S  &  U P D A T E S . . .

• In April, Representative Lisa Lyons Introduced House Bill 4531 into the Health Policy Committee. This bill would allow for Doctors of Naturopathic Medicine from accredited schools to be licensed in the State of Michigan. We have hired a lobbyist and had several meetings in Lansing. We are waiting for a hearing date. To keep up to date with our licensing efforts, please sign up for the MANP Email List.
• In May, we won a $10,000 grant from Emerson Ecologics to support our licensure efforts.
• In June, we held the first annual Michigan Integrative Medicine Conference in Novi, MI. This was a professional Continuing Medical Education conference with 12 speakers (including myself!) and over 50 attendees. The conference raised close to $14,000 for MANP.  

Yes, We Are Still Moving, but...

G I N G E R 

Ginger is a long-time favorite of mine. I love the spicy, pungent flavor. I often drink it as a strong tea prepared from freshly grated root, and I use it in cooking whenever I can. Ginger was first cultivated in Asia and has been used medicinally for at least 2,000 years for a variety of ailments, especially digestive complaints. It is one of the most-studied natural medicines. The availability of ginger and its wide variety of applications make it an easy, useful plant to have on hand.

Botanical Notes: Ginger (Zingiber officinale) is a perennial thought to be native to India and China; it is also commonly found in tropical areas such as the Caribbean. The rarely-seen flowers are similar in appearance to orchids. The root-like rhizome (an underground stem) contains many aromatic compounds and is the part used in cooking and medicine. The major constituents of ginger are the aromatic phenols gingerol and shogaol, although there are many other important active compounds in ginger. Gingerol is the primary constituent in fresh root; when the root is dried, the more pungent shogaol constituent increases, causing dried preparations to have a more spicy flavor. Both of these are related to capsaicin and piperine, the compounds found in chili pepper and black pepper, respectively, that give these plants their spiciness. (Side note: We do have a native ginger in the US, called Wild ginger (Asarum canadense). It is not related to Zingiber, but it does have an aromatic rhizome and has been used traditionally in a manner similar to Zingiber. However, Asarum should not be used long-term because it contains the carcinogen aristolochic acid.)    

Here are a few evidence-based medical applications of Ginger:

• Nausea and related digestive complaints: Ginger seems to bind to serotonin receptors in the gut, reducing nausea and vomiting. It may also increase gastric motility. Ginger has been shown to be effective in treating nausea and vomiting related to pregnancy, chemotherapy treatment, and post-surgery.  
• Menstrual cramps: Ginger seems to reduce inflammation by inhibiting various signaling compounds, including prostaglandins, thromboxanes, leukotrienes, and NF-kappa-B. It also seems to be active at the vanilloid receptor involved in pain signaling. Clinical trials have shown ginger to be effective in reducing menstrual cramps and heavy bleeding, and to be as effective as NSAIDs like ibuprofen in relieving these symptoms.  
• Arthritis: Ginger's anti-inflammatory properties are likely the reason it has been shown to be moderately effective in relieving pain and improving range of motion in people with osteoarthritis (1, 2, 3). The effect may take 3 months to become significant. In one clinical trial, oral ginger was equally effective to ibuprofen. In another, a topical preparation of ginger was equally effective to salicylate ointment. 
• Migraine: In one clinical trial, ginger was found to be equally effective to sumatriptan (Imitrex) in relieving common migraine. It has also been shown to be effective when combined with the botanical Tanacetum (feverfew). 

Other notable effect of Ginger:

• Anti-microbial: Ginger possesses anti-bacterial and anti-fungal effects, including against the yeast Candida albicans (1, 2, 3). It augments the anti-fungal activity of honey against Candida. It has also been shown to be effective against intestinal worms in animal studies (1, 2).  
• Lipids: Ginger may have cholesterol-lowering effects. In one study, ginger was associated with reduction in total and LDL cholesterol, triglycerides, and increased HDL.
• Anti-oxidant and anti-cancer: Ginger has been shown to possess a range of antioxidant effects in animal studies (1, 2, 3). It is active against several cancer cell lines including breast, prostate, and leukemia. 

Cautions and Contraindications: Ginger is generally regarded as safe and has a long history of safe use both orally and topically. However, several cautions are important to mention. 

• Most experts consider a daily dose of 1-4 g to be safe.
• The most common side effect of oral ginger at common doses is mild, transient heartburn. 
• Due to its anti-inflammatory properties, ginger can reduce platelet aggregation and therefore thin the blood. It should be used with caution and under physician guidance in people with bleeding disorders, and in people who are taking anti-coagulant and anti-platelet medications like Plavix, Lovenox, and Warfarin. A major interaction has been documented with the antihypertensive calcium channel blocker Nifedipine, in which ginger had an additive anti-platelet effect. 
• Ginger may lower blood sugar and therefore should be used with caution in people who are taking hypoglycemic medications.
• Ginger is generally considered to be safe during pregnancy, when used at common doses. However, this is somewhat controversial. There is insufficient information available on its use during lactation.

How To:

• Use ginger fresh or dried in cooking and baking. Its flavor blends well with garlic, onion, lemon, cayenne, curries, and Asian dishes. Some of my favorite ginger recipes: Healing Ginger Chicken Soup, Ginger-Citrus Salad with Carrot Avocado and Edamame, Ginger Beer, Cranberry Chocolate Gingerbread.
• Ginger tea can be prepared from dried root (teabags are widely available), or use fresh. Grate 1-3 teaspoons per cup of hot water, steep covered for 5-15 minutes, then strain. Or, slice a 2" piece of root thinly and combine with about 4 cups of water; simmer for 15-30+ minutes. Add lemon or honey. Or try adding mint, cinnamon, cayenne, or turmeric for variety. 
• Chew a 1/4" piece of fresh root to help stimulate digestion, reduce nausea, and keep breath fresh.
• Capsules and tablets are widely available, and most contain 250-500 mg each.

More on MTHFR

Hormones and Weight Management

Weight loss is one of the most common health goals I see in my practice. I do not specialize in weight loss, and I do not consider myself to be an expert on the topic. I do believe in the concept of "health at every size," which promotes the notion that, medically speaking, "overweight" does not necessarily equal "unhealthy." While it is true that being overweight is associated with increased risk of cardiovascular disease, diabetes, cancer, and others, it is possible to have a high BMI and never develop any of these diseases. Many people who are considered overweight have perfect blood pressure, cholesterol levels, blood sugar, etc.

So while I do not believe that "normal" BMI is necessary for health, I also want to help people reach their health goals; for many, this includes weight loss. My general view is that attaining a healthy weight should be a positive consequence of optimizing overall health - as we promote health of the digestive, endocrine, and other systems, normalize the inflammatory response, address psychosocial factors, and give the body the raw materials it needs, a healthy weight should be attained naturally. This is easier said than done, of course.

Identifying the various factors that contribute to unhealthy weight gain can be a challenging endeavor.  Hormones are just one piece of the puzzle, albeit an important one. Here are two of the most important hormones involved in weight management:

Insulin: This hormone is released by the pancreas in response to the rise in blood glucose caused by carbohydrate consumption. It acts like a key at the cellular level, allowing glucose from the blood to enter cells where it can be used for energy. Without insulin, blood glucose would stay high, and cells would be starved of energy. Insulin tells the liver to convert glucose into its storage form, glycogen. When glycogen stores are maxed out, insulin stimulates the conversion of glucose into fat building blocks in the liver and adipose (fat) tissue. The net result is that energy is stored as fat.  So, the more often you stimulate your body to release insulin by consuming a high carbohydrate meal, the more you are telling your body to store the energy as fat.  On the other hand, insulin is required for the conversion of thyroid hormone into its more active T3 form. Because thyroid hormones are important for maintaining healthy metabolism, ultra-low-carbohydrate diets can actually lead to lower thyroid hormone levels and lower overall body metabolism. Insulin also seems to act in the brain to help decrease appetite and food intake; however, this feedback mechanism may not be intact in the setting of insulin resistance.
Take home message: Avoid repeated blood glucose spikes: Emphasize nutrient-rich whole foods, especially lean protein, healthy fat, and colorful, leafy vegetables. Minimize refined sugars and other refined carbohydrates. Engage in regular physical activity; short bursts of exercise before meals may be especially effective when insulin resistance is present. (Other ways to balance blood  sugar.)

Cortisol: This hormone is release by the adrenal glands in response to stressful situations. Stress may be physical (infection, low blood sugar, sleep disturbance, etc.), or mental-emotional (related to work, relationships, etc.). We need cortisol to help us respond to changes in the environment, but it should not be chronically elevated. Cortisol triggers an increase in blood sugar, which will promote insulin release and the effects described above. Cortisol in particular causes fat to be stored around the abdomen (called "visceral adipose tissue" or VAT). VAT contains a higher concentration of an enzyme that makes cortisol, so it can become a cycle: cortisol causes VAT deposition, VAT makes more cortisol, cortisol causes further VAT deposition, etc. Furthermore, cortisol seems to disrupt the body's hunger and satiety signals - when cortisol is chronically elevated, the brain may not receive the signal that you are full, causing you to feel hungry and continue eating past your biological needs. In addition to its effects on blood sugar, cortisol increases inflammation, which is linked to a host of problems when chronic, including heart disease, diabetes, autoimmune disease, and depression. It also inhibits the conversion of the thyroid hormone T4 into the more active T3.    
Take home message: Manage stress: Laugh, spend time outdoors, cultivate positive personal relationships, use techniques like meditation or yoga. Reduce physical stress by prioritizing sleep, eating nutrient-rich, whole foods on a regular schedule, treating chronic infections, and avoiding prolonged, intense exercise routines. There are a number of botanical medicines and amino acids that can help balance cortisol levels in conjunction with lifestyle.


Shifts in hormones tend to occur on the order of months, and robust change can take time. Short-term solutions to weight loss are generally not sustainable. I encourage people to be patient and remember that we are addressing overall health in addition to weight. Other common hormones I look at include thyroid, estrogen, testosterone, DHEA, pregnenolone, and leptin.