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So much research on human health has to do with pathology, or how we get sick and how to treat that sickness so it goes away. This is good and necessary stuff, but typically I like to ‘choose toward’ rather than ‘run from’ or ‘battle’ things. After all, when we run or battle we are in stress mode - fight or flight. Ironically, stress contributes to most illness. What if we ‘choose toward’ feeling terrific? Valentine’s Day is a holiday intended to make us feel warm and fuzzy (and chocolatey!). Could we pursue those delightful feelings every day? I think we can. Medical science has opened its doors to researching what contributes to health and wellbeing. It mostly began in the early 1970’s when Candace Pert, PhD discovered endorphins. ‘Endorphin’ is a blended word taken from the word ‘endogenous’, meaning manufactured by the body, and morphine. Endorphins are just one of four primary “feel good” chemicals we synthesize that improve how we feel. These four are: dopamine, serotonin, oxytocin, and endorphins. It’s incredible that we are literally designed to elevate our mood and relieve our physical (and mental) pain. What do these four chemicals do? They are all produced in the brain. Oxytocin and endorphins are synthesized in the hypothalamus and released by the pituitary gland into the bloodstream to be carried wherever they are needed. Dopamine and serotonin are made in the brain and across the body, including in the heart’s nervous system and the enteric nervous system (or the “gut brain”).
More of these? Yes, please! Many have a misperception that these chemicals either are working in our bodies or aren’t, and that we really don’t have much influence over them unless we take medication. Sometimes medication is necessary, but how great is it that we really can boost them by what we choose to include in our lives? Let’s look at a few accessible lifestyle choices that will reliably support your mood. Food (of course!): What it boosts: serotonin, dopamine. What to choose: Protein (animal and plants), colorful vegetables, fruits, beans/legumes, nuts/seeds, fermented foods, whole grains, extra virgin olive oil & other healthy oils, herbs, spices, Celtic or Himalayan salt. Dairy is optional (if you tolerate it). Hydration. Very low intake of refined foods and sugar. As a guideline, follow this set up for your plate:
Touch What it boosts: endorphins, oxytocin, serotonin. There’s a reason oxytocin is called the “love hormone!” Our bodies ramp up production when we fall in love or have sex (with the right partner!). Sex also triggers endorphins, and the combo of oxytocin and endorphins makes our sense of wellbeing soar! However, any welcome touch will trigger the release of these mood boosters. Think of massage, holding hands, linking arms, gentle non-sexual stroking or rubbing, cuddling, snuggling with our pets, and especially hugging! I can’t help but note that oxytocin is the hormone of trust and relationship, and it’s no surprise that it’s released when we’re touched by or touch someone we care about. Community, positive relationships, and trust underpin emotional and psychological stability. Movement What it boosts: endorphins, oxytocin, serotonin, dopamine. While intense exercise does great stuff for mood balance, research shows that moderate aerobic movement done a few days a week is key to a balanced, positive mood and brain health (focus/attention, cognition, learning, memory, etc.). Bonus - it’s even more effective when doing it out in nature! Need a pick-me-up? Go out for a brisk walk! Movement puts a beneficial stress on muscles and bone and increases blood flow across the body, more effectively carrying nutrients and oxygen to cells. Muscle engagement triggers the brain to synthesize brain derived neurotrophic factor (BDNF), which I have discussed before here, while simultaneously triggering the production of those happy mood chemicals and facilitating their attachment to receptors in both body and brain (read more here). Music What it boosts: endorphins, oxytocin, dopamine. Enjoyable music increases oxytocin, especially when we sing in a group. The social component of this creates connection and relationship, enhancing the effect. Participating in music making - singing, playing an instrument, even drumming on a table - stimulates endorphins and has been shown to improve pain tolerance. Singing and listening to music also engages cranial nerves that communicate with the vagus nerve. We say it “tones” the vagus nerve to stimulate it in this way. A toned vagus nerve increases heart rate variability (read more here), which has a direct impact on our overall sense of wellbeing and resilience. This also triggers the release of dopamine, creating both better mood and improved focus and ability to be fully present. If you’re in a crappy, closed-off mood, put on headphones and turn on music you really love (don’t blow out your eardrums!). Get those good mood chemicals flowing to improve your emotional status, your clarity, and your connections! Meditation What it boosts: endorphins, serotonin, dopamine. Meditation and acupuncture are two of the best researched “alternative” treatments shown to be effective for improving mood, relieving depression and anxiety, and reducing pain. Not coincidentally, meditation also increases heart rate variability. There are a number of free phone apps and videos on YouTube to help you get started. I recorded a basic guided meditation which you can listen to here. Other Evidence-Based Options
We have the tools to “choose toward” feeling well and whole, even when we struggle with mental illness, whether we use them as stand-alone actions or in conjunction with medical care. The positive health cascade from a steady mood goes beyond emotions and psychology to improving disease risk and health outcomes. It can provide far reaching benefits into school, work, and relationships. Please respond to tell me which of these options you have used the most and how you like them! Tip of the Month What is Valentine’s Week without chocolate? Yum!
Dark chocolate offers benefits that range from supporting cardiovascular and bone health to contributing to immune function. Those benefits come from the nutrients found in the fruit of the theobroma cacao tree: aka cacao, or cocoa. Just to cover that, dark chocolate contains: far less sugar and fat solids than milk chocolate; mood-elevating polyphenols; fiber (!); flavonols (increase nitric oxide = better blood flow); antioxidants; and minerals (iron, magnesium, zinc, copper and phosphorus). Since it has a stronger, more bitter flavor, it only takes about 2 ounces for us to feel satisfied. All things in moderation. Here’s the tip: Unsweetened organic cacao nibs are surprisingly delicious - deeply chocolatey, a little naturally sweet, and crunchy. Sprinkle them on unexpected foods, like whole grain oatmeal, plain Greek yogurt, or your protein smoothie, or mix them into whole grain muffins and pancakes. Cacao nibs can give you a nutritious daily Valentine’s treat all year!
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Once we reach a certain age, blood work becomes standard operating procedure at our annual physicals. Your doctor usually says she’ll follow up if she sees something, and you end up trying to interpret the results on your medical portal. But what does it all mean? Maybe you have a family history of heart disease or diabetes. Maybe you mostly want to stay healthy into old age. The good news is, there's a lot of great data in there to help craft a Nutrition Care Plan that can help you meet your health goals! In this newsletter, I’m laying out what we all need to know about common blood work. Please let me know if this changes your conversation with your doctor or your thoughts on monitoring your own health! I’m always here to support you. And be sure to forward this issue. Everyone needs to understand the importance of these labs. My conversations about blood work with my clients typically go like this: Me: “Please share your most recent blood work with me.” All of my clients: “Which labs do you recommend?” The truth is, most people don’t really understand what different annual labs say about their health. In my work, lab data gives me clarity about where your body needs nutritional support so that cells and systems can function better. I use it to create a nutritional diagnosis that defines my recommendations. The nice thing about standard labs is that doctors want them AND insurance will pay for them. I’m all about saving money! You’ll see below all of the labs I typically request and (briefly) why. Standard Annual Blood Work I always ask to see these labs, which are a standard part of an annual physical: CBC with Differential; CMP; Lipid Panel, vitamin D. Complete Blood Count (CBC) with Differential Red blood cells, white blood cells, hemoglobin, hematocrit, MCV, MCH, MCHC, platelets, and five specific immune cells. Just as it sounds, a CBC gives us information about the size and content our red blood cells (RBC), percentages of white blood cells (WBC), and number of platelets. Ok, but what does this mean for you? RBCs carry oxygen to the cells to make energy. A deficit in B9, B12, and/or iron will result in anemia - and energy across the body will tank. Without energy, the cells can’t do their work well. Too many RBC’s and platelets increases the risk of blot clots and may indicate an underlying illness. This test also gives me a window into whether you’re dehydrated. White blood cells (WBC) give an idea of whether you are fighting an infection or allergies, both of which contribute to inflammation. Inflammation can be found in symptoms as diverse as sinus infections, joint pain, and mental illness. Certain foods and nutrients (e.g. vitamins A and C, zinc, some specific herbs) can help the body fight infection by bolstering the immune system naturally. You’d be amazed at the overlap between allergy and mood disorders. Comprehensive Metabolic Panel (CMP) Fasting blood glucose, calcium, sodium, potassium, CO2, chloride, albumin, globulin, total protein, ALP, ALT, AST, bilirubin, BUN, creatinine. A CMP measures certain blood substances, most of which are nutrients. It spotlights the risk of imbalanced blood glucose, health of the liver and kidneys, protein status, fluid balance, bone/teeth building blocks, electrolytes (esp. important for nerve transmission and fluid status), and overall metabolism. We learn a lot about what your body needs nutritionally based on whether you have a good blood sugar level and adequate other nutrients, like calcium, sodium, potassium, zinc, and protein. We can see what’s happening with your muscle breakdown, hydration, and immune cell building blocks. Lipid Panel LDL, HDL, triglycerides. Also called a cholesterol panel, we find out how your body is carrying fats, proteins, and other nutrients to and from the cells. In simple terms, LDL carries them out to the cells, and HDL picks up the leftovers and takes them back to the liver to be metabolized or repackaged. The health of blood vessels rely on a good lipid balance. Triglycerides partner with blood glucose in my assessment. Glucose (sugar) and triglycerides (a fat) are both used to produce energy in cells. If a person is insulin resistant, both glucose and triglycerides will be elevated in blood measurements. Blood sugar dysregulation will also be reflected in higher LDL (low density lipoprotein), increasing cardiovascular disease risk. Low HDL (high density lipoprotein) will mean that certain particles that need to be returned to the liver don’t have a ride to get there, so they remain in the bloodstream or cells. While total cholesterol is a useful data point for various things, it tells us nothing by itself about the risk of cardiovascular disease. In fact, evidence shows that higher cholesterol within a range has health benefits. Most people don’t know that some hormones, like sex hormones, are made from cholesterol. So, for example, as a woman’s estrogen goes down during menopause, she can expect to see her total cholesterol rise. Same for testosterone in both men and women. Research indicates that higher total cholesterol is brain protective as we age. Higher total cholesterol with well balanced other lipids can mean lower health risks in the right situation. Total cholesterol below 150 mg/dL significantly increases the risk of depression, aggression, and suicidality. The upshot is that we need to know the whole picture to understand our true health. Nutrient Testing There’s only one nutrient that I encourage you to have as a standard annual test - vitamin D. Vitamin D is also a hormone that must be present to support other hormones (insulin & glucagon, cortisol, thyroid hormone, sex hormones, hunger and satiety hormones…you name it), the immune system, bone strength, and more. You might need to be willing to self-pay for it because some insurance won’t cover it. I’ll never understand why not! There’s so much research about the health implications of low vitamin D, and other tests don’t capture it. Pro Tip: Aim for results of 40-80 ng/mL. The 30 ng/mL considered to be normal by Labcorp and Quest is based on population baseline health and is too low. Beyond the Annual Labs Iron panel, blood glucose markers, cardiovascular health markers, thyroid panel. Now that we’ve broken down your standard labs, let’s talk about further testing. I often request the following based on signs and symptoms and what I see in the standard labs. You’ll see that these are still “normal” labs that should be covered by insurance (and sometimes aren’t, depending). Iron panel serum iron, total iron binding capacity (TIBC), and iron saturation If I see that there is a risk of iron deficiency anemia I will often request an iron panel. It’s really important not to take an iron supplement unless you know you need it. Too much iron in the body can cause problems with other nutrients and oxidize cells (rust you from the inside!). Blood Glucose Status Imbalanced blood glucose (spikes and dips) messes with our mood, energy levels, nerve transmission, blood vessels, and cardiovascular health. If I want to know more than the fasting blood glucose on the CMP, here’s what I ask for: Hemoglobin A1c measures glucose levels over time. Glycomark measures the quality of glucose over time. A high, steady glycomark, even with elevated blood glucose, is safer than a low glycomark that shows a blood glucose roller coaster ride. Insulin is a hormone that secretes from the pancreas when we eat food and our blood sugar rises. It’s the key that unlocks cells so they let in the glucose, fats, and proteins that are used as fuel for energy. Elevated insulin may mean insulin resistance (the cells have blocked the keyholes because there has been too much insulin trying to use their keys). C-peptide measures insulin over time. Similar to a hemoglobin A1c, the c-peptide shows whether insulin has been persistently elevated. Cardiovascular Health These are informative tests for cardiovascular health that I wish doctors would order annually for those at risk for cardiovascular disease - I explain why next to each lab below. The good news is that you can request any or all of them! LDL-P measures LDL particle size. The standard lipid panel shows a calculated measurement of how many LDL molecules there are (LDL-C), but says nothing about their size. Large fluffy LDL is less likely to cause damage to blood vessels than small hard LDL. LP(a) is a type of LDL (low density lipoprotein). It is stickier than the LDL-C on a lipid panel. Even if your LDL-C is “healthy,” the risk of plaque buildup notably rises when a high percentage of it is LP(a). ApoB (or apolipoprotein B) is a primary component of “non-HDL cholesterol” on a lipid panel. ApoB is a direct measurement of our risk of developing plaque in our blood vessels. Homocysteine is an amino acid that is damaging to arteries when elevated, which increases the risk of blood clots that lead to stroke, heart attack, and other cardiovascular damage. Thyroid Health Thyroid stimulating hormone (TSH), Free T4, Free T3. (Free T4 is the inactive form of thyroid hormone. Free T3 is the active one) Depending on the client’s signs and symptoms, I might request a thyroid panel - another very standard blood test. Thyroid hormone is kind of a master metabolic molecule. Hypothyroid (too little thyroid hormone) or hyperthyroid (too much) will pull other hormones out of balance. Appetite, energy, weight balance, stress response, immune activity, mood (anxiety, focus/attention, depression, brain fog, etc.), and more all lean on that little butterfly shaped thyroid gland at the base of our necks. Requesting Your Labs We all know the challenges of medical insurance. I wish I could make it easier for you! However, it is our right to ask our doctors to order the labs that make sense for us. You may have concerns about particular areas of health or simply want a baseline. Your doctor should share your curiosity, and she can sometimes influence whether insurance will pay for the labs. I recommend that you bookmark this newsletter for future reference. When you go for your annual physical, write down the labs you want that are beyond the normal annual ones (including vitamin D!). Familiarize yourself with the information they provide. Then talk to your doctor about your concerns and interest in ordering them. Doctors should be your partner in supporting your health, and they should be willing to explain the results to you. A Nutritionist’s Interpretation of Blood Work Clearly I am not a doctor and don’t even play one on tv! I am not qualified to make a medical diagnosis. However, my nutrition diagnoses can make a big difference to what’s happening with your health situation.
As a healthcare professional my interpretation of labs lets me do two things:
A key point mostly missing from the medical field is that nutrition interventions are primary health care - for both prevention and treatment. Food and nutrient intake, drug-nutrient interactions, stress, sleep, movement, and more all influence nutrient status, and nutrient status is the foundation of all health. |
AuthorI am Mary Virginia Coffman (I go by “Mary Virginia”), a clinical nutritionist who focuses on mental health, digestive health, metabolic health, and nervous system regulation. My unique combination of clinical interventions, education, and coaching will help you feel well in body, mind, and spirit. Archives
October 2024
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