12 years and up: COVID-19 Vaccine for Children

The recent FDA and CDC Emergency Use Authorization approval of the Pfizer-BioNTech COVID-19 vaccine for individuals aged 12 years and older has prompted inquiries from my patients who are parents and from my pediatric population. I wanted to take some time to provide parents information that I believe may be helpful. Prior to May 2021, the Pfizer vaccine was approved for all those age 16 and older. Here are some details regarding the trial in ages 12-15:

• Phase 3 trial was completed in 2,260 adolescents (half received placebo, half received the vaccine)

• The dose and mRNA ingredients are identical to the vaccine already in use for those age 16 years and older

• It is still a 2 dose series, 21 days apart

• The vaccine demonstrated 100% efficacy and the most robust antibody response seen in any age group (1)

• The Pfizer vaccine is currently the only COVID vaccine with EUA for anyone younger than 18 years old in the United States

Regarding the choice to vaccinate your adolescent age 12 or older, the data appears to show safety and efficacy of the vaccine, similar to and better than the response in adults. As a clinician I have been carefully watching the reports from the millions of Americans who have already received the two dose Pfizer COVID-19 vaccine and I have been closely watching my own patient population here in Hawaii, where up to 60% of the adults in my practice have already received one of the mRNA vaccines. In general, this vaccine has been very well tolerated and safe, with specific side effects that I will say have mostly been minimal, although I have had a few patients who have needed some additional support to manage the side effects. 

Why are 12-15 year olds being added in so quickly?
The first thing to realize is that 12 years old and older is considered adolescence and the immune system at puberty and post-puberty is similar to that of an adult. The vaccine trials for children under the age of 12 years old will take much longer, since the immune system is notably different in pre-puberty children. 

Why vaccinate a population that has such a low mortality rate?
This is a valid question. It is true that the mortality rate of the COVID-19 infection in adolescence is extremely low. A recent study on 576 children hospitalized with the SARS-CoV-2 infection definitively shows a lower hospitalization rate compared with adults. However, children aged 12-17 years old accounted for 42% of the hospital admissions, reflecting potentially more severe illness in adolescents (2). Additionally, the long-term consequences of the infection might still be something of a problem for this age group. It has to do with the fact that at puberty the immune system goes through specific hormonally-induced changes. Prepubertal children are more resistant to severe infections from viral, bacterial, and other diseases (3). Once our immune system changes, we are more prone to long-term health consequences from disease. As an example, I see this often with teenagers who get infected with Epstein-Barr Virus, the virus that causes mononucleosis. Many individuals will show consistent health struggles on and off following this infection. The status of post-covid syndrome or “long-haulers” is appearing to be similar in nature. Meaning, the viral disease may not kill you but it may significantly alter your health metrics for an unknown amount of time. I have multiple patients who have been dealing with post-covid syndrome over the past year and it has been debilitating in some ways for these patients. As adults who have experienced illnesses as a child and felt that they have “never been well since”, we can understand these things. It is true that our bodies are amazing at healing and our natural immune system should be at its peak the younger and healthier we are. However, survival is not the only metric of health and the idea behind the vaccine in this population includes prevention of the long-term sequelae (4). 

Should my child receive the COVID-19 vaccine?
As always, my practice and the practice of naturopathic medicine in general is always focused on the assessment of the individual patient. It is not a ‘one size fits all’ approach. For this reason, I cannot give a blanket statement as to whether all individuals in all age groups 12 years and older should get the vaccine. I have specific patients in my practice with whom I may recommend delaying the vaccine or I may recommend looking at a different type of vaccine instead of the mRNA. It is the same in my pediatric practice. While I am impressed so far with the success and tolerability of the Pfizer mRNA COVID vaccine, it does not necessarily mean I will recommend it to everyone. However, to give a general statement, I do believe it is safe and the side effects are far less than the potential side effects of the infection itself.

If you choose to vaccinate your adolescent:

1. Space any additional vaccines at least one month apart. My general recommendation for all vaccines is to space them apart instead of doing multiple types in one visit. This allows the immune system to focus on one vaccine response at a time.

2. A discussion regarding the “Foundations of Health” would be very useful to have at this time. See my previous blog post for the importance of sleep, exercise, and gut health on the tolerability and success of vaccinations. I would recommend a 6 week time frame surrounding the course of the vaccine where you focus on high quality sleep, a very healthy diet, and additional time getting movement or exercise.

3. Probiotics - see my previous blog post (5) for more data on probiotic usage. For adolescents I often recommend a dose between 15-30 billion organisms daily.

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Note: The information in this post is a general overview on the COVID-19 Pfizer vaccine in the adolescent population. Because it is a generalized discussion, it is not designed to provide treatment recommendations for those individuals who might be at higher risk for a vaccine side effect. This is something that I reserve for discussion in my one-on-one patient visits. I also think it is important to point out that the mRNA vaccines are entirely different from all other vaccines for other diseases, meaning what I discuss for the COVID-19 vaccine protocol may be slightly different from a pre and post vaccine protocol for other vaccinations.

References:

1. BioNTech Announce Positive Topline Results of Pivotal COVID-19 Vaccine Study in Adolescents | pfpfizeruscom

2. Acute covid-19 and multisystem inflammatory syndrome in children

3. Why are children more resistant to mortality from severe infections? | Future Microbiology

4. Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 - Symptoms and causes

5. Understanding the COVID-19 Vaccine — Dr. Kristen Coles

Understanding The COVID-19 Vaccine

Before there was even a notable contender in the race for a COVID-19 vaccine I was already fielding questions from patients, friends, and acquaintances about the possible vaccine. It goes to show how very early on in this pandemic the decision was made to put most of our federal resources into the “vaccine search” as opposed to other options such as funding large-scale studies on treatments (both natural or pharmaceutical). As a physician, specifically a naturopathic physician, I have an express duty to understand the finer points of vaccine creation, potential responses of the system (positive or negative), and mode of action. It is also worthy of mention that I serve a diverse population of patients with a spectrum of different health concerns and conditions. I therefore find it of particular importance to understand the nuances of the science behind a vaccine, which patient populations it might be most helpful in, and any patient populations that it might be harmful for. 

In this post I will be addressing the mRNA COVID-19 vaccines from Pfizer and Moderna which are currently the only vaccines with EUA approval status in the US. I will also note that I wrote this post  in conjunction with my appointment to receive my first dose of the mRNA vaccine. You can scroll to the bottom of this article for my quick list of Pre and Post COVID-19 Vaccine Suggestions.

There are a few golden rules that I tend to stand by in my position as a physician and one of the more important ones is whenever possible I try out all procedures and treatments and diet recommendations on myself first. Now of course there are some things I might recommend for a patient that I have not experienced (such as a surgery, a particular type of medication, etc), but I rarely make a recommendation that I would not consider as something I would do myself if I ever needed to. This is a part of my decision to go forward right now with the vaccine. I am in a unique position in that I get comprehensive lab work-up done at least once a year so I can watch for changes or abnormalities outside of the norm; I have done my genetics so I am aware of specific risks that I hold on a genetic basis. I intend to keep my patients updated on my own response to the vaccine as I think this type of transparency is important. 

Since I am set up for my first dose of the vaccine I will also be sharing in the next few paragraphs my own pre and post-vaccine prep work in the hopes that it will improve the efficacy of working with my immune system and reduce risk for potential side effects. Let’s get some big questions out of the way first. 

What does the vaccine do and what does it not do? 

The mRNA vaccines are given as injections in the muscle of the upper arm. Your circulating immune system cells called macrophages will be some of the first cells to pick up the mRNA and as the mRNA is incorporated into the cell the “instructions” on how to build a protein are delivered. Some key points to note about mRNA vaccine: 

1. It does not enter the nucleus of the cell where our DNA is sequestered 

2. It  does not contain adjuvants (which are extra ingredients that have to work to “stimulate” the immune system, aluminum is a common adjuvant in many other vaccines)

3. It  is essentially a “recipe” that tells the cell how to make a protein that will work as the antibody against a crucial part of SARS-COV-2

4. It  does not have the ability to change our DNA 

5. It  does not cause COVID19 and does not teach the body how to make the full virus

6. It  does contain lipid particles to coat and protect the mRNA, one of them being polyethylene glycol (PEG), which could be a problematic ingredient for highly allergic individuals.

As the mRNA vaccine provides a recipe for the immune cells, we are able to essentially bypass the time it takes the immune system to learn how to respond and fight a completely new virus if the system is infected with COVID19. The immune system, if properly enhanced by the vaccine, will immediately begin its fight against the invasion of the virus by impeding the spike protein that allows the covid virus to enter our cells and hijack them to become viral producing cells. The current Pfizer and Moderna vaccines are given in a 2 shot series to verify that the immune system gets enough repetition and exposure to make enough of the protein antibody. 

With all vaccines there are other variables that also need to be considered. A big variable is the state of the immune system of the individual receiving the vaccine. Problems can arise in elderly patients who often have a less than robust immune response or in others who might be immunocompromised. There is a known and predictable decline of the immune system that accompanies aging known as immunosenescence. This results in higher rates of inflammatory related diseases and also increases in the severity and frequency of infectious disease. There is also a well known reduced response to vaccination in older adults. These situations can be where the vaccine may have less effectiveness, yet these are populations where we would prefer the most protection. For this concern I would like to discuss part of my pre and post vaccine protocol, or the “natural adjuvants” that anyone preparing to take a vaccination can consider.

Gut Health & Probiotics

There are certain ways we can interact with our own immune system to enhance the response to vaccines. We have specific studies that have been done over time already on this subject. We know for a fact that the largest reservoir of the immune system lies just beyond the walls of the gastrointestinal tract. Any system-wide immune response will have to come from this GI reservoir. Therefore we know that the health and integrity of our gut is crucial for immune response and also crucial for enhancing a response to a vaccine. Studies have focused mainly on the difference between taking probiotics directly before and then for extended periods post-vaccination. The results show that the vaccine effect is better in a patient who has been taking a probiotic supplement. To be clear, these studies have not been done with the COVID19 vaccine but have been done with the Hib, DTaP, rotavirus, polio, and influenza vaccines. The interesting finding with these studies is that the Hib, rotavirus, polio and DTaP studies were done on infants, but the influenza studies were done on elderly adults. Both showed that a probiotic administered for several days before the vaccine and then for at least 3-9 weeks after showed higher levels of antibody titers, protection rates and seroconversion rates.

Exercise

Additional research into metrics such as sleep and exercise show some ability to provide a positive vaccine response. The exercise component in the research shows particularly strong benefits for older adults. Timed exercise directly before vaccination is a researched and proven way to improve the vaccine response. The research points to cardiovascular exercise as compared to flexibility training as being the type of exercise that increases the vaccine protection and maintenance. In general, regular exercise improves immune function and improves the response to vaccination, especially in older adults. The research also discusses muscle-damaging exercise, which is a scientific way to describe weight-lifting. So from the research one could infer that doing an aerobic, cardiovascular exercise where you get close to breathlessness combined with a 10 minute weight training protocol (specifically on the arm muscles if the vaccine is going in the arm) would be a great activity to do within the 4 hours prior to receiving the vaccination. Then, if you are an older adult, maintaining a regular exercise routine for 10 months or more after the vaccination may help retain the antibody effect for longer.

Sleep

Sleep is another daily necessity that we can utilize to our advantage post-vaccination. Specifically, our levels of deep sleep enhance our immune system response. Getting adequate deep sleep within 24 hours post vaccination has been researched and shown to enhance the early stages of immune response. Not only does the sleep improve the immune response but sleep also enhances the induction of memory immune cells over the next 2 weeks. I am a big fan of tracking my sleep metrics (I am an Oura ring fanatic for this) and I encourage many of my patients to track their sleep as well. We know that as we age, the amount of deep sleep diminishes. We also know that deep sleep is the only time that the immune system repairs and regenerates. So paying special attention to your sleep metrics as you age is imperative to maintain a stronger immune system. 

Final Thoughts

In summary, I will be taking the COVID-19 mRNA vaccination series and I am encouraging most of my patients to do so as well, although there are certain patient populations that may need additional support around the vaccination beyond what I am laying out in this post. I always recommend my patients discuss their individual health concerns directly with their doctor who knows their health history best. I think it is important to note that we do not currently know how long the vaccine will provide protection and antibodies against the SARS-COV-2 virus, but as the vaccines are becoming available to more segments of the population, there are natural “vaccine boosters” that we can take advantage of, such as improving gut health and function, exercise, and sleep. My hope is that as we vaccinate and give at least some length of extended immunity to larger portions of the population, it will also allow for more research to be done into more effective treatment methods, as this is a virus that will be circulating with us for years to come. We clearly need better approaches to dealing with the virus than continued lockdowns and hospital systems in crisis.

Pre Vaccine Do’s:

1. Probiotic supplements - starting a minimum of 3 days prior and extending at least 8 weeks beyond the second vaccine dose

2. Prebiotics in the diet - garlic, onions, leeks, inulin - these help to feed the good bacteria living in the gut

3. Reduce strain or stress on the gut = healthy diet, no alcohol, minimal sugar, minimal inflammatory foods

4. Acute aerobic exercise + acute muscle damaging exercise = 30 min aerobic cardio + 10 minutes of arm-specific weights within 4 hours prior to vaccination

Post Vaccine Do’s:

1. Get plenty of Deep Sleep the night after the vaccine dose and for 7 days post-vax - enhances the immune memory response and improves antibody response (for those in night shift jobs - try not to work the night shift directly after the vaccination)

2. Continue probiotics + diet with prebiotics

3. Maintain a daily exercise or movement protocol

4. Continue to wear a mask to protect others around you who have not been vaccinated

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Note: The information in this post is a general overview on the thought process regarding the COVID19 Pfizer and Moderna vaccines and because it is a generalized discussion, it is not designed to provide treatment recommendations for those individuals who might be at higher risk for a vaccine side effect. This is something that I reserve for discussion in my one-on-one patient visits. I also think it is important to point out that the mRNA vaccines are entirely different from all other vaccines for other diseases, meaning what I discuss for the COVID19 vaccine protocol may be slightly different from a pre and post vaccine protocol for other vaccinations.

For more reading and other resources:

1. STAT video: What is an mRNA?

2. COVID19 vaccine comparison chart

3. Watch my sleep lecture - specific on deep sleep

4. Probiotics and the immune response to vaccinations

5. Effects of exercise on vaccine-induced immune response

6. Sleep after vaccination boosts immunological memory

Supporting the next generation of naturopathic physicians during COVID19

Being a student in the world right now is filled with a lot of challenges and uncertainty. Many have had drastic changes to their lives since the shutdown of services, clinics, schools, etc with the spread of COVID19. I’ve been checking in with a lot of the students that I’ve had the pleasure of knowing and meeting through preceptorships, education, or internships and I think everyone has a sense of feeling adrift – unsure when clinic will resume and whether you will finish your academics in-person or through online.

After hearing from you all I felt that there might be an opportunity to help connect with our next generation of naturopathic physicians to reignite that reminder that soon they will be out in the world as practicing physicians.

Dr. Laurie Steelsmith and I are excited to begin a weekly Naturopathic Grand Rounds Case Discussion group. It will be facilitated by Dr. Steelsmith and myself and the topics will be real world cases from our combined 30+ years of clinical experience that we have found to be instructive, useful, and thought-provoking. Our goal is to have a group of 10-20 students and/or recent graduates from any and all of the naturopathic universities. We will be using Zoom to connect with you all and will do our best to find a time that accommodates all who are interested.

Join us! Sign up via the form below and we’ll contact you with the collective date and time that works for everyone.

Please share with your classmates and colleagues!

Coronavirus Information and Updates

The Covid-19 aka the coronavirus is a virus that is known to cause symptoms such as fever, cough, and in susceptible populations more severe respiratory illness. It is transmitted via respiratory droplets and has been spreading around the world since December 2019. Currently we have yet to see the spread become extreme in the United States but that could change in the upcoming weeks.

My recommendations are as follows:

1. Repel the virus’ entryway into your system: wash your hands often, clean your phone daily with alcohol, do not touch your eyes, nose or mouth with your hands, avoid handshakes and hugs with strangers.

2. Keep your immune system strong: gets 7+ hours of sleep a night, reduce sugar and alcohol in your diet and focus on nutrient dense food, get fresh air daily, stay well hydrated.

3. Consider immune boosting supplements: vitamin D 2000-5000IU a day, elderberry 1 tsp a day, zinc 15mg a day, medicinal mushrooms (reishi, coriolus, chaga, lion’s mane, shiitake), vitamin C 1000mg a day, resveratrol 500mg a day. I am also recommending IV nutrients such as Myers cocktails for my patients.

4. For anyone over the age of 70 with heart disease, diabetes, or underlying lung conditions I recommend extra precaution and speaking with your doctor directly.

5. Currently it still appears that symptoms are milder or undetected in the population under 19 years of age.

6. If you do have a known exposure to an individual with coronavirus please call your doctor and you can increase dosages of the immune boosting supplements to 3 times a day. Watch for fever which will be the first symptom. The virus has a 5 day incubation period before symptoms begin to show. After infection it appears that most people are contagious for a full 8-13 days after.

It does appear that those with a healthier immune system and younger in age will be able to fight this infection well enough. The concern is in those with underlying health conditions and age. This is a primarily respiratory illness so any symptoms of shortness of breath or extreme cough may indicate that you need to seek more immediate care. Stay tuned for further updates, but if you want more immediate info and updates please follow me on instagram at: @drkristencoles

5 Things You Didn't Know About Naturopathic Physicians

It’s Naturopathic Medicine Week! To celebrate I have a lot of fun stuff coming up and I’m excited to share more about my passion as a naturopathic physician. I thought a great way to kick things off would be to answer some of the general questions I receive about being a naturopathic physician. Here we go!

1.     We attend 4 years of medical school and take rigorous board exams to become licensed physicians.
While naturopathic medical students don’t attend the same medical schools as students training to become conventional MDs, there are a lot of similarities in the basic training and a lot of differences in the technical training. For instance, the first two years of training for NDs, MDs, and DOs emphasize the biomedical science classes and the diagnostic science classes. After the first two years, in addition to standard medical curriculum and hands-on clinical training, naturopathic medical students must complete training in clinical nutrition, botanical medicine, physical medicine, and lifestyle medicine. The program consists of a minimum of 4,100 hours of class and clinical training over the four-year program.

During and after the four years of medical school training, naturopathic doctors are required to take and pass a series of board exams. These exams must be passed in order to obtain licensure as an ND. 

2.     We believe in the Healing Power of Nature
The healing power of nature is one of six core principles that guide naturopathic doctors in diagnosis and treatment. This principle speaks to the fact that there are many substances found in nature that can be utilized to promote healing. But it also encompasses a greater concept, the body’s inherent ability to heal itself. The body is part of the natural world and it contains patterns that aim to keep the system in homeostasis. Disease arises when events occur that overwhelm the body’s ability to maintain normal function. Even at a cellular level, there are therapies and treatments that will support and enhance the natural healing power of the body. Naturopathic doctors focus on identifying and removing obstacles to recovery (such as underlying food intolerances, poor lifestyle habits, unmanaged emotional stress, hormonal dysregulation), in order to facilitate the return of balance to the system.

3.     Naturopathic doctors are herbalists and nutritionists
Nutrition is a cornerstone in naturopathic treatment, since proper diet and nutrition are pivotal components of optimal health. Since many chronic diseases have links to poor diet, all medical providers should be well-versed in utilizing nutrition as a therapeutic tool. However, nutrition training for MDs and DOs is minimal.

Another foundation of naturopathic practice is botanical medicine, the science and practice of using medicinal plants and extracts to treat acute and chronic disease. During medical school, NDs complete an average of 130 classroom hours of botanical medicine education. Modern botanical medicine combines evidence-based science with traditional usage and knowledge to provide effective treatments. In fact, many conventional pharmaceutical drugs are derived originally from plant extracts.

By utilizing clinical nutrition and botanical medicine, naturopathic doctors can tailor a treatment plan that is individualized and impactful.

4.     Our philosophy is based on a set of principles that guides how we diagnose and treat disease
Based on a set of principles that guides how we diagnose and treat disease. It is a distinct philosophy that sets naturopathic doctors apart from other practitioners of medicine. In order to effectively create a shift towards optimal health, the root cause of the imbalance needs to be determined and removed. Additionally, the focus in our assessment includes treating the whole person. Naturopathic physicians understand that each cell, each organ, each system is actually intrinsically connected. This interconnectedness is a core component to enhancing the body’s ability to heal. Within this paradigm, the primary objective is to restore and regenerate health, not necessarily to treat pathology.

5.     We use the best of natural medicine combined with conventional medicine as needed
There are times when natural medicines should not be used exclusively and there may be need for pharmaceutical intervention. A naturopathic doctor is trained as a primary care physician and has the ability to prescribe medications when necessary. Additionally, we are trained to be excellent diagnosticians and able to discern when a patient may need a higher level of intervention. Naturopathic doctors will also refer patients out to other medical specialists such as orthopedics, cardiologists, etc. If I could make one recommendation about how to use naturopathic medicine within the conventional medicine system it would be to first seek out treatment from an ND and then if the situation warrants it, then see your MD. It is always easier to restore balance to a system in the early stage of illness and prevent the disease from developing in the first place.

The Healing Power of Nature - ParkRx Day

This past Sunday, April 28, 2019 was National ParkRx Day. This is a day celebrated across the United States to promote the growing movement of prescribing parks and nature to patients. When I first heard about this celebration I thought to myself, “Heck yes, this is what Naturopathic Doctors have been saying for ages!”. In fact, one of our founding principles of naturopathic practice is based on the Vis Medicatrix Naturae, aka the Healing Power of Nature. This principle represents both the ability of exposure to nature itself to create healing, but also the fact that many of our therapies and treatments that heal are made from the natural world (herbal medicine, vitamins, minerals, hydrotherapy, etc).

As with so many things in naturopathic medicine, the science is now catching up to what we have known and practiced for many years. In preparation for the celebration that I organized around National ParkRx Day (our very first Walk with the Doc) I started to delve into the research on the impact of nature on human health. Here are a few of the most compelling conclusions:

• Exposure to nature can improve depression, anxiety, and attention deficit hyperactivity disorder (Sugiyama, Leslie, Giles-Corti & Owen, 2008)

• Exercising outdoors can reduce sadness, anger, and fatigue and improve attention spans (Blower, Buyung-Ali, Knight & Pullin, 2010)

• Time spent in places with natural landscaping can encourage social interactions and integrations (Kweah, Sullivan & Wiley, 1998)

• Time spent in nature may contribute to children’s cognitive, emotional, social, and educational development (Strife & Downey, 2009)

The fascinating connection seen in these studies is that it is not just an outdoor setting that creates the positive improvements. It needs to be outside in an area with “greenscaping”, which is somewhere with growing plants and foliage of some sort. The inner city concrete jungle basketball court does not create the same changes in mental health that is seen when the children are exposed to a green park. This leads me to the next bit of research that is exploding on green light therapy. Perhaps you have heard of the more popular red light therapy? Green light therapy is similar in that it is the usage of a certain wavelength of visible light to impact health. The most stunning impact of green light therapy appears to be on pain and the nervous system. There is data on green light therapy being used to reduce the dosage of opioid painkillers. Green light has also been shown to reduce levels of stress and the hormone cortisol. The theory is that our brains developed very specific receptors for the color green in the evolution of human development given the fact that for thousands of years we lived in environments where the color green meant abundance in food sourcing.

I have been sharing this research with my patients over the past week and although this may sound like simple information, it is such a necessary reminder. I heard stories this week from a patient who is a schoolteacher and after she heard about this was inspired to do more teaching outdoors. Another patient shared this data with a friend of hers suffering from depression due to a recent cancer diagnosis to encourage her friend to get out of the house and take a walk in the park. I know that I personally feel a deep difference when I have spent time outdoors in nature and I encourage you to make an effort to spend some time outdoors in a beautiful setting every day.

Here’s my official prescription for all of you:

Rx: The Great Outdoors

Sig: 30 minutes

Dispense: Daily

Refills: Your soul

Dr. Kristen Coles

Eat Right for your Workout Type

When you make the commitment to start an exercise routine and find yourself frustrated months later because you haven’t seen the changes in weight or body composition you were expecting, it may be time to evaluate your pre and post-workout nutrition. The old adage about carbohydrate preloading that “fueled” the rage of Spaghetti Supers of high school football teams is not the approach needed for the weight loss goals that many people are looking for. In fact, recent research shows that protein tops carbohydrate in its ability to increase physical performance, training session recovery, lean body mass, and strength. Even at 24 hours post-exercise, the fat-burning effects from the workout will be significantly greater if you go for the protein and skip the carbs! To help get you started – see below for the timing and types of protein best suited to give you results.

Pre-Exercise: 20 grams of protein within 1-3 hours before exercise

-2 hard boiled eggs

-protein smoothie – ½ cup tofu, almond milk, chia seeds, frozen berries, spinach

-2 rice cakes with nut butter

-4oz salmon with avocado

-1 cup greek yogurt with pumpkin seeds, almonds

Post-Exercise: Protein that contains at least 3 grams of leucine, combined with carbohydrate – 20 minutes to 1 hour after exercise. Leucine is a specific amino acid (protein) that helps to promote lean muscle development and decrease body fat.

-1 cup edamame

-1 cup cooked lentils

-1 cup chia seed pudding with 1 tablespoon pumpkin seeds and berries

-whey protein shake

-1 cup tuna salad with rice cake

Bonus Tip: A shot of pomegranate juice 30 minutes before exercise results in improved exercise performance due to increased blood supply to muscles during your workout.

For a more personalized nutrition plan to help you achieve your healthiest self consider seeing a Naturopathic Physician.

Journal References:

1.      E.J. Roelofs, A.E. Smith-Ryan, E.T. Trexler, K.R. Hirsch, M.G. Mock. Effects of pomegranate extract on blood flor and vessel diameter after high-intensity exercise in young, healthy adults. European Journal Sports Science, 2016; Sep 20:1-9

2.      M. Stark, J. Lukaszuk, A. Prawitz, A. Salacinski. Protein timing and its effects on muscular hypertrophy and strength in individuals engaged in weight-training. Journal International Soc Sports Nutrition, 2012; Dec 14;9(1):54

3.      H.L. Wingfield, A. E. Smith-Ryan, M.N. Melvin, E.J. Roelofs, E.T. Trexler, A.C. Hackney, M.A. Weaver, E.D. Ryan. The acute effect of exercise modality and nutrition manipulations on post-exercise resting energy expenditure and respiratory exchange ratio in women: a randomized trial. Sports Medicine Open, 2015; Dec 1(1):11

4.      K.J. Hackney, A.J. Bruenger, J.T. Lemmer. Timing protein intake increases energy expenditure 24h after resistance training. Med Science Sports Exercise, 2010; May 42(5):998-1003

Women's Wellness Wednesdays

As a naturopath my tools of the trade can look a lot different than my conventional medical colleagues. During medical school we had to learn the details of over one hundred different botanicals by look, usage, taste, smell, action, etc. These form the basis of our herbal medicine cornucopia. Out of the hundreds of herbs I certainly have my favorites, my shining stars, so to speak. The next series of blog posts will focus on my favorite herbs for the menopausal transition.

Hops, not just for beermaking

Hops - Humulus Lupulus

Hops, yes you heard correctly, hops - as in the primary herbal ingredient to beer. Hops actually has a long history of medicinal use and is classified as an isoflavone in regards to its chemical constituents. Isoflavones are considered phytoestrogens - meaning plants that have an estrogenic effect. As an herbal medicine, hops could be used in any situation of low estrogen (specifically menopause). These phytoestrogens can weakly bind to estrogen receptors, tricking your body into thinking it has been stimulated by estrogen. Because of this property, hops has a potent effect on hot flashes and night sweats with an added bonus of helping with insomnia. It can be used in a combination herbal formula or as a single herb.

In regards to beer - I find that many of my female patients who are perimenopausal report that they have increased their alcohol intake, often in the form of wine at the end of the day. This seems to be directly correlated to the fact that they have a lowered ability to deal with stress and having a drink tends to be the only way they feel relaxed. This is very common in menopause and I encourage my patients to begin using other techniques for stress management if this is the case. These women also report that hot flashes and sleep are main concerns. incidentally, wine is one of the worst types of alcohol to drink if hot flashes are an issue - as wine causes flushing and is very warming. Ideally I recommend they discontinue alcohol, as any alcohol can often make these symptoms worse. But, if they must have something to drink I recommend trying a small amount of beer instead of wine (at least you will be getting the hops effect). One of my herbal medicine professors once told us that New Belgium 1554 was the perfect beer for a perimenopausal women - it apparently is similar to a recipe monks used back in the year 1554 and is full of additional helpful herbs. (Please note - this is not a plug for any particular beer brand. Also note - I do not recommend alcoholic beverages as any form of medical treatment).

This is not your momma's pumpkin spice latte - Introducing the AI Elixir

It's the new Pumpkin Spice Latte - or it should be. This spicy, warm, creamy delight has all the sweetness and spice of the good ole PSL but in reality it has health benefits that far outweigh any commercial concoction. In its first incarnation I termed this the "Anti-Inflammatory Elixir". However due to complaints from my father about the mouthful of the name for such a smooth and easy drink I have renamed it the "AI Elixir". The ingredients are simple - fresh ginger root, fresh turmeric root, and a cinnamon stick. Yet the effect this has on inflammation is profound. 

Turmeric has been touted for decades for its wide range of actions in the body - everything from digestive tonic to anticancer properties. It makes its magic because of an active constituent called curcumin - the reigning king of the anti-inflammatory kingdom. Everything that curcumin does inside the body is because of the potent ability it has to reduce inflammation across the entire system - from the gut to the brain and everywhere in between. Pair turmeric root with its cousin ginger and you get not only a culinary match but a medicinal match. Ginger has been used across cultures for the digestive tonic effect - it helps decrease nausea, prevent food poisoning, and it contains its own additional anti-inflammatory properties. Much of the warm, spicy flavor in the AI Elixir comes from the fresh ginger root and indeed ginger has the ability to warm and prime the digestion during cold months. Cinnamon is the final herb in this trifecta and it lends taste but also brings its own medicinal punch. Cinnamon is well-known for its ability to lower blood sugar levels and it does this by decreasing the absorption of sugars in the gut. One important connection to make is that excess blood sugar is a primary cause to the process of inflammation. Excess sugar in the system is like fanning the flames of the inflammatory fire.

These three herbs combined together are akin to health nirvana - drink daily and you will notice the change. So tomorrow do yourself a favor and consider ditching that sugar-laden, caffeine-pumped Pumpkin Spice Latte and try the AI Elixir. Your body will thank you.

Cheers to great health! - Dr. Kristen Coles

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Ingredients

·      4 slices of fresh organic turmeric root – cut lengthwise

·      2 slices of fresh organic ginger root – cut lengthwise

·      1 cinnamon stick

·      4 cups of water

·      1 tsp raw honey – optional

·      1 tbsp coconut milk – optional

Directions

Add water to pot and bring to a boil. Add turmeric root, ginger root and cinnamon stick. Simmer for 10 minutes. Remove from heat, strain, add honey and coconut milk if desired. Drink liberally.