Let's start this post with a little anecdote... one of frustration. I had a patient with a history of low iron who was taking Feramax (a polysaccharide-ion complex form of iron) for several years as instructed by their medical doctor. On this patient's latest blood work it showed that their iron levels (as measured by "ferritin" storage) hadn't budged an inch.
Yes, it's frustrating when a medication or supplement isn't working, but what was more frustrating was that even after seeing these test results, the MD told the patient to keep taking the Feramax.
Now, I have nothing against Feramax, in fact, it can be a fantastic supplemental iron and has been known to be more gentle on the stomach than other forms like ferrous gluconate. I've prescribed it among other iron supplements in the past. But it obviously wasn't helping bring iron levels up in this patient. This often means that there is an issue with bioavailability and absorption.
When left in the hands of patients, it's easy to become confused with several types of iron supplements available. While I was a pharmacy assistant, customers would come in regularly looking for iron as directed by their doctor. Of course, without any actual prescription or direction, customers typically went for the cheapest one on the shelf. But quality matters here and no one was educating these customers (and at the time, legally I wasn't allowed to since I was still a student) on the differences between these supplements.
Some iron supplements like ferrous gluconate and ferrous fumarate can be harsher on the stomach; Some can cause nausea and constipation; Many of them interact with other minerals such as calcium, and not all of them have a stellar absorption rate. In fact, the absorption rate of most iron supplements is less than 5%.
It's also important to note the needs of each individual. For those who are vegan or vegetarian, they may wish to avoid heme iron supplements - heme iron being derived from animal hemoglobin (typically porcine). Heme iron has about 3x more bioavailability to non-heme or elemental iron, making it an excellent treatment for increasing iron levels in those who are anemic.
Another elemental form of iron is iron glycinate or iron bisglycinate chelate. This form of iron is protected by glycine molecules so that it doesn't interact with other minerals in the GI tract; As well, it has better bioavailability than ferrous gluconate. Because of how gentle it is (and cost effective!), this one tends to be a client favourite.
The take home message here is not to be discouraged when one type of supplement isn't working. Even with something like B12... if taking an oral supplement isn't working, there's a better chance at increasing B12 levels via injection as the injected B12 is delivered directly into the muscle and avoids the stomach and GI tract altogether.
The wonderful thing about naturopathic doctors is the abundance of nutrition training we have in comparison to medical doctors. Try not to be discouraged on your path to wellness, but know that there is usually an alternative if something isn't working for you.
ND's Notes: It is not advised to take an iron supplement without the supervision of an MD or ND via blood work. The toxicity associated with excess iron can be extremely dangerous.
Showing posts with label supplements. Show all posts
Showing posts with label supplements. Show all posts
Thursday, August 16, 2018
Thursday, March 22, 2018
6 Ways to Prevent Knee Soreness and Injuries for Runners
So you wanna run, but your knees get too sore? I hear this frequently, and can understand the feeling. Most of the time, doing some training to start running can help but there are other considerations as well.
When I first started running I just wanted to get out there. I didn't have any accumulated running gear, and I was hitting the concrete streets of Toronto. At first it was uncomfortable - like my body didn't quite understand how to run, or how to run properly. I thought I was in good shape, but my heart was racing, and I was sore!
Fast forward to today and my knees have become a non-concern. It takes conditioning, the right gear and the right type of run, but you too can run with less knee pain.
Here are my top tips for reducing the knee pain of running:
1) Wear really good running shoes and rotate them often.
Purchase one pair of really great (and often more expensive) running shoes, but make sure to replace them within about 6 months - earlier if you're covering more distance in them. For runners hitting about 20-40km per week, your shoes might only last you 3-4 months. Or, you can purchase several pairs and rotate them frequently. Each pair of shoes will last longer in that way, though you may have to spend more in the short-term.
2) Strengthen your hips!
You can relieve the strain on your knees by increasing the strength of your hips and glutes. This even extends into the pelvic cavity and low back as strengthening these muscle groups help to keep the body and joints more stable. Lunges, squats, hip adduction and hip abduction will all support this.
Yoga can also act as a strengthening exercise for those muscles. Look for yoga videos or classes specifically tailored to runners. Christine Felstead has a great book called "Yoga for Runners" as well, and she often teaches at the annual Toronto Yoga Conference & Show.
At the same time, beware of deep tissue work that can over relax major muscle groups. Using a foam roller on the legs - especially the IT band - is fantastic, and can help to decrease knee soreness. However, a really deep tissue massage of the low back, hips and glutes might actually set you back by a few days. It's not uncommon to feel a little too loose and wonky after a really tough massage, so be prepared to restrengthen those muscle groups.
3) Avoid running on concrete.
Cement has very little give for a runner compared to a trail. If you can run on softer surfaces, opt for that! With a slightly lesser impact, your joints feel less of a shock. Myself personally, I find that I'm more sore the day after I've run on concrete versus a dirt trail or boardwalk.
4) Run with a mid-foot strike, or on the balls of the feet.
Running with a heel-strike may look good in an advertisement, but mechanically is murderous on your legs. When you strike with your heel, the impact of that strike shoots up the leg with a more compressive force on the knee and hip joints. By using the mid-foot or balls of the feet, the back half of your foot acts as a sort-of shock absorber. This allows you to bounce more gently, taking the pressure off the knee joint and putting it more on your muscles to catch you and propel you forward.
The only downside to this is that some newer runners may notice shin splints when starting this technique. Doing a proper warm-up and post-run stretch can help alleviate that stress. As can magnesium, foam rolling, and using hot and cold water therapy as appropriate.
5) Consider additional joint support via supplementation.
Depending on your age and physical and medical history, this might include cartilage helpers like glucosamine and chondroitin; anti-inflammatory substances such as Omega-3 fish oil and curcumin; or other vitamin, mineral, and amino acid support such as vitamin C, hydrolyzed collagen, and bone broths.
6) Visit a physiotherapist
If you're unsure about your running technique and you're getting pain or soreness, it might be time to go see a physiotherapist. They can assess your gait and stance, perform muscle testing, and then set you up with stretching and/or active motion exercises to reduce your pain and support proper body mechanics. (If you have insurance benefits for physio, this one is a no-brainer!)
When I first started running I just wanted to get out there. I didn't have any accumulated running gear, and I was hitting the concrete streets of Toronto. At first it was uncomfortable - like my body didn't quite understand how to run, or how to run properly. I thought I was in good shape, but my heart was racing, and I was sore!
Fast forward to today and my knees have become a non-concern. It takes conditioning, the right gear and the right type of run, but you too can run with less knee pain.
Here are my top tips for reducing the knee pain of running:
1) Wear really good running shoes and rotate them often.
Purchase one pair of really great (and often more expensive) running shoes, but make sure to replace them within about 6 months - earlier if you're covering more distance in them. For runners hitting about 20-40km per week, your shoes might only last you 3-4 months. Or, you can purchase several pairs and rotate them frequently. Each pair of shoes will last longer in that way, though you may have to spend more in the short-term.
2) Strengthen your hips!
You can relieve the strain on your knees by increasing the strength of your hips and glutes. This even extends into the pelvic cavity and low back as strengthening these muscle groups help to keep the body and joints more stable. Lunges, squats, hip adduction and hip abduction will all support this.
Yoga can also act as a strengthening exercise for those muscles. Look for yoga videos or classes specifically tailored to runners. Christine Felstead has a great book called "Yoga for Runners" as well, and she often teaches at the annual Toronto Yoga Conference & Show.
At the same time, beware of deep tissue work that can over relax major muscle groups. Using a foam roller on the legs - especially the IT band - is fantastic, and can help to decrease knee soreness. However, a really deep tissue massage of the low back, hips and glutes might actually set you back by a few days. It's not uncommon to feel a little too loose and wonky after a really tough massage, so be prepared to restrengthen those muscle groups.
3) Avoid running on concrete.
Cement has very little give for a runner compared to a trail. If you can run on softer surfaces, opt for that! With a slightly lesser impact, your joints feel less of a shock. Myself personally, I find that I'm more sore the day after I've run on concrete versus a dirt trail or boardwalk.
4) Run with a mid-foot strike, or on the balls of the feet.
Running with a heel-strike may look good in an advertisement, but mechanically is murderous on your legs. When you strike with your heel, the impact of that strike shoots up the leg with a more compressive force on the knee and hip joints. By using the mid-foot or balls of the feet, the back half of your foot acts as a sort-of shock absorber. This allows you to bounce more gently, taking the pressure off the knee joint and putting it more on your muscles to catch you and propel you forward.
The only downside to this is that some newer runners may notice shin splints when starting this technique. Doing a proper warm-up and post-run stretch can help alleviate that stress. As can magnesium, foam rolling, and using hot and cold water therapy as appropriate.
5) Consider additional joint support via supplementation.
Depending on your age and physical and medical history, this might include cartilage helpers like glucosamine and chondroitin; anti-inflammatory substances such as Omega-3 fish oil and curcumin; or other vitamin, mineral, and amino acid support such as vitamin C, hydrolyzed collagen, and bone broths.
6) Visit a physiotherapist
If you're unsure about your running technique and you're getting pain or soreness, it might be time to go see a physiotherapist. They can assess your gait and stance, perform muscle testing, and then set you up with stretching and/or active motion exercises to reduce your pain and support proper body mechanics. (If you have insurance benefits for physio, this one is a no-brainer!)
Wednesday, May 18, 2016
Do we really need to take supplements?
Supplements have gotten a bit of a bad reputation much to do with the lack of proper regulation. The media has reported that some products have been found to not contain the ingredients listed on the label, or in much smaller amounts than advertised. I like to believe that Canada is a little more restrictive than our neighbours to the south; It's common to find many "performance enhancing" supplements filled with steroids and sildenifil or similar drugs (the generic form of Viagra) at gas stations around the country.
Regardless of these incidents, there are still many great supplement companies who perform third party testing and whose products are standardized to contain the exact compounds and amounts of those compounds in each tablet/capsule.
As a naturopathic doctor I'm extremely picky with which companies I prescribe or recommend. But in recommending a higher quality product, the cost of certain supplements also goes up. So do we really need to spend hundreds of dollars on supplements? Do they actually do anything for you?
That all depends on you, your diet and your health status. Most people don't need to take supplements to survive, but they definitely have a role in optimizing your health.
Here's an example: do we all need probiotics? We need beneficial bacteria in our guts for proper digestion (and many other things!). Without a good gut microflora we experience gas, bloating, constipation or loose stools. Long standing, we may experience low mood or depression and a lower functioning immune system, including skin rashes. By incorporating fibre (vegetables) in your diet each and every day we eliminate the need to take high doses of probiotics as fibre helps to feed the good bacteria in your large intestine. However, if your gut bacteria has been out of balance for a while, taking a probiotic can help to repopulate your gut faster and crowd-out all the "bad" bacteria. In this example, taking a supplement (probiotic) will help you to feel better sooner.
Supplements in general aren't needed by everyone, but again, they optimize your well-being. Sometimes I forget exactly how many supplements I take daily - there's a lot of them! But I truly feel better on them. For most supplements, it can take up to three months to feel an effect. In some cases you might not even notice a difference but your blood work says otherwise. For example, using a high quality fish oil to manage cholesterol and triglyceride levels.
I would also bet that 90% of Canadians have less than optimal vitamin D status. Due to our winters, and decreased sun exposure, many of us don't get enough vitamin D. You may or may not notice any differences, but when your vitamin D levels are in a certain range, you decrease your risk for cancer, bone fractures, heart attack (men), and multiple sclerosis (click here for references).
I personally would still rather take multiple supplements now than to be on medications later in life, or even right now. By taking certain vitamins and botanical formulas, I'm decreasing my need to take ibuprofen (generic Advil) or naproxen. These over-the-counter medications have been around for years and seemed benign, but we've recently learned that NSAID's such as ibuprofen may lead to adverse effects such as heart attacks and stroke, as reported to Health Canada. Now someone who takes ibuprofen maybe once or twice per year is less likely to experience this, but for females who take Advil for 1-2 days each month to handle menstrual cramps... it all adds up, and personally it makes me very uncomfortable.
Instead I'll keep up with my fish oil, B6 complex and botanical formula (and even acupuncture!) to decrease the need for these pharmaceutical anti-inflammatories and pain relievers.
So do we really need to take dozens of supplements and spend all this money on them? That's an investment I'm willing to make and I encourage you to have your supplements reviewed by a naturopathic doctor. An ND can tell you if what you're taking is the best for your health situation, and also if the product you're currently taking is the best one for your money. As an example, several B vitamins such as B6 and B12 are available as cheap synthetic forms, but also as more bio-available forms - forms where your body doesn't need to take it and turn it into the "active" form. So what's the point in wasting money on a vitamin that you might not be absorbing? This is also a huge problem with multivitamins - but that's a topic for the next blog post.
The other issue is that we confuse all supplements with being "natural" when in fact many of them come with their own "warnings" or contraindications. Your individual allergies and health issues can be exacerbated with certain supplements, so make sure that you'r not just grabbing anything off the shelf - a naturopathic assessment is crucial for your safety.
Don't let the media influence you in avoiding all supplements. There are terrible companies out there and there are fantastic, responsible ones as well. Supplements are for improving your quality of life, preventing disease and optimizing your body's overall performance. We don't all need them, but they can really influence our health and proper functioning of our bodies.
Regardless of these incidents, there are still many great supplement companies who perform third party testing and whose products are standardized to contain the exact compounds and amounts of those compounds in each tablet/capsule.
As a naturopathic doctor I'm extremely picky with which companies I prescribe or recommend. But in recommending a higher quality product, the cost of certain supplements also goes up. So do we really need to spend hundreds of dollars on supplements? Do they actually do anything for you?
That all depends on you, your diet and your health status. Most people don't need to take supplements to survive, but they definitely have a role in optimizing your health.
Here's an example: do we all need probiotics? We need beneficial bacteria in our guts for proper digestion (and many other things!). Without a good gut microflora we experience gas, bloating, constipation or loose stools. Long standing, we may experience low mood or depression and a lower functioning immune system, including skin rashes. By incorporating fibre (vegetables) in your diet each and every day we eliminate the need to take high doses of probiotics as fibre helps to feed the good bacteria in your large intestine. However, if your gut bacteria has been out of balance for a while, taking a probiotic can help to repopulate your gut faster and crowd-out all the "bad" bacteria. In this example, taking a supplement (probiotic) will help you to feel better sooner.
Supplements in general aren't needed by everyone, but again, they optimize your well-being. Sometimes I forget exactly how many supplements I take daily - there's a lot of them! But I truly feel better on them. For most supplements, it can take up to three months to feel an effect. In some cases you might not even notice a difference but your blood work says otherwise. For example, using a high quality fish oil to manage cholesterol and triglyceride levels.
I would also bet that 90% of Canadians have less than optimal vitamin D status. Due to our winters, and decreased sun exposure, many of us don't get enough vitamin D. You may or may not notice any differences, but when your vitamin D levels are in a certain range, you decrease your risk for cancer, bone fractures, heart attack (men), and multiple sclerosis (click here for references).
I personally would still rather take multiple supplements now than to be on medications later in life, or even right now. By taking certain vitamins and botanical formulas, I'm decreasing my need to take ibuprofen (generic Advil) or naproxen. These over-the-counter medications have been around for years and seemed benign, but we've recently learned that NSAID's such as ibuprofen may lead to adverse effects such as heart attacks and stroke, as reported to Health Canada. Now someone who takes ibuprofen maybe once or twice per year is less likely to experience this, but for females who take Advil for 1-2 days each month to handle menstrual cramps... it all adds up, and personally it makes me very uncomfortable.
Instead I'll keep up with my fish oil, B6 complex and botanical formula (and even acupuncture!) to decrease the need for these pharmaceutical anti-inflammatories and pain relievers.
So do we really need to take dozens of supplements and spend all this money on them? That's an investment I'm willing to make and I encourage you to have your supplements reviewed by a naturopathic doctor. An ND can tell you if what you're taking is the best for your health situation, and also if the product you're currently taking is the best one for your money. As an example, several B vitamins such as B6 and B12 are available as cheap synthetic forms, but also as more bio-available forms - forms where your body doesn't need to take it and turn it into the "active" form. So what's the point in wasting money on a vitamin that you might not be absorbing? This is also a huge problem with multivitamins - but that's a topic for the next blog post.
The other issue is that we confuse all supplements with being "natural" when in fact many of them come with their own "warnings" or contraindications. Your individual allergies and health issues can be exacerbated with certain supplements, so make sure that you'r not just grabbing anything off the shelf - a naturopathic assessment is crucial for your safety.
Don't let the media influence you in avoiding all supplements. There are terrible companies out there and there are fantastic, responsible ones as well. Supplements are for improving your quality of life, preventing disease and optimizing your body's overall performance. We don't all need them, but they can really influence our health and proper functioning of our bodies.
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