Athletic Kids and Vitamins

Little Sis calls and asks what should we give to my future linebacker and Olympic swimmer nephews.   Loaded question as anyone I care for knows, handing out a one size fits all diet/supplement regime is basic but probably not sustainable.

Reminiscing to early practice.... I still remember in my old clinic at CDH, I used to have a folder of exercises put together for specific body aches.  Thought I was smart by having things pre-printed for my staff to hand out after I came up with a diagnosis.  One day I was walking out after clinic and saw the handouts sitting in the trash at patient checkout.  They didn't even wait to get home and dumped the one-size-fits-all hand out in our garbage.  Not everyone can afford physical therapy co-pays but if the suffering is bad enough/long enough or surgery is coming-I rather have a personally designed rehab program applied, modified and re-applied to get the body to heal itself properly.

Reminiscing to youth, my Sis and I grew up in a kitchen where mom had a meat dinner every night and eggs/spam for breakfast.  Having more than 1 dish available for dinner was a sign of success.   Having the best cut of beef for parties was living large.  That was when eating large volumes of steak was the way to "get big" if you were a guy and girls only did 'aerobics' to burn off the calories.   Creatine and protein came into vogue in the 90's, 'steroid stacks' were sold in the gym at the millennium.  Now we have complex bodybuilding "herbs", TRT (testosterone replacement therapy), epo, steroid hiding drugs all abound in sports because of endorsement deals and social media spotlight.  So the urgency to be the best has trickled down to grade school levels.  Training hours per week have surpassed what a division I crew team would be going through on full boat scholarships.  The problem arises in those little joints that haven't stopped growing yet.  Placing excessive leverage on a tween joints can pull growth plates off long bone causing things like shoulder dislocations, little league elbow, chondromalacia, osgood schlatter and severs disease of the heels.  

Once you find an activity of interest, be aware of how the coach treats his/her team.   It is habit to want to drop off for practice and do some errands but invest some initial time in observing and make sure coach sees you.  Tag team with other parents as well.  I trust that most coaches have good intention especially if their own kid is on the team but don't assume.  Observe the dynamics of how aggressive training is, how the ultimate concern is the experience of working with others and self improvement.  Now comes the meat and potatoes of what my sister was asking.  

Supplements are a good idea for an average American diet.  Dr Agus was recently on a DrOz episode and brought up his perspective on no vitamins.  I don't agree, average family eats OK, but usually has fast food mixed in 25% of the week (usually at school!).  Just to balance the trips to any place where you cant be in the kitchen to check the type of cooking oil or choice of meat, I feel a multivitamin will "supplement" the basic building blocks for maintenance, repair and growth.  I hope that with the other 75% of weekly intake coming from cooked meals at home, you may get some nutrient from the whole foods purchased from the periphery of the grocery.  No no no......soil today doesn't have the same nutrients as 2-3 decades ago, more pesticides are used, more GMO seed is used, distance of shipping has been solved with airfreight so you may be getting fruits and veggies picked before ripening over 2000 miles away that never had the opportunity to complete life cycle and consequently spoil much faster on your counter.  Anything that looks or feels a few hours over ripened will have degraded its nutrient content days before.  May not be getting appropriate vit K, magnesium or iron especially if parents are choosing a semi vegetarian lifestyle.  I don't feel we will see overt rickets, pellagra or beriberi in our schools but I do believe there will be (and already is) an abundance of unusual adult diseases popping up in childhood (reflux, depression, bipolar, diabetes type II, hypertension, high cholesterol, irritable bowel...) that were unheard of for kids in the 80's and 90's.   All diseases are multi factorial and no time to discuss here but going back to basic suggestions......a multivitamin would be a start.   More important for my young patients is to begin a habit of 'ritual' where the kid gets used to taking a tablet, capsule or liquid every morning.  Even if the cheap kid vitamin with inferior binders just ends up in the toilet, that young person has now ingrained the idea of always taking a vitamin daily.  If you try to start at teen years....get ready for resistance and failure.  So for me the habit is important and starting early is important.  If the little guy/girl has a medical problem then we should probably not just stick with cheap Walgreen's brand.....I would spend for higher grade vit's or get them compounded.   I remember in one of the ER's I worked at there was a stark contrast in home nutrition; had a very calm easy going patient care tech that spent her whole paycheck on organic for all the kids/then her counterpart- a registered nurse who was usually stressed out and stated she attempted to feed her kids 'healthy' but it was too hard so she goes with MacDonald's and all microwave stuff because they all refused.  It does take patience, planning but pays off in the long run.  If it is too stressful to change diet now, OK....but all that omega 6, fructose and caffeine will have an accumulative effect sooner or later-guaranteed.

Second on my list is omega 3 oil......fish or cod liver OK!  (just watch for piggy back vit A mixed in with some cod liver oils.   (preformed vit A can be a problem with acting as a proinflammaotry)  Again building on the idea that average kid has 50% or more of their weekly intake from fast food high in omega 6.  Too much omega 6 and too little omega 3 turns on inflammation- arthritis, bowel disease, skin disease, depression......short of cooking with EVOO, eating more fish less red meat, taking the omega 3 daily will re-balance away from 'standard American diet' and more to 'mediteranean diet/antiinflammatory diet'.  (in basic soccer-parent terms: given a choice of 3 days of knee pain vs 2 weeks of knee pain-diet can make the difference)  Kids are sensitive to burping smells so free the capsule (the tiny one are great, call the company to inquire about if they check for mercury in product regularly)   Liquid omega 3 can taste nasty.....although at the Arizona Integrative Medicine Fellowship, I sampled Barlean's pina colada omega 3 6 9 and it was yummy!  (children average about 700-1200mg daily)

Last is vit D3.  Due to melanoma scares, we sun-block the hell out of our kids which is good for skin cancer but bad for maintaining vit d levels in the body.  Most Americans are low on vit D, there is new conflicting evidence for pro's and con's on using supplement but for the last 10 + years low levels have been associated with diseases like cardiovascular disease, asthma and certain cancers.  The data on vit D toxicity(overdosing) is lacking so even if future studies say it doesn't help to keep blood levels high, it aint gonna hurt either.  Until NIH and the Cochrane show anything different.....please take vit D3 for yourself and your kids.   (children average about 400IU daily to be taken with healthy fat/food/oil)

So it seems like I am pushing alot of pills on kids and yes, if diet is lacking, don't wait until later.  Always, always change the diet first.  If you cant, then add the multivitamin and make it a habit.  If there is a medical disease, clear it with the doc and add the omega 3 and D3 at the least.....other things depending on the presentation.  (ie...zinc for adhd, inositol for anxiety, magnesium for dysmenorrhea, probiotics for irritable bowel, turmeric for muscle aches, licorice for reflux...)  Wedge in some healthy snacks and meals into daily nutrition and hopefully they become accommodated to always seeing a fruit, veggie, or fiber source thus take it with them to adulthood. Maintain a meatless Monday and fish Friday to cut down overall sources of red meat (high omega 6 and cholesterol) and experiment with non redmeat dishes to see if they catch on.   Even if training is 2 hours a day, 5 days a week (that is time consuming right in the middle of the day! God bless our parents!)  the antiinflammatory diet is the gold standard for keeping a healthy injury free athlete.   Eat Drink Weigh Less by Walter Willet, The Mediterranean Diet Cookbook by Harmon Jenkins (nice pics), John LaPuma's Big Book or his website for free recipes www.drjohnlapuma.com and of course my guru Andy Weil and his multiple books and informative website www.drweil.com .

(For my parents.)

Cold and Flu Herbal "Go Bag"

     I feel my chances are high regarding getting sick from a contagious patient.  Not so much at First Health Associates where I see complicated chronic conditions.  More at the immediate care centers where I "moonlight" for Alexian Brothers.  I get the occasional cough or stuffy nose but the last time I touched an antibiotic was 2003-2004 for a sinus infection after which I proceeded to come down with the rare psuedomembranous colitis from antibiotic over dose (this was after the first day!!!)   Note: this is when I was sleeping less, drinking a large coffee from McDonalds with 10 packs of sugar and a steak egg and cheeze bagel/hash browns every morning, beer with dinner which was mostly Filipino feast foods and the occasional 1 pound hamburger from Fuddruckers.  Oh...almost forgot the dozen warm cripsy cream donuts "for the staff" on fridays.  
     Those days are far behind me but the point is I try to stay healthy and set and example for friends, family and patients but still get a little cough, stuffy nose now and then.   I have confidently developed my "go bag" of herbal supplements that have truncated any/all infections my body is trying to express.  As in most integrative treatments, use is based on factual studies.  The higher the degree of disease presentation/complication, the more RCT's (randomized controlled trials) or Cochrane Reviews are necessary before making recommendations.  (This is the ultimate reason for putting myself through 2 years of fellowship study- outside the normal training set by the state and fed in order to practice medicine.)   I have adapted a few things to make sure natureal healing is maximized when homeostasis becomes imbalanced with infection.  

1 Avoid all dairy

product for 10-14 days (even organic) I would really cut out all processed food (no matter how much you crave it), complex/big meals, alcohol, excessive caffeine-if you cut out all caffeine now you will have a withdrawal headache ontop of the viral/flu/sinusitis headache.  The opposite is true if you starve yourself down to 1000cal daily, the immune system will "hit the wall".  If you want to keep at a minimum of food intake....the old way Bananas Rice Apple sauce Toast is ok for 24-48 hours but push fluids:
2 Make sure the minimal fluid

intake per day is 3 liters per day (13 cups) try to make the morning warm fluid and cool it down as the day goes on.....cold water is more palatable.   Ayurveda practice is to start with warm fluid as to not cool the fire (solar plexus chakra) that starts the day.  I also like using Airborne fizz tablets in the water to insure taste helps it go down.  There is argument as to whether Airborne has any healing properties at all....I just want it to taste better without adding sugar. 
3 Elderberry

has been studied to shorten the days of illness in children with viral symptoms.  The dark berry is surmized to accentuate white blood cell killing power.  For kids-Sambucus is a nice formulation with echinacea.  For adults I suggest New Chapter Sinus Take Care or Garden of Life Immunity Sinus usually at Whole Foods Market or Fruitful Yield.  All about 4-5 times daily for 5 -7 days. 
4 Astragalus

 a fantastic root that is known as an "adaptogen".  This category responds to stress with "boosting" to calm the stress response of white blood cells but also allow to unleash hell to bacterial and viral invaders.  Think of the professional boxer-cool, collected knows a strategy that works and is focused on getting a job done in the ring.  Compare to a drunk brawler who may have adrenaline but no control of emotion, decision making even if he has the same tools as the boxer.  Now think of a while blood cell that is focused on work vs a white blood cell that is over stimultated.  The overstimulated will either attack the wrong thing (a friendly knee cell in Rheumatoid Arthritis or an intestinal cell in Inflammatory Bowel Disease) or it wont fight the true invading bacteria/virus leading to infection after infection.  There have been small studies showing benefit of astragalus daily use in asthmatic patients during cold and flu season to decrease infection rates.  If you are lucky, your local herb shop will have astragalus tongue depressors, think slivers of the root you chop up and place in tea or soup if you dont mind the taste of bark.  (Whole Foods Market brand, Nature's Way-purple top, Now Foods from Fruitful Yield)
5 Neti Pot nasal irrigation

2-3 times daily followed by over the counter or prescription meds to decrease nasal swelling (if congestion or cough is part of the picture).  I like Nasacrom that can be purchased anywhere no script needed-I relied on it heavily 2 decades ago when it was only prescription and worked well then and still works now (albeit the otc dose is smaller than back in the day).  Some people dont like putting things in their nose......a spray form is probably ok but can irritate the ostia (hole) the sinus uses to drain discharge into the nose and out the nostrils.  Irritate the ostia too much and it may cause a nasty facial headache.  I do not believe the viral story that went out about a neti pot being the cause of a parasite killing someones brain-neti pots have been used for more than 2500 years even before antibiotics/antiparasitics where invented, those were times when infection and parasites were true life enders.  If there was a high association with brain absess formation, 2500 years would have shown a relationship of all the people in India dying of massive brain absess outbreaks.  Purchase at any herbal store, vitamin shop, most pharmacies.
Link to DrOz Oprah demo of neti pot

6 Aroma Therapy

is a technique of getting the proposed strength of a plant into the body via the nose and lungs.  Like asthmatics and their inhalers/nebulizers, so to can an ultrasonic nebulizer "shake up" plant oils to make a vapor for you to inhale/sniff.   There is some research saying it works it works to induce a relaxation response in the brain.  I havent seen specific reproducible data showing head to head trials vs prescription drugs but who cares?   If the potential side effects to the treatment are minimal (breathing in nice smells) then the treatment doesnt need multimillion dollar randomized control trials for me to have a patient use it.  (....and it has to be affordable since being broke is a side effect)  I experimented with Young Living Thieves.....used it in my office for people coming in with flu symptoms and they did feel very "different" with fewer symptoms.  If you are really lucky, there will be an herbalist or "aromatherapy blender" who can find the exact combination of essential oils to help change your mind body response.  Jenn from JennScents first introduced me to aromatherapy and herbal medicine- fantastic blends!  Or try Olabas Oil found at Whole Foods Market or Fruitful Yield in the water of steam bath or steam cave - link to my Flu Lecture

7 Medical Acupuncture

is a fantastic tool that improves normal functioning during the infection.  Although the data is still being studied, if an asthmatic cant breath and a few needles helps-positive response!   If a gastritis sufferer gets control of nausea with one single acpuncture needles-postive response!  I have used it with many different patients and at the least, it makes the patient feel empowered and helps get through the crisis.  (Used it for my mom when she was suffering from the abdominal pains from her pancreatic cancer......doesnt matter if it was placebo-she got relief.  Only in America to scientist minimalize the placebo effect.  In my heart, if it works, causes no harm, is affordable/free.....do it!  No such thing as "false hope")  See Dr Zhu in my office, Dr Leon Chen in Lombard, Frank Grill in Naperville.
8 Massage

from an energy healer/massage therapist to chest and facial acupressure points feels good.   It also is a way to stimulate the acupuncture points that heal if the patient doesnt like needles.  Using essential oils like Eucalyptus to the lung points in a bronchitis sufferer or along acupuncture meridias that help drain sinus infections help my average patient get through the infectious process with less drugs.  Only problem is finding a credible acupuncturist.  I studied 1000 hours from UCLA and I rate myself as"ok".  There are far better docs than me and this is where I send my patients.  Have to research where the acupuncturist went to school, how long in practice and what is their sole means of economic survival.  If it is a practitioner that only does needles and they have been around 10 years with training from China-probably good.  If a person that does alot of different things but also does needles and studied for 6 weeks to get a diploma-run for your life.  Most states have a credentialing board overseeing non MD's, then there is the American Academy of Medical Acupuncture certification for MD/DO's.  Don't forget your spouse.
9 Mushrooms

have great medicinal value and have been used for centuries in Asia.   Good studies regarding using only them to intervene with fighting infections.  The problem is which companies do we trust?  As is the problem with all the above where do we buy our herbs.  Regarding mushroom, I like GAIA brand "Throat Shield"  peppermint flavored.  Cant tell if its the alcohol/cinnamon or the mushroom that helps sore throats.......but it doesnt matter as the cost is little more than chloraseptic throat spray.  2 sprays every 2 hours or before bed helps get through a day or night with less drugs.  Also helps calm a throat so you can eat if strept throat or tonsillitis is the problem.  
10 RICOLAAA!!!

I like any throat lozenge for soothing if it has elderberry, eucalyptus, echinacea......and not too much sugar.  Comfort is important otherwise you wont eat or drink and be in pain all day.  If number 9 is too expensive.

And there is my "go bag" of winter illness rescue.  I have a few extra things like high dose D3, magnesium, zinc, high dose vit C, colloidal silver, homepathic Boiron products....but just with the 10 things above, people get discouraged when there are too many choices.  Even if an antibiotic is needed, I still do all the above plus a probiotic for 30 days to rebuild the gut flora I destroyed with the antibioic.  Shopping a Whole Foods Market causes a spasm in my wallet but speaking from personal experience, I have not touched an antibiotic for almost 10 years and I am sitting 2 feet away from people that are being seen with strept, bronchitis, pneumonia, MRSA, sinusitis and infectious diarrhea.   Make you own judgement but dont just keep on taking antibiotic after antibiotic thinking you have no other choices.

Link to a slideshare.net lecture on Colds Coughs and Capsules
Link to a video on my influenza experience

Homeopathic pellets

Had a great mom come in with daughter.  Seen at the ER for a bike accident few days ago.  Was wearing a helmet (thank God!) but took a face plunge and "road rashed" her left face with a puncture to the inside left lip from her tooth and residual night terrors from the event.  Couple of other minor scrapes to the arm and leg left side.  Mom is very "natural" tries to avoid conventional fruits and veggies, gluten, dairy and red meat.  This is a great mom- takes alot of effort and research in addition to high cost to purchase low toxin, pesticide and antibiotic exposed food sources.  Some of my average American families (especially the Dad's) will be saying "I grew up eating meat and potatoes with scrambled eggs every morning and look at me-I feel great and dont need to see a doctor or take medicine".  Truth is some people are lucky but most Americans are overweight (33.9% as of 2008), more Americans kids are on ADHD medicines than ever before, 25% of all deaths are due to heart attack even with all the sophisticated surgeries, medicines, hospitals you see advertised on TV, and following heart disease, the second highest cause of death in the US is cancer.  Anyway, doing as much at the younger years as possible for your children will probably keep them out of the "statistics" of an average American. 

Here is the other end of the bell shaped curve.  She was using tea tree oils for the wounds (helps with healing but can sting the hellll! out of the fresh abrasion) and it smells funny to kids.  Was using colloidal silver oral drops for speeding up white blood cell response (good suggestion but dosing in kids can be challenging and there have been cases with chronic use causing a permanent blue color to the skin (I took care of a man that did colloidal silver for years and yes he looked like Papa Smurf).  And she had read about homeopathic pellets, asked the herbal store clerk (who was well versed with pellets) and was giving her daughter 5 pellets of 30C Arnica Montana daily in addition to another.    The concept of Homeopathy is an old science that dates back about as far in the Hippocrates if you ask the Homeopaths but was officially practiced from the 17-1800's.  3 Principles of
1. Similarity (like cures like)
2. Process of Individualizing Therapy
3. Lowest Dose Necessary
Some of my collegues will say if the pellet contains only a parts per million fraction of a 'toxin'....how can if cure an illness.  Most people (doctor or layman) will usually fear or hate what they dont understand.  There have been meta-analysis back and forth in the medical communities across the globe on if Homeopathy is better than placebo from 1997 up to recent Swiss study in 2005.  Problem is results will be OFF when you study applying a standard sample of technique that is meant to be individualized.  This same problem came up with modern medicine "studying" the effects of traditional acupuncture for "western diagnoses" like high blood pressure.  Acupuncture (like homeopathy) is a "whole system" approach of healing.  It doesnt just look at a constellation of symptoms labeled under an ICD9 Diagnosis.  The ancient healing arts look at the individual, paying attention to the functioning, thinking, emotionality of the patient.  (Personally I disagree with the studies that said acupuncture is equal to placebo in treating disease)  Regarding homeopathy, I have seen great things with the Naturopathic doctor in my office reversing complex symptomatology in patients I was having so much trouble controlling.  (Most recent was a college age student with ulcerative colitis stuck on steroids that were worsening his ADHD/Anxiety; which in turn worsened his ulcerative colitis prompting is GI specialist to consider a "fecal transplant" from an unknown donor to reinhabit the kids colon......yes, in laymans terms...placing someones poop in your butt....ewwew!) Sorry I detracted, bottom line is the average intake questionaire a homeopath goes through to choose the correct medication/pellet is 8 pages long.   I learned from one of my Infectious Disease Integrative Collegues who is also a practicing homeopath-it can be very dangerous to "pick and choose" from the pellet display at Whole Foods Market for reversing disease.  It can be deadly to apply the same principals to a child. 

My patient's mom had all good intentions and I praise her for it.  The learning point is please consider seeing a practicing homeopathic doctor before just loading up on those sweet tasting tiny pellets to heal (could be considered candy as well so keep out of kid reach).  30C several times a day for an adult could be good or bad. 

-200C needs expert advise
-Kid dosing needs expert advise
-Using chinese herbs or multiple supplements or prescription medicine in addition to pellets needs expert advise

a Link to find expert advise;
 http://homeopathyusa.org/specialty-board.html
 http://www.hanp.net/
 http://www.homeopathy.org/

I advised my patient's mom she was right on with inention and offered a few changes:
-stop the pellets until seeing Dr Green (the naturopath in our office)
-instead of the pellet/tea tree combo, switch to the topical cream of Traumeel (lower dose homeopathic content with a cooling effect if placed in the fridge) at lunch for 10 days
-switch the oral colloidal silver to topical Silvadene Cream (also placed in the fridge for cooling effect)- well tolerated for burn victims of all ages and covered by insurance twice a day for 10 days
-continue to avoid dairy and gluten
-tylenol for pain before showering to reduce the burning sensation
-lavendar drops on her pillow to relax and induce sleep
-guided imagery (story telling) at night to help sleep http://triblocal.com/oak-park-river-forest/community/stories/2010/02/just-me-and-the-trees-new-childrens-book-introduces-families-and-classrooms-to-breathing-and-meditation-techniques/
-consider seeing a kid friendly counselor if the "nightmares" continued after 3 weeks

 

The Anti-inflammatory Diet

I guess this is a catchy phrase. In the last 3 lectures, whenever I open for Q & A afterward, people always ask for the info. I will always redirect to Healthy Aging by Andrew Weil. The concept is very healthy eating and once you read through I think the average person thinks ......ok, it's just a list of everything healthy.

http://www.drweil.com/drw/u/ART02012/anti-inflammatory-diet

The exerpt from the book is far more informative. Some people just need a list to post as a constant reminder. The food pyramid is a little more user friendly than it has been in the past but still doesn't have a wow factor. Some folks are probably looking for a new diet to follow also.

Most medical studies are centering on the role of inflammation in many diseases. Obviously in acute inflammation/injury but now in arthritis, heart disease, diabetes, bowel problems and even cancer. I have heard that people attending my conferences are trying to watch food intake but the economy is hitting hard. My beloved Whole Foods is a great store but leaving with half a bag full of stuff will usually run me the same price for a week of family eating at Jewel (a popular grocery chain in Illinois).

I am visioning a step wise approach to changing a diet will be with stuffing one's self with fruits and veggies. As is suggested by many a dietician, 5-7 f and v's per day is a basic. In my diet, getting 5 in daily will usually take up the volume in my stomach that would have been taken up by something else I would have been eating previously (fast food). Or the converse is true, the 5 would be filling up a stomach that would have been growling at 10-11am or 4-5pm for lack of anything being eaten. In 1999-2000, my medical practice was booming and my fund of knowledge was huge. My health was also the worst of my life. I remember often "powering" through lunch and dinner without eating and justifying that action as "at least I won't gain weight". I paid for those years with psychological scars I will never forget,(I still carry a wrist band from being admitted once to the hospital).

My wife made my daughters favorite spagetti dinner and I said, Oh No....I won't be able to stop so I shouldn't start. She said, why do I suffer so much. My reply was that I suffer more from the bloating, slowed bowel, and lethargy than I do from the act of starving. She often calls me OCD since I like to maintain eating small portions of fruits and veggies up to 4-5 times daily to keep the stomach full and stop the hunting for a dopamine rush with something carb loaded. I also rely on a small salad before eating a tasty dish just like the Italian restaurant does to postpone hunger.

So ultimately, the Saguil Approach is "stuffing down" 5-7 fruits or veggies per day will usually "push" out the space that would have been taken up by something else in the daily diet. The 5-7 "fillers" will also supply foods that are low glycemic index (keeping the stable and not crashing after food intake), high in fiber and easy on the bowel. A smooth working bowel will translate to proper absorption of nutrient, supplement and not to mention, secreation of serotonin, the hormone use to treat depression.....(another reason for carb hunting). Fluid plays a great role as well but thats for a later blog. Once a patient realized how good life is without bowel problems, and sleep is improved and workouts are more intense/rewarding, the process steamrolls and more aspects of the "Weil Antiinflammatory Diet" can be followed (without guilt)

Vitamin D3 (from the herbal411 library post)

It was a toss up betwen omega 3 fish oil and Vitamin D3. Because of some of the chronic pain flare ups I have seen in the clinic over the last few weeks, Vitamin D won. Well documented is the lack of ultraviolet stimulation to human skin to any state north of Georgia. Due to the angle the sun's rays hit during winter months, the amount of sun rays that get through is low. It takes 20-30 minutes during summer months from 10-2pm to create up to 10,000IU. That would be about 50 glasses of milk or 20 standard vitamins daily! I suggest taking a blood test first for 25 hydroxvitamin D, supplementing 5000IU daily and retesting in 3 months. With critically low levels less than 10, 50,000IU IV to load then 5000 daily. I frequently use 4000 daily of D3 in my "influenza cocktail" while working the ER. (astragalus, elderberry, mushroom extract throat spray and D3 twice a day for 3-4 days post exposure). There are very limited sources of data that show toxicity with vitamin d, and multiple new sources of literature with benefits of supplements. Many patients have felt improvement with supplementation in 4 weeks. Once levels are restored with pills, food and sunshine should be utlized to maintain a healthy state. Cod Liver Oil, Sockeye Salmon, Tuna, Sardines, Milk, Egg, Dairy Fortified, Mackerel, Yogurt, OJ are a few to consider. Use food as medicine!

A pulled hammy (torn hamstring muscle)

No one is bulletproof when it comes to injury or illness. As posted in my "Adventures", Thich Naht Hanh came up with The Five Rememberances:

1 I am of the nature to grow old. There is no way to escape growing old.
2 I am of the nature to have ill health. There is no way to escape having ill health.
3 I am of the nature to die. There is no way to escape death.
4 All that is dear to me and everyone I love are of the nature to change. There is no way to escape being separated from them.
5 My actions are my only true belongings. I cannot escape the consequences of my actions. My actions are the ground on which I stand.

A near and dear yogi, was taking the time to teach students a difficult pose and "pop", an audible tear from about 40 feet occurred. Seemed to be the area of an old injury so hopefully it was just scar tissue. (If a long muscle is torn off its bony insertion, the long end may reattach close to where is came off but theres always a little piece of where it originated from that still remains tight and stuck on fibrous tissue-its useless and can pop but wont affect walking). So the reason for this discussion is to mention my "go to" supplements to aid in a speedy muscular injury repair.

First control the injured area from further damage. No further stretches, runs, jumps. I like ice to the area to decrease blood flow and halt the "seeping" of further lymph and blood to the area of inflammation. Black and blue marks will usually track down the back of leg with gravity in 2-3 days since it bleeds deep at the sit bones and works its way to the surface skin later. I have seen it go black and blue from the buttock to the back of the knee but without pain or discomfort to any place but the hamstring insert. We luckily had a massage therapist who also did Thai Massage and he helped with cutting the spasm back from the muscle. As a muscle tears, the body of the fiber will start to spasm, contract-like a rubber band that has been stretched then cut-the ends flail apart. So the idea is to try and gently relax the spasming muscle and more importantly for the first few nights-keeping the muscle lengthened so you dont wake up after 6-8 hours and the back of the thigh is 2 inches shorter. Ice is therapeutic for about 10-15 minutes only. After that time, the skin can get frostbite and the blood vessels you were trying to choke off will soon spasm and open up to cause more products of inflammation to enter the area. So keep the cold packs on for 10 minutes at the top of every hour for 48 hours. (as best as you can maintain). Lightly massage or gently stretch the muscle body-this would be the other end of the muscle that wasnt in the "tear zone". Alot of the pain comes from the muscle bulk spasming up and shortening. You can actually apply heat or warmth to this part in a hamstring since it is so long. Placing heat to the site of inflammation will cause the blood vessels to open and a flood of more swelling will result.

After the ice, wipe off and get the topicals on. I like essential oils like TEA TREE, HELICRYSIUM, MARJORAM (I used "PANAWAY" by Young Living to get me through the Chi-town Marathon every few miles), I also like TRAUMEEL by Heel- its a German homeopathic oinment that contains many things, one of the most active ingredients is ARNICA. At UCLA Acupuncture they teach us to apply this to the upper back before Gua Sha (skin scraping) to avoid black and blue formation. Great thing is you cant overdose on the topicals....traditional chinese medicine says you can also apply plant essence oils to the opposite extremity in the same approximate area as the injured leg to effect healing. (It has to do with unblocking the matching meridia/energy channel on the opposite extremity to get the body to heal it faster)

And this beings me to external modalities. Hands on-massage and the healing touch of MASSAGE THERAPY, CHIROPRACTIC or REIKI in some cases will help the body pay more attention to the area of inury. (more white blood cells, more proper nutrients, more organized repair/less inflammation). ACUPUNCTURE can help with cutting down muscle spasm to the injured muscle, help the energy meridia start flowing like prior to injury, also release endorphins to help with the sensation of pain. I have also read of MARMA therapy from ancient India (southern?) Finger or hand pressure to special areas on the body that move energy through "nadi's" or the Indian equivalent to meridias in China. (I have to get Vasant Lad to teach me this once I get some of my more immediate schooling out of the way). Modern day physical therapists can also help with deep tissue massage, transverse friction rubbing, ultrasound, infra red heat or ionotophoresis the application of steroid gel through the skin using elecricity. I like TENS units but seems when I write for these to be given by the therapist, always very difficult to attain. (Transcutaneous Electrical Nerve Stimulation-kinda what I do with needles and electricity but tens is just with sticky pads on the skin)-these are great because they can be applied through the whole night so the muscle doesnt shorten and make for a very difficult pogostick walk/hop to the bathroom in the dark. Physical therapy can also help to rehab 2-3 times a week in order to return to sports performance(and work) faster.

Then comes the oral supplements. First off all my athletes are told for 2 weeks. the "ANTIINFLMMATORY DIET" is a must. Andy Weil has this summarized on his website and he even had put together his own food pyramid to show how someone with chronic diease should be eating not just for 2 weeks but forever. (www.drweil.com) When the body is given foods that heal instead of foods that cause inflammation, white blood cells destroy damaged tissue faster, collagen gets placed by fibroblasts to form a matrix/scaffolding to heal the wound quicker, and muscle fibers reattach in an orderly fashion to make for stronger tissue patches instead of just fibrous/scar tissue. Fill up with water as often as possible. Low glycemic foods to treat the white blood cells better and not cause insulin spikes throughout the day- they essentially screw up healing not to mention that after meal sedation/sleepiness that comes on from eating. (www.glycemicindex.com) And my favorite: TURMERIC. This is a fantastic vegetable mostly used by India for food. I have also seen some older patients with sprains and strains coming in with orange powder around the injured joint as a paste. There are studies being performed on high dose turmeric for the ultimate inflammation-cancer. I am hoping to see these released soon. I have found and used NEW CHAPTER (www.newchapter.com/products/turmericforce) and GAIA (www.gaiaherbs.com/products/detail/83/Turmeric-Supreme) brands and usually I take 1 capsule 4 times a day for about 10-14 days with food. Recommended dose is 1 daily. (about 300 to 400 mg of extract) VITAMIN D3 at 2000IU twice a day (www.naturessunshine.com/us/product/vitamin-d3-60-tabs/sku-1155.aspx) for about 10-14 days is my other mandatory go to supplement with new injury. Even if it is summer and you are outside sunning, any city north of Georgia doesn't get enought sunlight (in my opinion) to convert a daily required amount of D. And finally OMEGA 3 FISH OIL at 2000mg daily (www.naturessunshine.com/us/product/super-omega-3-epa-60-softgel-caps/sku-1515.aspx)

So ultimately, we all will go through an injury, it is inevitable. The people who are already healthy when it happens will go through it faster! The folks arent healthy (and havent taken yoga) will go through the injury slower and probably develop another muscle injury from the over-compensation. My yoga instructor had already started to heal just with the THAI MASSAGE, so she is on her way to recovery in the next 10 days or sooner-(especially if we send healing INTENTIONS her way!)

This is not meant for medical advise so please seek out a primary care doctor who is trained in sports medicine, certified in medical acupuncture, studies with Andrew Weil and teaches yoga if you want to heal up fast.

Take this vitamin or you'll go blind

I love my daughter but boy is it challenging to get her to take a vitamin regularly. I started early with my son and introduced chewables early. Or it could be that formulations are better? I have found "Herbasaurs" by Natures Sunshine and "FloraBear" by Renew Life as a good or should I say "tolerable" daily. The former is the vitamin and the latter is the probiotic. Due to my son's asthma, I have had to retreat to antibiotics several times and his intestinal flora is probably shot. The great thing is that this guy loves fruit and veggies (thank you Lord!) My daughter on the other-hand is a typical teenager with an appetite for the poor carbs found in drive through windows. Have tried several types of multivits with little to no success until recently! New Chapter was the first herbal company I started buying at Whole Foods. I think I stumbled on Zyflammend for a trapezius muscle issue and it opened the herbal world to me. Of course my friendly herbalists Wendy and Jennifer in Clermont Florida taught me the "way of the Herb".

http://www.clermontherbshop.com/

Although I am a big supporter of Natures Sunshine for supplement products, I stumbled on a bottle from New Chapter called Tiny Tabs Multi. Six of these smaller than tictac size tablets is required daily. We are finding that due to the small size, when the palmed tabs are "thrown back", one usually escapes due to it's microscopic size. But at least she really likes them since they are so "cute". Big problem with both kids is the lack of calcium. I will tackle that battle at a later campaign.

Of course the old go to will be Flintstones, Bugs Bunny or someother generic chewable but I just don't trust these companies....maybe since I can't find any great information on them. I don't remember taking any vitamins when I was a kid. (But I also remember frying eggs and spam in a pan soaked with cooking LARD from a big nasty can under the sink....oh, just thinking of those days gives me chest pain!) I believe parents should set examples and teach ritual. Eating right and consuming 5-7 fruits and veggies daily outdoes any multivitamin routine but what child will do that when the parent is eating a donut, having coffee and taking pepsid for morning heartburn. I will never forget my college age nephew lookin his parents in the eye and very arogantly stating....."I am NOT, waking up early just to eat breakfast". I just shook my head and proceeded to "pants" him.