RNC – Health Page

Editor’s Note: This article is a reprint. It was originally published August 30, 2017. For most people, an occasional bout of constipation is a minor aggravation. However, this is not the case for the nearly 12% to 19% of the U.S. population suffering from chronic constipation.1 This means 63 million people have difficulty passing hard, dry, lumpy stool, suffer from feeling bloated, have abdominal pain or feel as if there is something stuck in their rectum or intestines.2 For many, the topic of their bowel movements is a private matter. This makes understanding and learning about the actual mechanics of how stool is produced and eliminated difficult, as many don’t find it a topic they want to discuss, even with their physicians. The number of stools you have each week is closely linked to the types of food you eat, the amount of exercise you get and your hydration status. While many people may have a bowel movement once a day, the normal amount ranges between four times each week to several times a day.3 What differentiates infrequent stools and constipation is the consistency of the stool, the difficulty in passing it and other symptoms you may experience, such as bloating or feeling full. Unfortunately, the number of people who suffer from chronic constipation is rising, leading to a characterization of the condition as a “silent epidemic” as those who suffer often suffer in silence. Number of People Suffering From Chronic Constipation on the Rise A 2013 survey by the American Gastroenterological Association4 found 16% of Americans suffer from chronic constipation and nearly 33.5% over age 60 experience the condition. This leads to millions of visits to the doctor’s office or clinic, and nearly 700,000 visits to an emergency room every year.5 Although the condition is normally treated on an outpatient basis, the number of people admitted to the hospital since 1997 has doubled. One study estimated that if the 6% of Americans suffering from functional constipation incorporated natural lifestyle changes to improve their condition, $12.7 billion in direct medical costs could be avoided annually.6 The researchers felt this was a conservative estimate as it did not account for lost wages or productivity. While the survey found an increasing number of people suffered from chronic constipation, it was not a study that evaluated the causes behind the problem. There are several controllable factors common to a modern lifestyle that contribute to an increasing risk, and factors over which you have no control. For instance, the number of people who suffer from constipation rises significantly with age.7 This may be related to both lifestyle choices, such as diet and exercise, and to age-related neurogenic dysfunction.8 There are a significant number of choices you make each day that increase your risk of developing chronic constipation. One is learned constipation, as your rectum is flexible and can stretch. In a study using college students, researchers found participants could easily train themselves to evacuate their bowels every 51 hours instead of every 28, leading the scientists to conclude bowel habits may induce constipation.9 Other factors that influence your risk include:10,11,12,13 Low-fiber diet Changes in your routine Lack of exercise Avoiding a bowel movement when you have the urge Drinking insufficient amount of fluid Certain medications, such as opiates, antidepressants, antacids and anti-hypertensives Frequent use of laxatives or enemas Poor nutrition leading to vitamin deficiency, including magnesium deficiency Iron supplements Significant Health Problems Linked to Chronic Constipation Few people realize that chronic constipation, and the daily agony that accompanies the condition, may be dangerous or even deadly. The American College of Gastroenterology believes a diagnosis of chronic constipation warrants further medical workup, as patients may have a higher likelihood of colon cancer, even if they don’t present with colon cancer symptoms, such as GI bleeding, anemia or weight loss.14 When the scientists started the study, they didn’t expect too many surprises. Yet, after analyzing the results they found medical conditions they didn’t anticipate would be associated with chronic constipation, including ischemic colitis, diverticulitis and other gastrointestinal cancers. Chronic constipation is also related to at least one brain disorder: Parkinson’s disease. A number of studies have demonstrated a link between your gut health and your psychological health. A link between an unbalanced microbiome (one symptom of which is constipation) and Parkinson’s disease may be related to proteins from the gut that accumulate in the brain. In one study, 21 days after specific proteins were injected into the stomach and intestines of mice they were found to have migrated as far as the vagus nerve.15 Constipation may also increase your risk of kidney diseases.16 Researchers reviewed medical records of over 3.5 million U.S. veterans and followed their care for seven years. At the start of the study each participant had normal kidney function. Although a causative relationship could not be proven with the method used in the study, those with constipation had a 13% increased risk of kidney disease and 9% increased risk of kidney failure. Researchers have also found suffering from constipation may increase your risk of anal fissures, stool incontinence, hemorrhoids and urological disorders.17 The seriousness of the symptoms may vary, depending upon the severity of your constipation. An association has also been found between people suffering rectal prolapse, a condition where part of the large intestines slips out of the anus, and constipation. Another factor connected with constipation is back pain.18 In some cases, back pain may result in the use of pain medications like opiates that slow your intestinal tract and lead to constipation. In other cases, back pain is the result of your constipation. For instance, irritable bowel syndrome or a fecal impaction may lead to back pain. Steer Clear of Laxatives Constipation is a symptom of other conditions and not a disease or illness process itself. Thus, treating just the symptom may mean you’re overlooking another more serious problem. Many people turn to over-the-counter laxatives to immediately relieve the discomfort, but this may have additional consequences that hinder your recovery. Laxatives come in a variety of forms including pills, capsules, liquid, suppositories and enemas. Although tempting, if you choose to use a laxative, do it with extreme caution. The active ingredient in many enemas draw water from your body into your large intestines, softening the stool. When too much is used it can increase your risk of dehydration, and by altering your electrolyte balance, you risk kidney or heart damage and death. Stimulant laxatives work by increasing the muscular action in your intestines. This includes senna or cassia laxatives, often marketed as being “natural.” Over time, these types of laxatives damage the function of your intestinal walls and decrease the ability of your muscles to contract on their own. If you must use something to immediately relieve constipation, consider trying a glycerin suppository that doesn’t contain any stimulants. The suppository often produces results within two hours and works by drawing water into your large intestines directly where your hard stool is located, softening it enough to evacuate your bowels. Magnesium May Help Constipation and Protect Against Disease One of the most popular short-term natural supplements that is effective against constipation is magnesium. Magnesium is an essential mineral and a cofactor used in multiple enzymes.19 A deficiency is associated with poor absorption of vitamin D and an increased risk of heart disease, stroke, osteoporosis and diabetes. Supplementation is being used to treat migraine headaches, hypertension and asthma. Magnesium is important to mitochondrial health, and in the production of energy in every cell in your body. It is estimated that 50 years ago people routinely received nearly 500 milligrams (mg) of magnesium every day from their food. Today, with soil depletion and poor nutritional habits, many may only receive from 100 mg to 300 mg per day. Although organic, unprocessed foods are your best bet; the amount you receive will depend upon the soil the plants were grown in. The recommended dietary allowance (RDA) for magnesium is between 310 and 420 mg per day, dependent upon your age and sex.20 However, these amounts are based on reducing your potential for deficiency and don’t necessarily address the amount you need to maintain optimal health. Some researchers believe you may need between 600 and 900 mg per day. Dr. Carolyn Dean, author of “The Magnesium Miracle,” recommends that you use your body as a marker for your ideal personal dose. Begin by taking 200 mg of oral magnesium citrate each day and gradually increase the amount until you develop slightly loose stools. Magnesium citrate has a mild laxative effect — whatever your body doesn’t absorb will affect your intestines as it is flushed out through your stool, which helps you identify your personal cutoff point. There is ample evidence demonstrating the effectiveness of using magnesium to naturally improve constipation.21,22,23 Magnesium comes in several forms including chelate, threonate, citrate and sulfate. Citrate is the form that has the most effect on your intestinal tract and helps produce loose stools. However, if you are taking magnesium supplements for other health reasons, my personal preference is magnesium threonate as it appears to more effectively penetrate your cell membranes and boost your mitochondrial health, thus boosting your energy level. Try Squatting to Enhance Elimination Sitting on your toilet may be comfortable, but placement of your knees and upper legs at 90 degrees to your abdomen actually pinches off your anal canal and makes having a bowel movement more difficult. On the other hand, when you squat, your knees are brought closer to your abdomen, which changes the relationship of your rectum and sphincter, positioning your organs and muscles in a way that relaxes your rectum. This maximizes the efficiency of your evacuation. In this position, muscles around your rectum and pubic bones relax. This encourages complete emptying of your rectum and cecum without straining. It also reduces the potential for stagnation of stool in your lower intestines and subsequent accumulation of toxins that impact the growth of your gut microbiome. In many non-Westernized cultures people routinely squat to evacuate their bowels and don’t sit on a toilet. It is interesting to note that in cultures where people squat daily, people don’t have the high prevalence of bowel diseases experienced in countries where toilets are commonplace. Squatting without support is challenging when you haven’t grown up squatting on a daily basis. A simple and inexpensive method of achieving good body position is to use a small foot stool. This places your organs and muscles in a more natural position and enables easier evacuation. Fiber, Movement and Other Natural Ways of Reducing Constipation I list several ways of reducing your risk of constipation below. But, I strongly recommend you incorporate fermented foods to help “reseed” your gut with good bacteria that will help you regain and maintain bowel regularity. The video above includes a short demonstration of how to make your own fermented foods at home. In some circumstances these lifestyle choices are not enough to eliminate your constipation. As chronic constipation is one of the hallmark symptoms of hypothyroidism, it is important to discuss your situation with your physician. In many cases though, simple changes to your diet and daily lifestyle will reduce your risk of constipation and improve your gut health, such as: Swap out processed foods for whole, high-fiber foods, such as leafy green vegetables, squash and broccoli. These foods feed your gut microbiome, reduce your vulnerability to infection and promote softer stools that keep your intestinal walls intact.24 The American Heart Association recommends eating 30 grams of fiber each day,25 but the average American eats approximately 15 grams each day, which contributes to the growing rate of constipation.26 Remove gluten, artificial sweetener and sugar from your diet as they all damage your intestinal tract. Regular exercise can also help reduce constipation.27 The physical movement helps increase the motility in your digestive tract and can stimulate the urge to have a bowel movement. When you feel the urge to have a bowel movement, don’t wait. The longer the stool sits in your colon, the more water is removed and the more difficult it is to pass. Consider using a foot stool to get into a squatting position to have a bowel movement. This will strengthen the muscles around your rectum and encourages a complete emptying of your bowel without straining. Stay well hydrated with clean, pure water. Avoid pharmaceutical drugs that change the speed of your bowel function or cause GI disruptions, such as opiate pain medications, antidepressants, antibiotics, antacids and laxatives. Address your emotional challenges and life changes using tools, such as Emotional Freedom Techniques (EFT).

Fermented foods like sauerkraut and kimchi are powerful allies to your mental health, courtesy of the neuroactive microbes and molecules they contain.1 Microbes and their metabolites, created during fermentation modulate the microbiota-gut-brain axis, which involves neural, immune, endocrine and metabolic pathways.2 Writing in Neuroscience & Biobehavioral Reviews, researchers with University College Cork (UCC) in Ireland and colleagues reasoned that fermented foods “offer an affordable dietary intervention strategy” for better mental health.3 Their review highlights how different types of fermented food not only have the potential to alter the makeup of microbiota in your gut but also influence the immune system and microbiota-gut-brain axis, with profound effects on your brain. Fermentation — An Ancient Tool Valued for Modern-Day Mental Health Many cultures around the world have relied on food fermentation since ancient times to increase the shelf-life of food. Fermentation also makes food more flavorful while helping to control potentially disease-causing microorganisms and improving foods’ digestibility.4 The process involves the conversion of carbohydrates into alcohol or organic acids using microorganisms like yeasts and bacteria under anaerobic conditions. This leads to the production of beneficial compounds now known to boost physical and mental health. “Although ancient in origin, fermented foods are now seen as conduits for introducing beneficial microbes and molecules. Moreover, fermented foods are applicable therapeutics across various socioeconomic sectors given their potential affordability and cross-cultural accessibility,” the review explained.5 Fermented foods are rich in phytochemicals and microbe metabolites that include neurotransmitters and neuromodulators. These compounds stimulate pathways of the microbiota-gut-brain axis, including those of the immune system and neuroendocrine, enteric nervous and circulatory systems. When fermented foods are digested, they also produce compounds capable of modulating intestinal barrier and blood brain barrier permeability.6 Fermented foods may also help block dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, the system responsible for the management of stress, which has also been linked to multiple neuropsychiatric disorders.7 Researchers with APC Microbiome Ireland at UCC previously investigated the influence of a psychobiotic diet on the microbial profile and mental health of 45 adults.8 Participants were randomized to eat either a psychobiotic diet or a control diet for four weeks. The psychobiotic diet included fruits and vegetables high in prebiotic fiber, including onions, leeks, cabbage, apples and bananas, along with fermented foods, such as sauerkraut and kefir.9 After four weeks, those following the psychobiotic diet had a reduction in perceived stress. Those who followed the psychobiotic diet the most had the greatest decreases in stress. Further, significant changes were found in 40 different chemicals, along with subtle changes in microbial makeup. Professor John Cryan, one of the study’s lead authors who also worked on the featured Neuroscience & Biobehavioral Reviews paper, said in a UCC news release:10 “Although the microbiome has been linked to stress and behavior previously, it was unclear if by feeding these microbes demonstratable effects could be seen. Our study provides one of the first data in the interaction between diet, microbiota and feelings of stress and mood. Using microbiota targeted diets to positively modulate gut-brain communication holds possibilities for the reduction of stress and stress-associated disorders, but additional research is warranted to investigate underlying mechanisms.” Virtually Any Fermented Food May Improve Brain Health In the early stages of the research, study author Ramya Balasubramanian and colleagues compared sequencing data from more than 200 fermented foods in an effort to determine which are most beneficial for the brain. Nearly all of them showed promise, according to Balasubramanian, who said in a news release:11 “I expected only a few fermented foods would show up, but out of 200 fermented foods, almost all of them showed the ability to exert some sort of potential to improve gut and brain health … Fermented sugar-based products and fermented vegetable-based products are like winning the lottery when it comes to gut and brain health. … For all that we see on sugar-based products being demonized, fermented sugar takes the raw sugar substrate, and it converts it into a plethora of metabolites that can have a beneficial effect on the host. So even though it has the name ‘sugar’ in it, if you do a final metabolomic screen, the sugar gets used by the microbial community that’s present in the food, and they get converted into these beautiful metabolites that are ready to be cherry picked by us for further studies.” The Neuroscience & Biobehavioral Reviews paper outlined a wide range of fermented foods that may be beneficial. Among them:12 Sauerkraut Kvass Kimchi Kefir Yogurt Cheese Koumiss Airag Bonito flakes Sourdough Vinegar Tempeh Natto Miso Kefir water Kombucha Both food substrate and environmental conditions alter the fermented food microbiome and therefore its potential health effects. According to the review:13 “Fermented foods are diverse in their preparation, substrate category and type of fermentation. This can influence the microbiota and the molecular composition of fermented foods. Subsequently, these components can influence the communication between the gut and the brain resulting in modulation of the intestinal barrier and blood brain barrier, peripheral and central immune system and nervous system and thereby modulating the intestinal milieu, general gut and brain health.” Fermented Foods Help Ward Off Depression Lactobacillus, found in fermented foods like yogurt, kefir, kimchi and sauerkraut, has been dubbed a “psychobiotic”14 because of its effects on mental health, particularly anxiety and depression. Lactobacillus bacteria help dampen stress responses and prevent depression and anxiety, in part, by modulating your immune system.15 Further, a healthy gut microbiome also depends on the consumption of fermented foods. A study assigned 36 adults to consume a diet high in fermented foods or high-fiber foods for 10 weeks. Those consuming fermented foods had an increase in microbiome diversity as well as decreases in markers of inflammation.16 In another example, Lactobacillus was found to produce gamma aminobutyric acid (GABA), a neurotransmitter that inhibits excessive neuronal firing, helping to induce a natural state of calm,17 in animal studies,18 while also reducing depression-related behavior.19 A meta-analysis of cohort studies, involving 83,533 people, also found a significant association between consuming fermented dairy foods, including cheese and yogurt, and a decreased risk of depression.20 The study suggested the gut-brain axis may explain the link between fermented dairy foods and depression, as probiotic-rich fermented foods may help:21 Lower inflammation in the gut Make the gut barrier stronger Reduce stress responses via the HPA axis Alter GABA receptor expression One study using brain scans found that consuming fermented milk containing a variety of probiotics can lessen brain activity related to seeing sad or angry faces. Another study found that women who took probiotics had lower depression scores.22 Fermented Foods May Help Preserve Mental Health Dietary interventions based on so-called “psychobiotics” were described as a “novel nutritional approach targeting gut microbiota for managing cognitive performance and preventing memory decline across the lifespan.”23 The review, published in Food Research International, suggests that fermented foods may help preserve mental health. Further, feeding your microbes with a psychobiotic diet — one that’s rich in prebiotic and fermented foods — can also reduce stress and possibly stress-related disorders. The study authors stressed the benefits of using whole, fermented foods:24 “Although the more traditional psychobiotic candidates, such as probiotic and prebiotic supplementation, are promising approaches, using whole dietary approaches offers a number of advantages. This includes the benefits associated with nutritional needs met primarily through whole diet, a more accessible way due to the necessity to consume a food daily, costs of supplemental products as well as the potential synergistic effects in the microbiota that could be elicited by complex diets.” Interestingly, they also found that tryptophan metabolism may be one underlying mechanism behind fermented foods’ stress-relieving effects. “Tryptophan metabolism has been shown to be closely regulated by the microbiota and can serve as important bioactive messengers in the microbiota-brain communication,” the researchers explained, adding that it’s also involved in many brain-related disorders.25 How to Make Fermented Foods at Home Given the numerous mental health benefits of fermented foods, if you haven’t yet incorporated them into your diet, now is an excellent time to start. Fermented vegetables are both simple and cost-effective to prepare at home. While you can find fermented foods at supermarkets and health food stores, many commercial options, such as yogurt and kefir, are not healthy. Many of these products contain high levels of sugar, artificial sweeteners and additives, with a relatively low content of beneficial bacteria. The pasteurization process used in commercial products to extend their shelf life actually destroys the beneficial bacteria they’re supposed to contain. To reap the maximum health benefits, either purchase raw (unpasteurized) versions of these foods at a health food store or food co-op, or make them yourself. Consuming a diverse range of fermented foods is beneficial, as each offers a unique set of beneficial bacteria. Fortunately, making fermented foods at home is simpler than it might seem. It doesn’t require extensive time in the kitchen. Start by getting some wide-mouth canning jars and filtered water, along with select organic vegetables of your choice for fermenting. After packing your jars, the only step left is to wait a few days for the vegetables to ferment, or “ripen.” You can view a step-by-step guide in the video above. As demonstrated, you’ll see that culturing vegetables is simple and cost-effective. You can also make your own homemade yogurt and kefir. If you don’t eat fermented foods on a regular basis, a probiotic supplement shouldn’t be considered a replacement for whole, fermented foods.

Optimizing your vitamin D levels may be a simple way to relieve painful menstruation, or dysmenorrhea, according to research published in the journal Nutrients.1 Vitamin D shows promise as it reduces both inflammation and prostaglandin levels2 — elevated prostaglandin levels may lead to more intense contractions of uterine muscles, a key contributor to menstrual pain. While addressing other factors, like progesterone, is also important for menstrual pain relief, knowing your vitamin D level, and increasing it if necessary, is a straightforward intervention to be aware of. Vitamin D Supplementation Relieved Painful Menstrual Cramps To explore whether vitamin D can decrease pain in women with dysmenorrhea, researchers conducted a comprehensive review of existing studies, including randomized controlled trials up to December 30, 2023. The studies focused on the effects of vitamin D supplementation on pain intensity and the need for additional pain relief. Overall, 11 studies involving 687 participants were analyzed. The results revealed a significant reduction in pain intensity among those receiving vitamin D compared to controls. Further analysis showed that vitamin D supplementation effectively reduced pain associated with primary dysmenorrhea but had no significant effect on secondary dysmenorrhea. Primary dysmenorrhea is a common form of menstrual pain that’s directly related to the menstrual cycle. Secondary dysmenorrhea refers to menstrual pain caused by an underlying reproductive system disorder, such as endometriosis, fibroids, adenomyosis, pelvic inflammatory disease or cervical stenosis. Separate research found, however, that vitamin D supplementation was useful for reducing endometriosis-related dysmenorrhea as well.3 “In the pooled analyses,” the researchers wrote, “we found that vitamin D supplementation significantly decreased the pain intensity of dysmenorrhea, and the cumulative power supports a ‘true’ treatment response.”4 A subgroup analysis also revealed that vitamin D supplementation reduced pain intensity in those with vitamin D deficiency. As for how vitamin D works to relieve painful menstruation, the researchers explained that vitamin D receptors are present in various reproductive organs, including the ovaries, uterus, placenta and pituitary gland, suggesting that vitamin D plays a significant role in reproductive health.5 Research indicates that vitamin D interacts with these receptors to suppress the expression of markers induced by inflammation and factors associated with uterine contraction in the smooth muscle cells of the uterus. Interestingly, a reduction in vitamin D levels has been noted during the luteal phase of the menstrual cycle.6 This decrease may lead to an increase in inflammatory cytokines and prostaglandins, thereby intensifying the pain associated with dysmenorrhea. “Overall, through these mechanisms, vitamin D supplementation offers positive benefits in alleviating the pain severity of dysmenorrhea,” the scientists explained.7 Vitamin D Relieves Menstrual Pain in Adolescents It’s estimated that 45% to 95% of women8 — and 80% of adolescents9 — suffer from dysmenorrhea. Painful menstrual cramps, which can occur in the lower abdomen or back during menstruation, are among the most common gynecological complaints among women and can significantly affect quality of life, including disrupting sleep and mood. It’s also a common reason for missing school and work and brings with it a steep economic burden, costing $200 billion annually in the U.S.10 Nonsteroidal anti-inflammatory drugs (NSAIDs), which inhibit prostaglandin synthesis, are often prescribed to treat menstrual pain, but they increase the risk of gastric ulcers and gastrointestinal bleeding. Oral contraceptives may also be prescribed for treatment, despite little evidence that they’re effective for dysmenorrhea. Further, 50% of women stop using oral contraceptives for menstrual pain due to side effects,11 making vitamin D an attractive alternative. A systematic review revealed that abnormal low vitamin D levels increased the severity of primary dysmenorrhea, while vitamin D and calcium supplements reduced the severity and decreased the need for pain-relievers.12 It’s important to remember that calcium, vitamin D3, magnesium and vitamin K2 must be properly balanced for optimal overall health. Your best and safest bet is to simply eat more calcium-, magnesium- and vitamin K2-rich foods, along with sensible sun exposure. A study of 85 adolescents also revealed that vitamin D could be a viable therapeutic option to reduce the severity of primary dysmenorrhea. Participants received 50,000 IU of vitamin D weekly for five months, which significantly increased vitamin D levels while reducing dysmenorrhea symptoms.13 Vitamin D May Also Relieve Chronic Pain, Uterine Fibroids In terms of other pain-related conditions, patients with arthritis, muscle pain and chronic widespread pain had significantly lower vitamin D levels than those without pain in a systematic review and meta-analysis.14 Vitamin D may also be useful for other reproductive conditions aside form dysmenorrhea, including uterine fibroids, which are growths that develop from the muscle tissue of the uterus. They can cause a variety of symptoms depending on their size, location and number, including heavy menstrual bleeding, prolonged periods, pelvic pain and impacts to fertility. One study examined how vitamin D levels might affect the development and progression of uterine fibroids, and compared women with vitamin D levels equal to or greater than 30 nanograms per milliliter (ng/mL) to those with serum levels lower than 20 ng/mL.15 Among the 1,610 women included in the study, vitamin D levels equal to or greater than 20 ng/mL were associated with an estimated 9.7% reduction in the growth of fibroids when compared to people with vitamin D levels below 20 ng/mL. When the researchers looked at the data of individuals with vitamin D levels equal to or greater than 30 ng/mL, it was associated with an approximately 22% reduction in the incidence of fibroids compared to individuals with levels less than 30 ng/mL. The group with the highest vitamin D levels of greater than 30 ng/mL also had a 32% increase in fibroid tissue loss. Sunlight Is the Best Source of Vitamin D I strongly recommend getting your vitamin D from proper sun exposure, if possible, as it provides benefits beyond vitamin D optimization. Higher levels of vitamin D may even serve as a marker for healthy sun exposure, which in turn may be responsible for many of the health benefits, which include reduced risk of cancer and increased longevity, attributed to vitamin D. Regular sun exposure, for instance, enhances production of melatonin — a potent anticancer agent.16 However, if you’re unable to get adequate sun exposure each day, vitamin D supplementation may be necessary. The global prevalence of vitamin D deficiency (defined as a level of less than 20 ng/mL) and insufficiency (defined as a level of 20 to less than 30 ng/mL) is 40% to 100%,17 so many people are lacking. Further, 20 ng/mL has repeatedly been shown to be grossly insufficient for good health and disease prevention, which means the true prevalence of people without optimal levels of vitamin D is even greater. The only way to determine how much sun exposure is enough and/or how much vitamin D3 you need to take is to measure your vitamin D level, ideally twice a year. Once you’ve confirmed your vitamin D levels via testing, adjust your sun exposure and/or vitamin D3 supplementation accordingly. Then, remember to retest in three to four months to make sure you’ve reached your target level. The optimal level for health and disease prevention is between 60 ng/mL and 80 ng/mL (150-200 nmol/L), while the cutoff for sufficiency appears to be around 40 ng/mL. In Europe, the measurements you’re looking for are 150 to 200 nmol/L and 100 nmol/L respectively. Progesterone Is a Key Treatment for Menstrual Pain Progesterone controls prostaglandin production, and when progesterone levels decrease just before menstruation, prostaglandin levels increase. Women with dysmenorrhea have increased prostaglandin levels.18 Oral contraceptives, which often include progesterone or a synthetic form of it known as progestin, are commonly prescribed to manage dysmenorrhea — but they can destroy your health. Instead, progesterone supplementation may help. The dose of bioidentical progesterone I recommend is 30 milligrams (mg) to 50 mg a day, mixed with a long-chain fat as described below, taken orally in the evening before bed, as it can promote sleepiness. Women who still menstruate need to be careful with the timing of their progesterone supplementation, however. Progesterone is crucial for successful pregnancy, and you can severely inhibit your ability to get pregnant if you take it at the wrong time. (During pregnancy, progesterone actually skyrockets. In the third trimester, women produce about 600 mg a day.) If your menses are regular, start taking progesterone on the 14th day after your menstrual flow begins, and take it for 14 days straight (until cycle day 27). If your cycles are short, start on day 12 and continue for 14 days. Always take the progesterone for the full 14 days even if your menses begin before the 14 days are over. Start the next progesterone 14 days after the flow began.19 There’s no toxicity to progesterone, unlike estrogen and testosterone, neither of which I recommend. Supplementing progesterone also will not lower your natural production, so you don’t need to be concerned about that. In fact, it enhances your natural production. Progesterone, meanwhile, needs to be mixed into vitamin E for optimal bioavailability. Health Natura sells a progesterone in vitamin E product. Alternatively, you can make your own by dissolving pure USP progesterone powder in one capsule of high-quality vitamin E. The difference in bioavailability between taking progesterone orally without vitamin E and taking it with vitamin E is 45 minutes versus 48 hours. Another good reason for taking progesterone with vitamin E is that it binds to red blood cells, which allows the progesterone to be carried throughout your body and be distributed to where it’s needed the most. What’s more, Georgi Dinkov cites research showing that when you dissolve a substance in vitamin E, it specifically targets sites with the highest inflammation, which may be particularly relevant for dysmenorrhea. Ginger is another natural option. Evidence from six clinical trials showed ginger was effective to some degree in decreasing pain in women with dysmenorrhea.20 Fennel is another remedy for menstrual cramps and may relieve pain from primary dysmenorrhea as well as common NSAIDs.21

The makeup of gut flora at birth and during the first year of life may play a key role in the development of neurodevelopmental disorders, including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), communication disorders and intellectual disability.1 Worldwide, 3.4 billion people suffer from health conditions that affect the nervous system.2 While much remains to be discovered about how early gut microbiota affect cognition, it’s known that gut bacteria are involved in metabolism, neurological health, immune function and the health of the gastrointestinal tract. Further, gut-brain communication occurs via multiple avenues, including along the vagus nerve and through transport of short-chain fatty acids (SCAs).3 Gut microbes can also synthesize neurotransmitters, according to researchers with the University of Florida. In a study published in the journal Cell, they reveal that disruptions to gut flora in very early life may raise the risk of autism, ADHD and more.4 Gut Bacteria in Early Life Tied to Neurodevelopmental Disorders The study tracked a group of Swedish children from birth over a 20-year period to identify factors that might influence whether they develop a neurodevelopmental disorder. Researchers collected extensive data from early in the children’s lives using detailed questionnaires about infections, antibiotic use, stress, prenatal conditions and family health history. They also analyzed biological markers such as metabolites in umbilical cord blood and stool, types of body cell proteins and gut bacteria. Out of the 16,440 children monitored, 1,197 — or 7.3%5 — were diagnosed with a neurodevelopmental disorder, and significant links were found between certain early-life factors and the likelihood of developing NDs. Notably, the research connected changes in gut bacteria to these disorders and identified early signs of mood and digestive problems. “The remarkable aspect of the work is that these biomarkers are found at birth in cord blood or in the child’s stool at 1 year of age over a decade prior to the diagnosis,” study author Eric Triplett said in a news release.6 Interestingly, infants who went on to develop neurodevelopmental disorders were deficient in many bacteria known to promote gut health, including Akkermansia, Bifidobacterium, Ruminococcus and Faecalibacterium. “Akkermansia muciniphila was associated with substances that contribute to the production of chemical signals in the brain known as neurotransmitters. These neurotransmitters play a crucial role in brain function and mood regulation,” the University of Florida reported.7 Antibiotics, Stress May Alter Microbiome, Contributing to Neurodevelopmental Damage The study also revealed that children who had three or more ear infections treated with penicillin from the time they were born until age 5 were at increased risk of NDs compared to those in the control group. Specifically, they were:8 3.89 times more likely to develop a speech disorder 3.27 times more likely to develop ADHD 2.44 times more likely to develop an intellectual disability Further, among children who developed neurodevelopmental disorders, higher levels of Citrobacter bacteria, which are associated with inflammation, and lower levels of Coprococcus, which are linked to mental health benefits, were found in the microbiome. Antibiotics may be responsible for this effect, with researchers suggesting penicillin may increase Citrobacter while decreasing or eliminating Coprococcus.9 “We’re not trying to say that antibiotics are necessarily a bad thing,” lead study author Angelica Ahrens said. “But perhaps overuse can be detrimental to the microbiome, and for some children, for whatever reason, their microbiome might not recover as readily.”10 Meanwhile, both environmental and emotional stress also increased the risk of NDs. Children whose mothers smoked during pregnancy were three times more likely to develop NDs, while toddlers exposed to secondhand smoke were 4.88 times more likely to develop ADHD. Toddlers whose fathers smoked more than 15 cigarettes daily were also 3.47 times more likely to develop autism.11 Further, among children later diagnosed with autism, higher levels of PFDA (perfluorodecanoic acid) were found. PFDA is a breakdown product often found in food packaging, especially those made to be grease-resistant, such as microwave popcorn bags and fast-food wrappers.12 “These substances are known to be associated with chronic inflammation, oxidative stress, immune suppression, and possible involvement in autoimmune diseases,” the researchers noted.13 According to Ahrens, “There’s a pretty consistent pattern where it seems increased stressors — whether from emotional stress or exposure to adverse health influences — can impact the immune system and, subsequently, the microbiome — along with all its downstream effects.”14 Children Are Exposed to an ‘Enormous Burden of Stressors’ It’s rarely just one factor that triggers a neurodevelopmental disorder or other chronic disease. Typically, it’s a combination of factors — like processed food loaded with linoleic acid, childhood vaccines, antibiotic overuse and environmental pollutants — that causes gut dysfunction and other imbalances in the body. Beth Lambert, who in 2009 founded Epidemic Answers, a research organization focused on helping children with autism and other chronic diseases, explained in our interview that it’s the total load of modern living that often adds up to chronic diseases like autism: “It’s what we call the total load of modern living. The total load is a concept that’s been around for a very long time, especially in environmental medicine … Patricia Lemer, who wrote a book called ‘Outsmarting Autism,’ first applied the concept of total load to neurodevelopmental conditions like autism, where she would say, basically, ‘It isn’t one thing that causes autism. It’s really a perfect storm, a total load. It’s too many stressors of modern living on a body that doesn’t have enough resources to withstand those stressors.’ Here’s an example. Why is it that two children go into a pediatrician’s office, one gets their 18-month vaccines and the other one gets their 18-month vaccines, one develops autism and the other one doesn’t? Is it genes? Is it what the child ate that day? Is it the fact that one child had a sickness and the other one didn’t? Was it because this child was on antibiotics when he had vaccines and this one wasn’t? There are so many variables in each child and in each story. So, that’s where I think the total load concept or total load theory really stands up is because there’s so much medical literature on modern living and the ways that we live in the modern world and how it damages your health. Inflammatory foods, processed foods, the enormous quantity of sugar that modern children consume, the number of pharmaceuticals children have, the antibiotics, for instance … Antibiotics … destroy your gut bacteria. What is the significance of that? That gut bacteria regulates everything from your immune system to your digestion of food and your metabolism. So, all of those factors are going to impact a child, especially when they are in that critical developmental time. So, if you think about an infant and all the work they have to do to get to crawl, and walk, and talk, and relate to the humans in their lives, all of that takes an enormous amount of energy. If their body is burdened with toxins from the laundry detergent, and from the mercury and cadmium on their toys, and from the inflammatory foods they’re eating, and their vaccines and their antibiotics and their proton pump inhibitors … that’s when you’re going to see them begin to develop symptoms, whether those are skin symptoms, like eczema, allergies, or whether it’s neurodevelopmental symptoms. As we’re going through this developmental timeline, if you have an enormous burden of stressors, inflammation going on in your body, and you’re supposed to be developing vision or speech, your body’s too busy dealing with all those stressors, so you’re going to have an arrested, impaired, or delayed development.” Are EMFs the No. 1 Risk Factor? Electromagnetic fields (EMFs) are the cigarettes of the 21st century — and most people are being exposed 24 hours a day. Most of the radiation emits from cellphones, cell towers, computers, smart meters and Wi-Fi, to name just a few of the culprits. Exposure causes serious mitochondrial dysfunction due to free radical damage. Among the most common consequences of chronic EMF exposure to your brain are chronic conditions like Alzheimer’s, anxiety, depression and autism.15 Research published in Pathophysiology suggests autism may be associated with biological disturbances that are similar to the effects of EMF and radiofrequency exposures.16 Martin Pall, Ph.D., also discovered a previously unknown mechanism of biological harm from microwaves emitted by cellphones and other wireless technologies via voltage gated calcium channels (VGCCs) embedded in your cell membranes.17 VGCCs are found in high concentrations in the brain, and research involving animals has shown that even low levels of microwave EMFs can have significant and varied effects on the brain. Studies suggest that when these VGCCs are activated by EMFs, it can lead to a range of neuropsychiatric effects. At least 26 studies have linked EMFs to neuropsychiatric effects, and five specific criteria have been used to demonstrate that this relationship is causal, meaning EMFs can cause these effects.18 While it’s nearly impossible to avoid EMF exposure completely, there are practical ways to limit it. Given the number of EMFs that bombard you all day long, getting educated about the negative effects of EMFs is imperative to your well-being. Particularly if you are dealing with a serious illness or neurodevelopmental disorder like autism, it is well worth your time to reduce your EMF exposure as much as possible. One strategy is to connect your desktop computer to the internet via a wired connection and put your desktop — and cellphone — in airplane mode. Also avoid wireless keyboards, trackballs, mice, game systems, printers and house phones. Opt for the wired versions instead. If you must use Wi-Fi, shut it off when not in use, especially at night when you’re sleeping. Shutting off the electricity to your bedroom at night will also help reduce your exposure. How to Support a Healthy Microbiome Avoiding antibiotics, including those found in conventionally raised meat, is key to keeping your microbiome health intact. Ultraprocessed foods, artificial sweeteners, chlorinated and fluoridated water and antibacterial products are other culprits that can worsen your microbial health. Consuming fermented foods is an important step to increase microbiome diversity as well as decreases markers of inflammation.19 If you do take antibiotics or are looking for another supportive measure for gut health, consider spore-based probiotics, or sporebiotics. These are part of a group of derivatives of the Bacillus microbe and have been shown to dramatically increase your immune tolerance. During pregnancy and in early life, vaginal delivery (versus caesarean), breastfeeding and exposure to older siblings can help establish a healthy microbiome during these crucial periods of development.20 As noted by microbiologist Dr. Marty Blaser:21 “Before modern times, microbes were transferred from mother to child during vaginal birth, from the mother’s breast during nursing, through skin-to-skin contact, and from the mother’s mouth by kissing. Now, widespread cesarean delivery, bottle-feeding, extensive bathing (especially with antibacterial soaps), and especially the use of antibiotics have changed the human ecology and altered transmission and maintenance of ancestral microbes, which affects the composition of the microbiota. The microbes, both good and bad, that are usually acquired early in life are especially important, since they affect a developmentally critical stage.”

Some time ago, on a trip to British Columbia, I ate in a local restaurant. When eating out, I always try to order something simple, without a gravy or sauce, since these sauces are bound to contain MSG. So, I ordered a plain crab cake with rice and vegetables — no sauce, no mayo. Boy, did that crab cake taste good! About midnight I knew why. I woke up with a dry mouth, a terrible thirst and a headache. The next day I felt sore all over, like I’d been in a fight. My hands felt like they had arthritis. Fortunately, since I don’t eat food containing MSG very often, the symptoms cleared by the next day. Unfortunately, I attended a reception that evening, and since I had skipped lunch and was hungry, I ate things I shouldn’t have, including a peanut sauce I am sure came from a can. That night, the same thing happened, and the next day I was stiff and sore from head to toe. Of course, I knew the reason why and just resolved to be more careful going forward. But suppose I was a person who ate a lot of processed or restaurant food and didn’t know about the dangers of MSG. I would feel awful all the time: headache, dry mouth, excessive thirst, and aches and pains like arthritis. I might be told I had the disease du jour: fibromyalgia. But there is no treatment for fibromyalgia so I would probably be treated for the runner-up disease du jour: Lyme’s disease. The treatment for Lyme’s disease is courses of antibiotics, which would probably make my condition worse. If I complained to the doctor about the dry mouth and thirst, I would be tested for diabetes; and if I sought treatment for headaches, I’d end up on some pretty powerful pain killers. Which brings us to the question: could all these conditions, especially the rheumatism-like achiness that plagues so many people, be due to MSG and similar substances added to virtually all processed food? Glutamine Versus Glutamate For example, MSG allows food manufacturers to make something that resembles gravy — which we make at home with good drippings, flour and genuine bone broth — with water, a thickener, artificial coloring and artificial flavors, especially MSG. Apologists for MSG point out that it derives from glutamine, an amino acid needed for protein synthesis, immunity, liver health, detoxification and maintenance of acid-alkaline balance, among many other roles. Our bodies can make glutamine; however, in times of rapid growth or healing — especially healing of the gut — we need more glutamine than we can make and must get it from food. Homemade bone broth is an excellent source, one explanation for bone broth’s reputation as a healing food. Glutamine is a precursor to glutamate, an important neurotransmitter, for which we have receptors in the brain and all over the body. Apologists for MSG argue that the additive is not really different from glutamate (or its cousin glutamic acid). For example, journalist Liz Roth-Johnson writes, “Despite their different names, glutamate, glutamic acid, and monosodium glutamate are essentially the same molecule and behave the same way in our bodies.” She provides the following diagram. Roth-Johnson notes that ripe tomatoes and aged cheese contain high levels of glutamate, so what could be the problem with MSG? The problem is that most people don’t get headaches and arthritis-like symptoms when they eat ripe tomatoes and aged cheese. One explanation is that the sodium molecule added to glutamate makes it a very different molecule — after all, adding chlorine to sodium to make nutritious salt makes chlorine very different from poisonous chlorine gas! Small differences in molecules can make huge differences in the body. Free Glutamate Can Overload Your System Free glutamate is formed during fermentation — of milk into cheese, of soybeans into soy sauce, etc. That’s what gives these foods their delicious meat-like umami taste. Most people can eat small amounts of slowly and naturally fermented soy sauce without problem, but react strongly to cheap soy sauce made by rapid protein hydrolysis with added MSG. Another difference: most of the glutamate in our body does not come from free glutamate in our food but from the breakdown of protein into its separate amino acids. It’s a good assumption that these enter the bloodstream more slowly than MSG added to food, or even to glutamate naturally formed in food, so that their transformation into neurotransmitters is more controlled. Eating foods containing MSG or a lot of added free glutamate, can overwhelm the system, so to speak. And free glutamate is everywhere, I mean everywhere, usually not labeled but lurking in other food additives. Ingredients That Contain Free Glutamate Here’s a list of ingredients that contain free glutamate in one form or another: Anything hydrolyzed Any hydrolyzed protein Calcium caseinate Sodium caseinate Yeast extract Torula yeast Autolyzed yeast Textured protein Whey protein Whey protein concentrate Whey protein isolate Soy protein Soy protein concentrate Soy protein isolate Anything protein fortified Soy sauce Soy sauce extract Anything enzyme modified Anything containing enzymes Anything containing protease And these are foods that can contain a lot of free glutamate formed during processing: Carrageenan Commercial bouillon, broth and stock Any flavors or flavoring Natural flavor Maltodextrin Oligodextrin Citric acid, Citrate Anything ultra-pasteurized Barley malt Malted barley Brewer’s yeast Pectin Malt extract Seasonings And these are foods that extremely sensitive people have reacted to: Corn starch Corn syrup Modified food starch Lipolyzed butter fat Dextrose Rice syrup Brown rice syrup Milk powder Gelatin Reduced fat milk (skim; 1%; 2%) Most things low fat or no fat Anything enriched Anything vitamin enriched Anything pasteurized Annatto Vinegar Balsamic vinegar Certain amino acid chelates (used in supplements) Fermented Foods May Trigger Reactions if You’re Sensitive Furthermore, these sensitive souls need to avoid anything fermented, including natural cheese, naturally fermented soy sauce and homemade sauerkraut, and even tomato paste. Interestingly, the late Jack Samuels, creator of truthinlabeling.org (which created the above lists), told me that he could eat cheese made with old-fashioned animal rennet without problem, but reacted strongly to cheese made with vegetarian rennet (which is produced by genetically modified bacteria). I always purchase organic herbs and spices, often not reading the labels. But I looked carefully at the label of some organic chili powder I recently bought and was shocked to read that it contained “organic rice concentrate.” Rice concentrate is not in any of the above lists, but it is obviously a processed ingredient and why would the company add it to chili powder unless it contributed some kind of zip to the flavor? Just shows you can’t be too careful! Always read labels! But back to the main point: if you are suffering from any kind of chronic pain or discomfort, try limiting yourself exclusively to whole natural foods that you have prepared yourself. I’m betting you will see an improvement without taking any drugs. About the Author Sally Fallon Morell is author of the best-selling cookbook “Nourishing Traditions” and many other books on diet and health. She is the founding president of the Weston A. Price Foundation (westonaprice.org) and a founder of A Campaign for Real Milk (realmilk.com). Visit her blog at nourishingtraditions.com.