We're in the home stretch here at Avalon Natural Medicine. Dr. Haff has seen her last patients and will be back next week for our final transition work.

I couldn't have asked for a better boss and its been pretty sweet being an employee only for the past 5 years. Thankfully, she's had all the systems in place for a fairly easy transition, and has been walking me through all the steps of what she does as the business owner. 

There will be some changes over the next few months as I put my own spin on this place. If you've been in lately, you'll have noticed some new paint, new shelves, etc. I'll try to keep the newsletters and emails to a minimum and notify you here, and repeating the same info on other social media outlets. So if you have one you like in particular, follow us so you can get the latest. 

​Three years ago I was dealing with my mom dying from cancer. It was rough, to say the least, but I feel like I’m in a better spot now and able to share some things that I wrote back then. This compilation of comments I made on my personal page is edited for vulgarities (I swear!) and clarity, but since the statements still feel so very true and real to me I left all wording in the present tense.

It’s hard to say this out loud, because I may come off as callous, but if one just looked at my news feed on a regular basis, you would assume that all people with cancer are beautiful bald women and children with tons of social support. But cancer is ugly, and not everyone has a large social network to throw benefits in their honor. There aren’t organizations to help depressed old smokers to make a wish come true before they die. And it’s not that I begrudge anyone’s celebration, I just want to remind everyone that cancer is ugly and lonely, and not everyone gets to walk away with a trophy.

I think it would be fantastic if people acknowledged those battling cancer who won’t be able to hold up a sign on Facebook saying that they beat it, or that it’s their last day of chemo, etc. Not everyone with cancer is a “survivor". Some quietly fight for their lives, regardless of how brief it may be, to spend just a few more days or months on this planet. And they deserve our attention too.

My point is that we glamorize beating cancer, rewarding the “winners” with notoriety, giving preferential attention to the visible. All while many are too sick to join a 5K or have their picture spread on the internet. Cancer is ugly and it kills. It kills nice people and mean people, people who lived life to the fullest and those who didn’t, people who changed their circumstances or risk factors and some who didn’t, some who took charge and fought and some who give up early on. I think it would be far more honest if our society acknowledged the ugliness of all cancer and made a concerted effort to not glamorize it.

Like I said before, this is difficult to say publicly because it sounds like I don’t care about people like the adorable twin with fantastic dimples all over my news feed at the moment. But that couldn’t be further from the truth. I care about him, my friends who have had cancer in the past that have beaten it, a best friend who is currently battling stage 4 melanoma, my mom battling stage 4 small cell carcinoma, my patients who come in frightened about a symptom that may be cancer, and so many others.

But what I see, is that I’m one of a few who is willing to talk about the ugly side. I see this inspirational stuff and it makes me annoyed and angry. We put pretty pictures on Facebook of people beating cancer because talking about the death and destruction that cancer causes to the person and to their families is uncomfortable. I once had to rebuild 2/3rds of a man’s face because of jaw cancer that left him dead and mangled after 17 surgeries. [For those of you who didn’t know, my first profession was an Embalmer.]

And it’s partly my fault because I don’t want to talk about how in the last 1-2 months my mom was hospitalized for pancreatitis, found out all of her brain tumors are back, went through another 2 weeks of whole head radiation, suffered a pulmonary embolism on the final day of radiation, was put on warfarin, puked so hard she fell out of bed and is now covered in bruises thanks to the warfarin. But I’ve had enough of the beautifying of cancer. I’m officially done. I’ve kept quiet for far too long and I’m now going to be that outspoken jerk.

I don’t think there is an easy way to deal with it, but I can tell you that watching my mom slip away in tiny pieces, day by day is awful. She’s not my mom, but she’s not dead, and I don’t know which is worse. I see the inevitable and I don’t want it to ever come, but part of me wishes I could just rip the bandaid off quickly so I don’’t have to watch her suffer and wither into a shadow of the woman who sacrificed her whole life to make mine better.

And to bring up another ugly aspect of cancer, I feel that we sympathize less for those who don’t live a pristine life, or decide to get all holistic when diagnosed, or those who choose not to do the conventional route, or those who are older instead of kids. We get kind of judgy when it comes to the most personal of decisions. I wasn’t the least bit surprised with my mom, and I don’t blame her for choosing the conventional route over what I had to offer. And her life isn’t worth any less to me because she smoked all those years. But I definitely feel (and maybe it’s just me) like people put out a she-got-what-she-deserved vibe.
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No one deserves cancer. No one’s life is more valuable than others. No one deserves to feel guilty about how they choose to live their life. No one deserves condemnation during the hardest struggle they will ever endure. They just need our support. The ugly ones, the depressed ones, the ones too weak to get out of a chair much less walk a 5k.

Sometime before last Thanksgiving, I started dabbling in bread making. I wanted to make sure that it would be a habit that would stick with me, and it has, so I wanted to share my thoughts on the whole concept now that I have a couple loaves under my belt. 
First, I’m sure everyone wants to know why an ND would make bread. I am occasionally gluten free and a-whole-bunch-of-other-things free, but in my house I have one member who is gluten free and the other is corn free, so it pays to be flexible. The gluten free part is easy, I make a gluten free bread for my son. But for my nutritionally-challenged corn-free husband, things can get really complicated. 
Corn is in everything. Including bread. Corn syrup, corn starch, corn solids, corn meal. He is already very limited in what he can eat, or is willing to eat, so having a bread available to him makes all the difference. We did find a commercially available bread with no corn here in Vermont, but it has over 10 ingredients, which at any time might change. We are constantly re-checking ingredients lists for this reason and anything with a laundry list of ingredients is exhausting. Making something with only 4 ingredients (6 in the case of the gluten free bread) really appeals to the desire for my family to eat whole foods as much and as often as possible. 

But I’m a busy lady! I need something that is easy and doesn’t take a lot of time. Luckily, I’ve found all the things to make this happen on a regular basis and I’ll share it all with you. I’ll list all the resources and products that I use. I won’t have any links since this post is for informational purposes only. 

I originally used a recipe I found on Pinterest, but then when I needed more information, I bought a book called The New Artisan Bread in 5 Minutes a Day by Dr. Jeff Hertzberg and Zoe Francois. It has wheat and GF recipes, so it’s great for a mixed household like mine, but they have also written a completely gluten free cookbook as well. 

When I first started, I went by the recommendations to make a large batch and store it in the refrigerator. But, if your house is like mine, refrigerator space comes at a premium, so I started making one-loaf batches and keeping it on the counter most of the time. Except for the GF bread which I allow to rise on the counter, then store in the fridge until I’m ready to bake.

Ingredients for Wheat Bread:

• Water - 1 ½ cups hot tap water

• Salt - 1.5 teaspoons (0.5 Tablespoons)

• Yeast - 1.5 teaspoons (0.5 Tablespoons)

• All Purpose Flour - 3 ¼ cups 

The authors of the above book recommended memorizing a ratio so that it is easier to remember without constantly referencing the book. 6, 2, 2, 13 is the mnemonic that stands for 6 cups of water, 2 Tablespoons of yeast, 2 Tablespoons of salt and 13 cups of flour. As you can see above, my list is just ¼ of those numbers. 

The gluten free version is just as easy to remember. Switch out the All Purpose Wheat Flour for Bob’s Red Mill Gluten Free 1:1 Baking Flour. Add 2 whole eggs and ¼ cup of melted butter (for the ingredients listed above, multiply as needed for larger batches). Voila! The 1:1 flour works great without having to source a bunch of different individual ingredients to mix together for your own flour. Although, if you prefer to do it that way, the list of ingredients is in the book above. 

Directions:
Mix together the water, salt and yeast. In the case of the GF bread, also mix in the eggs and melted butter. Then add the flour. I prefer to keep my kitchen on the minimalist side, so instead of investing in a large blender or bread maker, I use a stainless steel mixing bowl and a Dough Whisk. After mixing everything together, I cover the bowl with a silicone suction lid. 

If you mix up the dough in the morning, it will be ready for baking in the evening, and vice versa. After a couple hours, I put the GF dough in the fridge to continue rising, but I leave the wheat dough on the counter for up to 1.5 days (usually when I need to bake a new loaf anyways, but if not, I’ll stick it in the fridge). You can store the dough in the fridge for up to two weeks, but I find it easier to mix a small batch every few days instead. 

The GF dough gets ladled into an oiled bread pan as it is not stretchy like the wheat dough. The wheat dough gets covered with more flour and cloaked, which means to gently fold the top and sides down and under to the dough ball. You will not knead either of these doughs. After you place them in the loaf pans, you should let them rest for 45 (room temp dough) to 90 minutes (refrigerated dough). Then place them in a 450 degree oven for 35-40 minutes. Pull them out and allow to cool on a rack before cutting into them. 

My last piece of advice is to have a great bread box and a good bread knife. I bought the Clean Dezign Bamboo Fiber Bread Box Bin with Cutting Board Lid and can’t believe how fresh it keeps my bread. For the knife, I have a
Victorinox 10.25 Inch Serrated Bread Knife with Fibrox Handle and I love how it cuts the bread with ease. 

Fresh bread, minimal ingredients, and easy enough to accomplish after work whenever we’re running low. The “5-Minute” portion of the book title is obviously in reference to prep time, not rising or cooking time, but you can do any other thing around the house while those happen so it isn’t included. 

*I have no affiliations with any of the brands listed here and receive no compensation from any of them.

Fatigue is the #1 complaint of my patients. There are a myriad of reasons someone can be fatigued, but my first set of questions revolve around sleep. If you aren’t sleeping enough hours because you can’t get to sleep, can’t stay asleep, wake too early, or wake up feeling unrested, then that is the first thing that needs to be addressed.

Everyone’s need for a certain number of hours of sleep is different, but there are some generalities we can apply. For example, I had a teen who was staying up until 11 or 12 to finish her homework after her extracurricular activities, then trying to get up at 6 for school the next day. Teens need 8-10 hours of sleep a night, adults need at least 7.

Not being able to get to sleep is another big issue. If you haven’t already applied sleep hygiene techniques, then you need to get started immediately. Turn off your electronics and turn down the lights in your home as early as you can to signal to your brain that sleepy time is coming. Try meditating or calm, deep breathing before bed to set yourself up for the parasympathetic state you need to be in in order to fall asleep. Calcium may be a beneficial nutrient to help sedate the mind before bed.

In Traditional Chinese Medicine, waking 1-3 AM is caused by an imbalance in the liver. Some of the situations that can cause a liver imbalance include anger, alcohol, or conditions of the eyes or tendons. Waking 3-5 AM is a disturbance in the lung, which can be caused by grief/sadness, or conditions of the nose and skin. I’ve also seen insufficient Magnesium cause waking throughout the night.

B12, Inositol, and melatonin may also be needed to help with falling and staying asleep.

But the biggest and most controversial issue is caffeine. It’s not controversial because it’s not true, but because you won’t want to admit that it’s true. Consumption of more than 250 mg of caffeine will cause restless sleep and early waking, even if you only consume it in the morning. Most people only consider that late day consumption could make it difficult to fall asleep.

Believe it or not, a serving of regular brew is 6 ounces. So the smallest portion you will get anywhere is 12 ounces, and is already at the 250 mg threshold of insomnia. And that doesn’t count any caffeinated teas, soda, chocolate, or coffee flavored foods. I love black coffee and unsweetened iced tea, but learning this tidbit has revolutionized my sleep. I have personally noticed that days when I consume less than 250 mg, my sleep is much more restful.

Here’s a chart of common sources of caffeine: https://cspinet.org/eating-healthy/ingredients-of-concern/caffeine-chart

​The good news is that as you cut back on your caffeine consumption, your sleep will improve so you won’t feel the need to consume caffeine to excess. I personally found an unsweetened energy drink that has about 105-150 mg of caffeine, so that I can still get that little boost in the morning without fearing that an iced tea with lunch is going to wreck my sleep. Runa’s Clean Energy Drinks in Unsweetened Blood Orange and Lime flavors have no added sweeteners, natural or otherwise.

Have you taken Folate and it caused anxiety, insomnia, or other signs of agitation? You could be undermethylated.

If you've been tested for MTHFR and found to have a single nuclear polymorphism (SNP), often the first treatment is adding folate. But it isn't just about one enzyme in the methylation pathway; it's a tug of war between a bunch of enzymes on either side that can make you more undermethylated or overmethylated.
Methylation is also more than that one little biochemical pathway, sometimes called the one carbon cycle. Methyl groups can also modify genes and modify the expression of genes, either inhibiting or increasing expression.
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Instead of looking at one biochemical pathway, or just a handful of enzymes, I ask you a lot of questions about your signs, symptoms, tendencies, current pharmaceuticals, reactions to drugs and more. Then I send you to get some labs drawn at a standard lab that will give me answers about which nutrients would be most helpful and which doses would be best.
Just having an MTHFR mutation/SNP is not enough information, and neither is homocysteine. It's a piece of the puzzle, but not the whole answer. If you've gone down that road and not seen results, come in for an assessment and testing.

​If you've seen me already, you know I talk a lot about copper, especially in women. All those high estrogen conditions like heavy menses, cramping, endometriosis, fibroids, post partum depression, PMS/PMDD, etc. can all be due to copper. But where is it coming from?

Exogenous hormones used for birth control elevate your body's copper levels. Women who feel terrible on oral contraceptive pills, shots, implants, ring, IUD, and patches, are the most likely candidates.

Copper sulfate is an algaecide, bactericide, desiccant, fungicide, and herbicide. It gets sprayed on fruits and vegetables, even organic, and especially grapes. It's also in Centrum and similar one-a-day multivitamins as a source of copper. Municipal water sources use it to kill off various microbes and algae, and public swimming pools use it too.You could also get it from copper pipes and pans.

For people with adequate zinc, gall bladder function, vitamin A, and ceruloplasmin (a blood protein that binds to copper), you might not have any problems. The more dysfunctions and nutrient insufficiencies you have, the more problems you will see related to copper. And, it's not just about being "within normal range". You could have a completely normal copper, normal ceruloplasmin, but a really high free copper or free copper index. These calculations show us that you can have elevated production of Norepinephrine, which will make you more anxious or manic. And, because copper is Cu++ in the blood, it is very pro-oxidative and can cause a lot of damage.
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Lowering your free copper is possible with appropriate nutrient supplementation.

Sorry for the very technical post, but I've had two different MDs tell my patients that I was wrong regarding the testing and interpretation of copper and ceruloplasmin and resulting concern of the possibility of Wilson's Disease (WD).

Wilson's Disease is a genetic condition in which the body makes too little of a protein called ceruloplasmin. The result is that the body can't keep copper in the blood and it ends up getting deposited into the liver, brain, and eye tissue.

But here is what they are misinterpreting:
- Ceruloplasmin levels are LOW in WD
- Serum copper levels are LOW in WD
- *this is the part where they are confused* FREE copper levels are normal or HIGH in WD. So these physicians are telling my patients that they could not possibly have WD because they have low serum copper. Again, serum copper is not the same as free copper.

Labs report *serum copper* and usually not *FREE* copper (I've seen it calculated on some alternative labs). Free copper is a calculation in which the ceruloplasmin (in mg/dL) is multiplied by 3; this value is then subtracted from the total serum copper level (in μg/dL). When the result is above 25 μg/dL, AND the person has low ceruloplasmin, AND low serum copper, I send them to an opthalmologist to have a slit-lamp test to look for Kayser-Fleischer rings, a keynote symptom in many WD patients.
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This scenario doesn't happen often, but it does happen. If you have an MD who doesn't understand the difference, I'd be happy to explain it to them.

Whenever talk of antioxidants comes up, glutathione is the star of the show. It is the body's first line of defense against pro-oxidative factors which are dominant in psychiatric issues. However, it has a limited capacity, even with supplementation of cofactors like Vitamin C, Vitamin E, Selenium, and N-Acetyl Cysteine.

The antioxidant that is available on demand is called metallothionein (MT) and has numerous functions in the body, and whose rate-limiting factors include zinc and selenium. Selenium speeds up the kinetics of MT's function, but zinc is needed for proper function. Each molecule of MT contains up to seven zinc atoms. In addition, zinc supplementation will increase production of MT.

This protein is useful in brain development and repair, detoxification of heavy metals, maintenance of the intestinal and blood brain barriers, breakdown of triggering proteins like casein and gluten, kills candida, improve HCl production in the stomach, improve taste sensors on the tongue, and maintain thymic and lymphoid tissues for improved immune function.
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WHEW! In addition, poor MT function is associated with ADHD, autism, schizophrenia, Alzheimer’s Disease, and Parkinson’s Disease.