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Should I Be Supplementing Vitamin K?

I get asked about Vitamin K1 and Vitamin K2 almost daily. I am amazed at how much mis-information about vitamin K is out there on the interwebby.

Vitamin K Basics

Vitamin K is an essential player in coagulation pathways of our body. It helps to maintain the viscosity or “thinness” of our blood. It is a cofactor required for the activity of several key proteins containing carboxyglutamic acid residues in the clotting pathways.

Despite what the “Keto-Guru’s” tell you, Vitamin K deficiency is rare. The exception is in neonates and patients with predisposing conditions including hepatobiliary (liver) or pancreatic disease.

Vitamin K Structures

Vitamin K1 (phylloquinone) has a phytyl side chain.

Vitamin K2 (menaquinone) has several forms, each with an isoprenoid side chain, designated MK-4 (or menatetrenone) through MK-13 according to the length of the side chain. The most common form of menaquinone has four residues (MK-4).

Using the Vitamin K In Your Diet

Vitamin K is fat soluble. You gotta’ have fat in your diet for it to be absorbed and used correctly. This is where the vegans and the vegetarians of the world may find challenges in using the vitamin K they get through diet.

Vitamin K absorption requires intact pancreatic and biliary function and fat absorptive mechanisms. Dietary vitamin K is protein-bound and is liberated by the proteolytic action of pancreatic enzymes in the small intestine. Bile salts then solubilize vitamin K into mixed micelles (little fat transport busses) for absorption into enterocytes (cells of the gut wall), where it is incorporated into chylomicrons (the largest of the cholesterol transport molecules), thereby facilitating absorption into the intestinal lymphatics and portal circulation for transport to the liver.  In the liver it is repackaged into very low-density lipoprotein (VLDL). It circulates in small quantities bound to lipoprotein. Yes, that means your vitamin K is transported in cholesterol molecules with the essential fats your body uses.

Vitamin K’s Functions

Coagulation – It is essential for activation of Factors VII, IX, X and prothrombinActivation of proteins C & S – These proteins require vitamin K’s presence and they facilitate too much thrombin generation

Reversal of coumarin-like anticoagulants – Vitamin K interrupts the reduction of inactive K2,3 epoxide to the active form of the vitamin to stop excessive bleeding from Coumadin (warfarin) or coumarin-like products. 

Bone formation – it helps in bone formation and use of calcium in the matrix Gla protein. The combination of vitamin K and D can significantly increase the total bone mineral density and significantly decrease undercarboxylated osteocalcin. A more favorable effect is expected when vitamin K2 is used. This finding has been used to promote the sales of Vitamin K2 among many “diet experts.” Remember, plenty of K2 is found in eggs, liver and meat when these are a part of your diet.

Coronary vascular calcification –  matrix Gla protein is dependent on vitamin K-mediated carboxylation for activity. In its active form it is thought to play a role in vascular calcification. Theoretically, vitamin K deficiency leads to increased vascular calcification because of lack of matrix Gla protein activity. Vascular calcification predisposes to coronary artery disease. Few trials have assessed the role of vitamin K in coronary artery disease. Those available are not conclusive, but they suggest that further studies are warranted. 

Dietary menaquinones are found in meat (especially liver), cheeses, fermented soybeans, and eggs.  This is why ketogenic or carnivores diets are so effective, as they provide the essential vitamins for efficient metabolism.

With this understanding, I explain to all of my patients that anyone peddling vitamin K supplements to those on ketogenic or carnivorous diets are just tryin to make their boat payment.

Symptoms of Vitamin K Deficiency

Clinical signs and symptoms of vitamin K deficiency include easy bruisability, mucosal bleeding, splinter hemorrhages, melena, hematuria, or any other manifestations of impaired coagulation.
Dietary Sources of Vitamin K:Vitamin K1 can be found in green veggies like spinach and broccoli and some oils

Vitamin K2  can be produced from phylloquinone by the body and is the main storage form in animals. The other menaquinones are synthesized by microflora in the gut, providing a portion of the dietary requirement of vitamin K. Daily requirements of Vitamin K are  90 micrograms daily in women and 120 micrograms daily in men.

Not familiar with ketogenic diets? Check out my diet page for the diet I use in my practice with my patients here.

References: 

  1. Food and Nutrition Board of the Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2000). National Academies Press, Washington DC, 2000. p. 162-196 http://books.nap.edu/openbook.php?isbn=0309072794
  2. Furie B, Furie BC. Molecular basis of vitamin K-dependent gamma-carboxylation. Blood 1990; 75:1753.
  3. Kuang X, Liu C, Guo X, Li K, Deng Q, Li D. The combination effect of vitamin K and vitamin D on human bone quality: a meta-analysis of randomized controlled trials. Food Funct. 2020 Apr 30;11(4):3280-3297. doi: 10.1039/c9fo03063h. PMID: 32219282.
  4. Shea MK, O’Donnell CJ, Hoffmann U, et al. Vitamin K supplementation and progression of coronary artery calcium in older men and women. Am J Clin Nutr 2009; 89:1799.

The Shovel will Fail You in Obesity, Finances & Life

A few years ago, my family and I set out to build a pond.

I have always loved Koi and the serenity of a Koi pond in my own back yard was very enticing. I spent about a year planning my design and the location.  I dreamed of a serene evening after a very long, hectic day seeing patients relaxing beside the pond.  The sound of trickling water, the occasional splash from fish, the cool breeze passing over the mist from a water-fall would sooth my soul after a busy day in the office.

I envisioned the perfect area.  An unused access path, previously worn by the previous owner with truck and trailer traffic, beside my now expanded patio. Twenty feet wide, thirty feet long and four feet deep. . . that seems just perfect.

I pulled out my shovel and set about digging. Eager to begin and filled with the energy of the final product, I set to digging.  What could be so hard about digging my own pond?  Think of the exercise I will be getting.  Thoughts spurred me on.

Minutes later, chest heaving, face glistening with sweat, I stared in dismay at the ground. All I had to show for my wild digging was a small 1/2 inch dent in the dusty Arizona top soil.

Sonoran Clay

Over time, calcium-carbonate, along with other minerals, accumulates and dissolves into the topsoil of the very arid regions of Arizona Sonoran Desert.  It forms a two to three-foot layer of soil called “caliche.” Periodic rains carry the calcium as far as three feet down into the soil, then the water rapidly evaporates in the blistering Arizona heat.  This often forms two to three feet of soil that is “literally” harder than concrete.

With tremendous zeal, a great deal of sweat and a round of painful blisters, I broke my third shovel on this impenetrable ground.  I realized this was much more difficult than I thought.  I pulled out the back-hoe attachment for my small farm tractor.  After a few hours and few gallons of diesel fuel later, still very little progress occurred.

Multiple weekends and evenings of digging in the Arizona caliche left me with three broken shovels, a ruptured hydrolic line in my tractor, anger that my expensive back-hoe attachment didn’t work, and only a small dent in the ground near my patio.  Even the brute force from the tractor would not budge the clay.  I wondered if dynamite would be effective?  (My wife would have none of this idea).

With my exuberance quashed, I concluded that this would require much more measured exhuming.

Escape From the Prison

We often imagine, with great delight, the removal or destruction of that which enslaves or imprisons us.  We dream that just a little sweat, exertion of a few shovel scoops of dirt and the foundation to our prison of obesity, addiction, debt, and depression are exposed.  A few extra scoops and we imagine freedom from that prison cell.

If only I had a jack hammer and a bigger, more powerful scoop, I imagine . . . I could make short work of these manacles that bind me.

But, our manacles and prison cells do not so easily give way.

The failings of our sharpened spades and powerful back-hoes form a new, even stronger fetter – the belief that our prison cell is unbreakable, that our challenge is just too great. These failings usually leave a person cured of any further desire to break free.  It quashs the dream and solidifying the depression of stagnation.

The in-fecundity of my shovel, no matter the strength and effort put behind it, was not cause to quit.  It was life’s lesson that prisons and shackles often only need a simple tool.

Enter the pick-axe.  During this process my wife said, “Honey, why don’t you use the pick in the garage?”

“If my shovel and the back-hoe didn’t work, there was no way I was going to break through this clay with a pick axe.” That was absurd, I thought.

Yet when I humbled myself to try, it was simple.  The pick-axe was unpretentious.  This simple tool allowed for an almost effortless stroke to a small area of weakness in the caliche.  A large flake of soil would pop free with each stroke. The process was repeated.

Scale by scale, the dragon’s flank was exposed. Careful work of the pick-axe began to loosen layer after layer, section after section, pellicle after pellicle.  Yes, it was slow work. But, each swing was a small victory.

At each little victory, my heart would leap, the dream would become ever clearer.

Working this magic again and again until finally the specter was weakened enough to pull out the shovel.  And, further work, allowed for bringing back the powerful back-hoe, in gratifying scoops.

The excavation that I thought would take two months took me fourteen.  But, it was gratifying.

I learned a powerful lesson. Wherever life has pinned you, fettered you or barred you in, put down the shovel, and pick up the pick-axe.  Second, if you really listen, your spouse may point out the tool you really need. Don’t be afraid to chip away at it a piece at a time.

Finances

Stop waiting for the sharper shovel or the bigger back-hoe to dig yourself out of your harrowing debt, mega mortgage, or your income dwarfing spending. The jackpot or financial windfall won’t come. While others await the jackpot, put down your shovel and shoulder your pick-axe.

  1. Pick one small debt and begin to pick at it by applying just a little extra each month until it is gone.
  2. Cancel your extra cable, sell the motorcycle and payoff the 21% interest credit card.
  3. If you must, pick up a side-hustle for extra to sharpen the pick.

Once you’ve lifted one flake, chip away at the next. Making progress will make it easier to continue.  It doesn’t matter how long it takes, just keep at it.

Marriage

You long for resolution of the apathy, progressive resentment and mutual stalemate that permeates your relationship.  You look in vain for the bigger shovel that will uncover the treasure that years of apathy have buried. You long to uncover your dreams and needs that have been covered and hardened under the clay of resentment.  The shovel and the back-hoe won’t help you here.

Drop the shovel.  Shoulder your pick-axe.

  1. Kiss your wife every time you leave, even if it’s just for a ten minutes to run to the convenience store.
  2. Hold her for five seconds longer every time you hug.
  3. Find a gift you can give her once a week, just because.
  4. Put down your phone and look her in the eyes when she talks to you and listen. Really listen and the flakes of hard clay will unveil the beauty of her soul.
  5. Find a way to praise her every day, even if it is through a simple text.

Health

You long to rid yourself of your addiction to sugar, bread, stress, and sleep deprivation.  You’ve tried to scoop them out of your life.  You even hired a trainer with some muscle to force you to change.  You’ve tried in vain to save yourself from yourself.

Trying to use the shovel here is like trying to use the shovel on steel forged walls of your life’s prison fortress.  Forget the shovel.  Shoulder your pick-axe.

  1. Start with one meal and make some substitutions.  My dietary plan can help you with this.
  2. Go to bed an hour earlier. Really, you’ll be surprised that the focus you have will more than compensate for the hour of lost time in the evening.
  3. Add a quality vitamin to your morning routine.
  4. Take ten minutes and do 20 push-ups and 20 sit-ups, then take a 10-minute walk.
  5. Simply remove the “white stuff” from your meals. You will be amazed at the results.
  6. Put down your phone for 30 minutes and read that book you’ve been meaning to read, instead of surfing Facebook.

Grand-standing with your back-hoe doesn’t help you.  Just swing the pick-axe once or twice.  Simple daily picking with the sharp point weakens the hardest of ground and the prison walls in our lives.  It takes time, so be patient.

Find the weak point, apply the pick.  Day by day, little by little you will be free.

I’ve been there.  I’m with you.  Keep me posted on your journey.

If you’re looking for a program that teaches you how to do this, check out my membership site.

Ketogenic Lifestyle Rule #1: There should ALWAYS be bacon in the fridge

BaCoN Fridge

I thought that over the next few weeks I’d address a number of Ketogenic Lifestyle Rules that I have adopted.  These seem to help and bring a little clarity to one following a Ketogenic Lifestyle or someone on the road to becoming a true “Ketonian.”

The first of these rules is that there should ALWAYS be bacon in the fridge!
Adapt Your Life

We address this rule and some interesting facts around having bacon in the fridge in this evening’s Persicope below.  We also address the benefits of journaling, how to help stop binge eating, what are your real protein needs, and red-meat fear-mongering. We even discuss whether or not pigs like bacon.  Enjoy!

 

Links referenced in this video:

Red & Processed Meats: Bacon Fear-Mongering

Calculating Your Protein Needs from Ideal Body Weight

The Power of a Good Vitamin

 

(Just a note: I love Katch.me’s service; however, due to the contract language allowing Katch.me to have unlimited rights to my Periscope Videos, I have withdrawn from Katch and my videos are no longer available on this medium until the contract usage can be modified.)

How to Stay Motivated on Carbohydrate Restriction

This evening on PeriScope, we talked about the 10 things you can do to stay motivated on your low-carb lifestyle.  A number of great questions were asked including:

  • How much carbohydrate should be restricted?
  • What labs should you be monitoring regularly?
  • What’s a normal blood sugar?
  • Why is Dr. Nally freezing in Denver?
  • Is fermented food good for you?
  • Why should you eat pickles and kimchi even when you’re not pregnant?

And, much much more . . . It’s like a college ketogenic course on overdrive . . . for FREE!!!

You can see the PeriScope with the comments rolling in real-time here: katch.me/docmuscles

Or, you can watch the video stream below:

See you next time.

Chewing the Phat with Dr. Nally (The Psychology of Fat & Many Other Questions)

Join me as we chew the phat of ketogenic lifestyles PeriScope style and answer many questions like, “Why do I get ‘hangry’?”  What causes hypoglycemia?  How many times a day should I eat? and many more . . .

We talk briefly about why 60% of people with insulin resistance may need methylated folic acid to help with B vitamin absorption/use and where it can be found.  (See me recent article about this called The Power of a Good Vitamin.)

You can see the whole PeriScope conversation on Katch.me/docmuscles with the comments scrolling or you can see the video stream below:

Thanks for visiting!!!

Obesity Leads to Silent Vitamin A Deficiency

Vitamin ARecent research from Cornell University, recently published in Nature, reveals that increasing obesity leads to poor uptake of Vitamin A in the organ tissues of mammals including humans.  Vitamin A (Retinol) is a key vitamin that helps in gene expression and regulation.   Vitamin A uptake has been shown to diminish in obese patients and patient with hepatic steatosis [fatty liver disease or non-alcoholic fatty liver disease (NAFTL)].

This is a key finding and gives further evidence of the genetic expression of obesity and it’s effect on both the parent and the child.   What is even more fascinating is that this appears to lead to alteration in immune response and changes in cellular differentiation in the human organs.   This means that the Vitamin A deficiencies within the organs are being driven by fatty liver infiltration that is driven by insulin resistance.  This Vitamin A deficiency cannot be detected with a blood test as serum levels of Vitamin A remain normal and has significant roll in masking the cause of autoimmunity function we are seeing more and more of throughout the world.

Metabolic effects of vitamins on the Immune System
Metabolic effects of vitamins on the Immune System

So how do you get your Vitamin A in a ketogenic diet?  Vitamin A can be found in meats (specifically liver and organ meats), eggs, butter, and cod liver oil.  It can also be found in leafy greens, squash and peppers.  The reduction in insulin production that occurs in a low-carb, ketogenic and even paleolithic diet reduces the fatty liver infiltration that arises with the standard American diet (SAD diet).  Clinically, I have seen people reverse the steatosis of the liver within 12 months in my practice through carbohydrate restriction.

More research is needed, of course, but the take home message is that the ketogenic lifestyle plays an even greater roll in genetics and immunity than we ever thought.  More to come . . . I’m sure.

You can see today’s periscope on this subject below . . .

or you can watch it here on Katch:  https://www.katch.me/docmuscles/v/0f7b9835-1ac2-378e-a844-5647e86b700d

Have a great Thursday!!!

The Power of a Good Vitamin

“So, Doc, which vitamin should I take?”

I’ve heard this question at least 5-6 times per day for the last 20 years.  The problem has been, there hasn’t been just one or two products that fit my or my patient’s needs.  I’ve seen many that are close, but no one seems to understand the needed nutrients for insulin resistance, leptin resistance and the tremendous effect adequate nutrients has on inflammation, atherosclerosis, uric acid, sodium balance, cholesterol and blood pressure.  That is, until I found a company that would let me design my own vitamin.

Working with a world renowned lab, I put together what I know to be the best ketogenic multivitamin on the market. I give you the “KetoNutritionals Multivitamin.”

It provides the nutrients that we recognize are essential to the TCA (tricarboxylic acid) or Krebs cycle.  I call it the Multivitamin Adult Formula, because it has the potential to enhance the body’s ability to use insulin, leptin and regulate normal blood sugar and maintain ketosis.  Now, it is essential that I inform you that these statements have not been evaluated by the FDA and that this product is not intended to diagnose, treat, cure, or prevent any disease.

Methylated Folic Acid

However, 60-65% of pre-diabetic and diabetic patients I see in the office do not correctly convert Folic Acid (Vitamin B9).  It is suspected that over 40% of the population in general has a genetic deficiency in the gene that codes for MTHFR.  MTHFR (also called methylenetetrahydrofolate reductase) is a genetic sequence that encodes for an essential enzyme in your body that helps make the active form of folate. Your body cannot make folate on its own, so it requires enzymes including the one encoded by the MTHFR gene, to make it from the foods that you eat. MTHFR enzyme also has an important role in making amino acids, the building blocks of proteins, by helping convert the chemical homocysteine to methionine in concert with Vitamin B12. Homocysteine is a harmful chemical made by your body that can damage the lipid membrane of cells leading to damage of the walls of your blood vessels, and may affect your blood clotting. In contrast, methionine is an amino acid required by your body for normal functioning.  Supplementing the methylated folate helps to provide the needed components for methionine production.  KetoNutritional Multivitamin contains both forms of active isomer, naturally occurring folates.  MTHFR deficiency can easily be tested for through a simple saliva test in the office.

MTHFR pathways
Metabolism of folate and homocysteine. American Journal of Physiology – Heart and Circulatory Physiology Published 1 July 2004 Vol. 287 no. 1

The conversion of methionine to SAMe is essential in this pathway. SAMe (pronounced Sammy) is necessary for methylation.  It is essential in the formation of neurotransmitters like serotonin and liver detoxification through the methylation pathway.  Serotonin is key in the treatment and prevention of depression, chronic pain, and liver detoxification.  In a number of cases, just fixing this methylation has dramatically improved symptoms of depression that would have otherwise been treated with strong psychogenic medications.

N-Acytylcysteine

Cysteine is used by the body as a source of sulfur for detoxification and the production of glutathione.  Glutathione is your body’s chief anti-oxidant and protector against all kinds of damage.  This is where Vitamin B6 plays a major role.  Vitamin B6 is also a cofactor in hundreds of different chemical reactions necessary for healthy hormones like estrogen, and progesterone.  It is also essential for the production of neurotransmitters like serotonin, dopamine, and GABA for proper brain function.

Carnosine

KetoEssentials contains the essential vitamins to allow these metabolic pathways to function properly. May people on a ketogenic diet don’t get the full effect of weight loss until adequate Vitamin B12 and Vitamin B6 are supplemented.  It also contains Vitamin B1, and carnosine that have been found to decrease the effect of inflammatory glycation and damage caused by higher blood sugars like diabetic retinopathy.  High gamma Vitamin E has also demonstrated retinopathy protection.

Alpha Lipoic Acid, Taurine, ECGC

Alpha lipoic acid combined with biotin has been shown to augment a more natural, healthy insulin secretion thereby promoting a more effective glucose metabolism.  Taurine, epigallocatechin gallate (EGCg) from green tea and Vitamin D have all been shown to improve the effect of the insulin you produce.

Improving insulin use and production has a direct effect your triglycerides. We now know that when your triglycerides are “out -of-whack,” leptin transport across the blood brain barrier is affected and this worsens your risk leptin resistance.  Leptin is that amazing hormone that tells your brain that your fat cells are “full” and to stop eating.

Vitamin A

Vitamin A as a carotenoid acts helps aid immune function and Molybdenum aids in detoxification processes in the body.

Zinc

Added zinc, taurine and EGCg to reduce the damaging effects that fructose can have in the liver, and also enhancing your insulin signaling. Added zinc also helps stabilize your testosterone and sex hormones.

Chromium, Manganese, Vanadium

But, these vitamins and anti-oxidants don’t help if they’re not absorbed correctly, so magnesium, chromium, zinc, manganese and vanadium help to enhance absorption. Correct supplementation of these nutrients may have the effect of normalizing glucose, insulin and leptin levels an reduction in risk for long term cardiovascular disease, diabetic complications, water retention, and more effective weight loss.

#KetoEssentialsIngredients #KetonianKing #DocMuscles

 

 

 

KetoNutritional Multivitamin 

#180 Capsule Bottle

TO BUY YOUR BOTTLE

-> CLICK HERE <-

 

References:

  1. Moat SJ, Doshi SN, Lang D, McDowell IFW, Lewis MJ, Goodfellow J.  “Treatment of coronary heart disease with folic acid: is there a future?” American Journal of Physiology – Heart and Circulatory Physiology Published 1 July 2004 Vol. 287 no. 1, H1-H7 DOI: 10.1152/ajpheart.00952.2003

  2. Hipkiss AR, Brownson . Reaction of carnosine with aged proteins: another protective process? Ann N Y Acad Sci. 2002 Apr;959:285-94.

  3. Waltner-Law ME, Wang XL Epigallocatechin gallate, a constituent of green tea, represses hepatic glucose production. J Biol Chem. 2002 Sep 20;277(38):34933-40. Epub 2002 Jul 12.

  4. Jacob S, Ruus P, Hermann R, Oral administration of RAC-alpha-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled trial. Free Radic Biol Med. 1999 Aug;27(3-4):309-14.

  5. Boucher BJ . Inadequate vitamin D status: does it contribute to the disorders comprising syndrome ‘X’? Br J Nutr. 1998 Apr;79(4):315-27.

  6. Hammes HP, Du X . Benfotiamine blocks three major pathways of hyperglycemic damage and prevents experimental diabetic retinopathy. Nat Med. 2003 Mar;9(3):294-9. Epub 2003 Feb 18.

  7. Maassen JA, Mitochondrial diabetes, diabetes and the thiamine-responsive megaloblastic anaemia syndrome and MODY-2. Diseases with common pathophysiology? Panminerva Med. 2002 Dec;44(4):295-300.

  8. Ozcelikay AT, Becker DJ. Improvement of glucose and lipid metabolism in diabetic rats treated with molybdate. Am J Physiol. 1996 Feb;270(2 Pt 1):E344-52.

  9. Banks WA, Coon AB, Robinson SM, Moinuddin A, Schultz JM, Nakaoke R, Morley JE. Triglycerides Induce Leptin Resistance at the Blood-Brain Barrier. Diabetes May 2004 vol. 53 no. 5 1253-1260. 

Burnout

Ask yourself the following questions:

  • Does your job limit interaction with people and/or do you spend most of your time with a computer screen?
  • Have you become cynical or critical at work?
  • Do you drag yourself to work and have trouble getting started once you arrive?
  • Have you become irritable or impatient with co-workers, customers or clients?
  • Do you lack the energy to be consistently productive?
  • Do you lack satisfaction from your achievements?
  • Do you feel disillusioned about your job?
  • Are you using food, drugs or alcohol to feel better or to simply not feel?
  • Have your sleep habits or appetite changed?
  • Are you troubled by unexplained headaches, backaches or other physical complaints?

burn outThese are the ten most common signs of “burnout.”  46% of respondents in surveys indicate at least one of the above symptoms of burnout. Two or more of these imply that you are suffering from some degree of “burnout.” The classic triad of burnout is:

  1. Exhaustion
  2. Cynicism
  3. Questioning the quality of your work, or questioning whether you are making a difference in the world any longer

What is burnout? It is defined by “Mr. Webster” as “physical or mental collapse caused by overwork or stress.” But, that definition doesn’t seem to do it justice, and many people experiencing burnout don’t actually “collapse.”  They do, however, become significantly less productive, depressed, and loose the enjoyment of life.  Work begins to feel like slavery, exercise becomes a chore, food begins to have associations with guilt, friendships are seen as obligations and love looses its luster and looks more like a social construct.

Burnout is often likened to discontent, however, these are two very different emotional feelings.  Discontent can be defined as dissatisfaction with ones circumstances. There are two kinds of discontent in this world: the discontent that works and the discontent that wrings its hands.  The first kind often gets what it wants and the second looses what it has.

Burnout differs from discontent, in that continued work toward a goal brings on the triad of emotional exhaustion, depersonalization and the feeling of reduced personal accomplishment. Burnout is, in reality, the sum total of hundreds of thousands of tiny betrayals of purpose.

Burnout can occur in any field of work, however, a study published in the 2012 issue of JAMA reveals that over 40% of the ~800,000 U.S. physicians are experiencing burnout and are more prone to burnout than any other worker in the United States.  The journal Academic Medicine recently reported that medical students, when compared to age-matched fellow college graduates, reported significantly higher rates of burnout.

So, how do you overcome burnout?

I’m an Osteopath.  I see disease in the context and inter-relationship of the mind, body & spirit.  Overcoming burnout requires one to restore balance in these three areas.  I am impressed by the work of Charlie Hoehn in his book, Play it away: A workaholic’s cure for anxiety.  Charlie does a wonderful job of describing the broken inter-relationship of the mind, body and spirit in a person experiencing burnout.

The first step to repairing the broken inter-relationship is to recognize and remove those anchors keeping you tethered to the feelings of burnout.  The anchors are the stressors that cause you to worry on a daily and weekly basis.  Journaling these stressors, writing them down in 3-5 word sentences is the start.  Identify which of these stressors is the biggest or causes the most angst, then write out the following question.  “How can I eliminate [stressor] from my life?  Do this with the largest two or three stressors. Then write out a solution that is small and uncomplicated to each stressor.  Put the solution to work immediately. If your solution has not improved your feelings of stress and anxiety within a week, then drop the first and try to find a second stressor, or otherwise switch to a second solution. Journaling these thoughts, questions, feelings and answers allows your mind to change from a self-centered focus to an action based focus.  It clears the mind to move into action. Nothing is more important in reducing burnout, than nourishing the imagination. Using a journal helps stimulate thought and the imagination.

The second technique is scheduling some real play. Write down the five most fun activity involved with play that you did as a child. Then, set aside dedicated time for your favorite activity of play.  It is essential that you actually schedule this play time into your daily activities.  There are a couple of rules associated with play time.

  1. Disconnect from all social media
  2. Harmony of the playtime is more important than winning
  3. Have some serious fun
  4. Shoot for 30 minutes of play time per day
  5. This should ideally be done outside in the fresh air and sunlight

“A lack of play should be treated like malnutrition: it’s a health risk to your body and your mind.”  (Stuart Brown)

“Play is the highest form of research.” (Albert Einstein)

Technique number three is related to sleep.  It is essential that you have a consistent bedtime and give yourself the opportunity to take an afternoon nap.  You can optimize your sleep by turning off electronics before getting into bed, going to bed at the same time each night, decreasing the room temperature to 68-70 degrees Fahrenheit, draw the curtains to make the room dark, and use a relaxing loop of quite background sound like ocean waves, or the sound of a trickling stream to ease your mind (can be found on a number of apps).

It may take up to a week for your body to unwind and get used to this schedule.  Also, schedule a 20 minute afternoon nap.

Meditation and/or prayer is the fourth technique.  Sit or kneel, close your eyes and observe the thoughts that enter your mind for 10-15 minutes. Listen to and keep your breathing calm and deep. Pay attention to the rhythm of your breathing.  Reading can also be a form of meditation and has become an important refreshing part of alleviating burnout.  We can only be as good as the books that we read.  Read, ponder over and talk about good books.

Fifth, eat healthy meals with healthy friends.  Decrease the carbohydrates and increase the good omega 3 fats in your diet.  The insulin response to carbohydrates stimulates the inflammatory and parasympathetic nervous system making you more fatigued and tired. Reduce the bread, rice, pasta, potatoes, carrots and corn intake in your diet.

Increasing the good fat in your diet (like Kerrygold Irish Butter, Coconut Oil, Olive Oil, and real animal fats) actually increases your bodies access to essential B vitamins and improves the use of Vitamin D.  Making dietary changes become a habit is often easier when it is done with a friend.  Schedule opportunities to eat healthy meals with family or friends attempting to do the same thing.  You will help support each other and be more likely to succeed.

The last recommendation is spend time in nature.  One weekend a month spend at least two hours out in nature. Take a hike, go on a nature walk, go camping, swim in the river, etc. Give yourself permission to unplug during these times.  Then, pay close attention to how you feel when your in different environments.

In the words of Shakespeare, “Self-love, my liege, is not so vile a sin/As self-neglecting” (King Henry V, Act 2, scene 4).

I conclude with the rhetorical question, “If you work for a living, why do you kill yourself working?” (The Good, The Bad, and the Ugly)

 

Vitamin D's Effect on Weight and Obesity

Vitamin D plays an interesting role in may aspects of human health. It plays a role in disease prevention including osteoporosis, some cancers, autoimmune disorders, hypertension, diabetes and has recently been found to effect weight loss.

VitaminD1What is Vitamin D?  It is an oil-soluble (fat-soluble) vitamin that helps in the absorption of calcium and phosphorus in the intestine and suppresses parathyroid hormone (PTH), the hormone that stimulates bone resorption (breakdown). Vitamin D also plays a role in muscle function and in the immune system, but our understanding in these roles are still limited. (1)
Vitamin D can be found in fatty fish, cod-liver oil and eggs. In the United States, cow’s milk is supplemented with Vitamin D and this is often the source from which most people obtain it. Deficiency in Vitamin D often occurs from lack of sun exposure, inadequate intake, surgery to or damage of the intestines ability to absorb, or from kidney or liver damage resulting in problems processing Vitamin D. Recent studies reveal that obesity is a major factor in altering the way the body uses Vitamin D and stimulates PTH.Vitamin-D_Sun

I find that about 30-40% of my patients are Vitamin D deficient.  Many researches claim this is due to poor sun exposure or the use of sun screens, however, I live in Arizona.  Sun “over exposure” is usually the problem here, yet I still find that 30-40% of my patients are deficient.  My patients should be able to get enough sunlight walking from their cars to the grocery store entrance.  I disagree that “lack of sun exposure is the cause.”  Although our current labs claim vitamin D levels should be above 20 ng/dl, I find people do not get the needed effect until 25 Hydroxy-Vitamin D levels should are greater than 32-35 ng/dl.
Poor Vitamin D intake is usually the problem.

Our bodies convert 25 Hydroxy-Vitamin D into the active molecule 1,25 Dihydroxy-Vitamin D.  Recent studies reveal that higher Body Mass Index (BMI) leads to lower conversion of 25 Hydroxy-Vitamin D to 1,25 Dihydroxy-Vitamin D. (2,3)

Simply adding 25 Hydroxy-Vitamin D as a supplement frequently helps with weight management in many of my patients. Supplementation with 1000-2000 IU is often adequate.  Higher doses should be discussed with your doctor.

References:
1. C P Earthman, L M Beckman, K Masodkar and S D Sibley. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications.International Journal of Obesity (2012) 36, 387–396; doi:10.1038/ijo.2011.119; published online 21 June 2011.
2. Frost M, Abrahamsen B, Nielsen TL, Hagen C, Andersen M, Brixen K. Vitamin D status and PTH in young men: a cross-sectional study on associations with bone mineral density, body composition and glucose metabolism. Clin Endocrinol (Oxf) 2010; 73: 573–580.

3. Konradsen S, Ag H, Lindberg F, Hexeberg S, Jorde R. Serum 1,25-dihydroxy vitamin D is inversely associated with body mass index. Eur J Nutr 2008;47: 87–91.