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The health of your gastrointestinal tract (GI tract) affects your entire body.  One of the main supplements that I recommend to my patients is a good quality high-dose probiotic. Why you ask? Let me tell you...

Your gastrointestinal tract is a complex ecosystem containing thousands of species of bacteria. These bacteria can be found in your stomach and small intestines, but the majority are found in your colon.  Collectively these areas make up your “microbiome.” These intestinal flora aid in digestion, synthesize vitamins and nutrients, metabolize some medications, support the development and functioning of the gut, and enhance the immune system.

There are times when this balance of beneficial bacteria gets out of balance such as with the extended or recurrent use of antibiotics, poor dietary habits, or recent infection.  This is where the use of a probiotic becomes advantageous.  A good multi-strain probiotic can help to recolonize the GI tract to the proper balance of beneficial bacteria.  But how do you recognize a high-quality probiotic?

Here's how:

  1. It is multi-strain.  This means that it has more than one type of bacteria in each capsule. The one I recommend the most contains Lactobacillus acidophilus, Lactobacillus plantarum, Bifidobacterium longum, & Bifidobacterium lactis.
  2. It is packaged so that oxygen cannot reach the capsules or is consistently refrigerated (even during transport) so that the organisms cannot get overheated and die.
  3. It is high dose.  For maximum results the GI tract needs maximum exposure.  For those patients that have GI issues or tend to have weakened immune systems, I recommend 100 Billion CFU (the measurement for bacteria is Colony Forming Units) daily.  Other patients that simply need to maintain GI health can take the 100 Billion CFU capsule every other day or just several times per week.

Some foods also promote healthy and abundant GI flora.  For example, sauerkraut and kimchi are fermented foods that contain probiotics.  Other foods provide the precursors to probiotics called “prebiotics”.  Those are foods like: asparagus, onions, garlic, cabbage, and artichokes.  These foods are mainly carbohydrates that cannot be digested by the body, but are food for the probiotic (or good) bacteria.  Following these guidelines will get you to a better place with your bowel movements (diarrhea or constipation), vaginal health, skin health, and even a healthier immune system.  Here’s to a healthy microbiome!



I have quite a few patients that are concerned about their bone health, and the first question they normally ask is “how much calcium should I be taking?” The answer is that amounts vary according to the patient, and you should not be taking calcium alone.

The first question you should ask is what is bone made of? Bone is composed of several calcium-based minerals and collagen. This means that if you are going to take a supplement to support your bones, you need to take multiple supplements.

Here's the basics...
1. Calcium is still a necessity. However, not all calcium supplements are created equal. My preference is for what is called MCHC (Microcrystalline Hydroxyapatite Concentrate). This is a standardized, and safe-source bone extract from New Zealand bovine, that contains a crystalline calcium and phosphorus matrix. It is also what your bones are made of.

2. Vitamin D3. Yes, you need Vitamin D3 (cholecalciferol) to support bone health as well. Vitamin D’s best-known role is to keep bones healthy by increasing the intestinal absorption of calcium.

3. Collagen. This is supported through a silicon based supplement (specifically orthosilicic acid). Collagen helps bone withstand sudden impact, and determines how “tough” your bones are.

4. Vitamin K2. Vitamin K2 (as menaquinone-7) supports calcium utilization and absorption. Some younger patients do not require added Vitamin K2 supplements.

How do you know the right combination of supplements for your bone health? Ask your doctor. The good news is that there are supplements available that contain all these ingredients in one packet, or you can purchase them separately. If you are a post-menopausal woman with osteopenia or osteoporosis, you are going to need considerably more of each of these supplements to ensure that you arrest your bone loss.



A brief introduction...

When most practitioners talk about “anti-inflammatory” they are generally referring to prescriptions that mask swelling such as NSAIDs like ibuprofen or naproxen.  When functional medicine practitioners talk about anti-inflammatory we are referring to the foods and supplements that prevent the cause of inflammation in the body.

Inflammation is the beginning of all disease states whether acute or chronic.  Obviously acute inflammation is necessary for the body to start repairing damage from some harm inflicted recently such as a sprained ankle or a cut finger.  Chronic inflammation is what you never want your body to experience.

First, how do I know if I have chronic inflammation? 

Chronic inflammation manifests itself in many different ways.  The most common are:

  • Joint swelling & tenderness
  • Muscle aches (not muscle soreness from exercise)
  • Abdominal pain & bloating
  • Chronic headaches
  • Constipation
  • Constant fatigue
  • Any autoimmune disorder

If you have one or more of these symptoms, you are experiencing chronic inflammation.

So I have chronic inflammation, what do I do now?

Step number one when working to combat chronic inflammation is to look at your diet.  I firmly believe that “you are what you eat.”  However, making healthy choices can be confusing.  The media and the internet are filled with conflicting information on “eat this food...but don't eat this, it's ok to eat this food in moderation.”  So what's a person to do?  I'm going to make this relatively simple.

A simple summary of what to eat:

  1. Eat organic, grass-fed/free-range meats or wild-caught seafood/fish
  2. Eat organic produce (this includes all fruits and veggies)

What not to eat:

Avoid as much of these as possible:

  • Grains of any type (yes, that means no bread)
  • Sugar in any form (use Stevia instead)
  • Artificial sweeteners (yes, pink ones, yellow ones & blue ones)
  • Caffeinated beverages (substitute herbal teas or better yet, just drink water)
  • Alcohol in excess
  • All dairy (yes, cheese too)
  • Eggs (food allergy testing can confirm if you must avoid these long-term)

If you have already progressed to an autoimmune disorder, then you need to be especially diligent in your eating habits and avoid everything on this list.

If you would like to get a firm answer on what exactly your food allergies & sensitivities are that are causing your chronic inflammation, see a practitioner that does testing.  In my office, we use Alletess Food Allergy/Sensitivity testing.  We welcome current patients to come in and request the test.

Focus on Curcumin

Once patients have begun to work on their diet to eliminate the foods that are perpetuating chronic inflammation, I look to one of my favorite supplements that can help reduce any remaining swelling & discomfort...Curcumin.

Curcumin is the active compound in Turmeric.  It is yellowish in color and has been a part of Indian and Asian diets for centuries.  Interestingly enough researchers began to notice that those countries had a much lower incidence of arthritis and other inflammatory diseases.  Additional research has found that Curcumin plays a role in decreasing inflammation and protecting the body from inflammation.

I never recommend starting any supplement without speaking with your physician first.  As with all medications your healthcare provider will make sure it will not interfere with any of your other medications.  I also recommend that you consult a physician on what dosage of curcumin would be best for you.


Prescription Rx Pic

As patients, we all strive to do what is best for our bodies. We eat well, exercise, and take any necessary medications when needed. However, what is not well known is that sometimes the medications we take can cause a depletion of important nutrients.

Don’t get me wrong, prescription medications are a necessity for many people and I am not in any way advising you to NOT take your prescribed medications. I simply would like to educate you on the nutrients you will need additional intake of, when taking certain medications.

Since there are a lot of medications that can cause nutrient depletion, I am going to break them up into a two-part series and only tell you about a couple of drugs at a time. This month I would like to address Antacids and Non-Steroidal Anti-Inflammatories (NSAIDs).

This category includes medications such as Pepcid, Tagamet, Prevacid, Prilosec, and magnesium & aluminum containing antacids (such as Gaviscon, Maalox, Mylanta).

Antacids work by neutralizing stomach acid or by inhibiting the release of a digestive enzyme (like pepcin). Unfortunately stomach acid is necessary to release vitamins from food, and when you decrease or stop the production of it, you absorb fewer vitamins.

These medications can cause deficiencies in the following nutrients:

Vitamin B12
Folic Acid
Vitamin D

Most common of these is deficiencies is B12. Vitamin B12 deficiency can cause anemia, depression, tiredness, and weakness. The good news is that Vitamin B12 is easy to supplement. When choosing a B12 supplement, you want to look exclusively for the methylated form…Methylcobalamin. Dosages range from 1 to 5mgs and it can be taken twice daily if needed. I recommend taking it in the morning and around noon. Vitamin B12 provides energy, so never take it too close to bedtime. Vitamin B12 is also “water soluble” meaning that you cannot overdose on it since the body automatically eliminates any excess through urine.

Talk to your doctor about the proper dosing for you when supplementing for Folic Acid, Vitamin D, Calcium, Iron, and Zinc. Vitamin D is a fat-soluble vitamin. You can take too much of it, so be sure to have your blood tested to keep your levels in check.

This group includes medications such as Motrin, Aleve, Advil, Anaprox, Dolobid, Feldene, and Naprosyn.

These are all known to cause folic acid deficiency due to a decrease in the body’s ability to absorb folate from the intestine.

Folic acid deficiency can cause birth defects, anemia, and a higher risk of cardiovascular disease.

Also in this group is aspirin and other salicylates.

Long term use of aspirin is linked to deficiency in the following nutrients:

Vitamin C
Folic Acid
Vitamin B5 (Pantothenic Acid)

Aspirin can cause the body to expel more Vitamin C in urine than normal and Vitamin C is essential for a healthy immune response. Calcium is necessary for bone, heart & dental health. Iron prevents anemia, weakness, fatigue, hair loss, and brittle nails. Vitamin B5 helps with fatigue and listlessness.

Most of these nutrients are available in a high-quality multivitamin, however if you are on an aspirin therapy regimen, I recommend talking to your doctor about dosage to replenish these nutrients.

Next month we will talk about some additional medications that can cause nutrient depletion. If you currently take any of these medications and want to know if you are nutrient deficient, we offer testing in our office through a company called Spectracell. You call any of our offices to request Spectracell testing. Until then I wish you continued good health.


Dr. Melissa Miskell


Antioxidant Boxers

Every so often a patient asks me, “What are antioxidants and why do I need them?”  My answer is always the same.  To understand what antioxidants are, you need to understand what a free radical is.

Let’s Start from the Top

Free radicals consist of harmful molecules that are missing electrons.  Electrons typically come in pairs.  This lack of electrons cause the molecule to be highly reactive and cause damage by attacking the most basic parts of our healthy cells causing what is considered “oxidation”.  Oxidation can set off an entire cascade of chemical reactions causing damage.  Free radicals can even cause cancer.

Ways we encounter free radicals every day:

Cigarette smoking
Airborne emissions/pollution
Ultraviolet radiation
Herbicides & pesticides

Free radicals aren’t entirely bad.  There are some body systems that require free radicals to complete their processes.  They actually play a role in the immune response to fight off viruses and bacteria and they start the process of inflammation that helps to repair injuries.  However free radicals obtained from the sources above definitely cause premature aging and disease, so we fight these with antioxidants.

What Antioxidants Do

Antioxidants basically have the ability to “render harmless” free radicals.  They provide the missing electron or break down the free radical molecule.  This then stops the cascade of chemical reactions (oxidation), thus   the name, anti-oxidant.  This process depletes the antioxidants, to where there are none remaining and must be replaced.

Where Do I Get Antioxidants?

Antioxidants are found in most fruits, vegetables, and nuts.  Vitamins such as A, C, and E have antioxidant properties.  Some foods that have more antioxidants are:

Blueberries, Dark Chocolate, Pecans, Artichoke, Kidney Beans, Cranberries, Blackberries, Cilantro

Antioxidants are also available in supplement form.  Remember to talk to your doctor before adding any supplement to your diet.  Just to name a few antioxidant supplements…

1. Glutathione is truly the master of all antioxidants, glutathione boosts the activities of all other antioxidants and vitamins. Up until a few years ago, glutathione was not stable when taken orally.  However recent advances have created S-Acetyl Glutathione that can be taken orally and has proven to boost the body’s antioxidant levels.

2. Vitamin C has been shown to regenerate other antioxidants in the body including Vitamin E. It is not made by the body and must be consumed in food or by supplementation.

3. Curcumin comes from Turmeric which is a member of the ginger family. Its roots are dried and ground into an orange-yellowish powder.  Curcumin has been shown to inhibit certain enzymes that cause inflammation in the body.

Because antioxidants are depleted when fighting free radicals, you want to be sure to eat a balanced diet that includes fruits, vegetables, and nuts every day to replenish your fighting power.  If you are using a supplement as well, be sure to check with your doctor and chose a high-quality supplement brand (preferably pharmaceutical grade).  Let’s do everything we can to keep ourselves healthy and young for as long as possible!

May you have continued good health,

Dr. Melissa Miskell

At Focus Total Health, our goal is to help you live as well as you can while feeling good. The aging process can take a toll, but its effect can be minimized with the use of appropriate hormone therapy and excellent nutrition.

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