The tact and grace of an inside joke.

I seem to mention at least every other blog or so, "mom guilt". It is a soul crushing distraction from all the other great things we have to be stressed and freaking out about. In my opinion, building a community based on inclusion and "laughing through the chaos" is one of the best ways to combat "mom guilt"

So what on earth does an inside joke have to do with chiropractic, pregnancy, fertility, or ketogenesis? Everything. Have you ever been so stressed out that you focused in on a doughnut until it was in your mouth. Have you ever been so tired or out of it that you missed an entire conversation someone was trying to have with you? Have you ever caught yourself looking at facebook on your phone while facebook is also open on the computer in front of you? These are symptoms of overwhelm; and they are part of the problem.

We, as humans, are meant for social interaction. We hug, we kiss, and for those of us who are really uncomfortable with physical touch, we have great intimacy in sharing the mundane tiny details and simply speaking to other people.

When we talk about inside jokes, the beauty and simplicity of the comment is that there's no necessary depth before the event comes to fruition. We have inside jokes with people we've only met a few times. To say to a person, "Remember that one time..." even if it was the first time, is no less valuable. An inside joke artificially (and then, of course, genuinely) increases intimacy. We want people to remember us. We don't all want to be the star of the show, but when you meet someone  for the second or third time and they remember something you were wearing or something you said, it makes us feel as if that person values that memory.

So, if you are tired of being home with babies, and you are looking for a mom group or a scheduled event for kids and moms alike, seek out the women that remember you. Those women are the goodies, the ones who pay attention, and the ones who are more likely to laugh at life with you, instead of chastising every decision you make.

The art of the inside joke takes the edge off of what could be a painful reintroduction to society. In general I think we could all stand to laugh a little more.

Recently I was asked, "What do you want to do with your life?" And I said, "I want to make people laugh." Can chiropractic make people laugh? Absolutely. If we know that the brain is speaking to the body and the body is speaking to the brain, and that person is "working on all cylinders" then we know that no matter what happens, they will be adapting to whatever life throws at them better.

A quick story to round out this pretty light post:
**This was told to me by a professor in Chiropractic School**

A man came into the clinic for low back pain. He brought his daughter with him. He didn't speak much, and his clothes were often dirty, and over all he seemed like a pretty angry man. After the first phase of his care plan ended he told the doctor he wouldn't be coming back. The little girl started crying. The doctor asked, "Are you not feeling better? Are we not getting the results you anticipated?" To which the patient said, "I feel much better, but I don't have pain any more so I'm not going to come in anymore." The doctor turned to the little girl and asked if she'd noticed any differences in her father since he'd started care. The daughter said, "Since he started chiropractic care he doesn't hit me anymore. I'm afraid if he stops he'll start hitting me again."

1. We can not down play the effect of the adjustment on the brain.
2. We can not down play the effect of dysfunction on behavior.
3. We can not pretend that "pushing through" issues has no effect on children.

Laugh more. Live better.

An unexpected opinion piece on the art and bastardization of supplementation.

Hi. I am Dr. Sam Curtis, DC. And in the past year I have made a dramatic shift away from supplementation.

How perfect is the idea of the vitamin capsule?

 Do you have an ailment but don't like the idea of herding to the doctor for a prescription?

 Have you heard that every pill you take will immediately shut down your kidneys and give you Alzheimer's!?!?!? 

Yep. Me too. So it only seems right that we, as the "thinking citizen", would opt out of those medications until ab.so.lute.ly. necessary. So, wayyy before chiropractic school, way back in my crunchy infancy, I started using supplements. Got a cold? Vitamin C, Zinc, echinacea. Heavy menstrual cramps? Cal/Mag, ginger tea, primrose oil, and a dash of black cohosh. These are the Dr. Google go-to's of supplementation. I firmly believed that if there was an issue, there was a vitamin, a mineral, or a pill to fix it. So maybe you are thinking, "A vitamin is way better than a prescription drug!" And in many ways you are right.

However, in my line of work, healing comes from the inside out. If you are dumping the highest quality gas into a car with a wrecked radiator.... it wont get you to your destination any quicker. As a chiropractor it is imperative that we ensure your brain is able to effectively communicate to your body and vice versa before we begin throwing the kitchen sink into the mix. You do you though. If you want to take a supplement, and you have either been advised by a trained professional or you have done your own research, I am certainly not speaking against that. What I am saying is that the sweeping protocols that make supplementation the billion dollar industry that it is, is really no better or more empowering than a prescription from the drug store. It may be better for you, it may cause less environmental and biological harm, but in simplest words: Allopathy is the method of taking a pill for an ailment

At present I can think of a few examples of supplementation that are misguided, and a few that are exceptions to my "no supplement" rule.

Misguided:

1. Vitamin D. We have ample research that says vitamin D is necessary for calcium to perform its best with bony lay down (new bone as old bone is broken down). Many people at this point will say, "The higher vit D levels the better!" This isn't true! [1]. Basically, about 2 decades ago, some researchers found that people with higher vitamin d levels had decreased homocysteine. Homocysteine is linked to cardiovascular disease. Because heart disease is still a heavy weight contender for most common cause of death, the healthcare world said, "oh, duh! Let's put everyone on a Vit D supplement and watch the heart disease plummet!" The major issue with this is that we aren't meant to ingest vitamin D. We are meant to create it inside of our bodies using our skin, our liver, and our blood. Vitamin D has a similar structure, or a base structure, of cholesterol; this is also true of estrogen and testosterone. So, structurally, vitamin d is like a hormone. What current research is showing us, is that when we put hormones in parts of our bodies that they aren't intended to be (ie estrogen in the digestive tract etc), we open a can of worms that we aren't exactly sure how to close. So oral  supplementation of vitamin D is increasingly controversial. That being said, regulated sun exposure is an AMAZING option for anyone with a heartbeat. I recommend downloading the D minder app (no I don't get any kickback from them, plus it's free :))  and starting there. The app will tell you when to come inside and can even estimate the D3 produced in your body per session.

2. Iron. My grandmother was "iron deficient" for over 40 years. As a kid my iron levels were amazing, and then in my late teens/early twenties, it dipped a bit. If you've ever supplemented with iron, you may know well the constipation and other unpleasantness of supplementation. And if you "picked up what I was laying down" about the digestive tract you may be thinking, "But we do absorb iron through our digestive system!" And to that I, "Heck yeah!" So here are some questions for your healthcare provider if they suggest that you start taking iron supplements:

            a) Is ferritin low? Or hemoglobin? 

            b) Given that Ferritin is NOT synthesized in the blood, EXACTLY how does a serum measurement of Ferritin (i.e. an extracellular marker, and akin to “Kitchen temperature”…) relate to, or have ANY relevance to, the Intracellular Ferritin Protein level (i.e. the storage protein synthesized INSIDE the cells, and is more akin to “Oven temperature”)?

            c) What’s the status of my mineral & vitamin co-factors that REGULATE Iron metabolism: i.e. Magnesium, Bioavailable Copper, Zinc, Ceruloplasmin (Ferroxidase enzyme), & several select Iron markers?

            d) Do I have markers of chronic inflammation (BUN/Creatinine ratio, H1c, CRP? If so, aren't those also heavily correlated to hypoferremia?

The list goes on. If you are ever interested, shoot me a message. There's about 12 other questions to ask before starting iron supplementation. 

3. Folic Acid. Folic acid was synthetically created in the early 20th century. Up until that point our exposure to B9, the well known vitamin that influences neural tube development, was through folate. As of 1998 folic acid is a federally required fortification in many grain products. Unfortunately, as we have seen a dramatic decline in spina bifidas and cleft palates, we have seen an increase in tongue ties, which has an impact on bilateral head movement (ie, breastfeeding on both sides). [2]

Exceptions to the Rule:

A generalized note: Therapeutic supplementation ( short term doses for a diet, for recovery, to support a new body function (like, say, breastfeeding), and for chronic illness, are vastly different than the daily grind of 15-20 supplements that are to "raise your levels". I'm a huge supporter of using supplementation to aid the body through a transition or rehab, but not for longterm generic use.

1. Electrolytes. I don't fan girl over things, and lately the bottom of the list of my fan girl options would be supplements. However magnesium is my jam. Magnesium is necessary for ATP production in the body, as well as muscle recovery after a workout. Without potassium, magnesium, sodium, and calcium our bodies would literally immediately wither into a puddle. I have heart palpitations from my apparent inability to hold on to water/electrolytes (probably a chronic inflammation that I have yet to address). I've been supplementing with magnesium malate off and on for over a year now. If you are taking magnesium I would highly recommend against magnesium oxide (unless it is an external use) and magnesium citrate. Magnesium oxide is used as a laxative if taken orally and will only further dehydrate you. Magnesium citrate has long term negative impact on the ceruloplasmin and can negatively impact iron production.

2. Fish oils/ DHA/EPA. So fish oils....heart health....blah...blah...blah. The biggest thing about DHA/EPA is that our brain needs DHA and EPA to stay healthy. As we get older our ability to hold on to omega 3s becomes even more important. Dr. Dan Murphy claims that a ratio of O3/O6 above 1:25 wreaks havoc on the mental health and memory loss. The american diet is inundated with omega 6's. My general recommendation is to purchase an Omega 3 only, or an O3/O6 ratio as close to 1:1 as possible. There's some evidence that the body can convert DHA to DHEA, though it's hard to solidly say. At the end of the day you are eating animal fat is pretty small doses; to that I say, "No harm no foul". 

A final note on quality. Calcium carbonate is calcite. It's a rock. It's a finely ground rock. You can take that rock, and eat it, and your blood calcium will likely increase. But what can your body do with rock? Chickens eat rocks and it helps to break down the food they eat. We don't have that function, as our stomach acid is pretty bad a** and can breakdown pretty much anything we can fit down our esophagus. Short advice: try to buy foods based supplements. Or even better, try to eat the foods that contain the vitamin/mineral you are looking for.

1.http://www.hopkinsmedicine.org/news/media/releases/vitamin_d_more_may_not_be_better

2. Flanagan J, Landa R, Bhat A, Bauman M. 2012. Head lag in infants at risk for autism; a preliminary study. Amer. J. Occup. Ther. 66: 577-585.

If you ain't first, you're last; an account from the lifelong 'last friend to....'

Good Girls don't....: A guide to true cultural sexual rebellion.

One of the defining moments of my life was when I was in the 5th grade. My mother had been mostly absent for years, my grandmother was my beacon of femininity, and my extended family was doing everything in their power to prevent me from slipping through the cracks (Thank God for them!)

I was 11 years old, and I was sitting in a rocking chair on the front porch of my great grandmother's house. I was on the phone with a friend. I said, "I want to be an obstetrician. They deliver babies and I want to deliver babies. I hear it's pretty complicated, but I think I can do it." At this point my well intentioned aunt (pronounced "aint") walked out to me and said, "Good girls don't talk about stuff like that." I remember giggling awkwardly and just telling my friend I had to go. Coincidentally, about a year prior to this I was terribly confused when I looked under that same aunt's bathroom counter and saw these flat wrapped objects, and I genuinely thought that menstrual pads were like rolling your own cigarettes. I was told then that I didn't need to worry with that stuff.

You know what this did? It led me down the rabbit hole. What else aren't we supposed to talk about? In retrospect my grandmother never called sex, "sex". She called it "Making Love" (to this day I hate that phrase). So, around this time AOL discs were a dime a dozen, or literally free at the local grocery store. I went through about 15 discs in 6 months; I think they were 500 minutes free? 1500 minutes free? Anyway, I looked up everything. I looked at always.com, I looked at kotex.com, I looked up informational pages about periods. I looked up books. I got books from the library. I wanted to know everything I could about sex, periods, and pregnancy. I read Judy Blume (not recommended), and other teen based books; often thick with "life lessons on the irresponsibility of sex out of marriage."

By the time I was 14, purity rings were a big deal. I see that they still are; the jury is out on that one. Needless to say, I was opposed to making promises I couldn't keep. I remember being in 3rd grade and refusing to sign the D.A.R.E. promise for the exact same reason. If you want to believe that indoctrination wasn't an issue while I was in school, I'll ask you to view my school record that shows me getting 1 referral in my life: because I refused to sign a piece of paper at 9 years old. PS, there is another referral unofficially on my record for skipping school; at least I'm honest.

In my household nothing was a big deal. Making mole hills out of mountains caused me to not be overly preoccupied with alcohol or sex. This is not to say that sexual curiosity didn't come on early for me, but I wasn't terribly concerned with having sex at an early age. Anywho, I went away to college, was put on birth control for a medical reason, met a boy, and the rest is completely.... deviant from the norm. :)

I moved to California when I was 22. I was put on birth control when I was 19, and around 24 when I stopped. I didn't stop because I wanted to get pregnant. I stopped because it was ruining my relationship. I stopped because my already "dry" emotional state became like a tin roof; nothing stuck. Nothing bothered me, but nothing made me happy. I was non-committal to everything. Plus, it wasn't getting rid of the symptoms it was supposed to. When I stopped taking birth control I was convinced for a year that I would get pregnant. And then I didn't; this is not a miracle or anything, we were using barrier method.

And then. And then. My old employer was a Catholic SAHM. She told me about NFP. And that part really is history. Through, what I can only identify as a rebellion, I've realized that how we speak and react to fertility is perpetuating an unnatural fear of sex. I love sex. I don't just love sex for me, I love sex for all consenting adults. I openly admit in my instruction that my goal as an instructor is to give a couple as many usable days as possible. Call it manipulative, call it unhealthy, but sex is a pretty savvy cure-many (notice it's not a cure all), for relationships. When two people are consenting and having a good time, let the good times roll! Whatever floats your boat, let it take you away. That part is no one else's business.

My goal is to help people be empowered in fertility. Fertility is not a barrier to sex. Fertility is the heartbeat of sex, one to be observed and listened to, like the heart pounding of a first kiss or the barely noticeable slow, patient, beat of a Sunday morning cuddle. You do not have to get pregnant while practicing fertility awareness. It is not a game of chance. It is not purely for Catholics and Muslims. You have been lied to, and I'm here to help.


Marquette efficacy:
https://www.ncbi.nlm.nih.gov/pubmed/18997569

Generic NFP research:
Frank-Herrmann P, Heil J, Gnoth C, et al. The effectiveness of a fertility awareness based method to avoid pregnancy in relation to a couple's sexual behaviour during the fertile time: a prospective longitudinal study. Hum Reprod. 2007;22(5):1310–1319....

Predicting ovulation with at home urinalysis (not produced by Marquette)
https://www.ncbi.nlm.nih.gov/pubmed/23831784

Medical training on forms of natural family planning:
https://www.ncbi.nlm.nih.gov/pubmed/28620604

Ovulation correlation to cervical mucus production:
https://www.ncbi.nlm.nih.gov/pubmed/25724738

Most common birth time: 8am. Surprised? I was.

I'm a huge fan of improvingbirth.org. When I was a wee fledgling in the world of birth and birth advocacy, they had information on hand that led me to the dark side, or the...like... empowered side... :) of birth.

They recently (today) shared an article that claims most infants make their appearance at 8am. And most commonly on weekdays. This made no sense to me. Birth is chaotic (commonly) and irratic in timing (ask any mom who really wanted a due date baby).

I trust improvingbirth to give me accurate information. So why would this report say that children are born at 8am? On weekdays? Babies don't have schedules. They are squirmy gushy little beings of smelly goodness (baby fever anyone?).

The article absolutely states that this information was collected across the board: hospital, home, cesarean, induction, natural, all of it. So I decided to dig a little deeper. The article claims that c-section rates are 32% across the nation. I happen to know they are slightly higher in my neck of the woods. But basically, that article is implying that medical intervention is skewing natural birth cycles. Most babies born without medical intervention are born at night.

There are two reasons that a baby would be born in the morning:
1. Medical intervention (C-section/induction). **Shocker** I'm not a c-section basher. Stuff happens and we are all blessed to have access to this emergency care. However, let's be real. If a mom has been laboring for a long time, she will fatigue and will need help or, in some cases, convinced she needs help. All research shows that after intervention (lets be conservative and assume pitocin or other forms of induction), the risk for c-section increases dramatically [1].

2. Delayed/difficult/regressing labor. If you prefer to believe that regressing labor doesn't exist, let's just pretend for now that it's not written down and I'll express my thoughts on the topic later. If a woman has slow progression of labor due to anxiety, 'back labor', structural complications, or is forced to labor in a less-than-ideal birthing position, the delivery can be prolonged.

Guess what? Most of that second reason can happen and does happen outside of the hospital as well. The other interesting thing of note in the chart above is that the hospital birth line has well defined peaks, as where the out-of-hospital births don't really have peaks, but instead gentle "hills" of commonality.

All this to say, it would be interesting to see how breastfeeding and other baby basics (eat, poop, sleep) are even temporarily affected by an altered natural birth time. I'll keep you all posted if I find a study, and hope you'll do the same.

Cheers!


1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751192/

The Judge-y thoughts.

There are people in my life that claim we can judge people as long as we hold ourselves to the same standard. There are .GIFs dedicated to the "Don't Judge Me!" phrase.

As most of you know I am hardcore in the opposing corner of mom guilt. The best thing we can do in life is find people who are similar to us, so if we ever feel the need to test our true north, we have family or friends or a tribe to set us straight. That's not to say that we need to surround ourselves with like-minded people. I seem to thrive in environments where people question my beliefs, but honestly, sometimes it's fun to make a joke about my crunchy ways and have some genuinely laugh with me instead of laughing AT me. 

Yesterday I was on (duh duh DUH!!!) Facebook and I saw a photo of a friend of mine. She sells fitness, as a package. And my immediate thought was, "She didn't have that much to lose in the first place (insert eye roll here)!!" 

And then, boom. UUGHH! I'd stupidly thought someone's battle was easier than mine! I demeaned her effort and her brand by thinking that she hadn't worked hard for her body. Meanwhile this woman is constantly bringing other women UP. I then thought, "She isn't really building a business. She's slinging crappy products at unsuspecting women." HOLD IT. HOLD.THE.PHONE. Where did this snarky woman come from? Who cares what she's doing? She is helping people love themselves; which the world is so lacking right now. 

I am known in my community as a silver-linings-loving-optimist-you-can-do-it-all-in-one-pep-squad. I am known as this because this is what I want for myself. I want people to surround me and say, "Starting a business is hard! But you are rocking it!" Guess what? this woman that I thought the snarky things about is always the first to tell me how great of a job I'm doing. 

So, my brief thought of the day is this: It's great to not speak poorly of someone else, but if you want all those benefits for yourself, you have to stop thinking them too. 

Secondary Infertility

It may surprise you to know that there are more than one type of infertility; and I don't mean male and female infertility. One of the lesser known types of infertility (or subfertility) is secondary infertility. This is described as the inability to conceive after birthing one (or more) children.

The causes of secondary infertility are along the same lines as primary infertility:

1. Sperm quality

2. reproductive organ damage

3. Scar tissue or complications from previous surgery/pregnancies

4. Risk factors like advanced age, obesity, and other health issues in both partners.

The reasons of secondary infertility are not all that shocking, however, when a couple decides to try to achieve pregnancy for the second, third, or fourth time, and they find themselves trying for a year or more, not attaining pregnancy can be a bit of a shock.

This is a huge benefit of charting cycles with FAM or NFP. Regardless as to how one approaches trying to conceive, knowledge of ovulation and symptoms that are (or are not) present can be a blinking red indicator of where the dysfunction lies.

Another concern for this issue is self-diagnosis. Often times I hear of couples who may have been surprised with their first pregnancy. And then a few years down the road, when it is time for baby number two they are discouraged when in the first month they do not conceive. I am in no way insinuating that secondary infertility doesn't exist, but I think it is very important that we stick within the diagnostic characteristics of the disorder at hand. 

In my opinion, secondary infertility can be just as harmful emotionally as primary infertility. To have the want and love for a baby you haven't met yet, and to month after month be disappointed is challenging enough, and then if you express sadness over secondary fertility often times the retort is that, "You already have one baby, some people don't even have that!" This goes back to that nasty old parent-guilt business that I talk about all the time. 

Below are some of my personal thoughts on the causes of secondary infertility:

1. Stress. I say this ALL the time in person, but let's say it here too! 

         If you go in to your kitchen and you see a kitchen fire, what is the first thing you are going to do? You probably wont start to fold laundry. You are going to try to put that fire out and save your house! Your body works similarly. There are natural cycles happening all over the place inside of you, and that's how its supposed to be; FSH, serotonin, insulin, TSH, even daily poops work on a schedule and cycle. So if your body perceives a greater threat, the focus will move away from those "activities of daily living" (think chores and errands) and hone in on the crisis at hand (think kitchen fire or basement flood). Managing family, friends, work, and toddler is pretty stressful. Take that natural stress and then impose upon it the rampant parent-guilt of modern culture, and stress levels easily become unmanageable. Then, on top of that, add the stresses of disappointment of not conceiving as quickly or as easily as a couple did the first time around, and you have a recipe for cortisol soup.

           To all of this I say: Chiropractic. Chiropractic is the methodology of helping the body adapt to stress. Often times people will say, "Oh, my shoulders are so tight! It's just stress though." I entirely disagree. Stress is common. Stress is everywhere and we all feel it in different ways and places and manifestations, but it's always there. However, you should be able to work with the stress in your life. When you fail to adapt, dysfunction becomes a major factor. This is most evident in people with knee pain; almost always, knee pain comes from hip or foot dysfunction. The most significant take away from that metaphor is that it is simply a metaphor; these mal-adaptations happen in our brains, in our lungs, in our visceral organs, in our nerves, and because our spinal cord is the main communication device between our brain and our cells and tissues, it plays a major part in how we adapt to stress. Long story short: get your nervous system checked.

2. LAM. Lactation Amenorrhea Method.

       This is actually a form of NFP, sort of kind of.... Basically, if a woman ecologically breastfeeds, as in, no schedule, and feeding baby whenever baby is hungry (including night time), she can and most likely will delay the return of her menses. I live in a community that has a higher than average age for first births. Some may think of this as a negative thing, but I think its pretty beautiful. We also have a higher than average single earner family rate. I also think this is beautiful. Families on the Central Coast tend to be pretty crunchy, and we have a much higher than average "prolonged breastfeeding" statistic. It is not impossible to achieve pregnancy while breastfeeding, and despite some old wives tales, it is not harmful to breastfeed throughout pregnancy. However, the return of menses is also accompanied by a shortened luteal phase. The stunted luteal phase means that while a woman may be ovulating, her body is not providing a nice soft endometrial pillow for the fertilized egg to implant upon. The luteal phase should be at least 12 days so that the egg has time to make the trip from the Fallopian tube to the uterus, implant, and begin the division processes that will lead to a viable pregnancy. If the luteal phase is too short, the egg will simply be disposed of during the period, like every other non-fertilized egg of her menstrual cycle's history.

3. Shortened luteal phase due to other circumstances.

     Unfortunately our culture is soy, and otherwise xeno-estrogen happy. Our government subsidizes the growth of soy beans, so much like wheat and corn, it is in everything. Hormonal birth control is also widely popular in our country. These are a few factors that contribute to the over all estrogen rich ecosystems that we walk around in daily. Estrogen dominance is not simply, "too much estrogen." Though, "too much estrogen" is absolutely an issue of its own. The greater issue is the amount of estrogen in relationship to the amount of progesterone in the body. For about half of the menstrual cycle, it is meant for estrogen to be the dominant hormone. Estrogen is responsible for the thickening of the endometrial lining; so it is safe to say that estrogen creates the pillow for the fertilized egg to implant upon. However progesterone is the luteal phase dominant hormone. This means that within 36 hours of ovulation, estrogen drops and progesterone starts to ramp up. Progesterone is the dominant hormone after ovulation and only when progesterone starts to wane, will the menses begin. If a woman's progesterone is low, then the woman is more likely to have a quicker onset of menses; so her period will start again quicker than if she had more progesterone. When the menses returns quicker, say, less than 12 days, the environment of her uterus becomes less friendly to conception, or rather, implantation.


In short, secondary infertility is a heartbreaking experience. The best thing you can do is be an advocate for your own health and chart your fertility. Note cervical mucus, LH spike, and how many days after ovulation your period comes. These factors alone can make a world of difference. You are not alone and you are not broken. You are not wrong for wanting another baby. Just because you have one baby doesn't mean you should be satisfied or accepting. Fertility is a natural cycle in our lives to be respected. Please don't feel selfish or arrogant for wanting another baby. And please reach out for help if you have feelings of depression and futility.

Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 2004;117:126-31.