Are You Sabotaging Your Vaginal Microbiome?

Ladies, did you know that there are good bacteria that live in your vagina and help to keep it healthy? Talking about bacteria living in your vagina might make you wary, but you should know that these friendly organisms are necessary for a healthy vagina. There has been a lot of press lately about the far-reaching importance of our gut microbiome and its impact on health. Research has been showing that the DNA of the microbiome plays a role in cell signaling and immune health. The vagina has its own ecosystem, usually dominated by species of Lactobacilli. When our vaginal bacteria become imbalanced, we can experience itching, burning, discharge, odor, and inescapable discomfort.
The healthy bacteria in the vagina have a job protecting the sensitive mucosal skin from invading organisms. The vagina is a dark, moist region, which is alluring and a perfect petri dish for many organisms. A healthy vaginal microbiome can prevent yeast infections, bacterial vaginosis, and communicable infections by out-competing these unfriendly organisms for precious real estate on the prime vaginal market. Another way the Lactobacilli help keep the vagina healthy is by producing lactic acid, which keeps the vagina at a healthy pH in the 3.5-4.5 range. When the pH of the vagina becomes too basic, then invading organisms are able to thrive.

There are some easy ways that you can support the health of your vaginal microbiome.

1. Do not use soap when you clean your vagina. Only use water inside your labia. Soap should only go on the vulva where you grow pubic hair. Do not use antimicrobial soap which sabotages our skin microbiome.
2. Do not use products with “fragrance” on your vagina. “Fragrance” is another word for chemical. You do not want artificial chemicals on the sensitive mucosa of the vagina.
3. If you have to take antibiotics, then also take a probiotic to help repopulate the microbiome that gets wiped out by the antibiotic.
4. Do not use vaginal lubricants with ingredients that are artificial or chemical, including petroleum jelly. Try organic coconut oil for a safe alternative which has the extra benefit of having antifungal properties.
5. Do not stay in wet bathing suits or sweaty work out clothing. Change to dry clothes so that the vagina has a dry surface in contact with it.
6. Do not use a vaginal douche. Vaginas are self-cleaning organs, and do not require douches.
7. Stay hydrated. Drink 8 glasses of water a day.

Persistent vaginal itching or discharge is a sign of possible microbiome imbalance caused by things like bacterial vaginosis, yeast infections, or hormone imbalance. If you are symptomatic, see your doctor right away to get a remedy, which may include vaginal acidophilus cream to provide the good bacteria. The longer your vaginal microbiome is out of balance, the longer it can take to repopulate it with the healthy bacteria.

Dr. Bren Boston sees patients at the Akasha Center for Integrative Medicine at 520 Arizona Avenue, Santa Monica, CA 90401. 310-451-8880.

Natural Strategies for Blood Sugar Control

No one was more surprised than me when I was diagnosed with gestational diabetes during my first pregnancy. Gestational diabetes is a temporary form of diabetes in which the hormones of pregnancy impair insulin’s ability to lower blood sugar. The diagnosis was a blessing in disguise because it led me to meet with a diabetic nutritionist to learn about how to keep a food log, introduced me to the glycemic index of foods, how to eat a Type 2 diabetic diet, and how to check my blood sugar after meals. The education I got about my body and about the hidden sugar content in foods was priceless and benefits me today.

I found out that a single piece of pizza would put my blood sugar over the limit. I had not thought of pizza as a sweet food, but pizza sauce has sugar in it and the crust becomes sugar in your body. I found out that if I walked for 10 minutes after a meal, the impact of the meal on my blood sugar was reduced. The flexing of muscles when walking helped to pump the sugar into the muscle cells where it was used to power my walk rather than raise my blood sugar. Walking after meals helped reduce my insulin resistance and improve my blood sugar.

I learned how to determine carbohydrate equivalents. One carb serving is 15g, and you can subtract a gram for each gram of fiber in the food. That is how the glycemic index works. All carbohydrates, including vegetables, fruits, grains, and beans, are ranked on the glycemic index. It is obvious that a bowl of beans will not spike your blood sugar the same way a muffin will, but I also learned some good tricks. I learned that I could eat a larger portion of apples or berries than of grapes or watermelon because apples and berries are lower on the glycemic index and have more fiber. The lower a food on the glycemic index, the less it will raise your blood sugar.

Women who have had gestational diabetes have a 7-fold increase in the likelihood of developing Type 2 diabetes. I am in prevention mode and continue to be mindful of a diabetic diet when I choose my foods and my dedication to exercise.

If you have already been diagnosed with prediabetes or Type 2 diabetes, there are several natural strategies that you can employ to help control your blood sugar.

  1. Diet: Learn how to count your carb equivalents and limit them to 2-3 per meal or 1-2 per snack. Eat small, frequent meals to keep blood sugar levels more stable. Familiarize yourself with the glycemic index and choose low-glycemic carbs. Increase the fiber in your diet and drink more water. Avoid processed fats and eat plenty of healthy fats like olive oil, avocado, wild salmon, nuts and seeds.
  1. Exercise: Aim for a minimum of 30 minutes per day of aerobic exercise. If you walk for 10 minutes after each meal, you will lower the blood sugar impact of the meal by improving the insulin sensitivity of muscle cells, helping the sugar go into muscle cells and out of the blood stream.
  1. Lose weight: Excess stored fat causes the body’s cells to become resistant to insulin.
  1. Supplements:
    1. Chromium – helps stabilize blood sugar and supports the job of insulin
    2. Cinnamon – reduces fasting blood sugar and improves insulin sensitivity
    3. Alpha Lipoic Acid – antioxidant that can help lower blood sugar by enhancing the uptake of glucose into cells and help inhibit glycosylation (the abnormal sugar-coating of proteins). It helps promote eye and nerve health.
    4. Magnesium – promotes healthy insulin production
    5. CoQ10 – antioxidant that helps support a healthy heart
    6. Green Tea – antioxidant helps support insulin and glucose control, reduces hunger, and reduces inflammation
    7. Botanicals such as blueberry, prickly-pear cactus, ayurvedic gurmar, and Asian bitter melon may help lower blood glucose.

Work with your physician to help implement an individualized program for your blood sugar control and monitoring. You can make an appointment to see Dr. Boston at the Akasha Center for Integrative Medicine at 310-451-8880.

An Integrative Approach to Neuropathy

Neuropathy can be a frustrating diagnosis given that there are not many treatments available for it. Neuropathy can cause weakness, numbness, tingling, burning, or painful sensations, depending on the type of nerves involved. Some common causes of neuropathy include diabetes, toxic trauma from chemotherapy, heavy metal toxicity, autoimmune disorders, vascular disorders, but many cases of neuropathy have no known cause. The common thread of all neuropathies are that the nerve cells (neurons) are not as healthy as they should be. That brings us to an integrative approach to neuropathy.

Nerves can best be treated when they are optimized on a cellular level. Keep in mind that neurons are living cells with nuclei containing DNA and mitochondria powering them, just like all other living cells in our body. DNA needs to be protected from the free radicals that are created during normal metabolic activities. Cells, including neurons, cannot survive without a steady supply of antioxidants to curtail free radical damage and oxidative stress. Glutathione, a master antioxidant, is important to the health of neurons. It can be given intravenously or through a nebulizer, but not orally because it is a tripeptide and our gastric juices will break it down into amino acids. Our glutathione levels can be boosted by eating cruciferous vegetables, like broccoli or brussel sprouts, which contain sulforophanes and the phytonutrient DIM which help our bodies make more glutathione. Antiox-Restore by Akasha Naturals is a supplement which helps boost glutathione levels and contains broccoli seed extract and DIM.

Living cells, including neurons, need to have adequate methylation for optimal cellular repair, production and repair of DNA, neurotransmitter production, and detoxification. An important gene involved in methylation, MTHFR, can be checked in a simple blood test. MTHFR has 2 main variants, and a mutation in either variant needs to be addressed to optimize nerve cell health. At the Akasha Center, we can assess your MTHFR gene and advise on supplements to optimize methylation.

Nerves are also electrical. Information travels from the cell body, down the axon, to the nerve terminal as electrical signals. The inside of a neuron is negative, and the outside is positively charged. “Earthing”, also known as “Grounding”, or standing on dirt, grass, or sand with your bare feet, allows electrons from Earth’s surface to flow into your body. Studies have shown Earthing reduces inflammation, improves wound healing, and can help prevent and treat chronic inflammatory and autoimmune disorders.

Neurons are chemical. Nerves talk to each other by releasing chemicals know as neurotransmitters across synapses to other nerves. Many supplements can be useful in optimizing neurotransmitter production, including B-complex vitamins, alpha lipoic acid which supports the tiny blood vessels that feed neurons (the vasa nervorum), acetyl-L-carnitine which supports cellular energy production, and gamma linolenic acid, an omega 6 fatty acid that supports nerve health.

Now that we have discussed optimizing your nerve health, let’s talk about treatments that reduce the symptoms of neuropathy. Neural Prolotherapy is an injection therapy that uses a low concentration of a dextrose solution that has been shown to reduce cutaneous neuropathic pain. Low Dose Naltrexone (LDN) has been shown to reduce neuropathic pain that involves the central nervous system, such as Complex Regional Pain Syndrome or multiple sclerosis. LDN is thought to work by reducing glial cell transmission and by boosting our endogenous opioid production (endorphins).

If you have neuropathy and would like to be evaluated for an integrative approach to treatment, make an appointment with Dr. Boston at the Akasha Center for Integrative Medicine.

The Buzz about Intermittent Fasting

The truth is you probably already do some intermittent fasting (IF) and don’t even know it. If you don’t snack after an early dinner and eat a late breakfast, you have done a form of IF. Intermittent fasting is an eating pattern that sets aside a specific period of time during the day for eating while the rest of day is devoted to fasting.

There is not a one size fits all protocol for intermittent fasting. Each person responds differently to how many hours they fast and how often they practice IF during the week. It does take some experimenting in the beginning to see if IF is right for you and which protocol allows your body to thrive.

The most common schedules are:

  • The Leangains Protocol (also known as the 16/8 method – involves restricting your eating period to an 8-hour period, for example 11AM -7PM. For many people we recommend lengthening the eating period to 12-hours (7AM – 7PM). This can be done 2 or more times a week.
  • Eat-Stop-Eat – fasting for 24-hours once or twice a week. For example, no eating from dinner one day until dinner the following day.
  • The 5:2 Protocol – involves only eating 500-600 calories on 2 nonconsecutive days of the week, for example every Monday and Wednesday.

What are the benefits of Intermittent Fasting?

You might be underestimating the benefits of not caving in to the late night snack food cravings. The benefits of IF are far greater than just helping to maintain weight.

Studies have shown that intermittent fasting:

  • Improves brain health
  • Increases energy
  • Enhances tissue healing
  • Promotes longevity
  • Improve insulin sensitivity
  • Supports weight loss
  • Normalizes the hunger hormone ghrelin
  • Raises adiponectin which tells our body to burn fat
  • Reduces oxidative stress
  • Reduces inflammation

People who practice IF report feeling more energetic and wake with a feeling of alertness and excitement to start the day. Exercise can work in conjunction with intermittent fasting to improve your health and weight loss. Following an overnight fast, we encourage avoiding strenuous exercise and embracing more gentle forms of exercise such as restorative yoga and walking. Generally after 2-weeks most people will know if Intermittent Fasting is right for them and which schedule feels best.

The benefits of IF are increased when you choose a fiber-rich, anti-inflammatory Mediterranean-type diet with lots of multi-colored vegetables, fruits, beans, nuts, seeds, whole non-processed grains during your non-fasting hours.

If you are interested in learning more about intermittent fasting and to discuss the best schedule for your body and your lifestyle, let us help you.

Dr. Bren Boston and Dr. Maggie Ney are practitioners at the Akasha Center for Integrative Medicine. You can schedule an appointment by emailing us at info@akashacenter.com, or calling 310-451-8880.

How Does Activated Charcoal Work?

Activated charcoal is a fine, black powder with an extremely high surface area, making it ideal for adsorbing, or trapping, toxins. Activated charcoal can be made from various carbon sources, including coconuts husks, hardwood, or peat. It is available as capsules, loose powder, tablets, or liquid.

In the emergency room setting, activated charcoal is used orally to treat certain kinds of poisoning, especially within the first hour. Charcoal works by soaking up the toxic compound so that the poison is not absorbed from the intestinal tract into the blood circulation. The charcoal, along with any toxins that are stuck to it, is eliminated in the stool. The dose to treat emergency poisoning in an adult is 25-100g of activated charcoal.

Activated charcoal is used in the non-emergency setting to detox ingested impurities at a much lower dose of about 1g after a meal. It can be used to help with digestion for foods that cause symptoms such as cramping, diarrhea, or nausea. One study showed that activated charcoal can reduce bloating and gas in the lower intestines, reducing cramping. Activated charcoal can be useful in food poisoning, especially if taken within 30min to 1 hour.

Activated charcoal carries a negative charge, so it attracts heavy metals and other toxins that are positively charged. Activated charcoal in a facial soap or facial mask can remove impurities and toxins from the skin, commonly used to treat acne or brighten dull skin. Activated charcoal can stain your clothing or carpet, but if used to brush your teeth, it actually whitens them by pulling out color impurities in teeth. Teeth should be rinsed well with water after brushing with charcoal powder.

Activated charcoal has anecdotally been used for hangover prevention, although there are no scientific studies. The use for hangover prevention is typically 1 capsule prior to each alcoholic drink, and 1 glass of water right after the alcoholic drink.  Excessive alcohol use is dangerous, and even potentially deadly, whether or not charcoal is used.

Safety concerns for activated charcoal include constipation or vomiting if too high a dose is used, intestinal obstruction if patient has a gut motility issue, temporary dark stools, corneal abrasion if it gets in eyes, and respiratory distress if it gets inhaled into the lungs. If you are taking prescription medications, there is a chance that they will be less effective if they are adsorbed and eliminated with the charcoal. Therefore, you should wait at least 2 hours after taking your prescription medication before you take activated charcoal. Activated charcoal should not be used concurrently with a laxative due to risk of electrolyte and fluid imbalance. If you are pregnant, you should ask your doctor before using activated charcoal.

Activated charcoal is not effective for low molecular weight compounds like cyanide, iron, ethanol, lithium, or methanol. Activated charcoal should not be used for caustic ingestions, such as cleaning agents, acids, or batteries. Contact your local poison control center if caustic ingestion is suspected.

In summary, the low dose of non-prescription activated charcoal available over the counter is safe for most people to use on an intermittent basis as part of their detox protocol. For best results, find a supplement that states the carbon source and avoid any extra additives.

Dr. Boston helps patients develop personalized detox protocols at the Akasha Center for Integrative Medicine located at 520 Arizona Ave, Santa Monica, CA 90401.  www.akashacenter.com  (310)-451-8880.

 

 

Pelvic Floor Dysfunction

Pelvic floor dysfunction is a common cause for chronic pelvic pain in women. An often-overlooked piece of the puzzle is pain stemming from laxity at the pubic symphysis and sacroiliac joints.

The pubic symphysis is a joint at the front of the bony pelvic ring. It consists of a fibrocartilaginous disc wedged between the two pubic bones. There are 4 ligaments that reinforce the pubic symphysis.

These ligaments can become more lax over time. Ligamentous laxity can occur due to athletics, trauma, the hormone relaxin during labor and delivery, or wear and tear from the variety of forces it undergoes on a daily basis, including traction, compression, and shearing.

Hypermobility at the sacroiliac joints often co-occurs with laxity at the pubic symphysis, since the pelvic bones are interconnected. Pelvic instability can cause spasm of the pelvic sling muscles, resulting in chronic pelvic pain.

Prolotherapy injections to the weakened pelvic ring ligaments will cause in increase in blood supply and regenerative cells to the area, stimulating repair of the lax ligaments. New collagen is added to the ligaments, strengthening them. Once stabilized, the pelvic ring resumes its purpose of being a stable base for pelvic floor muscles, reducing muscle spasms and pelvic pain.

Dr. Boston treats patients with chronic pelvic pain at the Akasha Center for Integrative Medicine at 520 Arizona Ave, Santa Monica, CA 90401. www.akashacenter.com (310)-451-8880.

I just found a tick! Do I have Lyme disease?

Summertime is around the corner, and hopefully we will all be outdoors enjoying the warm weather.  Unfortunately, ticks also enjoy warm weather.  There has been a lot of confusion lately about ticks and Lyme disease, so we should talk about it.

First of all, only deer ticks can transmit Lyme disease. Lyme is a spirochete bacterium that is transmitted through the tick’s saliva into the human that the tick is biting. So, we need to know what kind of tick it was. Deer ticks are brown or red/brown with 8 black or brown legs. If it has a white mark on it’s back, then it is not a deer tick. Before they are engorged with blood, the adult deer tick is about the size of a sesame seed and the nymph (teen) deer tick is the size of a pinhead. Once they are engorged with blood, they can be much larger.

Second of all, a deer tick has to be attached and feeding, for >=36 hours in order to transmit Lyme.  So, if the tick is discovered before 36 hours, or is discovered with a flat, non-engorged body, then there is no chance of Lyme transmission.

The key is finding and removing the deer tick before 36 hours.  

Tell all your campers going to sleep away camp that they should do a full body check for ticks once a day.

 When doing a body check for ticks after spending time outdoors, make sure to include the armpit, behind the knee, the groin, behind ears, and the scalp.

The way to remove a tick is to use fine-nose tweezers to grab the tick as close to the attachment point to your skin as possible. Lift with a steady, firm direction backwards from the skin. Do not squeeze the tick body, nor twist, nor use a match or fingernail polish, as these methods can make the tick express more saliva into the bite wound. After removing the tick, wash the skin and hands with soap and water. If the head is left in the skin, leave it in place as digging to remove it can cause trauma, and natural skin sloughing will eliminate it in a few days.

If you find a deer tick that is estimated to have been attached for >=36 hours, then your doctor can prescribe you a single preventative dose of an antibiotic to prevent Lyme if given within 72 hours of removing the tick.

There is no benefit in blood testing for Lyme at the time of the bite, as a positive blood test will not be apparent until 2-6 weeks after the bite.

If you develop a rash that looks like a target symbol, which is called erythema migrans (EM), then you do have early Lyme and need 14-21 days of antibiotics. EM occurs in 80% of patients, usually within 1 month following the tick bite.

During the first days or weeks of infection, patients often have nonspecific symptoms like fatigue, sore joints, headache, or enlarged lymph nodes.

If you found the tick after it was attached for 36 hours and develop neurologic or cardiac symptoms, then you could have early disseminated Lyme and could require intravenous antibiotics.

You may benefit from supportive treatments to optimize your immune system, methylation, and gut health during the stressful time of the tick bite. See your health care practitioner to guide you.

Dr. Bren Boston sees patients at the Akasha Center for Integrative Medicine at 520 Arizona Ave, Santa Monica, CA 90401. www.akashacenter.com   (310)-451-8880

Just in time for Mother’s Day…How Exercise Can Help Your Motherhood

I’ve always had a bit of a Type A personality. Probably most doctors do, how else can you make it through medical school? Having a Type A personality means that my sympathetic nervous system, my fight or flight instinct, can make me a bit on edge sometimes. It also helps me get stuff done. But, too much of a good thing, is a bad thing. Exercising is the main way I balance my sympathetic nervous system, burning off the excess adrenaline, helping me to be less uptight and less irritable. And, any mom knows, you are a better mom when you are feeling more relaxed, less uptight, and happier.

Staying fit by eating healthy foods and exercising regularly is also my mood stabilizer. When I go running, I am flushed with a sense of optimism that comes out of nowhere. It just washes over me, and my mind is flooded with creative ideas and positive thoughts. Natural endorphins and improved blood flow are the biological causes of these uplifting brain waves. These happy feelings spill over into my interactions with my kids, helping me to enjoy the precious moments and to tolerate the gripes with aplomb.

Staying fit also gives me energy. One of the biggest complaints I hear from moms is that they feel tired. I can honestly say that I have great energy due to an endurance built up from regular exercise 5 days a week, and sleeping 8 hours a night. Having energy allows me to play joyfully with my kids.   I can tell they are in tune with my energy, and it brings us closer together. I also feel good about setting an example for them of how exercise can be a fun part of your weekly routine, something to look forward to, not to dread.

Being healthy is important for longevity. I want to be there to see my kids grow up into adults, and to be a grandparent to their children. In fact, I don’t just want to be there for my grandkids, I want to be running around with them, babysitting them, and keeping up with them. Exercising, specifically weight training, gives me noticeable muscle strength that I am aware of when toting heavy grocery bags without flinching or lifting my kids into a bear hug.

Being fit is an important aspect of my self-esteem. What you see on the outside is not nearly as important as what is on the inside, but the real you is stuck inside your body. Keeping your vessel healthy and fit is a way to honor the real you, the soul, that lives within. Being fit allows me to feel comfortable in my clothing, and to feel good about my body. I don’t have a perfect body, but I do have a strong, energetic, healthy body, and that helps me be the mom I want to be.

If you are a mom who is looking to jump-start her fitness and weight loss plan, I would love to see you at the Akasha Center of Integrative Medicine for a comprehensive wellness plan.   Akasha Center for Integrative Medicine, 520 Arizona Ave, Santa Monica, CA 90401. www.akashacenter.com   (310)-451-8880

HIV: It Hasn’t Gone Away

I read an article in the January 2016 issue of the Journal of Family Practice titled, “HIV Prevention: A 3-Pronged Approach” by N. Yagoda, MD and R. Moore II, MD.

I have been thinking about HIV lately because I know many college students who are blossoming in their new-found freedom and sexual exploration, and they are not thinking about HIV at all. HIV is not in the headlines anymore, and therefore it seems to be less powerful in helping young adults to choose protected versus unprotected sex. This is despite the fact that total HIV incidence has failed to decrease in the last 25 years.

Per the article, there are more than 1.2 million people living with HIV in the USA, and 12.8% of them are unaware that they have it while only 30% of those diagnosed with HIV are receiving treatment to suppress the virus.  This means that the virus is out there, multiplying unchecked in almost million people in the US alone.

RISK FACTOR:  Unprotected sex.

RISK FACTOR:  IV DRUG USE.  In my realm of pain management, a scary truth is that a considerable number of people who become addicted to prescription pain medication eventually switch to injected heroin because it is a lot cheaper. In calm suburbs across the country, there are regular people who are secretly injecting drugs due to addiction and finances.  Intravenous drug use, or even sex with a person who uses IV drugs, is considered a major risk factor for contracting the HIV virus.

The 3-pronged approach to HIV prevention mentioned in the article includes  1) screening all individuals ages 15-65 for HIV, 2) pre-exposure prophylaxis for high-risk patients (taking anti-viral medications to reduce the risk of contracting HIV), 3) harm reduction.

Pre-exposure prophylaxis is for individuals who cannot or choose not to avoid risky behavior for a period of time in their life.  The downsides include possible drug resistance, high cost (although insurance covers part of it), stigma for those who seek to protect their sexual health, and possible affects to the kidney.

Harm reduction is a group of strategies that help IV drug users avoid HIV transmission.  Needle and syringe exchange programs and opioid substitution therapy (methadone or buprenorphine) are examples.

The bottom line is that young people need to be educated about safe sex, which means using a condom correctly every time, even if other forms of birth control are already being used.  I recommend all college-bound teens to read a book titled, “Seductive Delusions” by Dr. Jill Grimes which goes through all the sexually transmitted infections (STI), the ways you can catch them, and how to treat them, in a very readable format.  I also encourage all people to consider screening for STIs, given that infidelity is common, and treatment for STIs is available.

What to Eat to Heal from Surgery

What you eat can affect how well you heal from an orthopedic injury or surgery. When your body has to repair injuries, create new bonds, and strengthen tissues, its performance will depend on whether it gets the building blocks it needs. Imagine your food being digested into molecules, and those molecules being absorbed into your blood stream to be delivered to the site of healing.

Protein intake should be spread out evenly throughout the day in meals and snacks. Branched-chain amino acids (BCAA) are metabolized in muscles to provide energy and promote protein synthesis. BCAA found organic poultry, grass-fed beef, fish, soybeans, lima beans, eggs and nuts boost healing after musculoskeletal injury.

Vitamin C is required to make collagen to repair tendons or ligaments and heal surgical wounds. Good sources include citrus, broccoli, strawberry, kiwi, and bell pepper.

Zinc enhances wound healing. It is found in free-range beef, oysters, pumpkin seeds, and cashews.

Beta-carotene is a precursor to Vitamin A and promotes stronger bones, healthy scar tissue, and elasticity of skin. Good sources are sweet potato, kale, squash, carrot, prune, apricot, and mango.

Antioxidants (Vit C, flavonoids, Vit A, Zinc, Selenium, B vitamins, folate) neutralize the damaging effects of free radicals and repair cellular damage from injury or surgery. Found in leafy greens like kale, vegetables, fruits, legumes, whole grains, lean meat/poultry, fatty fish, nuts and seeds.

Flavonoids reduce swelling and protect cells. Flavonoids are found in cocoa, tea, red wine, fruits, vegetables, legumes, garlic, turmeric, green tea, blueberries, apples, citrus, and pineapple.

EPA and DHA Omega 3 fatty acids reduce joint stiffness, improve bone health, and provide anti-inflammatory benefits. You can find it in oily fish such as wild salmon, sardines, and anchovies.

Iron is required for oxygen delivery to the site of injury or surgery, and for wound healing. In addition to animal products, iron is found in dark leafy greens, legumes, beets, raisins, and black beans.

Calcium and Vitamin D optimize tendon-to-bone healing after injury or surgery. Calcium is found in dark leafy greens, salmon, rainbow trout, white beans, and fortified foods like almond milk and oatmeal. Vitamin D is found in mushrooms, salmon, tuna, soy milk, and egg yolks.

Healthy fats from avocado, olive oil, coconut oil, nuts, and seeds will improve immune response and help your body absorb vitamins A, D, E, and K.  Avoid partially hydrogenated oil (in processed foods) due to their pro-inflammatory effect.

Fiber is necessary to avoid post-operative constipation. The pain medications required for orthopedic surgery, as well as the anesthesia used during surgery, can cause slowing of intestinal transit and constipation. Up your fiber intake from vegetables, apples, berries, prunes, whole grains, flax and chia seeds.