When I heard Alzheimer's be referred to as "Type III diabetes", I didn't understand the reference as I don't know of Alzheimer's having a similar relationship with insulin.  However, it is relatable as it involves a different sort of metabolic hormone resistance, and it is strongly impacted by diet.  Of course, genetics has an important part to play in all of this, as genetics impacts everything from digestion to cravings and even the genetics of the mitochondria inside of our cells.  But to get on with our discussion, let's explore the involvement that mitochondria play in this disease.

Mitochondria are the "fuel-factories" inside every cell in the body- they produce ATP, the energy that is utilized to fuel every function that needs to occur.  [Interesting note- mitochondria are inherited from our mothers.] A recent study found that in Alzheimer's, mitochondrial use of calcium changed, and somehow this leads to cells creating more proteins that are not helpful.  What this means is that the metabolic function of mitochondria changes, as a result of being damaged and not functioning properly.  The cells that the mitochondria reside within change the proteins they produce to try to help with this, but those proteins actually cause more problems.

In another study, these proteins (beta-amyloid and tau proteins) then attach to & block ghrelin receptors (ghrelin is the "hunger hormone" produced by the stomach).  Ghrelin receptors and dopamine receptors work together in the hippocampus (where most damage in Alzheimers occurs and is a memory headquarters), and beta-amyloid blocks ghrelin and therefore blocks dopamine receptors as well. (I don't fully understand why the two have to work together, but that's what the article says!)

Essentially, this pattern is quite similar to insulin resistance, as ghrelin resistance occurs.

While there is ample evidence showing that intermittent fasting can help reverse Alzheimer's, there is now research showing that low-carb Mediterranean keto diets help stop progression of Alzheimers and repair damage from the illness. Exactly how this occurs is not yet fully explained, but the evidence is there, and I can say that in other illnesses linked to mitochondrial damage (fibromyalgia, autoimmune illnesses...), we have found great success in low-carb diets improving their conditions.  This helped many patients at the collaborative care clinic I worked at for the past 5 years.  There is something about carbs that seem to jam up mitochondria.  This will be my next area of perusing the research vaults!

A Mediterranean diet is known to be healthy and promote long life, but an important note for this research is that it needs to be a ketogenic Mediterranean diet.  This would require eliminating bread, pasta, and even rice, potatoes, and alcohol.  There are many excellent recipes to help replace these things, such as "cauliflower rice" or breads made from beans, so I recommend trying some recipes or finding solutions to help with yummy keto meals!

Ketogenic diets have risk involved, and need to be monitored by your doctor (especially for heart health and to make sure you don't deplete minerals).  There is also much debate about taking calcium supplements, and the step of discontinuing supplemental calcium can also be discussed with your doctor.  Nutritional calcium can be had through consumption of dark leafy greens and bone broth.

Ketogenic diets should also include digestive enzymes to help break down and absorb proteins and fats.  You can absorb digested proteins (amino acids) and digested fats (essential fatty acids), but this requires breaking down the proteins and fats with enzymes such as protease and lipase, plus bile salts.  (BTW- no gallbladder?  You MUST take bile salts!)  Poor digestion of proteins and fats will cause your digestive tract to flush them into lymph, where lymphedema can become an issue.  I have seen patients on Keto diets have particularly bad bouts of lymphedema, and digestive enzymes plus bile salts help resolve this!

As always, discuss your concerns and plans with your doctor, as there are many conditions that can become complicated on a Keto diet.

Chronic illness and pain deal with a unique set of challenges.  To wake up day after day, and often throughout the night, and be immediately faced with one's own limitations, pain, and vulnerability is, simply put, exhausting.

I have so much respect for my patients that deal with chronic illness and pain.  It is my desire to assist them, not just with decreasing pain and stimulating deep healing, but with recognizing the tremendous work they are doing day after day.  I want them to have patience and compassion with themselves, and to know that even when they fall off their program of healing, that's OK and human.  It's OK to be human!  With compassion, they can get back on track to feeling better.  With harsh self-criticism, their pain and illness often worsen.

Chronic illness, especially severe illnesses like autoimmune and Lyme disease, require a delicate balance of determination and perseverance with kindness and compassion for self.  The negative self-talk we often get taught as kids ("Don't be a slob!" "Why are you so lazy?!") is only going to devastate their energy and worsen their pain.  I want my patients to speak to themselves as if they were their own child- someone to protect, nurture, love, inspire, and see beauty in.

We live in a time and place that values individuals only by their contributions and resources.  Society demands that you prove your value to have a place within it.  This value system forgets that all life has value, and people bring value just by existing!  All life deserves basic respect and care, including plants and animals and fungi!

When individuals are in a state of need, needing help or assistance, and are not in a place of being able to do or accomplish much, they still serve a very important service to their communities- they bring us together. They become the glue that reminds us that we're all in this together.  They often become the wise ones that remind us about what really matters, and how we have so much to be grateful for.  And that's a lesson we could all be reminded of a little more frequently!  I try to remember to tell myself what I often tell my son: "A happy heart is a grateful heart!"  Gratitude is the greatest wealth a person can hold.

One of the hardest positions to ever be in is to be in a position of needing help.  How to maintain self-respect and autonomy when relying on others?  How to ask for help and not feel personally rejected when the answer is "I can't" or "no"?  How to keep asking, again and again, without bitterness and resentment?  Those are some harsh, compounded thought/feeling monsters built from self-loathing!  If you are angry at yourself for not being able to meet your own needs, and you force yourself to uncomfortably ask for help, only to be seemingly rejected... that self-anger becomes anger at others.  Patience and kindness and the realization that you have inherent value simply because you exist are the powerful allies in navigating such a situation.

I have been so fortunate to get to work with so many inspiring patients, many of whom have dealt with chronic pain and illness for decades, seeking help with numerous doctors, healers, neurologists, immunologists, counselors... some helping, some not, some kind, some judgemental... patchworking treatment plans together to navigate the choppy, ever-changing waters of chronic illness.  And they laugh, and smile, and cry, and share their stories with me like the warriors they are.

My patients often tell me that acupuncture is a necessary part of their healing process, and that it is something they look forward to during their weeks and months and years of difficulty and doctors appointments.  Acupuncture certainly can help!  It effectively reduces pain (both physical and emotional).  It can even reverse the physiological changes that occur in the brain with PTSD [acupuncture can reverse the growth of the amygdala and it can bring growth back to the hippocampus].

Somehow, acupuncture seems to make all the difficulties of life seem not so big and overwhelming.  My patients often find that they leave their treatment feeling much better, almost floating in a bubble or a cloud, and ready to charge on and face their week ahead. 

I often say that people already know what they need to do to feel better.  Sometimes I can give some insight into other changes that can help, like celery juice for inflammation or Chinese herbal formulas for various issues, but changes that are needed like quitting smoking or avoiding sugar and alcohol are things that people already know and already desire to do.  Many times they know those are the single most impactful variables contributing to their illnesses.  One of the biggest ways in which acupuncture can help, in my opinion, is by decreasing overwhelm. Then people can make the changes they already have been wanting to do.

I find acupuncture enormously beneficial, even when no words are spoken, but I also wonder how much benefit comes from entering a judgement-free zone of healing care.  This begins a headlong dive into psychoneuroimmunology!  For more on this subject matter, check back later!  Until then, listen to your body, and give it all the love you can.

Today I must link to a wonderful article posted by Brain Pickings (they send a variety of thoughtful, loving, deep, and memorable short articles focusing on artists and authors and philosophers throughout history and modern life). 

One of my favorite discussions to have with patients, that frequently dives deep into their sources of healing or disease, is simple: "What is your favorite thing to do each day?"

As a side note, every single patient I have seen with a frozen shoulder cannot think of a single thing, other than TV, that they enjoy in their daily routine.  However, TV is usually a numbing agent rather than something truly enjoyable. Certainly, when in overwhelm, we need our numbing agents from time to time.  I make no judgements!  Their daily burden is so severe, that even should they exercise, it is full of demands and rigors and goals rather than anything actually enjoyable, such as noticing the sky while out for a run.  A common response they have given to the question is, "Wow, I'm going to have to get back to you on that."

Please, find those small moments to savor, and find a way to discover them every single day.  The sunlight through the changing fall leaves.  The mist rising up off the grass when the sun rises.  The sudden dip in temperature the moment the sun crests over the horizon in the early morning.  The sound of tree frogs in the evening, or the sound of the city just after a rain storm in the dark.  Or arriving 15 minutes early to appointments and savoring a moment to read your favorite book, or just to watch the people coming and going in their own busy lives.

The busier our schedules are, the more we need these moments.  We don't have to let the advertisers tell us that a moment is empty if we don't have a loud stimulus of music, screens, shopping, or food.

So if you have 3 minutes, I suggest you catch breath of fresh air by reading this:  click here.

In my life, I can tell I have been particularly succumbing to stressful existence if I have not been taking photographs of beautiful moments.  I realized this again recently, so as I walked my son to his bus stop, I stopped to take a photo.  Artwork inevitably captures our thoughts and emotions at the moment of creation.  It is a wonderful way to track our own mindset, and looking back at old pieces of artwork, we can start to see more about how we were or what we were feeling.  When I used to photograph black & white buildings, or really enjoyed photographing peeling paint, I was processing a sense of harsh structures and how they erode over time.  I was also processing the beauty than be found in that erosion that we work so hard to prevent and cover up.

The photo above just seems like a splash of fall color livened up by sunshine to me now, but I do wonder what I will see in it when I review it from a new perspective years from now.

Here in the Pacific Northwest, we are beginning to realize that our beautiful region has a new reality- wildfire smoke is our new norm.

Wildfires are increasing in quantity and severity during dry season, and for the past few summers, our air quality has been taking a hit.  You can view a map of air quality here: -click here-.

The biggest issue with breathing wildfire smoke is the particulate matter- tiny particles that can aggravate the lungs and go directly into our bloodstream.  Here is an excellent article that goes into detail on the types of particles and at what point they can cause health issues:  -click here-.

In the clinic, whenever we have days on end of poor quality air from these wildfires, I notice my migraine patients have flare-ups, sometimes preventing them from even coming in.  I have had adult patients who have never had migraines previously come in with migraines on these days!  So what's going on?

I haven't found any research on the connection yet, but it makes sense that if wildfire smoke aggravates lung conditions and heart conditions, and that these particulates can go directly into the bloodstream (bypassing filtration in the lungs), that they can aggravate any inflammation in the body, especially related to blood circulation issues.  Particles that tiny could even cross the blood-brain barrier and aggravate central nervous system lesions or injuries (I'm thinking of MS or Alzheimer's).  Neurological issues like neuropathy in hands or feet could worsen as well.
UPDATE: I have recently seen air quality warnings not only mention lung and cardiac issues as being concerns with wildfire smoke, but also diabetes.  Again, blood circulation issues (build up of sugar crystals depositing in tissues will be worsened with particulate matter entering the bloodstream and also depositing in tissues).

Migraines can usually be stopped by increasing blood circulation to the brain, or by increasing oxygen in the blood stream.  It is frequently connected to vasculature, and so when these particulates are aggravating tissues and depositing in places and causing swelling (like it is in the lungs)... then it could do the same to the brain.

What can be done?  Here are some helpful suggestions from the Department of Health in Washington: -click here-.
But overall:
-stay indoors where you have filtered air
-certainly don't go exerting yourself outside
-drink plenty of water (flush the crud out!)
-consult your healthcare provider about using an N95 ventilator (can find at hardware store or on Amazon)

Please note that even a wet handkerchief or those medical masks won't help.  The only sort of mask that will block these particles is a well-fitting, sealed, N95 mask.  These masks can block out 95% of the particulate matter, but the masks are not for everyone.  It is more difficult to breath through an N95 mask, which might be a very bad idea if you have, say, COPD.  Better then to just stay indoors where you have filtered air.

Comments to the FDA need to be submitted by September 10, 2018!

If you have been living with chronic pain and have found helpful ways to manage it or heal from it, then I highly suggest you share your story with the FDA.  If great support for acupuncture, chiropractic, or even yoga is written and sent in, it may garner more support from the FDA, which may also bring about more insurance coverage.  Letting the world know how acupuncture helps us is the best way to make acupuncture become more available to us all.

Here is a summary provided on regulations.gov about the meeting that occurred on July 9, 2018, but will be open to public comments and testimonies until September 10, 2018:

"The Food and Drug Administration (FDA, the Agency, or we) is announcing a public meeting and an opportunity for public comment on “Patient-Focused Drug Development for Chronic Pain.” The public meeting will provide patients (including adult and pediatric patients) with an opportunity to present to FDA their perspectives on the impacts of chronic pain, views on treatment approaches for chronic pain, and challenges or barriers to accessing treatments. FDA is particularly interested in hearing from patients who experience chronic pain that is managed with analgesic medications such as opioids, acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants; other medications; and non-pharmacologic interventions or therapies."

(Non-pharmacologic interventions or therapies includes acupuncture, chiropractic, yoga, mind-body exercises, diet changes, or any other non-pharmacological pain management.)

Please follow instructions on their website to submit your comments, bearing in mind that it is a public forum: click here to visit their website (https://www.regulations.gov/document?D=FDA-2018-N-1621-0001).

Here is their list of questions to answer:

Topic 1: Symptoms and Daily Impacts of Chronic Pain That Matter Most to Patients

1. How would you describe your chronic pain? (Characteristics could include location, radiation, intensity, duration, constancy or intermittency, triggers etc.)

2. What are the most significant symptoms that you experience resulting from your condition? (Examples may include restricted range of motion, muscle spasms, changes in sensation, etc.)

3. Are there specific activities that are important to you but that you cannot do at all or as fully as you would like because of your chronic pain? (Examples of activities may include work or school activities, sleeping through the night, daily hygiene, participation in sports or social activities, intimacy with a spouse or partner, etc.)

​4. How has your chronic pain changed over time? (Considerations include severity and frequency of your chronic pain and the effects of chronic pain on your daily activities.)

Topic 2: Patients' Perspectives on Current Approaches to Treatment of Chronic Pain

1. What are you currently doing to help treat your chronic pain? (Examples may include prescription medicines, over-the-counter products, and non-drug therapies.)
a. How has your treatment regimen changed over time, and why? (Examples may include change in your condition, change in dose, or treatment side effects.)
b. What factors do you take into account when making decisions about selecting a course of treatment?

2. How well does your current treatment regimen manage your chronic pain? (Considerations include severity and frequency of your chronic pain and the effects of chronic pain on your daily activities.)

3. What are the most significant downsides to your current treatments, and how do they affect your daily life?

4. What challenges or barriers to accessing or using medical treatments for chronic pain have you or do you encounter?

5. What specific things would you look for in an ideal treatment for your chronic pain?