All posts by Jaime Askew

Collagen: What, Why, and How?

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Collagen is a protein abundantly found in:

  • Bones
  • Muscles
  • Skin, hair, and nails
  • Tendons and ligaments
  • Cartilage
  • Digestive tract
  • Veins and arteries
  • Teeth (dentin)
  • Eyes (cornea and lens)

Thus, it’s essential to maintaining optimal health.

The term collagen stems from the Greek word “kolla,” which means glue. This makes sense because its key responsibility is to provide structural integrity for a variety of tissues throughout the body.

Collagen Synthesis and Natural Decline

Symptoms such as wrinkles, loose skin, joint pain, and poor wound healing occur as we age due to a natural decrease in collagen production. This natural decline also increases the risk of heart disease and digestive dysfunction if damage to the arterial walls or intestinal tract occurs.

Your diet and lifestyle can also affect collagen synthesis. For example, the body needs an adequate supply of vitamin C and silica (trace mineral) among others to produce collagen. In addition, vitamin C is quickly depleted when your body is under stress.

High sugar diets, smoking, and prolonged sun exposure have also been shown to negatively impact or damage collagen in the body.

However, there are specific foods and supplements we can add to our diet to boost our synthesis of collagen. These include vitamin C and silica rich foods as well as bone broth, and collagen peptides, which I’ll discuss in more detail shortly.

Health Benefits of Collagen

Supporting your body’s natural production of collagen has many health benefits. Some key advantages include:

Skin: Collagen promotes firm skin. Thus, it’s nature’s perfect anti-wrinkle compound. And collagen will also help to reduce sagging skin, cellulite, and stretch marks. In addition, it helps to keep skin moist and smooth.

Hair and Nails: Collagen is the key structural component of your hair and nails. Thus, it keeps them from breaking. And this study suggests collagen may even help to prevent hair loss.

Joints: Collagen is a smooth substance that covers your bones and holds them together. Thus, it allows your joints to move with ease and without pain. Athletes may also benefit from collagen stimulating supplements to protect their joints from degeneration and improve their performance. Further, this study provides support for using collagen to effectively treat osteoarthritis and other joint disorders.

Digestive Tract: The key amino acids in collagen (i.e., glycine and proline) both nourish and heal the lining of the digestive tract. Thus, those suffering from gut-related disorders (i.e., leaky gut, irritable bowel syndrome, inflammatory bowel disorders, and reflux) may benefit significantly from consuming collagen. In fact, this study found that serum concentrations of collagen are reduced in those with inflammatory bowel disorders. It’s also worth noting that since a large portion of the immune system resides in the gut, maintaining a healthy digestive tract is essential for immune health.

Muscles: One of the key roles of glycine is to help create energy to build muscle cells. And strong muscles are necessary to effectively support your bones, especially as we age. In addition, muscle cells are effective at burning body fat.

Heart Health: Proline helps to repair arterial wall damage as well as keep your arteries free from plaque. Thus, collagen reduces your risk of developing heart disease.

Boosting Your Synthesis of Collagen

Increasing your intake of vitamin C and silica is recommended to increase collagen production. This can be accomplished by eating a variety of colorful fruits and vegetables each day. Silica is also found in oats.

Bone broth is a great source of glycine and proline needed to synthesize collagen. To learn more about bone broth as well as how to make it, please refer to this article.

When it comes to supplementation, I highly recommend Vital Proteins Collagen Peptides. It’s rich in glycine and proline, and it’s made from grass-fed, pasture-raised cows. Thus, it’s free from hormones, antibiotics, and pesticides.

Vital Proteins Collagen Peptides come in a powder form with virtually no smell or flavor. They are highly digestible and soluble in both hot and cold liquids. Thus, you can simply add a scoop or two a day to the following:

  • Tea or coffee
  • Fresh juice
  • Smoothies
  • Soups and stews
  • Sauces and gravies

In Conclusion

Collagen is the most abundant protein in your body and is essential for vibrant health inside and out. Its synthesis naturally declines as we age, which is why I often recommend supplementing with Vital Proteins Collagen Peptides.

Adding collagen peptides to your diet promotes youthful skin and strong hair, bones, muscles, joints, and teeth. It also protects your heart, boosts immunity, and improves digestive health.

Additional References:

Vital Proteins Website: Why Collagen

Medical News Today: What is Collagen? What Does Collagen Do?


The Ketogenic Diet

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(Originally written for Pure Plates)



The ketogenic diet, also commonly referred to as the “keto” diet, is a relatively recent nutrition trend sweeping the Internet. However, it’s been around for quite some time. And it has been proven to be beneficial for some people, especially those with metabolic-related diseases or neurological disorders.

The keto diet involves drastically restricting your intake of carbohydrates and consuming mostly high-fat foods instead. The concept is similar to the Atkins diet.

By significantly lowering your carb consumption, your body shifts from primarily burning carbs as fuel to efficiently burning fat. This metabolic process is known as ketosis (not to be confused with ketoacidosis).

As a result, blood sugar and insulin levels drop. And the liver begins producing ketones, which have been shown to supply energy to the brain. These are the key changes that make the keto diet beneficial for some.

Keto and Weight Loss

There is plenty of research suggesting calorie restriction is a successful weight loss strategy. There is also a strong body of evidence supporting the use of a keto diet for weight loss as well.

However, eating a high-fat diet is very satiating. This means most people on a keto diet naturally consume fewer calories. And they do so without having to count calories or keep track of points.

Turning the body into a fat burning machine as well as producing ketones and decreasing blood sugar and insulin levels may also be contributing factors.

Keto and Type 2 Diabetes

Type 2 diabetes is a metabolic disorder resulting from chronic high blood sugar and insulin resistance.

By lowering glucose and insulin levels, the keto diet has been shown to drastically improve insulin sensitivity. In some cases, individuals following a keto diet have been able to reduce or eliminate their diabetes medications.

Keto and Heart Disease

In many cases, eating a high-fat diet raises your “good” cholesterol (a.k.a. HDL cholesterol). It can also lower your triglycerides levels. And these two positive consequences are associated with a lower risk of heart disease.

Keto and Neurological Disorders

Studies have shown the keto diet is effective at reducing symptoms experienced with neurological conditions, such as Alzheimer’s, epilepsy, and Parkinson’s. Evidence suggests ketones are highly effective at protecting brain cells from damage.

What to Eat and What Not to Eat

The keto diet is based on eating high-fat whole foods, which includes:

  • Cold water fatty fish (i.e., salmon, halibut, sardines)
  • Eggs (with yolks)
  • Grass-fed and pasture-raised red meat and poultry
  • Grass-fed dairy
  • Nuts and seeds
  • Healthy oils (i.e., coconut, olive, avocado)
  • Avocados and olives
  • Herbs and spices
  • Low-carb and non-starchy veggies (i.e., leafy greens, onions, tomatoes, celery)

On the other hand, the foods that must be eliminated on a keto diet include:

  • Fruit
  • Sugar-laden foods (mostly all processed foods)
  • Grains
  • Starchy vegetables (i.e., roots and tubers)
  • Beans and lentils
  • Alcohol
  • Artificial sweeteners

Caveats of the Keto Diet

While the keto diet can be beneficial to your health in many ways, it’s not for everyone.

  1. The diet is very restrictive, which can prove to be challenging and stressful for some. And any change that adds stress to your life is counterproductive.
  2. It’s extremely important to understand your current health status to ensure you don’t make matters worse. Therefore, if you’re serious about trying the keto diet, we strongly suggest you work with your healthcare provider or a qualified nutrition professional.
  3. Not everybody will react the same way. While your friend may drop 20 pounds and gain lots of energy, your experience may be completely opposite. We are all unique in many ways, including our genetics, microbiome, and environment. Therefore, it’s important to understand there is no one size fits all approach when it comes to losing weight and improving your health.
  4. The keto diet may not be best suited for athletes and individuals wishing to gain muscle mass.

To Sum It Up…

The ketogenic diet is a low-carb, high-fat diet. It creates a metabolic state known as ketosis, which utilizes fat for fuel instead of carbs.

The keto diet has been shown to be an effective weight loss strategy as well as help those suffering from diabetes and neurological disorders. It may also reduce risk factors associated with other conditions, such as heart disease.

However, the keto diet is not for everyone. Therefore, before implementing this diet, please consult with your healthcare provider or a qualified nutrition professional.


Bessesen, D. (2006). Effect of a Low-Carbohydrate Diet on Appetite, Blood Glucose Levels, and Insulin Resistance in Obese Patients With Type 2 Diabetes. Yearbook of Endocrinology,2006, 149-151. doi:10.1016/s0084-3741(08)70336-6

Gasior, M., et al. (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural Pharmacology17(5-6), 431–439.

Hemingway, C., et al. (2001). The Ketogenic Diet: A 3- to 6-Year Follow-Up of 150 Children Enrolled Prospectively. Pediatrics,108(4), 898-905. doi:10.1542/peds.108.4.898

Hession, M., et al. (2009). Systematic review of randomized controlled trials of low-carbohydrate vs. low-fat/low-calorie diets in the management of obesity and its comorbidities. Obesity Reviews,10(1), 36-50. doi:10.1111/j.1467-789x.2008.00518.x

Manninen, A. H. (2006). Very-low-carbohydrate diets and preservation of muscle mass. Nutrition & Metabolism3, 9. doi:10.1186/1743-7075-3-9

Mcpherson, P. A., et al. (2011). The biochemistry of ketogenesis and its role in weight management, neurological disease and oxidative stress. Journal of Physiology and Biochemistry,68(1), 141-151. doi:10.1007/s13105-011-0112-4

Veech, R. L. (2004). The therapeutic implications of ketone bodies: the effects of ketone bodies in pathological conditions: ketosis, ketogenic diet, redox states, insulin resistance, and mitochondrial metabolism. Prostaglandins, Leukotrienes and Essential Fatty Acids,70(3), 309-319. doi:10.1016/j.plefa.2003.09.007

Yancy, W. S., Foy, M., Chalecki, A. M., Vernon, M. C., & Westman, E. C. (2005). A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & Metabolism2, 34. doi:10.1186/1743-7075-2-34

Yang, M. U., et al. (1976). Composition of weight lost during short-term weight reduction. Metabolic responses of obese subjects to starvation and low-calorie ketogenic and nonketogenic diets. Journal of Clinical Investigation58(3), 722–730.

Bowl of fresh mixed berries and yogurt

What Are Food Intolerances?

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Well, it’s first important to understand that a food intolerance is NOT the same as a food allergy.

Food allergies are reactions to food that trigger the immune system. On the other hand, food intolerances are reactions to food that do not initiate an immune response.

Causes of Food Intolerances

Enzyme deficiencies and digestive dysfunction are the most common causes of food intolerances. Let’s take a closer look…

Enzyme Deficiencies

Different types of enzymes are necessary to successfully digest some substances in food. And if your body lacks a specific enzyme, then you may react to a certain substance.

For example, lactase is an enzyme that breaks down lactose (a sugar) found in dairy products. Thus, those suffering from lactose intolerance simply lack the enzyme lactase. Symptoms then arise from the inability to properly digest lactose.

In addition, some people may lack an enzyme known as diamine oxidase, which is responsible for breaking down histamines naturally found in food. Thus, they may experience unpleasant symptoms when they consume foods high in histamine (i.e., fish, cheese, and fermented foods).

Digestive Dysfunction and Disorders

Two of the main responsibilities of the digestive tract are to neutralize potential threats and digest food into their basic components. But if you’re digestive system is not functioning properly, you’re more likely to experience reactions from the food you ingest. Thus, the health of your gut highly influences how your body reacts to food.

Gut infections, bacterial imbalances, and intestinal permeability (leaky gut) are just some of the digestive related conditions that may trigger food intolerances.

One specific example of an intolerance due to digestive dysfunction is known as fructose intolerance (or malabsorption). Fructose is a type of sugar naturally found in fruit as well as highly refined sugars, such as agave nectar and high fructose corn syrup.

For one reason or another, some people are unable to fully absorb fructose. Thus, it remains in the digestive tract and eventually begins to ferment. And the fermentation process typically causes uncomfortable gas and bloating.

Signs & Symptoms of Food Intolerances

Food intolerances typically cause delayed reactions as opposed to allergic reactions that usually occur within two to four hours. Thus, food intolerances are often more difficult to diagnose.

The most common signs and symptoms of food intolerances include:

  • Gas
  • Bloating
  • Fatigue
  • Diarrhea
  • Constipation
  • Abdominal pain

In addition, the frequency and severity of symptoms may fluctuate. As previously mentioned, gut health is a big factor. And sometimes the dose matters. Maybe you can tolerate a small dose of an offending food, but you react when that food is consumed in larger quantities.

It’s also worth noting that while these symptoms are not life-threatening, they can severely (and often do) impact your sense of well-being and quality of life. Thus, diagnosis and treatment are critical to achieving optimal health.

Food Intolerances and Irritable Bowel Syndrome

Food intolerances share many of the same symptoms of irritable bowel syndrome (IBS), which include gas, bloating, constipation, diarrhea, and abdominal pain.

And IBS is typically diagnosed when all other intestinal disorders are ruled out. Thus, it’s possible that food intolerances are an underlying factor. Especially since most medical doctors only test for food allergies.

So…if you’ve been diagnosed with IBS (as 15% of the U.S. population has), you may want to consider working with a nutrition professional, functional medicine practitioner, or naturopath to help identify problematic foods.

Common Food Offenders

You can be intolerant to any food for a variety of reasons. However, some of the most common offenders include:

  • Dairy
  • Fructose

What are FODMAPs?

FODMAPs stand for fermentable oligo-, di-, and monosaccharides and polyols. In laymen terms, this means fermentable carbohydrates.

For some, FODMAPs are poorly absorbed by the small intestine. Thus, similar to fructose, they remain in the digestive tract where they are fermented by gut bacteria.

Examples of FODMAPs include specific carbohydrates found in:

  • Wheat
  • Garlic
  • Onions
  • Legumes
  • Seeds
  • Dairy
  • Fruit
  • Sweeteners (natural and artificial)

How to Identify Problematic Foods

One of the best ways to identify problematic foods is by keeping a food journal. Essentially, you’ll need to start tracking the foods you’re eating and how they make you feel.

Maybe you’ll notice that you feel bloated when you drink milk. Or, that fruit gives you gas.

Another option is to consider implementing a low FODMAP diet. Essentially this means limiting your consumption of foods with high concentrations of fermentable carbohydrates. If your symptoms improve, it may be a sign that FODMAPs are problematic for you.

Finally, if you suspect dairy is a source of your digestive distress, there is a lactose intolerance test known as the hydrogen breath test. After consuming a solution containing lactose, the test measures the amount of hydrogen in your breath over the course of several hours.

If you’re successfully able to digest lactose, your hydrogen breath levels will be low. On the other hand, if lactose remains in your digestive tract, the fermentation process releases gas as well as hydrogen. Thus, if your hydrogen levels are high, it may be a sign of lactose intolerance.


Generally, it is recommended to avoid problematic foods. However, gut-healing protocols are often put into place as well. And once the gut heals, you may be able to tolerate small doses of certain foods again.

In Conclusion

Food intolerances are:

  • reactions to food that do not involve the immune system;
  • most often related to enzyme deficiencies and digestive dysfunction
  • difficult to diagnose because symptoms are delayed and not always consistent;
  • best identified by journaling your food intake and symptoms; and
  • treatment often involves the elimination of offending foods as well as gut healing protocols.


Hayes, P. A., et al. (2014). Irritable Bowel Syndrome: The Role of Food in Pathogenesis and Management. <em>Gastroenterology &amp; Hepatology</em>, <em>10</em>(3), 164–174.

Manzotti, G., et al. (2016). Serum diamine oxidase activity in patients with histamine intolerance. <em>International Journal of Immunopathology and Pharmacology,29</em>(1), 105-111. doi:10.1177/0394632015617170

Pasqui, F., et al. (2015). Adverse food reaction and functional gastrointestinal disorders: role of the dietetic approach. <em>Journal of Gastrointestinal and Liver Diseases,24</em>(3). doi:10.15403/jgld.2014.1121.243.paq

Ross, E., et al. (2016). The Low FODMAPS Diet and IBS: A Winning Strategy. <em>Journal of Clinical Nutrition &amp; Dietetics,02</em>(01). doi:10.4172/2472-1921.100013

Turnbull, J. L., et al. (2014). Review article: the diagnosis and management of food allergy and food intolerances. <em>Alimentary Pharmacology &amp; Therapeutics,41</em>(1), 3-25. doi:10.1111/apt.12984

Zopf, Y., et al. (2009). The Differential Diagnosis of Food Intolerance. <em>Deutsches Ärzteblatt International</em>, <em>106</em>(21), 359–370. doi:10.3238/arztebl.2009.0359

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5 Key Benefits of Keeping A Food Journal

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If you’re trying to lose weight, improve your health, or prevent disease, you must to take a closer look what you’re eating (and what you’re not). And there is no better way than keeping a food journal.

In fact, I require all of my clients to keep food journal. And here are my top 5 reasons why:

Compares Perceptions to Reality

Keeping a food journal is truly the only way to determine whether or not your perceptions match reality. Many people think they’re eating healthy, but often find it eye opening when they see their food intake on paper. Because it’s not just about what you eat. It’s also about your eating habits.

Helps to Improve Your Diet

When you keep track of what you eat, you get a more detailed picture regarding your nutritional intake. For instance, are you eating enough protein? Are you eating too much sugar? Is your diet lacking sources of healthy fats?

Thus, you can use your food journal to help create a more balanced and nutrient-rich meal plan.

Helps Break Unhealthy Eating Habits

A good food journal keeps tracks of what you eat, but also how much you eat and when you eat.

You might learn that you eat more when you’re dining with others than solo. Or, maybe you’ll notice you always reach for sugar in the mid-afternoon. Seeing these patterns will help you make the necessary changes to break any bad habits.

For example, maybe you need to be more mindful when eating out with friends. Or, maybe you need a more balanced lunch to ward off your 3:00 PM sugar craving.

Identifies Food Allergies, Sensitivities, and Intolerances

Even the healthiest foods can wreak havoc on some. Thus, for weight loss and optimal health, it’s really important to learn what foods work for you and what foods don’t.

For example, a food journal might help you realize that cheese is what causes your bloating, which may be a sign of a dairy sensitivity or lactose intolerance.

Connects the Dots Between Food and Your Health

What we eat affects every aspect of our physical and mental health. We can’t expect to eat poorly and feel great. Some foods may energize you, while others drain you. And some foods may lift your spirits, while others weigh you down.

Thus, by examining your food journal, you can learn a lot about how food affects YOUR body and mind. And once you connect these dots, I guarantee reaching your health goals will be much easier.

Food Journaling Tips

Food journaling may seem time-consuming, but it doesn’t have to be. While you certainly can carry your journal around with you, you can also take a picture of your meals and snacks with your phone and send them to yourself with notes about your energy level and mood before and you ate. Then, each night before bed you can use your photos and notes to complete the food journal.

In Conclusion…

Keeping a food journal is one of the best strategies you can implement to help improve your diet, break bad eating habits, prevent disease, and successfully achieve all your health and wellness goals.


Glaucoma in Dogs

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Glaucoma defines a group of eye conditions that are characterized by an elevated intraocular pressure, which typically leads to optic nerve damage. It’s a painful condition and the most common cause of blindness in dogs.

What is Intraocular Pressure?

The shape and size of the eyeball is regulated by fluid known as aqueous humor. Essentially, the eye is a fluid-filled ball, and the pressure of this fluid is known as intraocular pressure (IOP).

Eye fluid is constantly produced and contains nutrients and oxygen necessary for the eye to function optimally. Excess fluid is released through the “drainage angle” to maintain optimal IOP.

If fluid does not drain effectively, the IOP rises. Subsequently, the eye often gets larger and may take on an irregular shape. If not addressed immediately before this happens, the increased pressure can damage the optic nerve, which typically leads to vision loss.

An increase in pressure is what causes the pain, which most likely resembles a headache or even a migraine.

Early Warning Signs and Symptoms

Early intervention and treatment are necessary for the best possible outcome. Therefore, it’s extremely important to recognize the initial signs and symptoms.

At the onset of glaucoma, your dog may experience one or more of the following:

  • Red and/or cloudy eye(s)
  • Bloodshot eye(s)
  • Abnormally small or large pupil(s)
  • Abnormal blinking
  • Squinting or fluttering eyelids
  • Loss of appetite
  • Lack of interest in playing or socializing
  • Rubbing eye with paw or on the floor (due to pain)
  • Tearing or watery discharge
  • Crust around eye(s)
  • Bumping into walls and furniture
  • Swollen eye(s)
  • One eye larger than the other
  • Intolerance to light
  • Third eyelid elevation

Types of Glaucoma

Glaucoma is classified as either primary or secondary.

Primary Glaucoma

Primary glaucoma often occurs suddenly without warning. It’s believed to be genetic and caused by a physical or functional abnormality that prevents eye fluid from draining properly. For example, the drainage angle may be deformed or the opening may be too small.

Primary glaucoma typically starts in one eye and then moves to the other. Thus, always check for differences between the two eyes.

The age of onset is usually between four and ten years. However, it is possible at any age.

While primary glaucoma has been documented in mostly all dog breeds, some breeds are predisposed, which include:

  • Cocker Spaniel
  • Basset Hound
  • Wire Fox Terrier
  • Boston Terrier
  • Chow Chow
  • Shar-Pei
  • Norwegian Elkhound
  • Siberian Husky
  • Samoyed
  • Cairn Terrier
  • Maltese
  • Miniature Poodle
  • Beagles
  • Dalmatian
  • Chihuahua
  • Magyar Vizsla

In North America, the prevalence of primary glaucoma in these predisposed breeds can be as high as 5.5%.

Secondary Glaucoma

Secondary glaucoma occurs when IOP increases as a result of another eye related disease or damage to the eye. Such conditions include:

  • Cataracts
  • Tumors
  • Lens dislocation
  • Penetration of the eye
  • Infection
  • Inflammation (anterior uveitis)
  • Scarring from injury
  • Bleeding and blot clots
  • Retinal detachment

As a result, diagnosis and treatment of these conditions is also time sensitive to prevent the occurrence of glaucoma. Further, dogs with these disorders should routinely have their IOP measured.

While secondary glaucoma is not considered hereditary, the underlying conditions may be, such as cataracts and lens dislocation.

The combined prevalence of primary and secondary glaucoma is approximately 2% in the general canine population.

It’s also worth noting that the prevalence of cataracts (a common cause of secondary glaucoma) is estimated to be as high as 3.5% within the general canine population. However, for breeds with genetic predispositions, the prevalence has been calculated as high as 11%. Further, several of the same breeds predisposed to primary glaucoma are also more likely to develop cataracts, including cocker spaniels, terriers, and miniature poodles.

Inflammation caused by anterior uveitis is also very common in dogs.


As previously mentioned, immediate medical treatment is necessary if your dog exhibits one or more of the symptoms listed above. Complete loss of vision is more likely to occur the longer you wait. In some cases, blindness can occur within hours.

The veterinarian will perform an eye examination as well as measure the fluid pressure with an instrument known as a tonometer.

For a majority of dogs, a normal IOP is between 15 and 25 mmHg. Early stages of glaucoma typically produce IOP results between 20 an 30 mmHg. Moderate cases reach IOP levels between 30 mmHg and 40 mmHg. With advanced stages, IOP can rise between 40 and 50 mmHg.

If the pressure is raised above normal, and there are no other obvious explanations, glaucoma is diagnosed.

Promptly you will need to see a veterinary ophthalmologist whom has all the necessary equipment to further evaluate the eye to determine the best course of action. Specifically, the ophthalmologist uses special tools to examine the drainage angle and the optic nerve. X-rays and ultrasounds may also be required to rule out the presence of tumors, injuries, and abscesses.


Treatment depends on the severity of damage, and each case is different.

In general, the key goals of treatment are to:

  • Reduce pain
  • Reduce intraocular pressure
  • Increase drainage
  • Decrease fluid production

If there’s a chance to save your dog’s vision, medical treatment will be administered to reduce IOP. The drug or combination of drugs your ophthalmologist chooses with depend on the level of pressure and condition of the optic nerve.

Some medications are given orally, while others get placed directly in the eye. The most commonly prescribed drugs include:

  • Osmotic diuretics – reduce fluid production
  • Carbonic anhydrase inhibitors – reduce fluid production
  • Miotics – promote fluid release by constricting the pupil
  • Adrenergic drugs – promote fluid release
  • Prostaglandin analogs – promote fluid release
  • Beta – blockers – reduce fluid production

With secondary glaucoma, the underlying disease or dysfunction must also be treated. This may involve medications to reduce inflammation (i.e., corticosteroids) or treat an infection (i.e., antimicrobials).

While medication can reduce pain and delay disease progression, it’s not an effective long-term solution. Thus, once IOP has been reduced, surgery is most often necessary.

Some surgical procedures aim to reduce fluid production. However, other more successful procedures involve the use of implants to promote better fluid drainage. Specifically, a small hollow tube is placed in the eye to prevent blockages.

In either case, success is not guaranteed and complications are possible. Thus, the eye will need to be carefully monitored on a regular basis. Unfortunately, repeat surgeries may be necessary.

Further, certain medications (i.e., cholinesterase) may be prescribed to slow the progression of disease in the unaffected eye. As previously mentioned, primary glaucoma almost always occurs in both eyes.

In the case of irreversible vision loss, which occurs in approximately 40% of cases, surgical removal of the eye is recommended. It’s truly the best way to alleviate pain and prevent further complications.

Cost of Treatment

As discussed above, primary glaucoma can develop suddenly without warning. Further, treatment is required immediately after diagnosis.

Below is a summary of the expenses you will most likely incur if your dog is diagnosed with glaucoma:

  • Emergency veterinary hospital visit
  • Ophthalmologist office visit
  • Eye examinations (i.e., IOP measurement, optic nerve imaging, ultrasound, X-rays)
  • Medications (immediate and ongoing)
  • Surgery (possibly more than one)
  • Follow-up office visits

In addition, if your dog’s vision is lost, you may need to make certain modifications in your home to ensure his or her safety.

Needless to say, the cost of treatment can reach as high as $3500 in a very short period of time.

In Conclusion

  • Glaucoma affects the eye and is one of the leading causes of blindness in dogs
  • Identifying early warning signs is essential since the disease progresses quickly
  • Prompt treatment is necessary and most often involves medications as well as surgery
  • Cost of immediate and ongoing treatment is high


Gelatt, K. N. (2014). Essentials of veterinary ophthalmology. Ames, IA: Wiley Blackwell.

Gelatt, K. N. et al. (2005). Prevalence of primary breed-related cataracts in the dog in North America. Veterinary Ophthalmology,8(2), 101-111. doi:10.1111/j.1463-5224.2005.00352.x

Gelatt, K. N. et al. (2004). Prevalence of the breed-related glaucomas in pure-bred dogs in North America. Veterinary Ophthalmology,7(2), 97-111. doi:10.1111/j.1463-5224.2004.04006.x

Gelatt, K. N., at al. (2004). Secondary glaucomas in the dog in North America. Veterinary Ophthalmology, 7(4), 245-259. doi:10.1111/j.1463-5224.2004.04034.x

Johnsen, D. A., et al. (2006). Evaluation of risk factors for development of secondary glaucoma in dogs: 156 cases (1999–2004). Journal of the American Veterinary Medical Association, 229(8), 1270-1274. doi:10.2460/javma.229.8.1270

Mellersh, C. S. (2014). The genetics of eye disorders in the dog. Canine Genetics and Epidemiology,1(1), 3. doi:10.1186/2052-6687-1-3

Miller, P. E., et al. (2015). Clinical Signs and Diagnosis of the Canine Primary Glaucomas. The Veterinary Clinics of North America. Small Animal Practice, 45(6), 1183–vi.

Researchers Advance New Glaucoma Treatments. (2015, February 3). Retrieved March 10, 2017, from

Tinsley, David M., et al. (1993) Glaucoma: Past and Present Management Techniques. Iowa State University Veterinarian, 55(1).

Titanium Dioxide: What is it? And is it Safe?

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Titanium dioxide is a naturally occurring compound used as a coloring agent in cosmetics, personal care products, supplements, and processed foods. It whitens and brightens as well as prevents discoloration. Titanium dioxide also blocks ultraviolet (UV) rays, which is why it’s found in many sunscreens.

Powdered titanium dioxide generally appears to be safe. However, the widespread use of titanium dioxide “nanoparticles” has raised some concern.

What are Nanoparticles?

Nanoparticles form when titanium dioxide powder is further ground into microscopic particles. And while these microscopic particles are chemically identical to their larger counterparts, their behavior and reactivity may differ due to an increase in surface area. Further, their minuscule size may increase absorption and circulation within the bloodstream.

What are the Potential Risks?

Research has shown that titanium dioxide nanoparticles have the potential to cause free radical damage (a.k.a. oxidative stress), which results in cell damage, DNA mutations, inflammation, and immune system activation.

When inhaled, these particles have the capacity to travel directly to the lungs and brain. As a result, neurological damage is highly possible. This is why it’s never a good idea to use spray sunscreens, especially on the face.

Further, the International Agency for Research on Cancer has classified titanium dioxide nanoparticles as “possible carcinogenic to humans” according to animal inhalation studies. These nanoparticles are also considered an “occupational carcinogen” by the National Institute for Occupational Safety and Health.

Human studies using sunscreens have shown that titanium dioxide nanoparticles don’t substantially penetrate the skin. However, long-term safety studies have yet to be performed. In addition, the potential risks of oxidation caused by sun exposure are unknown.

Titanium Dioxide in Food

Titanium dioxide is found in the largest concentrations in candy and chewing gum. But it’s also found in cottage cheese, yogurt, condiments, processed meats, and snack foods. However, it’s worth noting that only one-third of the titanium dioxide used in food is in the nanoparticle form.

Nevertheless, we still don’t fully understand how titanium dioxide is absorbed, distributed, and excreted by the body. Thus, we couldn’t possibly understand its toxicity when consumed orally.

How to Reduce Your Exposure

Unfortunately, food producers can use up to 1% titanium dioxide (food grade) without declaring it on the label. Or, it may be hidden behind terms such as “natural color” or “natural coloring agent.”  

Thus, the best way to avoid titanium dioxide in your food is to consume more whole foods and to choose organic whenever possible. Interestingly enough, titanium dioxide is not approved for use in organic foods. 

When it comes to medications there is little you can do. However, you can opt for supplements without added colors as well as sunscreens with non-nanoparticle zinc oxide only. When it comes to cosmetics and personal care products, always read ingredient labels. And if you’re not sure, you can always check the Environmental Working Group Skin Deep Database.

In conclusion

The information we have so far on titanium dioxide and more importantly its nanoparticles is concerning. And a lack of data in some regards doesn’t imply safety.

Thus, I recommend applying the precautionary principle and avoiding exposure whenever possible.


Evans, S. M., Ashwood, P., Warley, A., Berisha, F., Thompson, R. P., & Powell, J. J. (2002). The role of dietary microparticles and calcium in apoptosis and interleukin-1β release of intestinal macrophages. Gastroenterology,123(5), 1543-1553. doi:10.1053/gast.2002.36554

Skocaj, M., Filipic, M., Petkovic, J., & Novak, S. (2011). Titanium dioxide in our everyday life; is it safe? Radiology and Oncology, 45(4), 227–247.

Weir, A., Westerhoff, P., Fabricius, L., & von Goetz, N. (2012). Titanium Dioxide Nanoparticles in Food and Personal Care Products. Environmental Science & Technology, 46(4), 2242–2250.

Heart Disease: Do you know YOUR risk?

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According to the American Heart Association, approximately 33% of all deaths in the United States are caused by heart disease. In fact, it claims more lives than all forms of cancer combined.

And rates of heart disease keep rising despite a booming statin drug (cholesterol lowering medication) industry.

The truth is there’s no scientific proof that lowering cholesterol levels reduces your risk of a heart attack or stroke.

In addition, there are many other factors involved in the development of heart disease. Thus, simply popping a pill to lower your cholesterol isn’t enough (and may even work against you). Sleep, exercise, nutrition, and stress management are just a few of the other factors that must be addressed.

Conventional Cardiovascular Blood Testing

Conventional medicine doctors typically run a series of tests each year to evaluate your risk of heart disease. However, they mostly only look at your cholesterol levels. Let’s take a closer look:

Total Cholesterol

Cholesterol is a critical component of steroid hormones (i.e., estrogen, testosterone, and cortisol) as well as every cell in the body. It’s also a powerful antioxidant. Thus, our bodies need cholesterol to thrive.

The total cholesterol test measures all forms of cholesterol found in the body (i.e., LDL, HDL, VLDL). And despite popular belief, most of the cholesterol in the blood is actually synthesized internally by the liver and intestines (as opposed to consumed with food).

Cholesterol levels alone doesn’t tell us much in regard to heart disease. However, abnormal levels may be a sign of dysfunction within the thyroid, adrenal glands, liver, and digestive system. They may also be associated with blood sugar imbalances and insulin resistance.

LDL Cholesterol

Low-density lipoproteins (LDL) transport essential fats and cholesterol from the liver to tissues. And there is concern about clogging the arteries as the cholesterol is carried throughout the body. Thus, LDL cholesterol has a bad reputation.

However, not all LDL cholesterol is bad. If you LDL cholesterol levels are high, further testing is necessary to determine if there’s truly a risk or not. Specifically, size and density matters.

Large, fluffy LDL particles are healthy and pose little risk. On the other hand, oxidized LDL particles are small, dense, and sticky. This combination makes them more likely to clog your arteries.

HDL Cholesterol

High-density lipoproteins (HDL) transport cholesterol from tissues to the liver. This process of binding cholesterol and moving it to the liver is believed to help keep the arteries clear.

In addition, HDL cholesterol helps increase the cellular absorption of LDL cholesterol. Thus, it’s known as the “good” cholesterol.


Triglycerides are a type of fat derived from food or synthesized by the liver. And they’re used as an energy source for heart and skeletal muscle cells. Thus, they’re essential to our wellbeing.

However, high levels are associated with an elevated risk of heart disease. Abnormal triglycerides may also be a sign of blood sugar imbalances, insulin resistance, liver disease, adrenal dysfunction, thyroid disease, and autoimmunity.

C-Reactive Protein (CRP)

CRP is a protein produced by the liver in response to an injury or infection. As a result, high levels signal inflammation. And inflammation is believed to be one of the key underlying factors when it comes to most modern diseases, including heart disease.

Conventional Cardiovascular Testing Pitfalls

The tests described above are all useful. In fact, I use them in my practice as well. However, this small set of tests only touches the surface when it comes to your risk of developing heart disease.

As previously mentioned, cholesterol is not the best predictor of heart disease. High cholesterol or triglycerides may be a sign of something other than heart disease. And, there are many other factors that affect heart health.

Therefore, if you want a complete picture, additional tests are necessary.

Functional Cardiovascular Blood Testing

As a functional medicine practitioner, I work closely with my patients to help them heal from chronic disease. However, helping my patients prevent disease is also a big part of my work. And due to the high prevalence of heart disease, I highly recommend comprehensive cardiovascular screening.

To start, I prescribe the tests discussed above in addition to the tests below:

Insulin, Blood Glucose, and Hemoglobin A1C

Metabolic syndrome is used to describe a set of symptoms that increase one’s risk for heart disease, which include:

  • Abdominal obesity
  • High insulin
  • High blood glucose
  • High triglycerides
  • Low HDL cholesterol
  • High blood pressure

And as you can see, there’s more to it than just cholesterol. In fact, blood sugar imbalances and insulin resistance are the key drivers of metabolic syndrome. All other symptoms are secondary. Thus, testing insulin, blood glucose, and hemoglobin A1C is essential to diagnosing metabolic syndrome and preventing heart health.


Testosterone, the primary male sex hormone, often decreases in men as they age. But, abnormally low levels may be a predictor of heart disease.

It’s also worth noting that testosterone is a precursor of estradiol, the primary sex hormone in women.


Estradiol (a form of estrogen) is a female sex hormone produced by the ovaries. In premenopausal women, estrogen is believed to promote healthy blood vessels and have antioxidant properties. Therefore, low levels may increase a women’s chance of heart disease before menopause.

High Sensitivity – C-Reactive Protein (HS-CRP)

Similar to CRP discussed above, HS-CRP also measures inflammation. However, this test is more precise and can be used to assess cases of chronic inflammation.


Homocysteine is a byproduct of protein metabolism. In high concentrations, homocysteine may damage the lining of blood vessels and promote plaque formation.

Lactase Dehydrogenase (LDH) and Aspartate Aminotransferase (AST)

LDH and AST are cellular enzymes, which are released into the bloodstream when cells are damaged or destroyed.

LDH is found in all cells. AST is specific to the liver, heart, and skeletal muscle. Thus, an elevation in both would prompt further testing to rule out damage to heart tissue.


Ferritin estimates that amount of iron stored within the body. And high iron stores are believed to promote arterial wall damage and the oxidation of cholesterol.


Fibrinogen is a blood clotting protein. High levels negatively influence arterial health and blood viscosity. Further, fibrinogen production increases in response to inflammation.

Vitamin D

The primary function of vitamin D is to increase the absorption of calcium to promote strong bones and teeth. However, there are vitamin D receptors on several types of tissues, including the heart. As a result, research has shown that a vitamin D deficiency may be a risk factor for heart disease.

In Conclusion

There is a global heart disease epidemic affecting millions each year, which is why it’s important to know your risk. Especially when heart disease is preventable.

This is why I offer the most comprehensive heart health screening tests available. I also carefully evaluate your diet, lifestyle, family history, and more. The information we gather allows us to create the best preventative strategy possible that is tailored specifically for you.


Galassi, A., Reynolds, K., & He, J. (2006). Metabolic Syndrome and Risk of Cardiovascular Disease: A Meta-Analysis. The American Journal of Medicine,119(10), 812-819. doi:10.1016/j.amjmed.2006.02.031

Ganguly, P., & Alam, S. F. (2015). Role of homocysteine in the development of cardiovascular disease. Nutrition Journal, 14, 6.

Judd, S. E., & Tangpricha, V. (2009). Vitamin D Deficiency and Risk for Cardiovascular Disease. The American Journal of the Medical Sciences, 338(1), 40–44.

Kloner, R. A., Carson, C., Dobbs, A., Kopecky, S., & Mohler, E. R. (2016). Testosterone and Cardiovascular Disease. Journal of the American College of Cardiology,67(5). doi:10.1016/j.jacc.2015.12.005

Ouyang, P., Wenger, N. K., Taylor, D., Rich-Edwards, J. W., Steiner, M., Shaw, L. J., … Merz, N. B. (2016). Strategies and methods to study female-specific cardiovascular health and disease: a guide for clinical scientists. Biology of Sex Differences, 7, 19.

Pourmoghaddas, A., Sanei, H., Garakyaraghi, M., Esteki-Ghashghaei, F., & Gharaati, M. (2014). The relation between body iron store and ferritin, and coronary artery disease. ARYA Atherosclerosis, 10(1), 32–36.

Stec, J. J., Silbershatz, H., Tofler, G. H., Matheney, T. H., Sutherland, P., Lipinska, I., . . . D’agostino, R. B. (2000). Association of Fibrinogen With Cardiovascular Risk Factors and Cardiovascular Disease in the Framingham Offspring Population. Circulation,102(14), 1634-1638. doi:10.1161/01.cir.102.14.1634

Weatherby, D., & Ferguson, S. (2002). Blood chemistry and CBC analysis: clinical laboratory testing from a functional perspective. Jacksonville, OR: Bear Mountain Pub.

How Tap Water is Harming Your Thyroid

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tap water

Tap water is polluted with pesticides, pharmaceutical drugs, heavy metals, and many other environmental toxins. All of which are harmful to your health.

When it comes to your thyroid, one of the biggest concerns is fluoride. And sadly, it’s intentionally added to local water supplies to promote healthy teeth.

However, research shows that fluoride actually increases the occurrence of cavities by as much as 27%. Fluoride has also been linked to:

  • Heart disease
  • Brittle bones
  • Neurological damage
  • Cancer
  • Attention Deficit Hyperactivity Disorder (ADHD)

Fluoride’s Link to Hypothyroidism

In 2015, a large observational study found that drinking fluoridated water is associated with a 30% higher risk of developing hypothyroidism (a.k.a. underactive thyroid).

This statistic is true for fluoride levels as low as 0.3 mg per liter. However, the U.S. recommends adding 0.7 mg of fluoride per liter of water. More than twice as much!

Scientists in this study also compared a community with fluoridated water to a second community without. They found reports of hypothyroidism were twice as high in the fluoridated region.

What is Hypothyroidism?

The thyroid is the body’s largest endocrine gland. It’s responsible for producing and secreting thyroid hormones. And these hormones play many vital roles in the body. In fact, all metabolically active cells rely on thyroid hormones to function properly.

Hypothyroidism is the most common form of thyroid disease. It results in an underproduction of thyroid hormones, which causes imbalances and dysfunction throughout the body.

Common symptoms include:

  • Weight gain
  • Fatigue
  • Cold intolerance
  • Constipation
  • Brain fog
  • Poor immunity
  • Brittle hair and nails
  • Dry skin
  • Depression
  • Poor memory
  • Achy joints
  • Muscle cramping

How Fluoride Negatively Impacts Your Thyroid


The thyroid gland is highly sensitive to the effects of fluoride. In fact, fluoride was once used to reduce the production of thyroid hormones in those with overactive thyroid glands (hyperthyroidism).

The therapeutic dose required to slow the synthesis of thyroid hormones was as low as 2 to 5 mg per day. Today, the average American consumes 1.6 to 6.6 mg of fluoride daily from tap water.

Research has also found that fluoride builds up in the thyroid gland more than any other soft tissue in vertebrates (except the kidney).

Studies have revealed several possible mechanisms in which fluoride may harm the thyroid, including:

  • Blocking hormone receptor sites
  • Physically damaging thyroid tissue
  • Preventing the conversion of inactive thyroid hormones to their active counterparts
  • Worsening the effects of iodine deficiency

In Conclusion

There’s plenty of scientific evidence linking fluoride in our drinking water to hypothyroidism (as well as many other serious health conditions).

In addition, the lack of safety studies doesn’t prove fluoride is safe. In fact, fluoride is listed as one of the top 20 toxins considered most risky to human health by the U.S. Agency for Toxic Substances and Disease Registry. Yet, it’s still added to our water!

For optimal thyroid health, reducing your exposure to fluoride is essential. Investing in a water filtration system that effectively removes fluoride is highly recommended.


Choi, A. L., et al. (2012). Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives,120(10), 1362-1368. doi:10.1289/ehp.1104912

Doull, J., et al. (2006). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. Washington, D.C.: The National Academies Press.

Gupta, A. K. (2016). Fluoride in Drinking Water: Status, Issues and Solutions. Boca Raton, FL: CRC Press.

Li, Y., et al. (2012). Association of vascular fluoride uptake with vascular calcification and coronary artery disease. Nuclear Medicine Communications,33(1), 14-20. doi:10.1097/mnm.0b013e32834c187e

Malin, A. J., et al. (2015). Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association. Environmental Health, 14, 17. doi:10.1186/s12940-015-0003-1

Peckham, S., et al. (2015). Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. Journal of Epidemiology and Community Health,69(7), 619-624. doi:10.1136/jech-2014-204971

salmon dinner

7 Reasons Why You Should Be Meal Planning

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(Originally written for Pure Plates)

salmon dinner

If your goal is to eat healthier to lose weight and optimize your health, then meal planning is the way to go. Hands down.

In addition to having nutritious meals at your fingertips, there are many other benefits of meal planning. Let’s take a closer look…

Top 7 Benefits of Meal Planning

Saves You Time

While you might spend 10 to 15 minutes once a week meal planning, you’ll still actually have more time in your week for other (hopefully relaxing) things.

For example, meal planning involves creating a shopping list of only the things you need. Thus, you’ll be able to get in and out of the grocery store much faster.

In addition, you should only need to make one weekly trip to the store. And, you’ll be sure to have everything on hand when dinnertime rolls around. Thus, no more last minute pit stops.

Eliminates Food Waste

If you head to the grocery store without a plan, you’re probably buying items without knowing what you already have at home and what you’re going to do with the foods you buy. In addition, you may forget about various events or activities in which you need extra food for guests or no food at all.

Thus, when you get home, you might find you’re missing a key ingredient or two. Or, you might be wondering what to do with the foods you got. And after a long day, take-out starts sounding much better than heading back to the store or finding a new recipe with the ingredients you do have.

As a result, some foods are likely to get tossed by the end of the week. However, with a meal plan, everything you buy has a purpose.

Saves You Money

With a meal plan, you’ll only be spending money on foods you truly need. You can also create your plan around your budget. In addition, planning ahead gives you the opportunity to take advantage of sales and coupons.

Reduces Your Stress

Having a meal plan takes the stress out of healthy eating. It gives you one less thing to think about. And, there’ll be no more scrambling last minute trying to figure out what’s for dinner, especially at the end of a busy day.

Adds Variety & Balance to Your Diet

Meal planning sets the stage for eating a variety of foods and well-balanced meals throughout the week.

For instance, when you see your plan on paper (or your computer or phone), you’re less likely to pencil in the same foods back to back. You’re also able to see whether or not your meals have a good balance of proteins, carbs, healthy fats, and (lots of) vegetables.

Gives Kids an Opportunity to Get Involved

Kids love to have a voice when it comes to dinner. Thus, meal planning is a perfect opportunity to get your little ones involved. For example, let each child pick one meal for the week. Or, let your children choose a veggie side dish.

They’ll be more excited about home cooked meals. And, they’ll learn how to meal plan, which will help foster healthy eating habits.

In addition, your kids will stop asking, “what’s for dinner” when you post your meal plan on the fridge for all to see. And, if they know what to expect, they’ll be less likely to complain at the dinner table.

Eat Healthier

Now let’s circle back to your original goal of eating healthy. Based on all the benefits of meal planning we discussed above, it would be almost impossible not to eat healthier with a meal plan.

Meal planning leads to more home cooking as well as more variety and well-balanced meals. Thus, it naturally leads to less take-out and fast food. And these things lead to weight loss and better health.

Meal Planning Tips

Meal planning shouldn’t be difficult. In fact, there are many online meal planning services as well as apps available. Some that even do all the work for you.

In addition, you don’t need to plan a home cooked meal every night. Most likely you will eat out a night or two. And one night you may have dinner at a friend or family member’s house. In addition, some nights you can even add Pure Plates meals to your plan. However, it’s still important to include those nights in your plan to reap all the benefits of meal planning discussed above.

And if you’re looking for a complete solution, Pure Plates offers a 30-Day Fresh Start Program, which provides a 30-day meal plan along with all your meals. It doesn’t get any easier than that!

In Conclusion…

The benefits of meal planning are substantial, especially when it comes to your health (and sanity). Thus, we hope you’ll give it a try.

And, if you’re already a meal planning pro, we’d love to hear from you! What are some of your best meal planning tips and tricks?

What Do Liver Function Tests Tell Us?

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A group of liver function tests are often performed as part of routine laboratory testing. However, as you will learn in this article, these tests may also highlight dysfunction or disease in systems other than the liver.

Thus, functional medicine practitioners don’t rely solely on the results of one specific test. We also carefully evaluate your symptoms, diet, lifestyle, history, and other lab test results to further narrow down all potential sources of dysfunction or disease.

Further, when interpreting results, functional medicine considers “optimal” ranges as opposed to “normal” ranges (learn more here). This allows us to identify and treat signs of dysfunction before a full-blown disease occurs.

Liver Dysfunction

When combined, the tests described below provide insight into how well (or poor) your liver is functioning. And it’s important to recognize that your diet and lifestyle are two key factors that affect liver function. For example, when the liver is overburdened with toxins, it may become congested. As a result, toxins may build up in your body and lead to additional problems.

Some common signs and symptoms of liver dysfunction include:

  • Abnormal cholesterol levels
  • Gas and bloating
  • Dietary fat intolerance
  • Constipation
  • Fatigue and weakness
  • Blood sugar imbalances
  • Brain fog
  • Depression
  • Poor memory
  • Food allergies
  • Skin rashes
  • Hormonal imbalances
  • Severe menopause or PMS
  • Liver spots (brownish spots on skin)

Thus, if liver dysfunction is suspected, functional medicine attempts to identify and eliminate all possible sources.

Common Liver Function Tests

Below are descriptions of the most common liver function tests performed.


Albumin is a protein synthesized and secreted by the liver. And it’s the most abundant protein found in human blood. It plays a role in balancing fluids, transporting nutrients and hormones, metabolism, pH balance, blood vessel health, and fighting free radical damage.

The rate of albumin synthesis depends on liver function as well as nutritional intake. Specifically, the body needs a source of energy and amino acids (building blocks of protein) to manufacture albumin.

Thus, abnormal albumin levels may indicate a variety of potential problems in addition to liver dysfunction.

Decreased albumin levels are typically associated with:

  • Liver dysfunction
  • Systemic inflammation
  • Nutrient deficiencies
  • Digestive dysfunction

Elevated albumin levels may be a sign of dehydration.

Total Protein

The total protein test measures both albumin and globulins, which combined make up a majority of blood proteins.

Globulins are synthesized and secreted by both the liver and the immune system. Similar to albumin, energy and amino acids are required. And one of the key roles is to transport minerals, hormones, and fats throughout the body.

However, one very important type of globulins are known as immunoglobulins (a.k.a. antibodies), which play a crucial role in preventing infections and neutralizing toxins.

Decreased total protein levels may be a sign of:

  • Liver dysfunction
  • Nutrient deficiencies
  • Digestive dysfunction
  • Kidney dysfunction

Elevated total protein levels may be associated with:

  • Systemic inflammation
  • Chronic infections (i.e., viral hepatitis and HIV)
  • Bone marrow disorders
  • Dehydration

However, it’s worth noting that an optimal total protein level may still be detected even if albumin or globulin levels are out of range. Thus, it’s essential to consider albumin levels when interpreting total protein levels.

Albumin/Globulin Ratio (A/G Ratio)

Total protein and albumin are often used to calculate the ratio of albumin to globulins.

A low A/G ratio may be a sign of:

  • Liver dysfunction
  • Autoimmune disease
  • Kidney dysfunction

A high A/G ratio may indicate low levels of immunoglobulins, which are observed with genetic related disorders and leukemias (blood cancer).


Bilirubin is a waste product created from the degradation of old red blood cells. And it’s the liver’s job to process bilirubin in a way that makes it easy for the body to eliminate.

There are two tests associated with bilirubin – total bilirubin and direct bilirubin.

Total bilirubin measures both indirect bilirubin (prior to liver processing) and direct bilirubin (after liver processing). However, as with total protein, total bilirubin doesn’t provide a complete picture.

Thus, direct bilirubin levels are also measured. And indirect bilirubin levels can then be calculated.

Elevated levels of indirect bilirubin may be a sign of:

  • B12 deficiency
  • Liver cirrhosis
  • Oxidative stress
  • Autoimmune disease
  • Hemolysis (premature destruction of red blood cells)

Elevated levels of direct bilirubin may be associated with:

  • Liver dysfunction
  • Viral hepatitis or other liver infections
  • Alcohol induced liver disease
  • Gallstones
  • Cholecystitis (inflammation of the gall bladder)
  • Liver tumors

Liver Enzyme Tests

The remaining three tests below evaluate blood levels of specific enzymes that reside in the liver. However, it’s worth noting that these enzymes are also found in other tissues within the body. Thus, these tests provide insight into a variety of potential issues, especially when evaluated together along with other laboratory tests.

Alkaline Phosphatase (ALP)

Alkaline phosphatase is found in the liver as well as the bones, skin, and digestive tract.

Elevated levels of ALP may be a sign of:

  • Viral hepatitis or other liver infections
  • Liver cirrhosis
  • Liver tumors
  • Fatty liver disease
  • Bone disorders
  • Leaky gut (increased intestinal permeability)
  • Shingles
  • Gallstones
  • Cholecystitis (inflammation of the gall bladder)

The activity of ALP is highly dependent on the presence of the mineral zinc. Thus, while low levels of ALP are optimal, abnormally low levels of ALP may be associated with a zinc deficiency.

Aspartate Aminotransferase (AST)

Aspartate aminotransferase is an enzyme found in the liver as well as the heart, muscles, kidneys, lungs, and pancreas. It is released into the bloodstream as a result of cellular damage or destruction.

Thus, elevated levels of AST may be a sign of:

  • Liver dysfunction
  • Cellular damage (in heart, liver, pancreas, muscle tissue)
  • Heart dysfunction or disease
  • Infectious disease

The functionality of AST heavily relies on the presence of vitamin B6. Thus, while low levels of AST are optimal, abnormally low levels of AST may be associated with a vitamin B6 deficiency, which can be caused by alcoholism.

Alanine Aminotransferase (ALT)

Alanine aminotransferase is found mostly in the liver, but smaller quantities are also found in muscle, kidney, and heart tissue. As with AST, it is released into the blood when cells are damaged or destroyed.

Thus, elevated levels of ALT may be associated with:

  • Liver dysfunction
  • Fatty liver disease
  • Viral hepatitis or other liver infections
  • Alcohol induced liver disease
  • Liver cirrhosis
  • Cellular damage (in liver, heart, or kidney tissue)

Similar to AST, abnormally low levels may be a sign of a vitamin B6 deficiency, which can be caused by alcohol abuse. In addition, abnormally low levels may also be associated with very a early stage of fatty liver disease.

In Conclusion

The liver function tests discussed above provide valuable information related to the health of your liver. However, the test results must be interpreted carefully. In addition, many factors and other laboratory tests must also be considered before drawing any conclusions.

Thus, if you suspect your liver isn’t functioning at top speed, functional medicine can help. We’ll look for signs and symptoms starting with a series of laboratory tests as well as thorough data analysis.

If dysfunction is detected, we’ll work closely together to identify and correct all possible sources. While this process will improve your liver function, it will also most likely improve your health in many other ways.


Giannini, E. G., Testa, R., & Savarino, V. (2005). Liver enzyme alteration: a guide for clinicians. CMAJ : Canadian Medical Association Journal, 172(3), 367–379.

Laker, M. F. (1990). Liver function tests. BMJ : British Medical Journal, 301(6746), 250–251.

Limdi, J. K. (2003). Evaluation of abnormal liver function tests. Postgraduate Medical Journal,79(932), 307-312. doi:10.1136/pmj.79.932.307

Weatherby, D., & Ferguson, S. (2002). Blood chemistry and CBC analysis: clinical laboratory testing from a functional perspective. Jacksonville, OR: Bear Mountain Pub.