Authored by Dr. Aidanne

IBS is considered a “diagnosis of exclusion” which means that it is typically given once the more serious conditions that affect the structure or function of the GI tract are ruled out (ie. IBD, celiac, endometriosis, or hypothyroidism).

What is normal?

In order to understand potential IBS triggers, knowledge of normal digestive function is key. 

Even before we eat, our body is setting our system up for success by making digestive enzymes and acid in response to the smells and sights we experience while cooking. When we finally take a bite, chewing both manually grinds foods and stimulates saliva production that contains enzymes to break carbohydrates down. Swallowing then sends our food down the esophagus and into the stomach where acid and digestive enzymes await to to break it down further. From there, the small intestine is responsible for absorbing micronutrients. The large intestine sucks out all the water to form our stool and is home to our gut microbiome.

So what can lead to IBS?

Although there may be more at play and the exact causes of IBS are uncertain, I commonly encounter these four triggers in my practice:

1.) Gut Motility Issues & Mental Health

Our autonomic nervous system has two main branches, the parasympathetic (aka “rest and digest”) and sympathetic (aka “Fight or flight”). You may recall that during a period of intense stress, your bowel movements were not normal. Maybe you experienced a loose stool due to overactive nerves or were unable to pass one for multiple days. This is due to the significant impact that stress has on our vagus nerve. The vagus nerve is responsible for stimulating digestive juices and driving muscle contractions (aka peristalsis) that keep our bowels moving smoothly. When we eat on the run or do not allow our body time to calm before eating we impair our digestive function. 

How we eat and when we eat can also play a role. IBS can often occur if meals are skipped, too large, or if we’re eating sporadically. Also, the plants we eat throughout the day provide us with fiber needed to regulate our bowel motility. The gut loves consistency! 

Also, there is a well established bidirectional set of signals that pass between the brain and our gut tissue. Ninety percent of our serotonin is produced in the gut, so when these levels are low it can not only impact our mood but also impede peristalsis and increase sensitivity of the nerves of the gut. Addressing both mental health concerns, neurotransmitter imbalances and gut motility is an effective IBS management strategy. 

2.) Microbiome Imbalances

Balance and diversity are essential when it comes to the community of bacteria, viruses, and fungi that live in our large intestine. Either insufficient or overgrown levels of these microbes can cause disruptions to bowel transit time and symptoms such as gas and bloating. Insufficiency is more common in cases of looser stools and the yeast Candida is a common culprit for those living with constipation, bloating and flatulence. Fiber is important here as well, as it not only helps to bulk up the stool but can nourish our gut bacteria. 

A stool sample is the best way to gain insight into possible imbalances in the large intestine. 

3.) Foods Sensitivities

When we eat foods our bodies do not tolerate well, the undigested food fragments that make their way through our GI tract activate our gut related immune system. This can cause a lot of local irritation and inflammation which serve to make the gut tissue more sensitive. 

Common food sensitivities that contribute to IBS symptoms include gluten, dairy, eggs, soy, nuts, alcohol, and foods rich in FODMAPs. 

FODMAPs are fermentable sugars that some individuals do not break down well. When undigested, FODMAPs draw water into the intestines resulting in looser bowel movements and increased peristalsis. FODMAPs often cause bloating from our gut microbes feasting on them and producing gas as a byproduct. Although a low FODMAP diet is not meant to be implemented long term, it can provide relief while other factors are being ruled out. 

4.) Genetics & Enzyme Deficiencies

Enzyme deficiencies can be inherited. The classic example is an inability to produce lactase which is needed to break down lactose. This then leads to lactose intolerance which can trigger diarrhea, bloating, gas and abdominal pain if someone eats dairy. Sucrase, isomaltase and alpha-galactosidase can all impact ones ability to break down sugars. Supplementing with digestive enzymes or herbs to support enzyme production can be helpful in these cases. 

5.) Medications

Common medications that can worsen or trigger IBS symptoms include NSAIDs, antibiotics, antidepressants, PPIs, opioids, hormonal medications, etc.

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References:

• Patel N, Shackelford K. Irritable Bowel Syndrome. [Updated 2022 Oct 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534810/
  
• Wald A. Clinical Manifestations and Diagnosis of Irritable Bowel Syndrome in Adults. UpToDate. Updated July 20, 2022. Current through July 2023. 

Authored by Dr. Aidanne

Authored by Dr. Barrett

Abdominal bloating and distention are two of the most commonly reported gastrointestinal concerns. Bloating is a feeling of tightness, pressure or fullness in your abdomen. You may even notice a visibly distended abdomen and clothing can feel tight. While it is not usually a serious medical concern, chronic or severe bloating can significantly impact one's quality of life. In this article, we will explore the various causes of abdominal bloating.





Causes of bloating:

Gas Production:

• Gas production occurs naturally as a part of digestion. Bacteria live in our intestines and fermented leftover carbohydrates. If there is too much fermentation happening excessive gas can be produced. This gas is eventually passed as flatulence. 
• SIBO (small intestine bacterial overgrowth) is just what it sounds like, an overgrowth of bacterial in the small intestines. This causes excessive bloating and discomfort with most meals. This gas can become trapped for long periods of time before being passed. 

Swallowing Air:

• Swallowing air unintentionally is a common cause of abdominal bloating. This can happen when talking while eating, chewing gum, drinking through a straw, or consuming carbonated beverages. Individuals who are anxious or nervous may also swallow air more frequently, exacerbating bloating symptoms.
  

Stress:

• Stress can impact the movement and contractions of your gastrointestinal tract. It can either speed up or slow down the movement of food through your intestines, leading to changes in bowel habits and potential bloating.
  
• Stress can lead to the redirection of blood flow away from the digestive system to support other parts of the body preparing for the sympathetic or "fight or flight" response. This reduced blood flow can hinder the optimal functioning of the GI tract and cause bloating.
  

Food Sensitivities/Intolerances:

• Food intolerances and sensitivities occur when the body has difficulty digesting certain substances, such as lactose, fructose, or gluten. In these cases, the undigested components can ferment in the intestines, leading to gas production and bloating. Common culprits include dairy products, wheat-based products, beans, and certain fruits.
  

Menstruation:

• Bloating and water retention can occur during the menstrual cycles due to hormonal fluctuations. This monthly occurrence can lead to abdominal discomfort and swelling.
  

Bowel Obstruction or Serious Conditions:

• In rare cases, abdominal bloating can be a symptom of more serious conditions, such as bowel obstruction, ovarian cysts, uterine fibroids, or even certain cancers. If bloating is accompanied by severe pain, sudden weight loss, or persistent changes in bowel habits, medical attention should be sought immediately.
  

Therapeutic options:

Dietary Modifications:

• Identify and avoid trigger foods that can cause bloating, such as carbonated drinks and certain artificial sweeteners.
  
• Avoid food intolerances. These are often identified by using an elimination diet. 
  
• Consider trying a low-FODMAP diet, which restricts fermentable carbohydrates that may cause gas and bloating in some individuals. Note: this diet is for temporary relief and should not be followed longer than 6 weeks. 
  

Chew Slowly and Avoid Swallowing Air:

• Eat meals at a slower pace to reduce the amount of air swallowed during eating.
  
• Avoid using straws and chewing gum, as they can lead to swallowing excess air.
  

Microbiome Support:

• Consuming probiotic-rich foods or taking probiotic supplements can promote a healthy balance of gut bacteria and improve digestion, potentially reducing bloating.
  
• Eating prebiotic fibers can help support a healthy microbiome. Foods high in prebiotic fibers include garlic, onions, bananas, apples, and oats. 
  

Deep Belly Breathing:

• Deep breathing activates the parasympathetic nervous system, which is responsible for promoting a "rest and digest" response in the body. This helps relax the muscles in the gastrointestinal tract, facilitating better digestion and reducing bloating.
  
• Deep breathing can aid in the release of trapped gas from the digestive system. When you take slow, deep breaths, you stimulate movement in the intestines, which may help relieve gas and bloating.
  

Herbal teas:

• Certain herbal teas such as peppermint, ginger, fennel and chamomile can aid in digestion and help to reduce bloating. 
  

Apple Cider Vinegar (ACV) and Bitter Herbs:

• ACV contains acetic acid, which is thought to stimulate the production of digestive enzymes, potentially aiding in the breakdown of food and improving digestion.
  
• Bitter herbs such as dandelion, gentian, chamomile, and artichoke can help stimulate the production of digestive enzymes and the release of bile to improve digestion. These herbs may also have carminative properties, meaning they help reduce gas and gloating in the digestive system. 
  
  • These herbs can be consumed as a tea or tincture or incorporated into dishes.
    

Regular physical activity:

•  Regular exercise can help improve bowel motility and prevent constipation, both of which can reduce bloating.
  

Manage Stress:

• Stress and anxiety can worsen bloating symptoms. Practicing relaxation techniques, such as deep breathing, meditation, yoga, or mindfulness, can help reduce stress and its effects on digestion.
  

Resources:

• Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol. 2021 Feb;19(2):219-231.e1. doi: 10.1016/j.cgh.2020.03.056. Epub 2020 Apr 1. PMID: 32246999.
  

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Authored by Dr. Barrett

These microbes do many things for us. So much in fact that without them it would be difficult for us to survive. They digest certain fibers turning them into short chain fatty acids that we need for our digestive health. They communicate with our immune cells and control how we respond to infections. New research indicates that there is a strong connection between our brain health and our microbiome. The microbiome is also considered to be an endocrine organ because it exerts influence on distant organs and pathways (1).

Oral contraceptive pills (OCPs) also known as birth control, impacts the health of our microbiome. The hormones that are naturally produced in our bodies and the hormones that we take orally both impact the composition of our microbiome (2). It makes sense that taking hormones orally would alter the microbiome. For millions of years we were only exposed to hormones that we produce naturally. It’s only been in the last 70 years that we started taking hormones by mouth. 

Folks who take oral birth control (hopefully) know that when they take antibiotics the birth control pill can become much less effective. One hypothesis for this effect is that antibiotics dramatically alter the microbiome where a significant amount of estrogen metabolism takes place (3).

Unfortunately the birth control pill can also increase your risk of inflammatory bowel disease. In two large studies it was found that women who use oral contraceptives for over 5 years had a significantly increased risk for developing inflammatory bowel disease, particularly Crohn’s (4).

It’s not just the gut microbiome that’s impacted by birth control pills. The vaginal microbiome is also altered and the risk of vaginal yeast infections is increased in people taking birth control pills (5).

We need more research into the microbiome but we know enough now to know that taking oral hormones impacts the health of our microbiome. 

In general here are some ways to support a healthy microbiome:

• Consuming fiber daily from a variety of sources. Aim for 30-35g daily. 
• Limit processed foods and high sugar foods in your diet.
• Consume fermented foods.
• Limit your use of antibiotics.

References:

1. Qi X, Yun C, Pang Y, Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes. 2021 Jan-Dec;13(1):1-21. doi: 10.1080/19490976.2021.1894070. PMID: 33722164; PMCID: PMC7971312.
2. Hua X, Cao Y, Morgan DM, Miller K, Chin SM, Bellavance D, Khalili H. Longitudinal analysis of the impact of oral contraceptive use on the gut microbiome. J Med Microbiol. 2022 Apr;71(4). doi: 10.1099/jmm.0.001512. PMID: 35452382.
3. Adlercreutz H, Pulkkinen MO, Hämäläinen EK, Korpela JT. Studies on the role of intestinal bacteria in metabolism of synthetic and natural steroid hormones. J Steroid Biochem. 1984 Jan;20(1):217-29. doi: 10.1016/0022-4731(84)90208-5. PMID: 6231418.
4. Khalili H, Higuchi LM, Ananthakrishnan AN, Richter JM, Feskanich D, Fuchs CS, Chan AT. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut. 2013 Aug;62(8):1153-9. doi: 10.1136/gutjnl-2012-302362. Epub 2012 May 22. PMID: 22619368; PMCID: PMC3465475.
5. Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The impact of oral contraception on vulvovaginal candidiasis. Contraception. 1995 May;51(5):293-7. doi: 10.1016/0010-7824(95)00079-p. PMID: 7628203.

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Authored by Dr. Barrett​ and Jesse Haas, CNS, LN

​Maintaining wellness all winter long is more important now than ever. Most of us face at least two major health challenges this time of year...but we're throwing in a suggestion for a third just in case!

First we think about our immune systems. Flu and cold season is always a challenge - this year that challenge is compounded by the COVID-19 pandemic and the incredible importance of staying well so our health care system can manage the influx of patients combating that disease.

In addition to maintaining robust immunity, our digestive tracts also tend to take a hit this time of year. The holiday feasts often introduce new foods to our meal plans and encourage overindulgence of both food and drink. Bloating, gas, diarrhea and constipation are common companions from Thanksgiving through Valentine's Day. Since our digestive tract and immune systems work together so closely, we can't address one without considering the other.

Getting a personalized health prevention and maintenance plan is always the gold standard, but here are a number of nutrients and supplements we often recommend to patients this time of year.


IMMUNE SUPPORTIVE NUTRIENTS AND BOTANICALS:

Vitamin D is always on the top of our list for immune-related health goals. Vitamin D deficiency is associated with increased risk of infection(1). Because we live so far north of the equator, Minnesotans are especially at risk of vitamin D deficiency. The UV-B rays we need to make vitamin D in our skin does not penetrate our atmosphere from approximately Labor Day to Memorial Day. This makes supplementing with vitamin D an imperative act of self-care through cold and flu season.  

Vitamin C is probably the nutrient most well-known for it's role in the immune system. This nutrient is a power antioxidant, helping to stabilize cells in our body that will attack and destroy viruses (2). Vitamin C is easy to get enough of in a plant-focused diet, but also a worthy contribution to the medicine cabinet. 

A word of caution regarding supplementing with vitamin C: high doses of ascorbic acid (the most common and least expensive form of the nutrient) will cause loose stool. Look for a product that contains bioflavonoids to reduce the risk of this side effect while still optimizing your antioxidant protection. 

Zinc lozenges are another worthy investment. Probably the second-most well-known immune system warrior, zinc actually kills viruses in the mouth and throat. Lozenges containing 3-5mg of zinc are great to have for when you feel that scratchiness in your throat at the onset of illness or as a preventative measure to suck on after forays out into public spaces.

Elderberry syrup is a traditional herbal remedy often used during flu season. Elderberries contain vitamins A and C as well as the flavonoids quercetin and rutin which may improve immune function. Elderberry is anti-viral particularly against the influenza (flu) virus and may even reduce the duration of the flu (3).  Traditionally elderberry syrup is used daily throughout flu season. For more information about elderberry syrup check out this blog post authored by Jesse. ​

Authored by Amy Daws, CMT, CSt

Springtime brings with it the energy for a fresh start, which means there is often a desire to clean out the clutter in our external and internal environments. This may include a deep clean of the basement, a desire to revamp your exercise routine, or refresh your eating habits with a diet cleanse. In the spirit of “spring cleaning” I would like to discuss how abdominal massage is a gentle and effective way to “clear the clutter” in and around your organs. This allows them to function more smoothly. Abdominal massage is like a tune-up for your organs and it feels good too!
 
How does it work? Abdominal massage can:
 
Increase circulation and move lymph
Bodywork in general increases circulation and lymph in the body, but abdominal massage focuses all that goodness in the abdomen. Lymph is the fluid responsible for moving metabolic waste. It can accumulate in the body for various reasons. Moving it specifically in the abdomen can be a great way to start the detoxification process in the body. Increasing circulation in the abdomen helps to  pump fresh, oxygen-rich blood to the area and can help with organ function and tissue health/repair.
 
Break up physical tension and restrictions
Abdominal massage addresses the connective tissue that surrounds and holds the organs in place. It works to break up adhesions and/or scar tissue that can result from surgeries in the abdomen, organ dysfunction, postural patterns, and much more. These restrictions over time can pull on the organ and restrict function as well as cause compensation patterns that reverberate out into the body creating pain and tension. In this way, loosening the tissue around the organs can affect tension and pain patterns in other areas of the body, as well as give the organs more freedom of movement to function efficiently.
 
Help get things moving (or not moving)
This is one of my favs. Abdominal massage is great for chronic constipation, as well as diarrhea and/or alternating diarrhea and constipation lovingly called constorea. This kind of treatment would focus on the small and large intestine to regulate peristalsis, the involuntary muscle contractions that moves food through the digestive process. Chronic constipation or diarrhea is often a result of peristalsis that is happening too quickly or not quickly enough. Abdominal massage stimulates this function and can help to retrain the body to do it on it’s own at a balanced rhythm.
Chronic constipation or diarrhea is also often linked to stress. Stress puts the body in “fight or flight” mode, which slows down normal body functions, allowing you  to react quickly to the stress. It’s possible to get stuck in a continuous state of “fight or flight” response when there is chronic stress, which in turn creates a continuous state of slowed digestion (along with other body functions). Abdominal massage (and bodywork in general) helps to shift us out of the “fight or flight” response and into “rest and digest” mode which allows us to digest our food more effectively.
 
Move stuck emotions
The abdomen can be a place where we hold deep emotional tension. All of the abdominal massage modalities that I practice understand that specific emotions are linked to each individual organ. An organ can be affected by an emotion and an emotion can be a symptom of an organ’s dysfunction. Working on the abdomen can be a great way to release any stress and emotional tension that is being held there. Breath also comes into play here. When under stress many people breathe more shallowly. I like to include breathwork into my sessions as a way to help client’s release and grow awareness for that area of the body.
 
Tonify sluggish organs
This is a little more woo, but basically what I’m trying to say is that spending time on a specific organ and holding the intention of healing for that space can do a lot to help promote healing, balance, and optimum function. The abdomen is an area of the body that for most of us is mysterious, overlooked and/or gets a bad wrap because it rarely is the shape that we want it to be. Sending some extra special attention to this area can be huge and have profound healing.
 
In addition to focusing on the organs and the connective tissue around them, there is also musculature in the abdomen that can affect organ function and is connected to hip and low back pain. So many reasons to include abdominal massage in your next bodywork session! 

Abdominal massage can be booked as a session on its own, or included in a full-body massage or shiatsu session. Just let me know what your goals are and we'll tailor our time together to your needs!

Authored by Dr. Sara Jean Barrett

We have trillions of microorganisms (bacteria, viri, parasites) living in our intestinal tract. This is called the microbiome or gut microbiota. Your microbiome starts to develop the moment you are born and complete colonization occurs within the first three years of life. Factors such as mode of delivery, antibiotic exposure, and feeding patterns determine the health of your particular microbiome. The microbiome is constantly in flux the rest of our lives. What we are exposed to, how we eat, our stress levels and more all influence our microbiome. For example, exposure to furry pets in infancy and young childhood reduces the risk of atopy (allergies, eczema and asthma) and being overweight by increasing levels of certain organisms. It is even more beneficial if you grow up on a farm! Starting at birth, our microbiome helps train the developing immune system. The commensal (good) microbes can directly attack the disease causing microbes signaling to the human immune system when to launch an attack. This training also includes teaching the immune system to ignore harmless stimuli (such as pollen or even self tissue). Without this critical training we are more at risk for conditions such as autoimmune disease and allergies. When our gut microbiome is in a stable, harmonious place this is called ‘symbiotic’. When our microbiome is unstable or out of balance it is called ‘dysbiotic’. We are finding that a dysbiotic flora or dysbiosis is a factor in many conditions. Our microbiome plays a significant role in many aspects of our health ranging from the obvious gastrointestinal conditions such as IBS, constipation, diarrhea, and inflammatory bowel disease to the less obvious such as psychological resilience, mental health, autoimmune disease, allergies and much more.
 
We know what we eat significantly impacts the health of our bodies and it also significantly impacts our microbiome. For example, one study found that switching from a low fat, plant polysaccharide rich diet to a high fat, high sugar (standard American diet) shifted the entire microbiome in one day. One day! The majority of our microbiome lives in our large intestine and they feed off of the food we eat. At the end of this article I list out some ways to feed your beneficial flora.
 
Last year a comprehensive review of recent research in the microbiome-gut-brain axis revealed that the vagus nerve plays an important role in the communication between the gut and brain. The exciting part is that the information is bidirectional. That’s right, your ‘gut instinct’ is now backed by science. They have even gone as far as looking at the microbiota of people who stay calm during stressful events and found they share common microbiome traits. So there might be a correlation between resilience and your microbiome. Are you getting a sense of just how important the microbiome is to your health? Data published in March of this year shows that social stressors can change the microbiome in hamsters and that the bacteria present in the GI tract prior to social interactions predicted outcomes of those interactions. The hamsters that ‘won’ in the social interactions had similar microbiomes. Pretty incredible.
 
What do we do with all of this information? Don’t run out and spend a lot of money on one of these new stool tests that will tell you all about your microbiome. They are interesting but not very clinically useful, yet. I am excited about the possibilities for medicine as we continue to learn more. Predicting health based on your microbiome and altering it to improve your health is very exciting. For now, consider how your eating habits and vagal nerve health can positively influence your microbiome.
 
Take home tips:
 
As mentioned above the vagus nerve is an important connection between the gut microbiome and the brain. Healthy vagal tone is indicated by a slight increase in heart rate when you inhale and a slight decrease in heart rate when you exhale. You can increase your vagal tone with any of the following activities:

• Deep diaphragmatic breathing with a slightly longer exhale
• Loving kindness meditation
• Singing, especially singling loudly enough to us the muscles in the back of your throat.
• Gargling at least once daily, loudly to use the muscles in the back of your throat.
• Laughter- the deep belly shaking eye watering laughter.

 
You can keep your microbiome healthy by:

• Consuming fiber daily from a variety of sources. It is an important food source for your microbiome. Most patients in my practice are not consuming enough fiber in their diets. I recommend around 30-35g daily on average but that changes depending on the individual.
• Minimizing processed and high sugar foods in your diet.
• Consuming fermented foods
• Avoiding excessive use of antibiotics.

 
Resources:
Yang, Irene, Elizabeth J. Corwin, Patricia A. Brennan, Sheila Jordan, Jordan R. Murphy, and Anne Dunlop. “The Infant Microbiome: Implications for Infant Health and Neurocognitive Development.” Nursing Research 65, no. 1 (2016): 76–88.
Tun, Hein M., Theodore Konya, Tim K. Takaro, Jeffrey R. Brook, Radha Chari, Catherine J. Field, David S. Guttman, et al. “Exposure to Household Furry Pets Influences the Gut Microbiota of Infants at 3–4 Months Following Various Birth Scenarios.” Microbiome 5, no. 1 (April 6, 2017): 40.
Turnbaugh, Peter J., Vanessa K. Ridaura, Jeremiah J. Faith, Federico E. Rey, Rob Knight, and Jeffrey I. Gordon. “The Effect of Diet on the Human Gut Microbiome: A Metagenomic Analysis in Humanized Gnotobiotic Mice.” Science Translational Medicine 1, no. 6 (November 11, 2009): 6ra14.
Lima-Ojeda, Juan M., Rainer Rupprecht, and Thomas C. Baghai. “‘I Am I and My Bacterial Circumstances’: Linking Gut Microbiome, Neurodevelopment, and Depression.” Frontiers in Psychiatry 8 (2017).
Georgia State University. "Social stress leads to changes in gut bacteria." ScienceDaily. ScienceDaily, 8 March 2018.

Authored by Amy Daws, CMT

What is Chi Nei Tsang?
Chi Nei Tsang is a form of abdominal massage that is rooted in Taoism. It focuses on clearing energetic and physical blockages in the abdomen so that the Chi (energy) can flow smoothly. 

​Chi Nei Tsang treatments:

• Address the digestive, nervous, muscular, respiratory, and immune system
• Promote detoxification and stimulation of the internal organs
• Increase personal connection to body and breath
• Support emotional balancing

Who is a good candidate for Chi Nei Tsang?
Most people can benefit from Chi Nei Tsang, BUT it can be especially helpful for:

• Someone who is having digestive issues: constipation, bloating, diarrhea, acid reflux, diagnosed with SIBO
• Someone who is wanting to address scar tissue and tension from a surgical procedure in their abdomen
• Someone who reports a lot of stress and/or sleep difficulty
• Someone who is feeling emotionally stuck and/or working with a mental health professional to address depression, anxiety, excessive worrying, grief
• Someone who is experiencing chronic muscular pain/tension
• Someone who could use support in connecting with their body in a positive way

What is a Chi Nei Tsang session like?
Sessions start with a thorough intake focused on the client's goals for the session, their health history, energy levels, sleep/digestion patterns, physical activity, and where any pain in the body is felt.
The client will lay on the massage table face up and bring shirt up and shimmy pants down to pubic bone to expose abdomen. We will start with connecting to the breath and having the client sense areas of tension in the abdomen and whole body. I will use manual technique with oil and essential oils to increase circulation, break up areas of tension, stimulate organs, clear pathways of elimination, etc. We may also do specific breathwork or mediations based on the client's needs.

Between sessions:
I like to give homework! Homework depends on the client's goals for the sessions. I may have them do daily abdominal breathing, self massage, or meditation. I often also recommend an observational exercise related to their goals. 

Feel free to contact me with any questions you have about Chi Nei Tsang and how it could benefit you. 

Authored by Tara McCoy, CHC

​Health coach and book nerd, Tara McCoy, is a voracious reader. Her mission is to find the most insightful and life-changing wellness and personal optimization tips and deliver them to you in digestible, actionable bites. She reads broadly from psychology, medicine to spirituality - hunting down the  best nuggets of wisdom so you don’t have to. Each month, she’ll review a book and dish out the top insights gleaned.

Authored by Jesse Haas, CNS, LN

If you're hip with holistic health, it's likely that you've endeavored a liver cleanse or detox...or been encouraged to do one...and with good reason. In 2002, the Environmental Working Group conducted a small study (9 participants) to measure the chemicals found in their blood. A total of 210 chemicals were found, each participant housing an average of 91 compounds. Heavy metals, chlorinated and brominated chemicals, PCBs, pesticides and herbicides, plastics and plasticizers, parabens and phthalates were all found. These compounds get stored in fat and bone, disrupting homeostasis and our efforts (both conscious and unconscious) at acquiring health.

The question is not "do I need to detox?" but "how do I detox effectively?"

Many people can navigate their lives without feeling the effect of this "body burden." Others experience symptoms of toxification, including autoimmune disease, allergies, food sensitivities, chronic fatigue, brain fog and hormone imbalance. 

Thankfully, detoxification is a daily process in the body, not something that waits for an annual cleanse. More appropriately called "biotransformation," detoxification occurs in phases:

• To begin biotransformation, toxins and metabolites must first be transported to the liver. This is considered to be phase 0.  
• In phase 1, the liver rearranges these chemicals into intermediates, which are either more or less harmful than their "parent" forms. For this reason, we need to keep the momentum going so these intermediates shuttle right into phase 2.
• The function of phase 2 biotransformation is to attach molecules that make the chemical water-soluble and safe to enter the bloodstream. There are multiply ways the liver accomplishes this - processes called methylation, acetylation, acylation, sulfation and glucuronidation.
• Once phase 2 is complete and the safer chemical compound enters the bloodstream, it's time to get it out of the body. Phase 3 of biotransformation occurs mostly in the kidneys and colon, where toxins are eliminated in urine and stool. Phase 3 also occurs in the lungs and skin where toxins are eliminated in our breath and sweat, but to a lesser extent.

Authored by Monica Mack, CHC ​

You may have just stepped out of your doctor’s office with the recommendation that you should begin an Elimination Diet. Or, if you are like me, you are sick of lingering unwelcome symptoms, and have decided to try going through the diet yourself, to see what insights it can reveal about your health. 

Regardless of how you got here - even though it is a temporary diet plan with a multitude of benefits - its strictness can be intimidating. I’m here to share what I learned through my experience on an Elimination Diet, with the hope that it will leave you feeling more prepared and confident as you embark on this journey. You are not going at this alone!

The Elimination Diet is used to uncover food intolerances that can be at the root of a variety of health conditions such as allergies, gut imbalances, skin issues, and inflammation; the food we eat can even effect our mood and mental health. Spending three weeks removing all foods that have a track record of causing these issues: gluten, dairy, soy, and caffeine to name a few, gives the body time to reset and begin the healing process. From there, these foods are slowly reintroduced, one by one, and the culprit(s) can be identified.
 
As we all know, knowledge is power. With this information at your disposal you can not only relieve the symptoms of your primary health concern - the one that brought you down this path in the first place - but you can also look forward to increased energy, relieved brain fog, reduced inflammation, a boost to your immune system, and a solid step towards jump-starting clean eating and removing any undesirable processed foods from your diet.

But, perhaps even more important to stress, is that you will have made a huge stride in proactively improving your own health and wellbeing. You will have made new discoveries about yourself; what it means to focus on how the foods you eat make you feel, what foods make you feel good and not so good, and about being more mindful of what you are putting in your body.

Once you identify the foods that work best for your body, you can create a custom meal plan tailored just for you. So consider this challenging endeavor an act of self-care and self-responsibility; you are honoring your body by discovering the most beneficial way of eating that nourishes you, fills you up, and gives you energy to pursue what you want out of life.
So first, give yourself a big hug  for taking the initiative to make a change in your life for the better by focusing on healing and improving your health. Next, I’d like to give you five tips to make the next few weeks as illuminating, encouraging, and as painless as possible:

Authored by Dr. Pharis 

If you’re not familiar with castor oil you’re likely wondering what this oil is, and why it is so beneficial. Castor oil is derived from the plant Ricinus communis (castor seed). These seeds contain very high concentrations of the fatty acid ricinoleic acid, which has been shown to exert analgesic (pain reducing) and anti-inflammatory effects.(1) Additionally, studies have shown it has similar pharmacological properties to that of capsaicin, an anti-inflammatory compound from in chili peppers.(2)  In observational studies looking at the anti-inflammatory properties of ricinoleic acid, it recognized as a new capsaicin-like, non-pungent anti-inflammatory agent suitable for topical application.(2)
 
Through my years in practice, I have seen the use of topical castor oil demonstrate significant benefit in reducing a variety of symptoms. Common conditions for considering its application include:

• Joint pain and swelling
• Inflammation
• Gas, bloating, abdominal cramping
• Constipation
• Uterine fibroids & non-malignant ovarian cysts
• Menstrual cramps
• Gallbladder and liver conditions
• Detoxification

 
Utilized since the ancient Egyptian times, castor oil is not a new therapy. Castor beans were found in ancient Egyptian tombs dating back to 4000 B.C., and according to the Ebers Papyrus (an Egyptian medical text from 1500 B.C.) it was utilized to protect the eyes from irritation.(3) Using castor oil for medicinal purposes in the United States dates back to the 18th and 19th century pioneers, at which time it was labeled as a heroic cure for the treatment of everything from constipation to heartburn to inducing labor. With the primary function of castor oil traditionally being viewed as an oral cathartic and laxative, modern use has a stronger focus on its topical applications.
 
A 2011 study published in Complementary Therapies in Clinical Practice examined the effect of topical castor oil pack administrations on constipation in the elderly. This 14-day study involved 80% of study subjects who had been experiencing constipation for 10 years or longer. Results revealed “castor oil pack administration did not have an effect on the number of bowel movements or amount of feces, but decreased the feces consistency score, straining during defecation, and feeling of complete evacuation after a bowel movements, thus decreasing symptoms of constipation.”(4) While the mechanism of action is not fully understood, the benefits are becoming more and more clear.
 
In addition to practitioners of naturopathic and alternative medicine utilizing castor oil packs, several hospitals are starting to include this treatment as integrative therapy. The North Broward Hospital District, one of the ten largest hospital systems in the US and the largest in Florida, utilizes castor oil pack therapy for lung cancer patients to decrease the side effects of chemotherapy and aid detoxification in the lungs. Other institutions recommending castor oil packs for various treatments include the University of Maryland Medical Center as an integrative approach to pelvic inflammatory disease, irritable bowel syndrome, low back pain, kidney stones, and lung cancer; the Mercy Medical Center for the use of gallbladder disease and congestive heart failure; Allina Hospitals and Clinics for the use of pelvic inflammatory disease; and the Baltimore Washington Medical Center for the use of ulcerative colitis and pertussis.(5)
 
Castor oil packs are an affordable and easy option for the management of many health conditions, and best of all, they can be performed in the comfort of your home. If you are interested in utilizing this therapy but are uncertain if they are a good option for you, please consult your doctor.


Castor Oil Pack Instructions
 
Materials:

• Piece of cloth (flannel, wool, or cotton), double layered, and cut to the size of the are of application
• Plastic wrap or ace bandage to secure wrap in place and protect clothing from staining
• Glass dish (to heat castor oil pack in)
• Heating source (hot water bottle, heating pad)
• Castor oil
• Container with lid (for storage of castor oil pack)

Directions:

1. Fold the piece of cloth so it is 2 layers thick
2. Pour oil onto cloth until it is well moistened (this is your “castor oil pack”)
3. Heat castor oil pack in glass dish in oven or microwave to a comfortable temperature
4. Place castor oil pack directly over the targeted area while relaxing comfortably. Cover the pack with plastic wrap or an ace bandage to secure and to provide a protective barrier (note that the oil may stain clothing or bedding)
5. Apply external heat source to keep the pack warm for the duration of its application (suggested time: 30 minutes)
6. After removing the pack, cleanse the area with a dilute solution of water and baking soda (3 tbsp baking soda/quart of water)
7. Store the pack in a covered container in the refrigerator between use, or up to several months. Each pack may be reused up to 20-25 times

* Castor oil packs should not be used over open wounds or ulcers, during heavy menstrual bleeding, during pregnancy, or over areas of malignancy or neuropathies.

** The above information is for informational and educational purposes only, and is not intended as a substitute for medical professional help, advice, diagnosis, or treatment. Please consult with your doctor to learn if castor oil packs are appropriate for you.

References:

1. Vieira C, Fetzer S, Sauer S K, et al. Pro- and anti-inflammatory actions of ricinoleic acid: similarities and differences with capsaicin. Naunyn Schmiedebergs Arch Pharmacol. 2001;364(2):87-95.
2. Vieira C, Evangelista S, Cirillo R, et al. Effect of ricinoleic acid in acute and subchronic experimental models of inflammation. Mediators Inflamm. 2000;9(5):223-228.
3. Sims, Judith; Frey, Rebecca Gale. Castor Oil. Encyclopedia of Alternative Medicine, 2005 The Gale Group, Inc. http://www.encyclopedia.com/topic/castor_oil.aspx
4. Arslan G G, Eser I. An examination of the effect of castor oil packs on constipation in the elderly. Complement Ther Clin Pract. 2011;17(1):58-62.
5. Mein E A, Richards D G, McMillin D L, Nelson C D. Transdermal absorption of castor oil. Evid Based Integrative Med. 2005;2(4):239-244.

Authored by Karen Townsend, CMT
Many people think of massage as a luxury to be reserved for special occasions or times of heightened stress or injury. Here are few few situations when massage and bodywork can be very beneficial that you may not have thought of.

1) Your position in life demands that you be in control all the time.
If you are in a position of power at work, home, or in your community you may find that you're holding your body in a rigid and defensive manner without even realizing it. Bodywork is an excellent and safe way to have the experience of being passive, quiet and relaxed. You can literally let your therapist take the weight off of your shoulders. The somatic experience of having someone else safely move your body while you remain passive can be rejuvenating and give you a fresh perspective on life.

2) You struggle with poor body image/self esteem.
Let's face it, we are taught to judge and dislike our bodies and the bodies of others. It is big business for some to keep us in this frame of mind. My personal remedy for this situation is similar to my approach to eating well. The more gestures of self love you fill up with(nourishing, whole foods) the less room there is for destructive thoughts to reside (foods and eating patterns that are potentially harmful). When I stopped consuming media, images, and culture that promoted a self destructive and judgmental mentality, I started filling up on gestures of self love, including the healing and nurturing touch of massage. It's liberating to become your own authority on what helps you look and feel happy and comfortable in your own skin.

3) You are recovering from trauma or suffer from PTSD.
Trauma can be an extremely scary/painful event or it can be a life situation forced upon you such as extreme poverty or neglect. Traumatizing experiences and situations live in our cells and obscure our ability to feel safe in our present situations. Recent research suggests that trauma can be passed through DNA to our children. Unaddressed and unresolved trauma can be debilitating and is the root of many health issues. Working with a trained and trusted bodywork/somatic therapist can be one important step in the process of healing. 

4) You suffer from digestive issues.
There are many variations, causes of and treatments for digestive issues, including various forms of bodywork such as Chi Nei Tsang and shiatsu. However, even if you are receiving a massage for stress relief you are encouraging yourself to deeply relax which allows your autonomic nervous system (i.e. rest and digest) to function properly. Not to mention if you suffer from constipation, abdominal massage is an excellent way to get things moving again.

Authored by Dr. Barrett

If you aren't turning around and taking a peek after your daily bowel movement you are missing out on an opportunity to assess your health. Your stool can help identify if you are getting enough fiber, drinking enough water, eating enough fermented foods or if you are having some difficulty breaking down your food. Check out the Poop Pageant below from the Practical Paleo cookbook and take a peek at your own poop next time you head to the bathroom.

(Excerpt from this article in the New York Times on Bone Broth)