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Center for Integrative Medicine, Spring 2014

5 Ways to Win Your Battle With Weight Loss

Balancing blood sugar and metabolism are the keys to success

If you’re struggling to lose weight, Christine Spiroch, PhD, of the Center for Integrative Medicine, has five tips to share to help you achieve success.

1. Don’t skip breakfast.
Eating a balanced breakfast — including protein, fat and carbs — will give you the energy you need for the day. “If you skip breakfast, you’re starting the day on a dead battery,” says Dr. Spiroch.

Skipping meals can make your body think it is in starvation mode. “Think of Sumo wrestlers. They eat little or nothing all day, then eat a big meal late in the day — hence their size and high fat-to-muscle ratio,” she says.

2. Eat small meals often.
Take your pick: three meals a day with two or three snacks, five or six small meals a day, or eating every three to four hours. Each of these approaches will keep your metabolism even — and your blood sugar levels stable.

Balance will help your body function at its best and will help you avoid weight gain. “You don’t want your blood sugar to rise and fall as if you’re on the Magnum or Millenium at Cedar Point. That will make your energy levels fluctuate and all your body processes work less efficiently,” explains Dr. Spiroch.

“It’s better to have blood sugar levels mimic a kiddie roller coaster. It may seem less exciting, but it won’t throw off your metabolism as much.”

3. Exercise moderately.
An intense workout regimen is great if you‘re happy with your weight and are in good health. But if you’re struggling to shed pounds, a moderate exercise program will work better for you. Walking 30 minutes on a regular basis will benefit you more than an intense 90-minute routine you can’t maintain.

“Moderate exercise is especially important if you have problems with blood sugar. An intense workout will add more stress to your body by making your blood sugar spike and then fall,” says Dr. Spiroch. She adds that setting goals too high and failing to meet them will keep you from feeling successful. “It’s better to set small goals and surpass them.”

4. Fill your plate with the right portions.
Too many of us don’t pay attention to the portions we’re putting on our plates. Carbohydrates (including grains and fruit) should fill just 25 percent of your plate. Protein should fill another 25 percent. Vegetables should fill 45 to 50 percent of your plate. And fat should fill just 5 percent.

“If you’re an average person trying to lose weight, carbs should not fill half your plate,” says Dr. Spiroch. “Vegetarians need to balance brown rice with beans and vegetables. And I warn people never to eat fruit alone, or your blood sugar will spike and crash.” Pairing fruit with a fat like peanut butter or a protein like nuts will help bring your blood sugar back to baseline.

5. Be aware of ‘emotional eating.’
If you eat when you’re stressed out or starved for comfort, awareness is half the battle. “Many people get frustrated because they’ve gone to Curves, they’ve joined Weight Watchers, they’ve done everything right. But they just can’t seem to lose weight,” says Dr. Spiroch.

She says the six-week Trim-Life Program from the Center for Integrative Medicine can provide insight into eating patterns. It focuses on weight “release” rather than loss using hypnosis, meditation, holistic psychotherapy and other tools, plus medical information and supplements.

“People realize, ‘wow, I eat when I’m not that hungry,’ or ‘I remember how apple pie at grandma’s would comfort me when I was little. That’s what I’m thinking of when I want comfort today,’“ says Dr. Spiroch. After letting go of eating patterns that no longer serve them, Trim-Life participants often find themselves fitting into clothes they haven’t been able to for five years.

Useful resources

Dr. Spiroch recommends two authors on healthy weight loss:

  • Diana Schwarzbein, MD: This endocrinologist is interested in metabolic health and integrative medicine looks at how we eat in relation to weight loss. She stresses balancing protein, fat, vegetables and carbs in our diets. Her books include, “The Schwarzbein Principle: The Truth about Losing Weight, Being Healthy and Feeling Younger,” and “The Schwarzbein Principle Cookbook.”
  • Mark Hyman, MD: This specialist in functional medicine takes a common-sense approach to metabolism and weight loss. His books include, “The Blood Sugar Solution: The UltraHealthy Program for Losing Weight, Preventing Disease, and Feeling Great Now!” His healthy eating blog is at

For an appointment with Dr. Spiroch or another Center for Integrative Medicine specialist, please call 216.444.HEAL (4325).

Are You Taking Too Much Calcium, A and D?

Overdoing supplements can hurt you

Vitamin and mineral supplements are a good thing. But too much of a good thing can negate any health benefits — and even pose health risks.

With calcium, vitamin A and vitamin D, “more is not necessarily better,” cautions Melissa C. Young, MD, of the Center for Integrative Medicine.

1. Calcium

Why it matters: Calcium plays a critical role in building and maintaining healthy bones. For decades, experts have recommended high-dose calcium supplements to prevent osteoporosis. The bone-thinning disease is responsible for fractures that cause many elderly men and women to lose their independence — and sometimes their lives.

How too much can hurt: “More and more studies are showing increased risks for heart attack and stroke among men and women taking calcium 1,000 to 1,200 milligrams (mg) per day as directed,” says Dr. Young.

Researchers believe that without adequate vitamin D to help absorb it, the extra calcium settles in the arteries instead of the bones. There, it helps form plaques that threaten the heart and brain. Excess calcium can also cause muscle pain, mood disorders, abdominal pain and kidney stones.

What to do about it: “We recommend trying to get your calcium from food,” says Dr. Young. “The body absorbs and utilizes calcium better from food than from supplements.”

Probably the best source of dietary calcium is fat-free organic Greek yogurt. It gives you 450 mm of calcium per serving, plus vitamin D and protein, and two servings fulfill your calcium needs for a full day. Other sources of calcium include:

  • Leafy green veggies like spinach and kale
  • Legumes and beans
  • Sardines
  • Fortified foods, like soy and almond milk and orange juice
  • Salmon with soft bones
  • Sesame seed
2. Vitamin D

Why it matters: Vitamin D works in tandem with calcium to fortify your bones, and research shows it improves asthma and depression. Vitamin D also strengthens the immune system and boosts immunity.

Your skin manufactures the vitamin after exposure to the sun’s ultraviolet rays. “Yet we are an indoor society and, unlike our ancestors, we wear clothing (and sunscreen) when we go outdoors,” says Dr. Young.

Most Americans are deficient in vitamin D and have blood levels in the 20s. So most doctors recommend vitamin D supplements to bring blood levels up to 30. “Past studies have suggested improved benefits when vitamin D levels are closer to 50, so that is our target in the Center for Integrative Medicine,” says Dr. Young.

New studies question the benefits of vitamin D supplements for prevention and survival from diseases. However, “in the Center for Integrative Medicine, we see significant improvement in patients’ pain, mood and quality of life with vitamin D supplements,” says Dr. Young.

How too much can hurt: Vitamin D blood levels exceeding 100 ng/mL can be dangerous. The extra vitamin D triggers extra calcium absorption. This can cause muscle pain, mood disorders, abdominal pain and kidney stones. It may also increase risk for heart attack and stroke.

“Most reports of toxicity involve patients taking synthetic vitamin D2, so we prescribe natural vitamin D3,” says Dr. Young.

What to do about it: “We recommend starting with a simple blood test to determine your levels of vitamin D, and then prescribing vitamin D3 supplements,” says Dr. Young. You should see your doctor every three months until you reach steady vitamin D blood levels. That usually takes six to 12 months. After that, checkups every year or every other year are fine.

3. Vitamin A

Why it matters: Vitamin A is important for visual health. It also contributes to healthy skin and hair, and boosts your immunity. Signs of deficiency include night blindness, dry, scaly skin around your eyes, coarse hair and respiratory infections.

How too much can hurt: Fat-soluble vitamins like vitamin A can lead to toxicity because the body stores any excess in fat and does not excrete it. Two signs of vitamin A toxicity are headache and skin rashes. Research also suggests that extra vitamin A may work against vitamin D and cause osteoporosis.

Vitamin A’s presence in so many different supplements compounds the problem. “Patients who take a variety of supplements are getting much more vitamin A than they should,” says Dr. Young. “We recommend no more than 5,000 international units (IU) per day from both supplements and your diet long-term.”

She does not recommend cod liver oil; it has pre-formed vitamin A that can lead to toxicity.

What to do about it: It’s better to get vitamin A from orange-colored vegetables and fruit — carrots, sweet potatoes, squash and papayas. Dark green, leafy vegetables and egg yolks are also good dietary sources of A.

The bottom line

It’s important to get as many vitamins and nutrients as you can from your food. “However, widespread changes in farming practices mean a lower nutrient content in our fruits and vegetables,” cautions Dr. Young. “Many people still benefit from their nutrient levels assessed and taking a high-quality daily multivitamin.”

To see Dr. Young in the Center for Integrative Medicine, please call 216.444.HEAL (4325).

Psychology and Acupuncture: An Effective Combination

Emotions may be at the root of your symptoms

By Jamie Starkey, Lac

Traditional Chinese Medicine takes a holistic approach to care, addressing mind, body and spirit.

Psychology first surfaced in China between 475 and 221 BC. That's when the classic Chinese medical text, “Yellow Emperor’s Inner Canon,” referred to the “mind-body connection.”

Today, patients often come in with a whole collection of symptoms and have no idea why — until we look at them from a psychological point of view. Then it is easy to connect the dots.

Traditional Chinese medicine focuses on emotional health in a rather unique way. It pairs the seven major emotions — anger, joy, fear, anxiety/worry, grief and pensiveness — with different organs. An excess of any of these emotions produces an energy imbalance. This causes physical symptoms and sets the stage for disease.

Anger and the liver

In traditional Chinese medicine, anger (including irritability, rage and resentment) affects the liver. In fact, all emotional disorders affect the liver, so a disruption in the liver can affect all the other organs. The liver also influences the menstrual cycle. Chronic anger may cause:

  • Emotional disturbances
  • Premenstrual syndrome
  • Dizziness
  • Headaches
  • Muscle cramps/spasm
  • Jaundice
  • Irritable bowel symptoms
  • Dry or bloodshot eyes
  • Brittle, weak nails
Joy and the heart

In traditional Chinese medicine, the heart houses mind and spirit. It governs mental and emotional processes, and acts as a filter for the emotions. Joy, generally viewed as a positive emotion, affects the heart. But too much of a good thing can impact the body in a negative way. Excessive joy may cause:

  • Palpitations
  • Shortness of breath
  • Sweating too easily
  • Mental restlessness
  • Forgetfulness
  • Chest pain
  • Anxiety
  • Insomnia
  • Poor memory
  • Depression
  • Disturbed sleep/excessive dreams
Grief and anxiety, and the lungs

In traditional Chinese medicine, the lungs not only control breathing. They also govern the hair, skin and pores. The lungs also control fluid in the lower parts of the body. Excessive grief and anxiety affect the lungs and may cause:

  • Shortness of breath
  • Cough
  • Asthma
  • Chest pain
  • Phlegm production
  • Bloating/edema
  • Loss of voice
  • Frequent colds
  • Loss of smell
  • Nasal congestion
Fear and fright, and the kidney

These emotions are responses to sudden shock. In traditional Chinese medicine, the kidneys regulate water metabolism and help to control growth, development, reproduction and fertility. Chronic fear and fright affect the kidney and may cause:

  • Low back pain
  • Infertility
  • Impotence
  • Urinary incontinence
  • Tinnitus
Pensiveness and worry, and the spleen

In traditional Chinese medicine, the spleen is a primary digestive organ. The spleen takes the lead in health and vitality by producing “Qi” (energy) and blood. Excessive worry or pensiveness affect the spleen and may cause:

  • Lack of appetite
  • Limb weakness
  • Indigestion
  • Abdominal fullness
  • Bloating
  • Bruising
  • Anemia
  • Fatigue

What does all of this mean in practical terms? It means that I can adjust my acupuncture treatments based on the emotional needs of my patients. For example, when patients say they have had a terrible week at work and a lot of stress at home, I may alter my treatment. I know the energetics of the heart and probably the liver are being disrupted.

This leads to a lot of “aha!” moments in the treatment room as patients understand how our emotional state can impact our health. Understanding that an emotional imbalance can be one reason for feeling fatigued or experiencing digestive problems provides a sense of validation.

Tanya Edwards, MD

Tribute to an irreplaceable healer, teacher and trailblazer

Tanya Edwards, MD, founder and leader of Cleveland Clinic’s Center for Integrative Medicine, passed away on March 12, 2014. The center has been renamed The Tanya I. Edwards M.D. Center for Integrative Medicine in her honor.

A compassionate caregiver

Dr. Edwards believed in the power of nutrition, acupuncture and mind-body therapies. She brought hope to countless patients who found little relief from conventional treatment alone. Under her care, conditions such as migraine, chronic fatigue and irritable bowel syndrome lost their mystique.

Dr. Edwards was a gifted teacher, encouraging future physicians to explore natural cures along with the latest medical advances.

“She cared deeply about us all…and made everyone feel like they were part of her family,” says Michael Roizen, MD, Chief Wellness Officer, Cleveland Clinic’s Wellness Institute.

A leader and innovator

A family physician with a master’s degree in medical education, Dr. Edwards paved the way for mainstream practitioners to offer alternative treatments. “As an institute chair, you want department leaders to keep pushing the envelope of science and transmit that to medical care,” says Dr. Roizen. “That’s what Tanya did.”

Dr. Edwards helped integrate complementary medicine into the curriculum at Cleveland Clinic Lerner College of Medicine. She taught complementary and alternative medicine at Case Western Reserve University School of Medicine and won a faculty mentor award there. She also won an award from students for promoting gender fairness in education and training.

A physician with a vision

Dr. Edwards joined Cleveland Clinic in 2004 and opened the first Center for Integrative Medicine that year in Broadview Heights. Four years later, she was directing five outpatient integrative medicine centers.

In 2008, these centers merged into the current Center for Integrative Medicine at the Wellness Institute in Lyndhurst. Under her guidance, the number of patient visits to the Center for Integrative Medicine exceeded 20,000 by 2013.

Don't Miss These Wellness Events

Environmental Toxins

Tuesday, June 3, Noon – 1 p.m. with Melissa Young, MD

Environmental toxins are all around us. From the food we eat and water we drink to the products to the energy we consume. Toxins have been found in beauty products, household cleaners, carpets, furniture, mattresses, and even house dust. Being surrounded by chemicals on a daily basis can have some harmful effects on your health. Take this opportunity to join us as our expert discusses different environmental toxins, their effect on the body and how to avoid them.

What You Should Know about Chinese Herbal Therapy

Wednesday, June 25, Noon – 1 p.m. with Jamie Starkey, LAc and Galina Roofener, LAc

Chinese herbal medicine is a major part of Traditional Chinese Medicine. It has been used for centuries in China, where herbs are considered fundamental therapy for many acute and chronic conditions. Like acupuncture, Chinese herbs can address unhealthy body patterns that manifest in a variety of symptoms and complaints. Chinese herbal therapy aims to help you regain balance in your body and to strengthen your body’s resistance to disease. Join us as our experts discuss this therapy, what conditions it can treat, and what to expect during Chinese Herbal Therapy sessions.

Mark Your Calendar for Women's Wellness Week 2014

Nov. 9 – 16, 2014
‘Tween Waters Inn, Captiva Island, Florida

Renew, replenish and rediscover yourself during this week of restorative, healthy living on the Gulf of Mexico. Learn the latest from our experts on women’s fitness, nutrition, stress reduction and life management in a tranquil setting. Enjoy Mediterranean-style cuisine featuring anti-inflammatory, immune-boosting foods.