If you found my blog because functional/root cause medicine resonates with you, then you already have half the answer to this question. If you’re new to functional medicine and aren’t sure what I’m talking about, listen up!

My focus is root cause medicine, meaning I work to find the cause and trigger behind symptoms, whether that’s hidden infections, stress, trauma or environmental exposures, as examples. In our current world, we are exposed to more and more environmental toxins than ever before. Our bodies have excellent built-in detox systems—liver, lymph, kidneys—and in a healthy person, they filter out the offending toxins. But with constant assaults, these systems are overwhelmed and become sluggish. Then these toxins build up in our bodies and alter our normal function, sometimes minimally but sometimes enough to cause disease.

What’s a toxin? A toxin is essentially a poisonous substance. Colloquially, we use it to describe any poisonous substance, but if we are being completely accurate, toxins are only derived from natural substances, like poison mushrooms. Whereas toxicant describes any man-made substance that is poisonous. Because toxin is used colloquially to describe all poisonous substances, it is the term I use when describing these substances, and will be what I use going forward. (Semantics, right)?

When a living organism is exposed to poisons in a certain amount—the amount depends upon both the organism and the poison—it can cause disease or damage. Sometimes that is mild and reversible. Other times it is life-altering and deadly. We each have unique physiology and predicting our response to these exposures is not always possible. Anything we can do to minimize these exposures is protective to our health and the health of our future children, if we plan to procreate.

It’s easy to identify certain toxins. We now know asbestos is a material that can cause cancer, specifically mesothelioma. And at this point, most of us are familiar with bisphenol-A or BPA and its potential carcinogenic (cancer-causing) effects. What about lead? We know this can cause neurological damage and we actually screen children for lead levels because of how detrimental it can be. And all three of these substances have some amount of regulation by the FDA to keep us safe and protected. So the natural progression of thought is the FDA is regulating all chemicals and products that have potential negative health effects, right?

I wish.

In the United States, there hasn’t been a major federal regulation regarding the personal care industry since 1938 (it’s 2022 as I write this)! There are about two pages of legislation for this over 90 billion-dollar-a-year industry. Two pages! The United States has approximately 30 ingredients banned or partially banned from use in personal care products. Compare this to the European Union’s 1400. That discrepancy is unreal. Can you feel my outrage?

Why should you care? Because your skin is your largest organ and is one of the first barriers against outside invaders. It is not a solid barrier but instead is semi-permeable. It absorbs materials it comes into contact with, which is why there are medicines that are delivered transdermal—via skin, like a patch. When we apply products to our skin, our skin absorbs the ingredients which are then circulated through our body via blood and lymph and tissue.

Because we have such limited regulation in the personal care industry, there are ingredients in our everyday products that are known to cause adverse health effects or are highly suspicious of affecting our health. Some examples include parabens and phthalates. These have been buzz words in the industry lately—there are products now labeled as “paraben-free” or “phthalate-free,” so many people are conscious of these ingredients as potential hazards to human health.

But these aren’t the only examples! There are hundreds of ingredients and chemicals we have concerning data on and hundreds more where we don’t have enough safety information. There have been approximately 80,000 chemicals introduced into the market since WWII with only about 10% having adequate safety data. Unfortunately, the attitude of the regulating bodies is “safe until proven harmful,” versus “harmful until proven safe in human use.” And we suffer for it.

We are getting sicker and sicker. The most recent CDC data says 6 in 10 adults have a chronic disease and 4 in 10 have two or more1. A study from 2018 shows trends towards chronic diseases have been increasing2—but let’s be honest, I don’t think we need a study for us to know that.

And there are many reasons for this. It is multifactorial, like so many things. However, we know we are constantly assaulted by environmental toxins. One of the biggest offenders is from the personal care industry! According to a survey from the Environmental Working Group, a non-profit organization working to improve the safety and transparency of many industries, including the personal care industry, the average number of products anyone uses in a day is 9. For 1 in 100 (1%) men and 25 in 100 (25%) women, 15 or more products are applied daily3.

Our skin is absorbing all these chemicals and ingredients. It is not selective about which ingredients, so we get the good with the bad and dangerous. We are using ingredients that have known and potential human health effects—things like cancers, infertility challenges, hormonal imbalances, even neurological effects. We are not as protected as we want to imagine ourselves to be by our governing bodies. It is the sad state of the personal care industry in the United States. And it is only marginally better in our neighbor, Canada.

As a healthcare provider focused on root cause and prevention, this doesn’t sit well with me. How can we really be focused on health and wellness if we aren’t doing our due diligence and screening all the chemicals present in the market to ensure human safety? It’s backwards that we allow these ingredients to be used and assume they are safe until proven harmful. That would never be allowed in the medical community. Medications especially have to be tested and retested over and over to ensure they are safe and to list side effects and contraindications so patients and providers can make informed decisions. The personal care industry takes away our right to an informed consent because we don’t have enough data and we operate under the mistaken assumption we are being protected.

What does this mean for you? As the consumer, you have to make educated and informed decisions. While there are changes happening in the industry, they are slow. In the meantime, finding ways to make safer choices and slowly transitioning to a less toxic life is the best way to protect yourself. Using the Environmental Working Group database to lookup both products and ingredients is a great place to start. Another it to align with a company or companies fighting the safer beauty fight and walking the walk, so to speak. There are many companies out there doing this, in the personal care industry and other industries, like cleaning products. This is the reason I’ve aligned with Beautycounter—a safer personal care product company. Read more about Beautycounter here! And know that the transition to safer is slow, and that’s okay. It is easy to become overwhelmed and my advice is to make slow, steady, small changes over time.

References

Center for Disease Control. Chronic Diseases in America. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm. Updated October 23, 2019. Accessed November 11, 2019.

Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018;15(3):431. Published 2018 Mar 1. doi:10.3390/ijerph15030431

Environmental Working Group. Why Skin Deep? https://www.ewg.org/skindeep/contents/why-skin-deep. Updated 2019. Accessed November 11, 2019.

Why did you decide to become an NP? What drew you to functional medicine?

This is part 1 of 2 because the answer is too long to reasonably fit on one blog post!

I get asked this question a fair amount. People are curious about what draws their providers to make the choices they have, and they want to know more so they can decide if their experience matches what they need. Typically, in my office, it’s a simple answer: a few sentences that summarize my choice and the type of medicine I believe in. But as I continue to be asked this, and as I continue to evolve as a person and provider, I’ve been able to reflect on my choices. There are multiple pieces to this answer, with some of it being tied into my own health journey. I have shared some of that over on Instagram and will continue to share in the future. I wanted to put into better words some of what’s led me on this journey!

I remember when I decided to go into nursing school, I didn’t really know what to expect. I just knew it was a profession where I could combine my love of science and emerging love of health with helping people. Medical school was only partially on the table—my father is a physician and I often envisioned caring for people the way he did. But when I realized the reality of medical school, I didn’t think I wanted that life. I explored becoming a nurse and it seemed like a great compromise that would allow me to meet my professional and personal goals. So off to nursing school, I went!

One of the first things we learn in school is about the “art of nursing” which is, in part, the art of compassion and caring. It’s about listening to the people under our care and really understanding what they are going through in order to really serve them. It’s whole-person care, which I connected with because I knew the importance of addressing health from multiple angles because I had been a patient, too.

When I started working in the hospital, I soon realized the art of nursing was not what I had envisioned. My colleagues deeply cared about people, but the fast-paced, task-oriented mentality of hospital care meant there was little time left to spend getting to know our patients outside of their illness or their immediate needs. The sad truth is nursing is not the same now as my more experienced colleagues remember it when they began as nurses.

I remember one time, a couple of years into my career, working with a patient who unfortunately frequented the hospital. She was being treated for diabetes and COPD, as well as Clostridium difficile. If you’ve never worked in a hospital with someone being treated for C. diff, you don’t realize how difficult it is for both the patient and the providers. The staff has to gown and glove up before they can enter the room, which means the patient has to wait longer to have their needs met. And they don’t feel good—C. diff is a bacteria that infects the gut and gives you frequent, fowl-smelling diarrhea. When you have to go, you have to go! I had a rare instance of time to spend with her. She had a book on her bedside table she had been trying to read, but she was feeling so poorly it was hard for her to focus on the words. I offered to read to her and sat with her for a period of time, just reading. She was profoundly grateful, she told me. And at future visits when I cared for her, she would reminisce on how much she appreciated this seemingly small gesture.

This is what I envisioned nursing, and healthcare in general, to be. The sad reality is instances like this are rare. It’s not because we don’t care. It’s because we don’t have time. We feel rushed to provide care—both in and out of the hospital—because we know we have to move on to the next task to meet productivity levels and meet everyone’s needs.

It’s an impossible job some days. But it also can be so rewarding. Twenty minutes of my time reading a book to a patient seemed trivial to me, but to her, it helped her get through a difficult time. This simple human connection is vital to us providing whole-person care.

Stay tuned for part 2, where I talk about becoming a functional medicine nurse practitioner.

I get this question a fair amount, though less frequently than I used to! Nurse practitioners are more common in healthcare than they used to be. Which I think is wonderful because we provide excellent and compassionate care.

A nurse practitioner is a licensed and certified healthcare provider. We have advanced clinical expertise in diagnosing and treating a range of health conditions, with a focus on disease prevention and health management. We are licensed by state but sit for national certifications. We are able to practice autonomously in many states. We have a focus on health education and counseling, disease prevention and health promotion, as we have been trained under the nursing model of care.

The nursing model of care is considered both an art and a science. At the heart of nursing is a fundamental respect for human life, and a compassion for human suffering. We are trained in health promotion and with a whole-persons approach to health and wellness.

Incorporating this nursing model of care, nurse practitioners can meet most of your healthcare needs. We can provide care in many specialties, including primary care, acute care, women’s health, psychiatric/mental health and more. At a minimum, we have four years of undergraduate study, followed by at least 1-2 years working as a registered nurse, then an additional 2-4 of schooling to obtain a master’s or a doctorate degree.

In New Hampshire, where I practice, nurse practitioners have autonomous practice. We can diagnose, assess, treat, provide orders and prescribe medications. We can open our own medical practice if we want, or work for an organization. For me, it is an honor to be a part of an organization of professionals with skill and expertise, as well as deep compassion and caring for others.

I hope this answered your question if you’re someone who has wondered what a nurse practitioner is.

The winter gets harder and harder for me each year. It is beautiful in New England when the snow falls and everything is white and sparkly. But the dark and the cold are a long season!

Something I do look forward to every winter is pomegranates. I remember coming home from school as a kid, and my sister and I eating pomegranates together as our afternoon snack. There certainly is no easy way to get the arils, but it’s worth the work. And they are quite beautiful little jewels!

A fun little snippet: If you like mythology, you know pomegranate’s feature in the story of Hades and Persephone. Hades kidnaps Persephone, and her mother, Demeter, considering her lost, goes into the morning. The earth becomes dark and cold. Persephone’s father, Zeus, commands his brother to release Persephone. But Hades had tricked Persephone into eating 6 pomegranate seeds, and the Fates had decreed anyone who eats or drinks in the underworld is bound there. The compromise Hades made was to release Persephone for 6 months of the year. These 6 months were spring and summer. This story is about how the ancient Greeks explained the cycle of the seasons. Pomegranates are often symbols of fertility and abundance because of this.

Whether or not this is true, I certainly understand Persephone’s difficulty resisting eating pomegranates. And paired with dark chocolate and a little flaky salt–even harder to resist!

Salty Pomegranate Dark Chocolate Bark

A slightly sweet treat, with a hint of salt and a burst of brightness as you bite into a pomegranate aril. This will be sure to satisfy your sweet tooth.

Equipment

  • Baking sheet
  • Parchment paper
  • Double Boiler

Ingredients

  • 9 oz dairy free dark chocolate I prefer Enjoy Life
  • 1 T palm shortening
  • 1/2 cup pomegranate arils
  • 1-2 pinches of flake salt I prefer Maldon

Instructions

  • Line a baking sheet with parchment paper
  • Using a double-boiler, melt chocolate and palm oil together. (You can use a microwave, just heat it in 30 second increments so you don’t burn the chocolate).
  • While chocolate is melting, very gently press a paper towel onto the pomegranate arils to remove excess moisture
  • Once the chocolate is melted, spread onto the baking sheet. Be careful not to get water in the chocolate. Spread to about an 11 x 9 inch rectangle
  • Sprinkle pomegranate arils and flake salt onto warm chocolate
  • Put into freezer for 5-10 minutes, until hardened
  • Break apart with a knife or your fingers.