When was the last time you cracked a nut?

When was the last time you cracked a nut? 🤔

When people ask me “How many nuts is it okay to eat in one sitting?” I tell them “as many as you would crack yourself”.

When we think about our sedentary culture, we forget about all of the non-exercise movement behaviors that we’ve outsourced.

When you enjoy a jar of almond butter, there was energy input by someone/something else, somewhere else to grow, collect, crack and grind those almonds; energy that you had the privilege not to perform. As a result, you are at a movement deficit and then need to perform structured movement (exercise) elsewhere in your day to essentially make up for the lack of movement in obtaining your calories.


Now, I’m not saying everyone needs to crack their own nuts every time you want almond butter or to source their own food for all their meals, this is the benefit of a modern society where we can each choose an occupation that suits our talents and skills. BUT this does not negate the necessity for our bodies to move! 

Regardless of our career choice, movement is a necessary part of life. And arguably, the excess of calories we consume would be considered nonessential given the lack of physical demand. 

What are ways you think you can realign your body’s need for movement with the foods you choose to eat?

For some ideas, check out this step-by-step post by Katy Bowman, author of Move Your DNA and Movement Matters,  to see what it means to live a movement-rich lifestyle and practical ways to reintroduce movement into your life without taking additional timeout of your day to “exercise”.

On that note, if this concept intrigues you, Katy Bowman recently published a paper in the Journal of Evolution and Health titled “Move Your DNA: Movement Ecology and the Difference Between Exercise and Movement”. Click here to read.

Interested in finding out other ways to holistically approach lifestyle change?

I'm seeing clients in-person at Cascade Integrative Medicine in Issaquah (request an appointment here) or online!

Let me know in the comments below how you are trying to move more!

Always Tired? Maybe It's Iron Deficiency

Because my patient population involves primarily women of child-bearing age, I see iron deficiency A LOT.

We've been told for many years that we should be avoiding red meat and opting for more plant-based food options to be "healthier". Naturally, health-conscious women begin reducing or completely eliminating red meat from their diets. Depending on what their levels were before the diet change, it may take a couple years for iron to get so low that they start exhibiting symptoms.

Depending on the age this diet change was made, a woman may have no clue that this may be impacting her menstrual cycle. I can tell you from my own experience (and I see this reflected in my patients) that period cramps were extremely painful when I was iron deficient. I was vegetarian from the time I was in high school all the way through college, I was both extremely tired AND had heavy and painful periods. Oddly enough, the female body tends to lose more blood when a woman is iron deficient, further worsening the cycle.

Technically, a woman is not considered iron deficient unless her Ferritin is at 15 ng/mL or below. I can tell you from personal and clinical experience that every patient that I've had who had a Ferritin below 20 ng/mL really struggled to stay awake during the day.

This is one of the reasons why men typically do far better on a plant-based diet because their iron needs are much lower. Women often crave burgers and steaks as they are about 5 years into a vegan/vegetarian diet. Why? Because the body knows best! These cravings point our bodies in the direction of nutrient density.

It took me about two years to increase my iron stores from 32 ng/mL in 2013 to 56 in 2015. And that was while eating liver and red meat regularly (just not enough)!

So why do we need iron?

Iron's main role in the body is to carry oxygen on red blood cells. You've all heard of Lance Armstrong blood doping with EPO to increase his red blood cells right? Well, the reason why he benefited from more blood cells is because he had more oxygen carrying capacity! So think of it like this: If you become iron sufficient, how much better would you be able to perform in athletics, at work, or in school?!

If you've been exhausted and requiring caffeine and/or a nap to make it through the day, consider seeing me in my office so I can help determine what might be causing your fatigue. There are too many good things in life to go through it with sub-optimal energy!


The Most Unsexy Reason to Lift Weights

I recently turned 25 years old. Being the data tracker that I am, one of the first things that came to mind was, "I should get my bone density measured". I promise, I'm not crazy. Okay, maybe a little. Hear me out.

Our formative years of bone building peaks around age 25. In the back of our heads we all know that resistance training is essential for preventing osteoporosis and/or osteopenia. "But you only need to worry about those things once you're old, right?" Wrong! If we peak at age 25, then anything you do afterward only works to maintain the bone density that you already have and prevent further bone loss. Our bones are constantly being remodeled throughout life. Good nutrition and resistance training are essential to promote healthy bone homeostasis.

Anisa's DXA scan

So, earlier this week I went and got my bone density measured using a DXA machine. I've never had my full-body bone density checked before and wanted to get a baseline so I can see how I am maintaining it throughout my life. My Mamani (grandma) had severe osteoporosis through the later part of her life, so if it's partially related to genetics, I definitely have the genes. However, my Mamani grew up in Iran raising 5 kids on her own, breaking her back to feed the family. She couldn't afford to be optimally nourished, a privilege I do not accept lightly.

 This is why my husband always calls me an outlier

This is why my husband always calls me an outlier

Initially, trying to add meaning to the numbers can seem difficult so I won't try to explain them. What is important to notice is that the technician wrote that I am in the 96th percentile of bone density compared to other white women my age. That means I have better bone density than 96% of these women. I actually wonder how it might've been different, had I been actually lifting heavier weights this year... (I had to take a break due to my knee injury).

The reason why weight lifting has such an immense impact on bone density is because as the muscle attaches to the bone, it pulls on the bone, creating a higher demand for mineral deposits. That's where all your calcium and phosphorus comes in! But in order for those minerals to be deposited there, having enough fat soluble vitamins is ESSENTIAL! Especially vitamins D and K. So, if your muscles are never pulling on the bone (by resisting the force of a barbell, for example) then both the muscle and bone atrophy, increasing the risk for low BMD and therefore increased risk for osteoporosis down the line. Loading weight on the shoulders, for example, puts a demand on your spine, requiring it to get stronger.

DXA for Body composition

Another measurement the DXA scan does is body composition, although it's not the gold standard. Here's how I rank these tests based on accuracy (in measuring body fat):

Hydrostatic (underwater)> DXA> Skin calipers> Bioimpedance (BIA)

The DXA technician at Washington Institute for Sports Medicine (where I did the test) said that DXA can overestimate body fat by 3-8% percent, depending on the machine. He gave the example that the leanest bodybuilder he's ever seen, 3 days before competition, weighed in at ~10% body fat (which I would expect was around 3% in reality), giving it about a 7% error.

Above, you can see that my total body fat was 21.3% (which was likely 14.3% if we consider the accuracy of that machine). That number is much more realistic to me because when I've previously done hydrostatic weighing (more accurate), my body fat came back at 10.8 % and 13% in 2013 and 2015, respectively. See below.

 Body comp results from 2015 and 2013. Interestingly, I've consistently, though unintentionally, had this tested every 2 years within a week of each other.

Body comp results from 2015 and 2013. Interestingly, I've consistently, though unintentionally, had this tested every 2 years within a week of each other.

It's interesting to see how these compare to my Fitbit scale. It's consistent, just not accurate.

Just a note: I am an outlier, I can't say that enough.

Very few women can get below 14% body fat and still have a regular menstrual cycle. It is NORMAL, HEALTHY, and ESSENTIAL (for most women) to have a body fat percentage in the 20% range.

I find it quite fascinating to be able to see what my body is made of. Just by looking at my legs and hips in the mirror, I would guess I had much more body fat than was measured on the scan. Under the hood, it's mostly just muscle! Doing this exercise of objectively looking at the body can be a great practice in testing the inner dialogue we have about our bodies.