New offices, Bitters, Recipes: Endive & Fire Cider, Drug-Induced Nutrient Depletion II
View this email in your browser

Late Fall Health News


Michelle Crowder, ND - Licensed Naturopathic Physician


I am not quite ready for winter, so this is a "late fall" newsletter. A friend of mine posed a question the other day - what do you do to make it through (and even enjoy) winter? If winter is not your favorite season, I encourage you to ponder this question. A few ideas... Support your circulation and immune system by consuming more cooked, warming foods containing garlic, ginger, and possibly bitter foods (see articles below...). Spend time with friends and family. Bundle up and go for a walk outdoors. Focus on indoor activities you enjoy like reading, art, baking, knitting. Consider purchasing a light therapy box (10,000 lux is a common intensity) and sitting near it for 15-30 minutes shortly after waking. 

Please see below for updates on my naturopathic medical practice. I am thrilled to join Beaumont Integrative Medicine. I am also excited to move into a newly remodeled, larger and more functional space with Dr. Kennedy's practice in January. Lots of exciting change!

Previous newsletter from Early Fall 2014.
Archive of past newsletters. 
To share this newsletter, forward it from your email, or use this web link.

"Like" my page on Facebook.
Follow me on Twitter.

En salud,

Dr. Colleen Kennedy Family Practice
75 Barclay Circle, Suite 225
Rochester Hills MI 48307

Beaumont Integrative Medicine
Beaumont Vein Center, First Floor
87 Kercheval, Grosse Pointe Farms MI 48236 


New office!

I am very excited to announce that I am joining Beaumont Integrative Medicine at their Grosse Pointe location! I will be there on Tuesdays beginning in December. For more information or to schedule, please call 248-964-9200. The proper address is:

Beaumont Integrative Medicine
Beaumont Vein Center, First Floor
87 Kercheval Ave, Grosse Pointe Farms, MI 48236

I will continue to see patients at Dr. Kennedy's practice in Rochester Hills (moving to downtown Rochester on January 1 - see below) on Mondays, Thursdays, and Fridays. 

New office location!

As of January 2015, the office of Colleen Kennedy, D.O., including myself, will be located at:
427 W. University Dr.
Rochester MI 48307

This is 3 miles from our current location. We will have our own building, more treatment rooms, and more space!
Dandelion (Taraxacum officinale), a bitter green suitable for salads or sautés
Image courtesy of



As the standard western diet has become more focused on processed foods dominated by sweet and salty flavors, we have lost much of the bitterness from our palates.  Even our fruits and vegetables have become sweeter over the years, as Jennifer McLagan, the author of Bitter: A Taste of the World's Most Dangerous Flavor, has noted - think about how the white grapefruit, with its thick, bitter pith, has been largely replaced in supermarkets by the much sweeter ruby red grapefruit. Coffee, one of the only bitter foods still widely consumed in western society, is often mixed with milk and sugar in order to mask the bitterness.  

Bitter is not an inherently pleasant flavor to humans - and possibly for good reason: Many poisons are bitter, and it is thought that our distaste for bitter may be an evolutionary adaptation to protect us against poisonous plants and the like.* (Children, who are more susceptible to adverse effects from these naturally-occurring poisons in foods, have an even lower tolerance for bitter flavors.)** As such, when we taste something bitter, our digestive system ramps up production of enzymes, acids, and bile - perhaps as an attempt to neutralize and eliminate any poisons that may be coming down the line. As a positive side-effect, this increase in “digestive juice” helps us better digest and absorb our food. (Dr Andrew Weil has suggested that small doses of bitters “challenge” our digestive organs, much like exercise challenges our muscles, increasing digestive power over time.)

Bitter herbs have traditionally been used in many cultures to stimulate and tonify digestion - think aperitifs like fernet, and salads containing endive and radicchio. I believe that the loss of bitter flavors from our eating routines may be an underlying factor contributing to functional digestive problems like reflux, gas and bloating, and constipation. And since “the road to health is paved with good intestines,” finding ways to incorporate bitter foods back into our life could positively impact overall health for many people.    

A Closer Look at the Physiology of Bitters
Bitters are known to do the following:
  • Stimulate Normal Digestion. There are receptors for bitter taste throughout the digestive tract - on the tongue, in the esophagus, stomach, and intestine. (There are even bitter receptors in the respiratory tract that help regulate lung function and immunity!) Stimulation of these receptors by bitter substances activates nerves, including the vagus nerve that helps to stimulate our “rest and digest” response. The stomach releases hydrochloric acid (HCl) and pepsin, the pancreas releases enzymes, and the liver releases bile. As a result, food is properly broken down and nutrients are better absorbed. In addition, because many metabolic wastes and toxins (including many drugs) are excreted through the bile, bitters also support our body’s detoxification mechanisms.
  • Prevent and Treat Functional Digestive Disorders. In vitro studies show that components of bitters formulas bind to serotonin, muscarinic, and opioid receptors in the intestines, modulating contraction of smooth muscle so that stool moves through properly and intestinal spasm is reduced. Clinical studies further suggest a possible “amphoteric,” or balancing, effect of bitters formulas; for example, they can increase muscle tone in atonic constipation and reduce muscle contractions in spastic conditions. 
    • Bitters formulas have been shown to significantly alleviate the symptoms of IBS and other functional digestive disorders, collectively termed “functional dyspepsia”  (1, 2). 
    • A bitters formula showed equivalent efficacy to the pro-kinetic drug cisapride in treating functional dysmotility, or impaired intestinal muscle/nerve coordination.
    • Although you wouldn’t think so based on the wide use of acid-suppressing medications, many clinicians have found that GERD and heartburn respond well to therapies that increase stomach acidity, such as bitters. Jonathan Wright, MD has found that of his patients over 40 years old with heartburn, greater than 90% have low stomach acid. Nearly all of them experience improved symptoms using therapies that increase stomach acidity. Proper acidity promotes passage of food through the digestive tract, so supporting it may prevent build up of food and gas that can increase intra-abdominal pressure and contribute to reflux. 
  • Maintain Healthy Flora. Digestive secretions like HCl, in addition to helping us digest and absorb our food, help maintain a healthy balance of microorganisms in the gut. The pH of the stomach should be 1.5 to 3.5, which prevents colonization from unwanted microbes like parasites, fungi, and bacteria such as Helicobacter pylori. Low stomach acid is a risk factor for conditions like Small Intestinal Bacterial Overgrowth (SIBO), gastroenteritis, and community acquired pneumonia.
  • Protect. Although they increase gastric secretions, bitters also seem to increase the production of gastric mucus (1, 2) and reduce the inflammatory response, thereby protecting the stomach lining from damage.  

Who Should Try Bitters?

Due to their tonifying effect on digestion, most people would benefit from bitter tonics and bitter foods. In people with otherwise regular digestion, bitters provide extra support when taken with a larger or heavier meal rich in protein, fat, or foods that you are not accustomed to eating (think holiday dinners!). They are especially indicated for those with functional digestive disorders like heartburn or reflux, irritable bowel syndrome, and symptoms such as nausea, upper abdominal pain or pressure, early feelings of fullness, gas and bloating, constipation, or diarrhea. Digestive secretions naturally decline with age, and bitters can help blunt this decline, allowing us to maintain healthy digestion and nutrition as we grow older.  

Where to Find Bitter Flavors
  • Many people consume bitter foods on a regular basis: coffee, beer, and dark chocolate are the most common in our society. Bitter flavors do seem to be making a comeback: various small businesses and individuals are creating bitters formulas to be used in craft cocktails, and/or for health purposes; bitter foods like dandelion and endive are more commonly seen on restaurant menus. 
  • A common traditional formula is called Swedish Bitters (and the related “Sweetish Bitters” by Gaia, a favorite of mine). Iberogast is another formula developed in Germany. Various botanical companies (1, 2, 3) make “Digestive bitters” formulas. The Angostura and Peychaud’s bitters used in cocktails can even be used.
  • The specific ingredients in many bitters formulas are kept highly secret. Commonly used bitter herbs include Gentiana lutea (gentian), Taraxacum officinale (dandelion), Rheum (rhubarb), Commiphora species (myrrh), Angelica species, Silybum marianum (milk thistle), and bitter orange.

How To
  • You may decide to incorporate more bitter flavors into your eating habits by increasing intake of foods like asparagus, brussels sprouts, kale, dandelion greens, endive, arugula, citrus peels, turnips, turmeric, ginger, walnuts, and celery. These foods can pave the way for an appreciation of bitter flavors in general. In addition, reducing intake of sugar and salt allows for a more complex palate to develop - one that can enjoy bitter, sour, and savory tastes.  
  • A simple digestive tonic can be prepared by adding ~ 1 teaspoon of apple cider vinegar to 1-2 ounces of water, and sipping before, during, and after a larger meal. Apple cider vinegar has mild bitter elements.
  • For a stronger effect, use a formula like Gaia Sweetish Bitters, prepared similarly to the apple cider vinegar tonic. You may need to start out with a more dilute preparation if you tend to be sensitive to bitter flavors.

A couple of important points to note: (1) One of the great beauties of using plants as medicine is their capacity to exert multiple actions on the body, creating a balancing effect. For example, chamomile has mild bitter elements, but it is also calming to smooth muscle. (2) Most of the research described above was done on bitters formulas containing multiple herbs, rather than on single bitter elements. Good formulas combine herbs with complementary and synergistic actions. For example, a strong bitter like gentian might be too stimulating on its own, so it is often paired with a more calming herb like anise or fennel.   
Although bitters have a long history of safe use and many are common foods, it is always best to work with your doctor before introducing new therapies. Bitters may be contraindicated for people with peptic ulcer disease, esophagitis, chronic diarrhea, alcoholism, and in pregnancy. In addition, use of bitters to promote healthy digestion should be part of an overall plan that is tailored to individual needs.

Further Reading

* The notion that distaste for bitter foods is an evolutionary adaptation to protect us from poisons, while widely held, has recently been called into question by researchers in population genetics (1, 2).
** Furthermore, there is evidence that we vary in how we perceive bitter tastes, and that this variation is at least partially genetic. Some people seem to be more sensitive and less tolerant to bitter flavors than others. These people tend to eat fewer vegetables, due to their association with bitterness. 
More bitter plants (clockwise from upper left): Radicchio (Chicorium intybus, a common culinary bitter), Wormwood (Artemesia absinthum, traditionally used to treat intestinal parasites, and to make the beverage absinthe), Star anise (Illicium verum, used in Asian cuisine, in various beverages including absinthe, and to treat cold stagnation in Chinese medicine), Bitter melon (Momordica charantia, used in Asian cuisine, and for various medicinal purposes, including treatment of diabetes). 

Bitter Recipe: Curly Endive with Miso and Chile

This recipe comes from the book, Bitter: A Taste of the World's Most Dangerous Flavor, by Jennifer McLagan. She says that this dish can be served hot or at room temperature, and that it also works well with escarole, dandelion greens, or brassicas like brussels sprouts or rapini in place of the curly endive (cooking time may need to be adjusted). 

  • 17.5 ounces of curly endive, outside leaves only (the inner leaves are more tender and can be used in a raw salad)
  • 2 tablespoons of olive oil or lard
  • 1 red pepper, seeded and diced
  • 1 shallot, diced
  • 1 serrano chile, seeded and diced
  • 1 tablespoon finely chopped fresh ginger
  • 2 cloves of garlic, sliced
  • 1 tablespoon red miso paste

  • Cut the endive leaves from the base. Rinse and spin dry. Slice into 2 inch pieces.
  • Place the oil or lard in a large saucepan over medium heat. When it is hot, stir in the pepper, shallot, chile, and ginger. Cook, stirring until the pepper softens. Add the garlic and continue to cook until it starts to color. 
  • Add the endive leaves, cover, and cook for 5 minutes, giving the pan a shake from time to time. Uncover and stir in the miso until it is well mixed. Cover again and cook, stirring, for 5 more minutes. Uncover; the leaves should be dark green. Taste a piece of stem to see if it is tender and the seasoning is right. You should have enough salt from the miso and heat from the chile. Serve hot or at room temperature.

Serves 3 or 4
image courtesy of

Immune Health Recipe: Fire Cider

Earlier this month, I led a workshop on immune health at Balanced Living Chiropractic. We discussed ways to support the immune system naturally and formulated our own botanical tinctures. Participants also took home a handout with the following recipe, which I would like to share with you all.

Fire Cider is a traditional recipe used to prevent and treat colds, flu, and sinus infections, to aid digestion (partially due to its bitter elements!), and increase circulation. There are many variations, and it is very adaptable to what you have on hand. This version comes from Mountain Rose Herbs, a wonderful botanical supply company and resource.  

A few ways to use Fire Cider, from Mountain Rose and The Kitchn
  • Take 1 tablespoon daily for prevention during cold and flu season.
  • Herbalist Rosemary Gladstar recommends taking 2 tablespoons at the first sign of a cold, and then every 3-4 hours until symptoms subside.
  • Mix with olive oil to make a spicy, pungent salad dressing.
  • Use to flavor stir-fry, soup, or cabbage-carrot slaw.  
  • Use in marinades.
  • Add to veggie juice. 
  • Mix with hot water and possibly extra honey to make a tea. 


  • 1/2 cup fresh grated ginger root
  • 1/2 cup fresh grated horseradish root
  • 1 medium onion, chopped
  • 10 cloves of garlic, crushed or chopped
  • 2 jalapeno peppers, chopped
  • Zest and juice from 1 lemon
  • Several sprigs of fresh rosemary or 2 tbsp of dried rosemary leaves
  • 1 tbsp turmeric powder
  • 1/4 tsp cayenne powder
  • apple cider vinegar
  • raw local honey to taste (add after the steeping process - see below)


Prepare all of your roots, fruits, and herbs and place them in a quart sized jar. Use a piece of natural parchment paper under the lid to keep the vinegar from touching the metal, or a plastic lid if you have one. Shake well. Store in a dark, cool place for one month and remember to shake daily.

After one month, use cheesecloth to strain out the pulp, pouring the vinegar into a clean jar. Be sure to squeeze as much of the liquid as you can from the pulp while straining. Add 1/4 cup of honey and stir until incorporated. Taste your cider and add another 1/4 cup until you reach the desired sweetness.

Refrigerate and use within 1 year. 

Possible variations: thyme, parsley, oregano, peppercorns, rosehips, burdock, star anise, beet root, chili powder or whole chiles, schisandra berries, astragalus root, fresh juice and peels of orange, grapefruit, lime, and whatever sounds good to you!

Drug-Induced Nutrient Depletion Part II

(See Part I HERE)  In Part I, I reviewed the nutritional effects of 3 major drug classes: acid-suppressing medications, lipid-lowering medications, and the anti-inflammatory acetaminophen.  

Another class of drugs that I commonly encounter in my practice are female hormonal therapies. Many women take oral contraceptives as a form of birth control, to regulate menses, or treat hormone-related conditions like migraine. In addition, Dr. Kennedy and her assistants offer bio-identical hormone replacement for women and men, so a significant fraction of my patients are taking some combination of estrogen, progesterone, testosterone, as well as DHEA and pregnenolone. I believe that part of my job as a naturopathic doctor is to educate patients about the potential nutritional or other side effects of medication use and to help prevent or mitigate them when possible.    

Nutrients Commonly Depleted with use of Female Hormones, including Oral Contraceptives and Estrogen Replacement Therapy:
  • Folate is important for DNA synthesis and methylation throughout the body. Deficiency can be associated with anemia, depression, fatigue, elevated homocysteine and increased risk for heart disease. There is an increased risk of neural tube defects in women who are folate deficient during pregnancy; it is therefore recommended that women who have used oral contraceptives before trying to conceive ensure that their folate levels are sufficient. I recommend avoiding the synthetic form, folic acid, as it is not well-metabolized by most people. Instead, maintain levels with regular intake of uncooked leafy greens and if you supplement, be sure that the product contains some form of "folate" or "folinic acid."  
  • Vitamin B6 is an important cofactor for many reactions in the blood, central nervous system, and skin. It is required for the conversion of tryptophan into serotonin, a neurotransmitter involved in mood regulation. Alterations in tryptophan metabolism have been observed in women who take oral contraceptives. This could contribute to depression, as well as insomnia or circadian rhythm imbalances, as serotonin is a precursor to the sleep hormone melatonin.
  • Vitamin B12 works with folate to make DNA and blood cells, and is important for nervous system function. Vitamin B12 is not found in plants (so vegans need to supplement) and requires proper digestive function in order to be absorbed, so it is commonly deficient for reasons unrelated to hormone use. Deficiency can be associated with anemia, neuropathy, depression, cognitive difficulty, elevated levels of homocysteine and increased risk for heart disease.
  • Vitamin B2 or riboflavin, is important in carbohydrate metabolism and methylation reactions.
  • Vitamin C maintains the health of skin and connective tissue, the immune system, and is an important water-soluble antioxidant.
  • Vitamin E is an important fat-soluble antioxidant and maintains health of membranes throughout the body.
  • Magnesium is a commonly deficient mineral, partially due to depletion from soils and therefore food. Magnesium deficiency is associated with a range of symptoms and disorders; see here for a good review by Dr. Christiane Northrup. 
  • Selenium is important for thyroid hormone metabolism and synthesis of glutathione, a major antioxidant throughout the body. Brazil nuts are a good source.
  • Zinc is important for immune function, health of skin and connective tissue, mental health and cognition, and thyroid function. I commonly see deficiency in my patients. Pumpkin seeds (pepitas) are a good source. 
  • CoQ10 deficiency is more of a concern with estrogen replacement therapy than with oral contraceptives. 
References: 1, 2

What To Do
If you are taking any of these medications, this does NOT necessarily mean you should discontinue taking them. Sometimes the benefit of a drug, or the risk of not taking it, outweighs the risk of taking it. Part of the physician’s job is to navigate the available evidence to determine the best course of treatment for any given patient. If you are concerned, it is certainly worth discussing with your physician. If the underlying causes for your original symptoms can be identified and addressed, many people find that they no longer need certain medications. Please consult your physician for guidance

What is Naturopathic Medicine?

In short, Naturopathic Medicine combines the best of conventional and alternative medicine into an individualized, whole-person approach to primary health care. NDs are trained as primary care providers with an emphasis on natural and common sense approaches including clinical nutrition, lifestyle counseling, and botanical medicine.

What to Expect from Your Visit

I work with my clients to identify the root causes of disease, taking into account the various factors that influence health, including lifestyle, genetics, physiology, and mental-emotional state. First visits are 90 minutes and include a thorough health history, followed by discussion of my preliminary assessment and recommendations. I may order conventional or specialty lab work to aid in my understanding of your condition. We work together to devise a plan that will meet your health goals.

Follow-up visits generally last 30-45 minutes and are important so that I can better get to know your unique physiology, track your progress, and refine my recommendations. I can consult with your other health providers and make referrals as necessary.

Integrative Medicine

I am fortunate to work in an integrative primary care practice, alongside a D.O. (Doctor of Osteopathy), N.P. (Nurse Practitioner), and P.A. (Physician's Assistant).  We share patients and regularly consult with each other to coordinate care. 

I believe this approach benefits patients by offering them the best of both worlds - conventional and natural.  These two worlds are not mutually exclusive; in fact, many health concerns are best addressed by a multifaceted approach.  The power of Integrative Medicine is backed by research, especially for chronic conditions such as heart disease.
Gift Certificates are available at both Dr. Kennedy's office and Beaumont Integrative Medicine. Please call the appropriate office to inquire.

FYI: Licensing and Regulation of Naturopathic Medicine

Licensed Naturopathic Physicians attend a 4-year post-graduate medical school accredited by the Council on Naturopathic Medical Education and recognized by the U.S. Department of Education. They must pass basic science and clinical licensing exams administered by the North American Board of Naturopathic Examiners. Currently, 16 states license Naturopathic doctors as primary care providers. National and state legislative efforts are organized by the American Association of Naturopathic Physicians.  Because NDs are not currently licensed in Michigan, they function as complementary providers.

For more information about the active legislative efforts to license Naturopathic Medicine in Michigan, visit the Michigan Association of Naturopathic Physicians.


About Michelle Crowder, ND

Michelle Crowder, ND is a licensed Naturopathic Physician with a focus in holistic and preventative primary care.  She works with people of all ages to identify and treat the root causes of disease, empowering her clients with the tools they need to understand and take control of their own health. Areas of special interest include digestive health, hormone imbalance, and immune dysfunction, including thyroid disease.

National College of Natural Medicine, Doctorate of Naturopathic Medicine, High honors
University of Vermont, Master of Science in Botany, Summa Cum Laude
University of Michigan, Bachelor of Science in Biology, Summa Cum Laude
Copyright © 2014 Michelle C Davila, ND, All rights reserved.
unsubscribe from this list    update subscription preferences 

Email Marketing Powered by Mailchimp