Poverty and Healthcare in Nicaragua, YOUR HELP IS NEEDED!

Dear Madrona Wellness Readers~

As always, I hope this message finds you happy, healthy and feeling grateful. I suppose I'll skip the part in this update where I apologize for my (predictable) lapse in communication, I know you all understand and undoubtedly have been waiting with bated breath for my most recent Nicaraguan news!

These past months with Natural Doctors International has truly been a roller-coaster. We ran into some difficulties with the Ministry of Health that forced us to close our doors temporarily, which affected many patients in our small community who depend on our medications for serious conditions like diabetes, arthritis and many others. We are hopeful that this situation is near resolution, and we will continue to provide the much needed medical care that we have provided for over 10 years.

I am amidst our 50th natural medical brigade as we speak, and the silver lining of our above mentioned problem is that we've had the opportunity to bring this group to other communities in tremendous need. We spent 3 days volunteering with a clinic outside of Managua, in a neighborhood called Nueva Vida (new life). After Hurricane Mitch in 1998, thousands of Nicaraguans migrated to this area in search of aid, and the government built them "houses." Really, these homes are nothing more than tin and sheets, with 10 people living in a one or two room house. The rate of teenage pregnancy is astounding (7 out of 10 pregnancies in Nicaragua are girls 17 and under) and access to resources is next to nothing.

On day 4, we traveled to a town just north called Nagarote, where we've worked with an amazing project called NicaPhoto. Here, we've given classes on nutrition and sex ed (this really tested my translation skills!), and learned about biointensive farming practices being promoted country-wide to combat the rising hunger. Most of the children served by this wonderful organization are from a barrio called Sonrisa de Dios (smile of God), which is perhaps even more shocking than Nueva Vida. The government recently distributed 180 small plots of land to needy families, but the catch is they have to be physically living on the land, if not it gets taken away. This land used to be a soccer field, so there is no shade, the sun and wind are brutally strong, and they live without water, electricity, or latrines. They are prisoners in their homes, because if they leave even for an afternoon, the few possessions they own will be stolen. Their "houses" are plastic tents, and with the heavy rains of winter become flooded and the earth floors become pure mud.

This is reality here for so many people, and not only in Nicaragua. Over half of the worlds' population lives on less than $2.50/day. We are talking about an intense...a severe and shocking type of poverty. We are talking about daily hunger and illiteracy and hopelessness. And while seeing it makes me incredibly grateful for all I have, it makes me sick with the injustice that exists in the world.

Please consider supporting and/or continuing to support my work here. Having so recently witnessed this extreme poverty, I struggle to complain about the volunteer stipend I make that any one of these families would be elated to receive. Still, this doesn't change the fact that my US expenses don't just disappear. My goal is to stay and continue to help in the small ways that I can, and any help you can provide will go a very long way. 

Please donate here.

Lastly, consider sharing with others in your circles that are allies in fighting poverty and promoting global access to healthcare.

Thank you for taking the time to read, I wish you all a beautiful summer.

"Thank-God-For-Our-Health...."

On this New Years Eve day,  I find myself, almost 7 months since my departure from the United States, still here on this magical island in Nicaragua. Sipping coffee on the patio outside of my little casita, and feeling astounded and grateful for the many moments and events that have made my 2014. This morning, instead of trying to reflect and recap the mountains of change this past year has provided, I'll simply offer a look into where I find myself today...

It's a somewhat gray, windy morning. I'm alone here on the property, one neighbor on Christmas vacation, and another staying in the warmth of family at her mothers' house. It is so very quiet, just me and the horses chomping and the roosters crowing. Well, and lets not forget the 3 kittens running like madmen around my ankles...one thing I can say for certain is that this year has made me a cat lady.

The pulse of the village is always beating. Kids playing baseball with sticks and rocks, moving aside for motorcycles and herds of cows. Men going to and from the campo, dirt covering their hands and faces and blue plastic backpacks full of pesticides on their backs, full or empty depending the time of day. Some are on horseback, and more have surely walked for a very long time in the blazing sun.

Women mill about outside of their homes of 1, 2 or 3 rooms with rusted tin roofs. They wash by hand, hunched over a pila, then cook huddled over a fire of lenya. On a special day like today, perhaps the fruit of their labor will be something special like tamales, or maybe the usual gallo pinto or plantains prepared in one of ten different ways. Naked children run around them as they work, and dust swirls in plumes around them all.

I don't know that I'll ever really feel a part of it all, and maybe that's okay. I feel more and more comfortable approaching those open doors, sitting on the old rickety plastic chairs, and chit-chatting about the weather and how thank-god-we-have-our-health. I receive constant lessons of gratitude, and daily reminders of simplicity.

And with these lessons and reminders in my mind and heart, I leave one year behind and move into another. Some questions have been answered but even more formed. This is life...the dust and the work and the smiles and the questions...the spectrum from sadness to happiness and every sentiment in between.

But as the chit-chat teaches, thank-god-for-our-health, this is all we really know for sure.

Nicaraguan Reflections and Recipes

I hope this article finds you lovely Madrona Wellness readers happy, healthy and enjoying the transition into fall. Here in Nicaragua we are in "winter," which means more rain and humidity, and I dream of crisp, cool days and winter squash and changing colors....

Admittedly, my nutrition blogging has fallen off the wayside since I arrived here on the island of Ometepe in Nicaragua to begin my new position as Programs Director for Natural Doctors International. Its been a process of settling in and finding my footing, yet now that things are settling down a bit, I'd like to share with you some reflections on these past few months. While I know this is veering off my usual topics of health and nutrition, in the more holistic sense of health, our mental, emotional, and spiritual self is equally (if not sometimes more) important. And since I just can't resist, stay tuned below for a delicious twist on a typical Nicaraguan dish...vigoron!

Its hard to believe I've been here for only 3 months, as it all at once feels like just yesterday I boarded the plane, and also that I've lived here on this island forever. Despite the challenges (and there have certainly been challenges), I feel oddly comfortable and at home considering I am on a rural island in Nicaragua. I love the people, the culture, the language and the music. I love the way kids are able to play in the streets and grow up with a deep sense of community, and I love that people end half of their sentences with "si dios quiere" (god willing). Whether it may be a simple "god-willing-I'll-see-you-tomorrow," or "god-willing-my-family-will-eat-next-week," it is a culture of faith, spirituality, and accepting that we cannot control the future. This, I love.

The challenges? Being a single woman amidst a sea of families. Nicaraguans are known for their bluntness, and I get asked several times per week (at least), how old I am, and am then met with a gasp which is followed by "you are so old!!" While this was funny at first, it has come to accentuate the occasional loneliness that I had expected living here in a small village. The food is a challenge, we are so blessed in the US to have access to fresh fruits and vegetables that are not laden with pesticides, and meats that are not pumped full of hormones. That is not the case here. I am challenged daily by conducting life in my second language, living amongst profound poverty and the discomfort and guilt that brings up, and more...

But amidst those challenges, the work I am privileged enough to be doing here has exceeded my expectations. I have opportunities here for professional and personal growth that are simply astounding. These include organizing and co-facilitating our medical brigades where I get to translate for Naturopaths, Acupuncturists and other practitioners, so by shear osmosis am learning so much. I hear stories of patients' lives that have been so filled with pain I cannot even begin to imagine, yet they leave their houses at 3am in order to arrive at the clinic by 5:30 to get an appointment for later in the day, and I've never once heard a complaint about the wait...there is no sense of entitlement. Although it is a struggle due to lack of resources, I have been able to offer nutrition coaching to my patients, and am beginning this month to organize a nutrition class which I will present to groups around the island along with our resident Psychologist. 

Thank you for taking the time to read, and now for the fun part....check out this delicious twist on a typical Nicaraguan meal, vigoron. This dish is a lime cabbage salad over a bed of yucca. YUM!!

VIGORON 

adapted from globaltableadventure.com

Ingredients:

2 lbs. yucca

1 small head of cabbage, thinly sliced

2-3 tomatoes, chopped

1/2-1 onion, thinly sliced

2-3 limes

1/2 tsp of salt (or to taste)

handful of cilantro

1 jalapeno papper, diced (or to taste)

**add your choice of protein, this is typically prepared with chicharron, or you can include any other type of thinly sliced or ground meat.

Instructions:

Peel yucca and cut into 3 inch pieces. Simmer in salted water until tender (should have texture like a potato). While yucca is cooking, combine all salad ingredients and mix. Traditionally, this dish is served on a banana leaf, yucca is the base and salad and meat on top. If banana leafs are hard to come by, a simple plate will do :)

Enjoy!

Ometepe, Nicaragua and Healthcare

As most of you know, I have recently moved to the island of Ometepe in the south of Nicaragua, an island known for its' kind, warm, welcoming people, beautiful landscapes centered around 2 large and 1 active volcano, and also its' growing tourism. I feel grateful and excited to be settling in and building a life amidst all of this beauty.

I have come to work with a small but mighty nonprofit organization, Natural Doctors International (NDI).  As the Programs Director, I organize and facilitate throughout the year groups of natural medicine practitioners to come and serve in the organization's naturopathic clinic here on the island. The population of Ometepe has an acute lack of access to health care, and, over the last ten years, many have come to see NDI as their primary care clinic. All services are offered free of charge.

As a Holistic Nutritionist, I am thrilled to learn from our resident Naturopath and visiting doctors, and anxious to do more programming for the community centered around nutrition. Amongst the top complaints we see each and every day here in the clinic include gastritis and a myriad of digestive upset, kidney stones and infections, urinary tract infections, and overall pain (bone, joint, and muscle). While there are some very knowledgeable doctors working in the public clinics here on the island, the reality is they see upwards of 45 patients per day and very rarely connecting diet and lifestyle to any of the above mentioned symptoms and conditions.

The typical diet here is gallo pinto, which is simply beans and rice. Poverty is rampant, the typical Islander making perhaps $4/day. Sure, we can advise them to eat more fresh vegetables and fruits, but often this is well over their daily food budget. This year has brought the worst drought the country has seen in many years, and the price of frijoles (beans) has quadrupled, leaving many families subsisting largely on rice. Diabetes is shockingly common, as well as high blood pressure. Sadly, the diet and lifestyle solutions that we much more readily have access to in the US to both treat and prevent such conditions are largely not feasible for those living in Nicaragua, the 2nd poorest country in the western hemisphere after Haiti.

So what do we do? What can we do? There is no easy solution, that is certain. Thus far, the only thing I can say for sure, is that each and every time I sit down here for a meal in my humble yet more than adequate casita, is that I am filled with a deep and profound gratitude for the food on my plate and the access to healthcare that allows me to live happily and free of disease at this moment in my life. I only hope I can help to bring just a tiny bit of that immense privilege and sense of security to the people here in Nicaragua. It feels, after all, like our duty.

Mid-Afternoon Energy Crash

I think the number one complaint I hear year after year from my clients is the all-too familiar mid-afternoon crash. For many, it has become so familiar that we’ve simply accepted it as a normal way of going through our day. The good news is, it is absolutely not normal, there are reasons you are experiencing this energy dip and things you can do to fix it.

What this afternoon energy plummet usually signifies is a blood sugar dip (which was often preceded by a blood sugar spike). We’ve talked a lot in my previous articles about the importance of supporting our adrenals and blood sugar levels via food, supplementation, and exercise to achieve sustained and optimal energy, so lets review.

Maintaining stable blood sugar throughout the day begins in the morning. When we start the day with a high carbohydrate or no breakfast at all, we are setting ourselves up for a blood sugar rollercoaster that is hard to get off. Think, the SAD (standard American diet) includes a typical breakfast of cereal and milk, maybe some fruit. While there are some great vitamins and minerals in fruit, this breakfast is mostly carbohydrates. Out of the 3 macro-nutrients (protein, fat, carbs), carbs are the fastest burning (fats are slowest, then proteins). This means, we get a blood sugar spike from eating lots of carbs (particularly when we don’t eat them alongside fat and protein), and this is followed by a big dip is blood sugar levels, which we experience as low energy! The roller-coaster part comes in when, after we’ve set this unfortunate tone for the day, we continue to overeat carbs in order to recover our energy (sugar/carb cravings, anyone?), and the cycle repeats.

That mid-afternoon crash is commonly a result of either dipping and spiking due to the wrong kind of or no breakfast, high carbohydrate/sugary foods and snacks and lunch, OR big gaps of time where we’re not eating at all, causing blood sugar dips that, again, can be very hard to recover from.

Interestingly, there is a big connection between our primary adrenal stress hormone, cortisol, and insulin. Cortisol inhibits insulin production in an attempt to use glucose immediately instead of storing it. So, when our blood sugar levels are spiking high due to the reasons mentioned above, our adrenals have to work extra hard to meet the cortisol demand. This can lead to adrenal fatigue. If you’re experiencing frequent energy dips, testing your cortisol levels is incredibly beneficial.

I always tell my clients who experience energy dips and fatigue to start with breakfast! If you change nothing else, incorporating a breakfast within one hour of waking that includes good quality protein, fat, and (ideally) some veggies, can make a huge difference for the rest of the day. This could be eggs (with the yolk, pasture raised if possible) cooked in coconut oil or organic butter and some raw sauerkraut, a breakfast sausage with some raw or cooked greens, or one of my favorites is a slice of frittata or egg muffin that can be made over the weekend and eaten throughout the day. Try this for a few weeks and see the difference it makes!

As always, thanks for reading and please contact me if interested in working together to create a personalized diet and supplementation protocol and adrenal testing.

NY Style Pizza

Gluten free pizza has been popping up like crazy around San Francisco. Many popular pizza places around the city are now offering a gluten free option. For a once in awhile treat, this may not be so bad; however, for those of us suffering from IBS or other gut-related symptoms, a bread still centered around processed grains could cause some problems.

I've tried all sorts of "alternative" pizza crusts. And to be honest, most are horrible. I've tried almond flour crusts which are delicious but feel like you just ate 2,000 calories worth of nuts because, well, you did. I've experimented with cauliflower crusts which, while many paleo chefs swear can be the answer to all of your pizza cravings and woes, and its not that I don't believe them, but mine was no such thing. Coconut flour crusts were boring, cornmeal crusts were indeed delicious but corn is very hard to digest for many people and they usually use another flour as well. Ok, enough!

The point is, when I discovered this pizza crust recipe from zenbelly catering, I was thrilled. It is a crisp, thin crust pizza that is nice and light and easy to prepare. I'd also never really experimented with yeast before, so it was fun! I hope you enjoy this pizza as much as I do. And remember, you can always experiment with toppings: cheese or no cheese, a tomato or pesto sauce, whatever veggies or meat toppings you have on hand. ENJOY!

Notes / Tips:

✽ If you have a pizza stone, use it. If not, use the heaviest sheet pan you have.
✽ Warm the bowl you’ll be putting the yeast mixture in, as well as the measuring cup you’ll be measuring the water with. If it’s cold, the water will cool right away, and might not activate the yeast. Just run some hot water in it before using.
✽ This recipe involves high heat cooking, which might rub some people the wrong way, since there is olive oil and nut flour involved. This is one of those situations where I absolutely put taste and texture first. Good pizza is cooked at high temperatures, and that is part of what makes good pizza good.  You can use a different fat if you’d like.
✽ Results are best when the crust is cooked almost entirely before adding toppings, so I recommend having your toppings almost completely cooked before adding them in the last step.

NY Style Pizza Crust

1 tablespoon gluten-free yeast
1 tablespoon raw honey
1/4 cup warm water (should feel warm on the inside of your wrist, but not burn)

3/4 cup almond flour
3/4 cup tapioca starch
3/4 teaspoon sea salt

1 tablespoon olive oil (or other melted fat if you’re opposed to heating olive oil)
1 tablespoon egg whites (less than one egg)
1 1/2 teaspoons apple cider vinegar

and of course your favorite toppings! 

1. In the warmed bowl of your stand mixer (or alternately, the bowl you’ll be using with hand-held beaters), combine the yeast, honey, and warm water and whisk to combine. Let sit for a good 5 minutes. It will get foamy and active.
2. In a small bowl, combine olive oil, apple cider vinegar, and egg white.
3. In a medium bowl, whisk to combine the almond flour, tapioca starch, and sea salt.
4. Once the yeast is foamy, add the wet and dry ingredients to the bowl and mix on medium high for 30 seconds, scraping down the bowl once to make sure it’s all incorporated.
5. Scrape down the bowl with a rubber spatula again to gather the dough together. It will NOT look like the dough you remember, it is much wetter. Use the spatula to get it into as much of a ball as possible.
6. Cover the bowl with a tea towel and set in a warm (but not hot) place. Allow it to sit for 75-90 minutes. I know, it’s torture.
7. After 75 minutes, check the dough to see if it’s risen. It won’t rise as dramatically as a conventional dough would, but it will have changed, and gotten aerated, and a bit larger. (see above pics). If this has happened, Turn your oven on to 500 and if using a pizza stone, place it in the oven to to heat up while the oven warms.
8. Lightly oil a sheet of parchment paper and turn the dough out onto it. It will likely be a bit stuck to the bottom of the bowl, just scrape it out as best as you can.
9. With oiled hands, gently flatten out the pizza dough into a 9-10″ circle. It will be aerated, so might want to leave empty spaces.
10. Carefully transfer the parchment with the dough onto the pizza stone or sheet pan.
11. Bake at 500 in the lower 1/3 of your oven for 6-8 minutes, or until it’s starting to brown at the edges.
12. Add desired toppings and cook for 2-3 minutes more. Allow to cool for a minute before slicing.

April 13th Spring Detox Workshop!!

Overcoming Stress and Adrenal Fatigue with Revitalizing Diet, Lifestyle, and Yoga 

with Sonya Genel & Rachel Fiske 

Hour one of this workshop will be facilitated by Holistic Nutritionist and Functional Medicine Practitioner, Rachel Fiske of Madrona Wellness. Rachel will focus on educating the class on how stress impacts our adrenal glands, symptoms of adrenal fatigue, and how to heal our adrenals via diet, lifestyle, and supplementation when appropriate. Rachel will go into detail on the importance of managing blood sugar, macronutrient ratios, and key micronutrients for supporting the health of our adrenal glands and feeling consistently energized.

The second hour will be led by yoga teacher Sonya Genel, ERYT. This is the part of the workshop where we get up and move! Sonya will lead a detoxifying and invigorating sequence to help clear your physical and energetic body. You will also get practical tools for managing stress, detoxifying physically, and releasing negative patterns. You will learn safe and effective physical postures, breathing exercises, meditation, and self-massage. Leave feeling profoundly revitalized and empowered with the tools and knowledge you need to live radiantly!

WHEN: Sunday, April 13th from 2-4pm 

WHERE: Yoga Garden of San Francisco, lower haight on the corner of Divisadero and Page 

HOW TO SIGN UP: Simply CLICK HERE to register