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10 Ways to Influence Autoimmune Recovery

Truth #1: It is possible to reverse your autoimmune condition.

Truth #2: There is no one way to get there — everyone is unique. What works for me may not work for you. And, what works for you may not work for me. Don’t let anyone tell you otherwise.

Truth #3: There a multitude of core principles at play and finding your right mix is critical to reversing your condition. 

Truth #4: There is one key to this entire process that no one mentions. Stick with me and I will share it with you.

For the past 3 years I’ve had the privilege of working side-by-side with Dr. Susan Blum, one of the foremost authorities on autoimmunity. I work with patients at Blum Center for Health and with individuals through our CoachMe online platform, to implement the four steps of Dr. Blum’s international bestselling book, The Immune System Recovery Plan.

Two years ago we created the Immune Recovery Challenge — an online program that allows people from all over the world to learn directly from Dr. Blum in a LIVE group setting. It only happens once a year, and it’s coming up soon! Learn More

From working with hundreds and hundreds of people, I can tell you this: The Four Steps Work!

You might be wondering, “What are the four steps?”  They are: 1) Food as Medicine 2) Learning to Relax 3) Healing the Gut and 4) Supporting the Liver

Within those steps there’s a lot to learn, and it’s within those steps that things get personal. Here’s where YOU come into the equation. If you’ve been struggling with an autoimmune condition and autoimmune recovery, look at little deeper — look within the steps.

10 Ways to Influence Autoimmune Recovery

Eating the Right Foods — You’ve probably heard the phrase, “Food is Medicine.” Indeed it is! And, it can also be your poison. The first step to relieving symptoms, and getting a grip on which foods are right for you, is to do an autoimmune elimination diet. This is not only therapeutic, but it is also diagnostic. When done properly you walk away with a personalized nutrition plan.  How does this differ from person to person? Someone with an autoimmune arthritis, for example, may need to remove nightshades. Someone who is struggling with digestive distress may need to consider high lectin foods that might be exacerbating symptoms. The great news is, that once this short-term food plan is complete many people successfully reintroduce favorite foods back into their diet.

Healing your Gut — About 70% of your immune system lives in your digestive tract!  Nearly everyone who suffers with an autoimmune condition needs to heal their gut. Think of your gut as a garden with trillions of good bacteria, and includes hundreds of different species. Pretty cool, right? But when all those beautiful good bacteria get infiltrated with bad bacteria, yeast or parasites, the good bacteria get crowded out. And that, right there, can compromise the integrity of your digestive tract lining, creating minuscule breaks in the barrier where food leaks into the bloodstream. This is known as Leaky Gut Syndrome. Healing your gut is a CRITICAL component to healing your autoimmune condition.  And the amount of gut damage is different from one autoimmune person to another, and thus the treatment and focus will need to be different, too. 

Supporting your Liver — We live in a world filled with toxins that can trigger autoimmune disease and harm the immune system. These include pesticides/herbicides, hormones and plastics in food and water, solvents and mold in our homes and heavy metals in the fish we eat and water we drink. Others can come from cosmetics and products we use at home. At Blum Center for Health, we also believe that some relationships, home and work environments and thoughts can be toxic and have a negative impact on the body. We highly recommend detoxing at least once a year. This is another place where things get personal – your toxin exposure is going to be different than everyone else’s, and how much detox you need will be different, too. 

Taking the Right Supplements — Targeted supplements facilitate healing, reduce inflammation, heal the gut, and remove toxins. It’s important to use medical grade supplements that do not contain fillers, preservatives, additives, gluten, dairy, soy or corn. You’ve got to check labels carefully. You could very well be putting something in your body that’s contributing to your autoimmune condition!  

Learning to Relax — Stress, even low grade stress (you know, they kind we wave away, like having to make lunch everyday for your kids to take to school) fuel the fire of autoimmunity. Even good stress, like getting ready to go on vacation, can cause a flare. Many people will get on board with the food plan, and start taking the appropriate supplements, but have a hard time implementing a stress reduction process. This may very well be the most difficult part of an autoimmune program. And this is where coaching can make all the difference in the world. In a world that’s built on distraction and endless motion it can be difficult and uncomfortable to be quiet with oneself. 

Implementing Exercise When You Don’t Feel Well — Exercise is one of those “loops”— you don’t feel well so you don’t exercise (don’t worry, I feel the same) and when you don’t exercise you don’t get its anti-inflammatory benefits. Drop all the ideals you have about exercise: the person running on a treadmill, the women pushing weights at the gym, the man doing headstands in a yoga class, the people doing hardcore spin. You don’t have to go to the gym! You don’t have to run on a treadmill! You don’t have to do weights! You just have to start with moving. Start slow. Start low. Start with something you enjoy. Just start.

Getting enough Sleep — The research is clear: Lack of sleep or poor sleep impacts just about every system in your body, and increases inflammation. It increases your risk of autoimmunity and if you already have an autoimmune condition it impedes your ability to heal it. And by the way, lack of proper sleep drives sugar cravings and carb cravings, which makes it nearly impossible to stick to a healthy, anti-inflammatory food plan!

Learning to Say No — This is not scientific, but this is my observation in working with hundreds and hundreds of women: You can heal your autoimmune condition by holding your boundaries firm. No more giving away your time, no more saying yes to things that don’t serve you. Taking care of yourself means saying no. Or in other words, when you say no, you give yourself the space you need to heal. Want to read more on this subject? Check out 8 Reasons All Women Need Non-Negotiable Self-Care

Understanding Hidden Infections: Doing everything and still symptomatic? You may need additional testing. Functional medicine will help you get to the root of the problem.

AND FINALLY:  

The KEY that I promised you – CONSISTENCY:  

Yes, consistency! Taking imperfect action daily. Notice I said “imperfect.” We’re not trying to be perfect. In fact, it’s impossible to be perfect. It’s not all or nothing. When someone starts something new, they often give up. If they can’t do it “right,” they don’t do it at all. (Think New Year’s Eve resolutions. Done by February 1st!) You can be consistent. You can even learn to be consistent if it’s eluded you in the past. It’s all about figuring out your personal plan … a combination of what you need right now and the baby steps you need to get there. 

And, this is where it’s important to have a coach or a coaching program so that you’re not figuring it all out alone.

Are you ready to begin reversing your autoimmune condition? Join Dr. Blum and me for the Immune Recovery Challenge — a step-by-step companion to Dr. Blum’s bestselling book, The Immune System Recovery Plan. During the course, you will follow the 4-Step Immune System Recovery Plan together with Dr. Blum, using video and live coaching to help you personalize it just for what you need. It is a wonderful opportunity to learn from Dr. Blum in a group setting. Join Now

 

Meet Melissa: Melissa Rapoport is the Manager of Health Coaching and Lifestyle Programming at Blum Center for Health in Rye Brook, NY. She combines her graduate work in Developmental Psychology with her education in nutrition, health and coaching to create highly individualized programs that result in lifetime change. A contributing author to three international bestselling books, Melissa’s greatest joy is her relationship with her two daughters.

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How Conventional Medicine Gets Autoimmune Disease Wrong

Here’s a common scenario in our practice:  A patient comes in with a prior diagnosis of autoimmune disease. Sometimes it is a new diagnosis, and the patient is worried about how to proceed. Sometimes it is a longstanding illness they have lived with for much of their life. In most cases, they are looking for help where the conventional approach to autoimmunity has failed them.

There are many different types of autoimmune disease. All have in common the curious fact that the person’s immune system has become misdirected. The immune system is meant to provide protection against infection and foreign invaders to the body – like bacteria, viruses and other pathogens. When one has autoimmune activity, it means that the person’s own body is under attack.  

Falling under the umbrella of autoimmune disease is a variety of ailments, which vary widely in prevalence, symptomatology and severity. Some autoimmune diseases are very common, like Hashimoto’s thyroid disease. Others are rare, like Scleroderma. Some attack a single part of the body, like Hashimoto’s, while others, like lupus, can be more systemic, attacking multiple organ systems. Other examples of autoimmune disease are rheumatoid arthritis, multiple sclerosis, Grave’s disease, Type I diabetes, inflammatory bowel disease, psoriasis, and alopecia.

The Typical Conventional Response to Autoimmune Disease

Patients routinely describe that their physician — be it primary care or specialist — has diagnosed a condition or worse, a disease. Sometimes the patient is already on prescribed medications as treatment, but other times they are not.

Invariably, what they have been told is that there is nothing to be done:

  • “We will wait and see.”  
  • “You will probably need to be on medication at some point.”
  • “Let’s continue to watch your blood testing yearly and wait and see when symptoms develop.”  

Few, if any of these doctors, offer advice on how to potentially keep the disease from progressing. Or, if already in the throes of symptomatic disease, offer suggestions how to lessen the symptoms with anything but anti-inflammatory medications, replacement hormones or immune-modulating drugs.

This is a very serious problem, and a failing of conventional medicine. It’s exactly why our practitioners chose to continue their training with the Institute for Functional Medicine.

A Functional vs Conventional Approach to Autoimmune Disease

Let’s take the case of early autoimmune thyroid disease:

With Hashimoto’s, for instance, the patient will often be told that they have autoantibodies – which means there are immune markers in the bloodstream directed not against invaders, like bacteria or viruses, but actively attacking the body’s own tissues of the thyroid or its receptors. This is the basis of autoimmune thyroiditis, or Hashimoto’s thyroid disease, which often leads to low functioning thyroid and the need to take thyroid hormone medication.  

The conventional doctor will let the patient know that these antibodies are there, and that most likely the thyroid will begin to malfunction, causing too little hormone to be released into the blood and causing the symptoms of hypothyroidism – low energy, weight gain, constipation, dry skin …  When that occurs, treatment with thyroid hormone replacement will begin.  

This leaves many people wondering – what can I do now?  Is there anything I can do to stop this from happening?  Am I going down a road I can’t switch out of?  

How can one reverse the damage – or halt the progression of the autoimmune disease ravaging the body?

The Functional Medicine Approach

We like to think of a Functional Medicine approach to treatment as two-fold:

  • Doing everything we can to improve the immune system’s ability to rebalance while…
  • Lessening the odds of the immune system continuing to rebel — and, quite possibly, beginning another attack on another system in the body — which could then lead to another autoimmune disease.

How do we do this? First, we work to support whatever system or systems in the body are under attack – replacing nutrients or hormones that are lacking due to the autoimmunity. We frequently use B-complex, D3 and multivitamin supplementation; and, of course, hormone replacement, as needed in hypothyroidism.

Then, we work to build resilience and decrease inflammation in the body by using good old detective work to find the root cause, or triggers, of the immune dysfunction, and treat that. We look at food, stress, gut health, toxin exposure and infections.

5 Steps to Decrease Inflammation & Rebalance Your Immune System

  • Practice improving your emotional and physical response to stress. Getting good sleep and exercising is imperative. Mindfulness meditation and other mind/body techniques are helpful for reducing stress hormones.
  • Experiment with your food – discover sensitivities, triggers, and intolerances. We usually recommend an allergy elimination diet – taking out gluten, dairy, soy, corn, and eggs, along with other common allergens depending on your specific medical condition- for a short time and reintroducing to see if symptoms are affected by food.
  • Support your microbiome and heal your leaky gut.  Eat healthy whole foods and lots of vegetables and fiber. Start taking a probiotic. Our go-to is Dr. Blum’s formula, created for our patients. Learn More
  • Decrease your exposure to toxins and improve your body’s ability to manage exposures. Watch out for common toxins in food (herbicides and pesticides), cleaning supplies, and even in personal care products.  We recommend looking at the Environmental Working Group and following their suggestions for cleaning up toxins in the home.
    If you are concerned about the toxin build-up in your body, you might want to consider our 21-Day Simply Detox. It’s the exact program we use with our patients at the Blum Center for Health. Learn More
  • Be assessed with functional testing for nutritional needs and to rule out any chronic or acute infectious disease processes.  We will often request stool testing for microbial balance, in depth blood testing for nutritional needs, and more extensive saliva and urine testing for hormone balance.

If you live near the New York City metro area, come see us! We would be happy to help. People travel from all over the world to work with us. Come join our family!

If traveling to us is not possible, Dr. Blum’s Immune Recovery Challenge is a great place to start. The Immune Recovery Challenge is the step-by-step companion to The Immune System Recovery Plan. During the course, we will follow the 4-Step Immune Recovery protocol together, using video live coaching. It’s devoted to recovering your health and your wellness. Sign up here.  

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Do You have Estrogen Dominance?

Estrogen Dominance

In Functional Medicine we often refer to the relationship between estrogen and progesterone as the “dance of the hormones” or the “hormone orchestra.”

Ironically, what sounds like a beautiful evening at the ballet often plays out each month as a real hand-banging, body-slamming cacophony!

So what gives?  Why is it that we often feel out of control, and sometimes out of body, for days at a time?

The answer could be Estrogen Dominance.

Here are typical symptoms that can be attributed to a relative excess of estrogen in relationship to progesterone:

  • irregular bleeding
  • mood swings
  • depression
  • water retention/bloating
  • painful breasts
  • hot flashes
  • heavy periods
  • painful periods
  • fatigue
  • brain fog
  • sleep disturbance

How did we get here?  Unfortunately, there are many roads that lead to estrogen dominance.  Let’s start at the beginning.

The Typical Menstrual Cycle

During a typical menstrual cycle, the first half of the month, known as the estrogen dominant phase, progesterone is relatively low and estrogen levels steadily rise. Due to some nifty feedback loops that involve the brain and other hormones, ovulation occurs at around Day 14, and an egg is released from the ovary.  During this second half of the menstrual cycle, estrogen levels fall somewhat and progesterone levels rise significantly. This is when progesterone takes the lead in our hormone tango.

5 Roads that Lead to Estrogen Dominance

  1. Irregular Ovulation — One road that leads to estrogen dominance is if ovulation doesn’t occur and progesterone doesn’t have the opportunity to take that lead. We see this type of problem in young girls who haven’t started ovulating regularly, and in peri-menopausal women who are close to the end of their ovarian reserve, and also aren’t ovulating normally.
  1. Any Type of Stress — Often stress can lead to skipped ovulation. Typically we think of extreme episodes of stress such as a severe illness, anorexia/malnutrition, intense athletic training. But commonly, your average woman who goes through a stressful time will notice that her period becomes irregular. Even long standing, chronic stress can take a toll on your female hormones.
  1. Foods and Food Packaging — In this day and age of genetically-modified, pesticide-laced, prepackaged food to go, we are constantly exposed to xenoestrogens. These are toxic chemicals that act like weak estrogens in your body. These nasty chemicals can be found in pesticides, plastics that our food comes wrapped in, that “to-go” coffee lid, even the lining of your canned goods and drinks.
  1. Cosmetics and Household Products — Other examples of endocrine disruptors are phthalates and parabens that are used in hygiene products, cosmetics, and fragrances. This is where women are potentially very vulnerable considering how many bath, haircare, cosmetic, nail, feminine hygiene products we use daily. These just add to your total estrogen “load” that your body sees on a regular basis and that your liver has to metabolize and detoxify.  It turns out that optimal liver function is very important in estrogen metabolism and clearance.
  1. Your Gut Flora — The gut microbiome and your gastrointestinal function is another major player in this hormonal dance that is now looking more like a square dance with all its moving parts. It turns out that the bacteria that reside within our GI tract plays a very important role in helping us eliminate our estrogen by-products once the liver has packaged them up nicely for excretion. Sadly, the average American diet, full of high fructose corn syrup and other inflammatory foods often keep our livers working over-time just trying to detoxify lunch, let alone efficiently remove spent hormones from our systems.  Obesity itself is a problem since estrogen is stored in fat cells.  The fact that 2/3 of Americans are overweight or obese points to how prevalent this form of estrogen exposure is.

As you can see, there are many, many influences that lead to Estrogen Dominance. It’s not just “the way you are.”

The great news is there is something you can do about it.

First, you don’t need to treat Estrogen Dominance with birth control pills!

While birth control pills may help alleviate symptoms, they do not solve the root problem, In fact, taking birth control pills to treat estrogen dominance could possibly lead to more longer-term problems. (There are other excellent uses for birth control pills, such as actual birth control, and it is important to understand a woman’s goals for her health when deciding how to treat her.)

As a fellowship-trained Integrative Medicine and Functional Medicine doctor, I attack this problem of Estrogen Dominance from many angles.  The truth is we have so many ways to help women feel better, without the use of medicine and surgery.  We can, and should, use food as medicine, weight loss, botanicals, mind-body modalities for stress management so that women can actually heal themselves.

About Dr. Fitz:

Dr. Bronwyn Fitz is a board certified Obstetrician Gynecologist who is fellowship trained in Integrative Medicine.  In her practice she melds traditional medicine with non-Western approaches, nutrition, botanicals, mind/body therapies and lifestyle interventions to help women address their gynecological and reproductive health concerns. Her interest in mindfulness and meditation led her to pursue a two-year Fellowship at The Arizona Center for Integrative Medicine, under the leadership of world-renowned Integrative physician, Dr. Andrew Weil. 

 

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3-Steps to Finding Chronic Headache Relief

Find Chronic Headache Relief

 

Headache blogger Kerrie Smyre expresses the sentiments of many with migraines or other forms of chronic headache.  “Headaches steal so much of your life. The list is long, but includes jobs, relationships, having children, self-respect, ambition and identity”.

Headache symptoms can vary from a dull ache, to razor sharp pain that stops you in your tracks. Even the simplest headache can be life altering.  In making your way through treatment options, often there aren’t good choices– either the medications don’t work, or they work for a while. And then over time, you find yourself taking more and more medications, which can also end up paradoxically being the actual cause of (rebound) headaches themselves!

There are many different triggers for headaches, and uncovering the cause of yours is essential to finding the cure. Many of our headache patients come in thinking that their sinuses are the cause.  Usually they are not!

The 3-Prong Approach to Alleviating Chronic Headaches 

IDENTIFY THE TRIGGERS:

Could It Be Food?– There are many foods that can cause headaches. Unfortunately, they are not universal. For one person it may be raw onions, for another it could be vinegar, red wine and aged cheese. Just as every person is different, so are individual triggers. The good news is that a skilled practitioner can help identify your triggers and help you remove them.

Could It Be Non-Food Lifestyle Triggers? – There are a significant number of lifestyle triggers that are often overlooked as a cause of headache. For instance, do you get a headache if you don’t wear sunglasses? How about going in and out of air conditioning? Again, just as with food triggers, it is possible to figure this out and then help you make a personalized plan.

Could It Be Stress? (Particularly if you say you don’t have any!) – Stress and headaches often go hand-in-hand. It does not have to be acute stress (“Oh my gosh, I’m so stressed?”) It is also related to long-term, under-the-surface stress, like financial pressure, a troubled relationship, or putting off life decisions. It is important to work with a practitioner to learn mind-body tools to help you relax for headache prevention, and also for in-the-moment when-you-need-it-most stressful situations.

Could It Be Hormones? – Many women find that headaches are in some way related to their cycle. Once you and your practitioner determines that this is the issue, these kind of headaches can be treated easily with herbs that help balance your hormones.

Could It Be Toxins? – Toxins like pesticides, heavy metals, and plastic residues can build up in both your body and your brain, and trigger headaches. A skilled Functional or Integrative Medicine practitioner can evaluate your toxic load and then help you reduce the toxins in your body and treat your headaches with a detox program that provides supplements and a food plan to help support the liver in doing this important toxin-clearing work.

Could It Be A Structural Issue? – A common cause of headaches for many people is an issue in their musculoskeletal system. Problems like TMJ (temporomandibular joint inflammation), neck issues, myofascial pain syndromes (muscle pain in the scalp, shoulders and neck radiating up into the head) and others, can all be causes of headaches. Once we figure out this is the issues, we can treat it and the headaches can be gone for good!

Could It Be Sinusitis? – Of course it could be! But now you know that there are many other possibilities and we need to check for them all. However, sinusitis remains on the list and if it turns out this is the culprit, there are great herbal and alternative ways to treat this other than antibiotics. Also, food and environmental triggers are often an underlying issue, and these can be treated as well.

2. WORK WITH A HEADACHE PROFESSIONAL

It takes skill and experience to create an individualized plan. At Blum Center for Health, while all the practitioners treat headaches, it is a particular focus of my practice. I work with my patients to uncover and treat the underlying causes. Remember, it is critical to find someone who will be your partner – if they are only throwing medication at the issue, walk away!

3.  STAY COMMITTED:

It takes vigilance and attention on your part and mine to discover all the triggers that contribute to your headaches, but it can be done and I can show you how. Most importantly, once this is sorted out, you will have the tools and strategies you need to remain headache-free.

Ready to take aim at your headaches? A great place to start is with our 10-Day or 30-Day HealMyGut program — it’s a total gut reset with a nutritional plan, recipes, just-right supplements, daily email support, and a private online community. Our 30-Day program includes the added bonus of a weekly chat with our Functional Nutritionist to answer all your questions. Find out which program is ideal for you: Take the Assessment

Meet Dr. Gereau: Dr. Gereau is an Allergy and ENT (Ear, Nose and Throat) specialist who uses an integrative and functional medicine approach to conditions such as chronic sinusitis, allergies, sleep apnea and headaches.

CLICK HERE to learn more about Dr. Gereau.

 

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Mercury and Your Health

Sardines

By Susan Blum, MD 

Are you concerned about your exposure to mercury from the food you are eating?  If you eat fish at all, then you should be. This can be confusing, but is very important because mercury can cause autoimmune disease and other health-related problems.  That is why I decided to dedicate our April newsletter to this topic…to shed some light on this issue and to help you decide what to eat, and what to do to protect yourself from this environmental toxin.

Where do you find mercury and what is it?

Mercury is part of a group of compounds called heavy metals. There are ‘good’ heavy metals like iron, cobalt, copper, manganese, molybdenum, and zinc.  They are good because humans require these metals to function properly.  However, keep in mind that these too can be toxic at excessive levels.

On the other hand, heavy metals such as mercury, lead, and plutonium are ‘bad’ toxic metals and if they accumulate in the body over time, can cause serious illness.   For our purpose today, I will focus on mercury because there is plenty of data that explains what it does in the body and how we are exposed.

Where does Mercury come from?

There are 2 main sources of mercury that we are exposed to.  First, mercury is released into the air from coal burning power plants and from volcanoes.  After it settles in the oceans and soil, we end up eating it from the fish or plants or animals that grow and live in these places. The big fish eat the little fish, and the mercury bio accumulates, which means it gets more concentrated in the bigger fish.

The other main source of mercury is the vapor released from silver fillings.  While this is somewhat controversial, there is enough evidence suggesting this is a real issue, and why I recommend replacing your fillings if possible.

There are also other places you can be exposed to mercury, like in the preservative of some vaccines, and old thermometers.  But fish and silver fillings are the biggest problem.

How does mercury accumulate in your body and make you sick?

Your body was created with multiple detox systems in place to clear out the mercury you are exposed to.  One of these, called the glutathione system, is very active in your liver and also in all the cells in your body.  If you are exposed to more mercury than this system can handle, the mercury can build up in your body and cause damage to your nerves, thyroid, immune system (autoimmune disease, for example), and all the cells in your body by causing something we call oxidative stress.  This simply means that you run out of the important antioxidants that your body needs to protect itself, resulting in free radicals created by the mercury that can then damage the tissues.

To protect your cells and tissues, it is critical that you keep your liver detox system in tip-top shape by eating lots of antioxidant-rich fruits and vegetables with plenty of color.  In addition, you can take specific antioxidant supplements to boost your glutathione.  Our favorite and most convenient way to do this is by taking our BlumBox Immune & Antioxidant Support Packets, created for just this purpose.   

The next step is to support your liver and its ability to clear this metal out of your system. The best strategy is to do a liver detox program once or twice/year, and to make sure you are eating foods with selenium, sulfur (onions), cruciferous veggies, and lots of antioxidants.

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Detoxing Deliciously: Shrimp Masala

Bowl of Shrimp

For your weekly fish dish, we love this low-mercury, flavorful recipe rich in nutrients that will help your body clear out toxins.

Serves 4

Ingredients

  • 2 tbsp coconut oil
  • 2 tsp cumin seeds
  • 2 red chili peppers – dried
  • 11/2 cups onion – diced
  • 1 1/2 tbsp fresh ginger – minced peeled
  • 2 tsp garlic – minced
  • 2 tsp coriander – ground
  • 11/2 tsp, cumin – ground
  • 1/2 tsp turmeric – ground
  • 1/2 tsp cayenne pepper
  • Pinch Salt and freshly ground black pepper
  • 1 14-ounce can tomatoes – diced
  • 1 lb medium shrimp – peeled and deveined
  • 1 cup coconut milk
  • 1/4 cup cilantro – chopped

Directions

  • Heat the coconut oil in a large skillet over medium-high heat. Add the cumin seeds and red chilies and cook, stirring, until the fragrant, about 30 seconds.Add the onion and cook until lightly browned, about 5 minutes. Then add the ginger, garlic, coriander, cumin, turmeric, and cayenne, and season with salt and pepper. Cook until dark and fragrant, about 3 minutes more.
  • Add the tomatoes and cook until somewhat soft, about 3 minutes. You can make the sauce up to this point a day ahead.
  • When ready to serve, heat the sauce over high heat. As soon as it starts to bubble on the edges, add the shrimp and cook, stirring, until the shrimp turns opaque. Lower the heat, gradually stir in the coconut milk, and gently heat it through – do not allow to boil.
  • Season to taste with salt and pepper. Transfer to a serving platter, garnish with cilantro and serve over rice or quinoa.