How's your MTHFR?

The MTHFR gene provides information for your body to make an enzyme called methylenetetrahydrofolate reductase (MTHFR). This enzyme enables our bodies to use the vitamin folate properly so that our methylation cycle can run. Biochemically, methylation is the process of transferring a methyl group (one carbon with hydrogens attached to it) from one molecule to another. Methylation affects over 200 processes in the body, turning on and off specific genes, affecting antioxidant production - including the master antioxidant glutathione, cell repair, cell replication, brain chemistry, detoxification, and much more. Clinically, an issue with methylation can show up as anxiety, depression, chemical sensitivity, brain fog, sleep problems, hormone imbalances, fertility issues, heart disease, histamine intolerance  - to name a few. 

We all have two copies of every gene, one inherited from each parent. We all also have many small variations in the nucleotides (the smallest part that makes up our DNA) where one nucleotide gets switched out for another nucleotide. This may affect the functioning of that gene. These are called single nucleotide polymorphisms, or SNPs. The SNPs associated with the MTHFR gene do not automatically cause health issues, but they can, especially if both copies of the gene have a SNP, but also depend on the environment they are in - our diet and lifestyle. There are many known SNPs in the MTHFR gene, but two most researched ones that have the most known significance for health are known as A1298C and C7677T. These SNPS are super common - about 45% of the population has one SNP and 10% has 2 SNPS, which can affect the function of the MTHFR enzyme. But again, just because we have a SNP does not mean we have a medical problem due to that SNP. There is a saying in functional medicine - genetics loads the gun, but the environment pulls the trigger - and that truly applies here. 

Testing to see if you have the MTHFR SNP can be done by most providers or commonly available genetic testing companies. Many of my patients come to me with their genetic results and we need to determine if this SNP is actually a problem for them. I will often test people who have a history of depression, anxiety, infertility, signs of poor detoxification, and heart disease. If they have a SNP we think is affecting their methylation, I will give a methylated form of folate to bypass the genetic blip so that the methylation cycle can move forward. We also look into other reasons methylation may not be functionally optimal - including having required nutrients like vitamin B6, vitamin B12, magnesium, choline and betaine, and looking into medications and toxicity from the environment which can affect the cycle. For instance the toxin BPA, found in many plastics, is a major demethylator. You don’t always need to inherit a gene issue to have a methylation issue.

Methylation is an intricate process that can have many implications if not running smoothly. If you think you can possibly have an issue with methylation, talk to your provider about looking into MTHFR SNPs and other factors that could be affecting this very important cycle.

Xenoestrogens

PMS? Irregular periods? Painful periods? Fertility issues? Maybe it’s time to think about xenoestrogens - chemicals that mimic the estrogen in our bodies and are part of a larger group of chemicals known as endocrine disrupting chemicals. They can lead to the symptoms of excess estrogen mentioned above as well as endometriosis, acne, breast tenderness, premature puberty, insulin resistance, depression, breast and uterine cancers. They interfere with the body’s hormone system and can be found at much higher concentrations than our own hormones.

There are over 85,000 synthetic chemicals registered with the US Environmental Protection Agency and 2,000 new chemicals are introduced each year. Most of these chemicals are not studied for adverse effects in humans. The main xenoestrogens we encounter on a regular basis are in the form of parabens, phthalates, BPA, pesticides, insecticides, and hormones used to grow our food. These show up in products we are exposed to everyday: make-up, soap, shampoo, lotion, sunscreen, deodorant, toothpaste, feminine hygiene products, household cleaners, non-organic food, meat and dairy, plastics, fragrance, air fresheners, the “new car smell”, teflon cookware, cash register receipts, flame retardant clothes and furniture, and chemically treated lawns. It is overwhelming. But there are very actionable steps to take to decrease our xenoestrogen burden and help rebalance our hormones.

The first step is to limit our exposure to these xenoestrogens:

-Eat organic and hormone free foods - airy, even if organic will contain hormones, so you may want to watch your intake

-Get rid of the plastic - especially plastic water bottles and plastic food storage containers. Limit use of plastic wrapped food items and opt for beeswax food wraps

-Say no to teflon cookware and other dubious non stick pans - stick to cast iron or stainless steel

-Check ingredients in all personal care products - they should at least be paraben and synthetic fragrance free. Take a look at the environmental working group (EWG) website for lots more information

-Wash your hands after handling cash register receipts or skip them altogether and take an e-receipt. They are coated in plastic that can absorbed through the skin

-Eliminate toxic lawn care - opt for more natural ways to keep the weeds away

The second step is to help your body get rid of these xenoestrogens:

-Make sure you’re pooping daily. Constipation can lead to reabsorption of  estrogens

-Eat your veggies and lots of fiber. Dark leafy greens can give you the nutrients you need for estrogen detoxification in the liver and fiber is good for the gut microbiome which aids in estrogen detoxification and also helps with estrogen elimination

-Love your liver and avoid excessive alcohol and drugs like tylenol that stress the liver and make it harder to metabolize estrogen

Avoiding xenoestrogens as much as possible and giving our body what it needs to help get rid of the xenoestrogens that we already have can put us on the path to better hormonal balance.

Menopause

Menopause is a scary word for many women—so scary, in fact, that few want to talk about it, even with each other. Given that every woman will go through menopause in her life, it’s time to take this transition out of the closet and bring it into the light. Let’s start by reframing menopause— while it’s the end of childbearing years, it is also a new beginning and time for regrowth and increased personal power. Often the signs and symptoms of menopause are so unpleasant—and for some, unbearable—that they can get in the way with embracing who you’ll be on the other side of it. My approach is to give women tools to ease these effects and help make the journey more bearable, with a focused eye on what a woman’s body needs at this time and beyond.

Menopause is defined as the permanent cessation of menses after one year of being completely period free. The hot flashes, sleep disturbances and mood issues of perimenopause should be on their way out by this time, but may linger for some. Here’s where many experience weight gain, overall dryness including vaginal dryness, stress incontinence, bladder infections, increased wrinkles, fatigue, low libido, hair loss, facial hair, joint pains, insulin resistance, as well as increased risk of osteoporosis, heart disease and memory problems. Some women may have no significant symptoms, while others can have symptoms for years. Here are a few actionable tips to help with some of the more common symptoms:

Weight Gain - You’re not alone if you haven’t changed a thing in your eating and/or exercise habits and have gained weight, especially around the middle. Estrogen increases insulin sensitization and can help increase muscle mass. Losing estrogen can be a big player in higher insulin levels, known as insulin resistance, and can lead to decreased muscle mass and subsequently decreased metabolism. High insulin levels cause more fat storage, weight gain, and inflammation. Insulin resistance can lead to type 2 diabetes, metabolic dysfunction and contribute to heart disease. Elevated cortisol can also lead to insulin resistance by increasing abdominal fat and increasing blood sugar. What can help: Exercise, a lower carbohydrate diet with higher protein and good fats like olive oil, and intermittent fasting. Thyroid problems are more common after 40, so making sure your thyroid is working optimally is important. I typically run a full thyroid panel and support with nutrients and possibly thyroid hormone to ensure optimal thyroid function.

Stress and Adrenal Health The adrenal glands make the stress hormone cortisol, which can lead to more hot flashes when dysregulated. Elevated cortisol can also contribute to abdominal body fat. The adrenals also make the hormone  DHEA which is a hormone of well being and can be metabolized to estrogen which can help the body when the ovaries have stopped making estrogen.  Adaptogens like ashwagandha, cordyceps, ginseng, eleuthero, and rhodiola, can help with resistance to stress and can help regulate cortisol. Incorporating a mind-body technique like meditation or yoga can also help to regulate the stress response, as can sleeping and eating well.

Hot Flash Help  - See if you can find the triggers of your hot flashes. Often the culprits are alcohol, stress, caffeine, spicy foods, blood sugar problems (highs and lows), hot drinks, and warm environments. Black cohosh is an herb that has been extensively studied for hot flashes. Some studies see a benefit and others don’t, but many women do find it helpful. And magnesium helps here too.

Bio-identical Hormones - Estradiol, micronized progesterone, testosterone, DHEA, and thyroid hormones can all be very helpful with many of the menopausal symptoms and can offer protection for heart disease, osteoporosis and memory problems. You can speak with a healthcare provider to see if bio-identical hormones would be a good fit for you.

Embracing the menopausal transition can help you feel like you’re more in the driver’s seat rather than just a passenger.  Remember, you don’t have to go it alone. Sharing your experience with friends can ease the burden and even help you find some humor in it. And find a health care provider who is knowledgeable in lifestyle support and bio-identical hormones for menopause—it can make a big difference in quality of life during this time and well beyond.

Acne - not just for teenagers

If you are in your 20s, 30s or even 40s and find yourself breaking out like a teenager, you’re not alone. Acne can surface well into the adult years—even for those who never experienced it as a teen—for many reasons. Fluctuating hormones, diet, gut health, and stress can all be culprits. By the time patients come to see me, they’ve usually sampled a variety of “outside-in” remedies, such as over-the-counter products like benzoyl peroxides or topical prescription medication like retinoids and antibiotics, but still find themselves combating acne.   As a functional medicine practitioner, I take the “inside-out” approach. Meaning, is there something happening internally that is causing these unwanted flare-ups? 

Chances are, if you’ve gone to a doctor for acne, it is unlikely that diet  is mentioned. Yet, acne has been found to be a disease of Western civilization and practically unheard of in parts of the world shielded from Western dietary influence. So the first thing I do is look at diet. We know that diets that are high in refined carbohydrates (sugar, white bread, white rice, etc.) and soda are associated with an increase in acne. These types of food lead to insulin resistance, which leads to inflammation that worsens acne. Other inflammatory foods include dairy, especially milk, as well as red meat. Eating to improve skin health consists of a Mediterranean style diet that balances blood sugar and decreases excess inflammation from foods. It includes fresh, whole, unprocessed foods; lots of veggies and berries; whole grains; good fats from avocados, olives, and fish (with anti-inflammatory omega 3 fats);proteins (mainly from fish and legumes); nuts; and seeds. What you don’t see is dairy, added sugars and lots of meat. Luckily, chocolate is not a culprit--keep it dark and dairy free. I also like to put a person suffering from acne on an elimination diet to see if they have personal triggers from foods adding to inflammation and gut disruption.

Looking for other sources of body inflammation is also important for decreasing acne, the big one being gut health. Imbalance in gut bacteria, gut infections and leaky gut are all promoters of inflammation. Following the diet mentioned above is one of the first steps towards good gut health, as well as protocols to heal a leaky gut, reducing stress, and adding in certain probiotics, such as those with Lactorhamnosus GG, which has been shown to improve acne too. 

Hormones are another huge contributor to acne. Androgens, a class of hormones that includes testosterone, which are produced in large quantities in men and lesser amounts in women, act on the sebaceous gland to produce more sebum (aka oil). This increased sebum fuels growth of the bacteria c.acnes, which in turn causes inflammation in the follicle and the surrounding area. Some people have higher levels of testosterone (in women, most commonly this is from polycystic ovarian syndrome), however people can also have normal testosterone levels but have an increased sensitivity to testosterone at the level of the skin. Balancing out hormones can be helpful. Both high estrogen and low progesterone can lead to higher effect on the skin of androgens. Stress can also lead to increased androgens.

In fact, stress can add to acne in many ways. Taking care to manage stress and learning how to decrease the sympathetic stress response with meditation yoga, journaling, breathing and maybe adding some adaptogens on board is for sure part of the therapy for acne.

Diving deeper into the body’s root causes of acne can lead to major changes—not just in how good your skin looks, but also how great your body feels. These are not quick fixes, but they are highly do-able, and I always say to give it a good 2-3 months until you’re in the clear. 

The Highs and Lows of Perimenopause

Sleepless and sweaty nights, irritable days, wacky periods? Aren’t hot flashes, night sweats and insomnia part of menopause? Unfortunately, the process, and very real physical and mental effects of menopause, take shape long before the last period stops. Welcome to perimenopause. This long lead up to menopause usually starts in the mid 40s but can begin as early as the 30s, and typically lasts 3-4 years, but it can go on for as long as 10 years. Although women largely experience similar physiological changes, symptoms can vary widely—with a lucky few sailing right through, and others at the mercy of fluctuating hormonal levels and ups and downs that go along with it.

Here’s what’s actually going on: In childbearing years, women usually have a well-timed ebb and flow of estrogen and progesterone, maintaining a harmonious hormonal status quo. Perimenopause upends that balance, and is a time of estrogen dominance. Progesterone is the first hormone to drop, and starts declining in our late 30s. This is where we start to see sleep issues and anxiety, since progesterone’s metabolite promotes sleep and calms the nervous system. Other symptoms can include heart palpitations, heavy periods, depression, as well as hot flashes and night sweats. By the time we are in our 40s, the ovaries start to sputter, with fewer follicles being released and poor quality control. But sometimes the ovaries come to life and release more follicles. This translates to times of super high estrogen and other times of low estrogen. Periods become irregular—ranging from very heavy to light, shorter to longer time between cycles, and/or shorter to longer days of flow. High estrogen symptoms include breast pain, an irritable mood and heavy periods, while low estrogen symptoms can be vaginal dryness, hot flashes, night sweats, insomnia, and poor memory/brain fog. While this sounds, well, intense, it should be comforting to know that everything you may be feeling can be tied back to a physiological reason.

The good news is that perimenopause doesn’t last forever and the ovaries eventually go offline and a low estrogen state then dominates and hormonal fluctuations level out. Having a game plan for this period of time can be extremely helpful. Taking care of adrenal health can have a large impact. High adrenal output can make hot flashes worse. This means managing stress, eating regularly to avoid low blood sugar, exercising, and limiting sugar, caffeine and alcohol intake. Self care needs to be a priority. Magnesium is a great supplement here - it promotes the brain’s calming neurotransmitter, decreases cortisol, and promotes sleep.

Helping the body decrease the amount of estrogen can also make a difference. Estrogen is detoxified through the liver (there are supplements that can support this) and eliminated in poop--in other words, regularity is key. A healthy gut microbiome promotes estrogen detoxification and alcohol interferes with it. Also, be aware of xenoestrogens—chemical toxins that act like estrogens—that are in many items like personal care products, pesticides, and plastics. They can contribute to the estrogen load in the body. And eating phytoestrogens found in some vegetables, soy and flaxseed can also be helpful. Many people find black cohosh and red clover to help with hot flashes and night sweats. Micronized progesterone, or bioidentical progesterone (not progestins like Provera) can be used to balance out estrogen and treat low progesterone. It promotes sleep, relieves anxiety, improves one's ability to cope with stress, supports thyroid function and can lighten heavy periods.

Perimenopause is a bit of a hormonal whirlwind, but steps can be taken to calm the winds and help this transition into menopause. 

Autoimmunity

The immune system’s job is to protect us from foreign invaders like bacteria, viruses, and parasites. Sometimes, that system gets its signals crossed and we see autoimmune disease--that’s when our immune system perceives our own body as foreign and begins to attack our own cells and organs. Antibodies are made against a specific body tissue and tag this tissue to be destroyed by other parts of the immune system. This immune system dysregulation can manifest as at least 80 different known autoimmune diseases, each one characterized by the specific body tissue that is being attacked. For example, antibodies to the thyroid can result in either Hashimoto’s disease or Grave’s disease; or antibodies to islet cells in the pancreas can result in type I diabetes. As in many diseases, genetics may load the gun, but the environment pulls the trigger. As a functional medicine doctor, I want to find out what some of these immune triggers are and work to correct them.

About 1 in 12 women and 1 in 24 men suffer from autoimmune disease and the prevalence is rising. Many people have autoimmune disease but are not diagnosed since symptoms can overlap with a variety of diseases. And many people have a diagnosis but do not know that it is an autoimmune disease—like psoriasis, inflammatory bowel disease and certain types of arthritis. Every person with an autoimmune disease will have a personalized combination of immune dysfunction patterns and immune triggers, even two people with the same diagnosis. That’s what makes it so crucial to search for each individual’s triggers and address them specifically.

Lifestyle factors like sleep, stress, and exercise all have a significant impact on autoimmunity. Poor sleep can increase inflammation. Stress can increase inflammatory cytokines and cortisol which also add to immune dysfunction. Exercise can be a Goldilocks situation with autoimmunity—not moving can exacerbate autoimmunity, as can overdoing it. There is a sweet spot that increases blood flow and opioids, which helps balance out the immune response.

Dietary influence on autoimmunity is huge. Food proteins can act as antigens and be immune triggers. For example, if a person is sensitized to gluten they will start to make antibodies to gluten. Parts of the thyroid have similar protein sequences that resemble gluten and these antibodies will mistake the thyroid for gluten and attack it, leading to autoimmune thyroid disease. The more gluten eaten, the more the thyroid can be destroyed. This is called cross reactivity and is a frequent mechanism in autoimmunity. Common food triggers include gluten, dairy, grains, lectins, nightshades, and salt. 

Chemicals are another trigger for autoimmunity—often binding to proteins in the body and changing their structure so they are no longer recognized as self tissue and are then a target for attack by the immune system. Supporting detoxification in these situations can be helpful.

Pathogens are another big trigger. These can range from bacteria to viruses to parasites to molds and yeasts. Screening for specific pathogens and supporting the immune system is important. Current research shows that SARS CoV-2 may be a major player in triggering autoimmunity. One researcher referred to this virus as “the queen of autoimmunity” with potential cross reactivity between our human tissue and this virus. It is also theorized that autoimmunity caused by SARS CoV-2 may be behind the suffering of the “long haulers”.

Autoimmunity is a complex disease. If you aren’t feeling well, have been to multiple doctors but nothing has truly helped, various treatments may have helped at certain times, consider looking into an underlying autoimmune condition. Although we can’t erase autoimmunity once it has been turned on since the body has memory T cells that never forget, we can work on the triggers for autoimmunity and make a person feel better by helping them into remission and preventing flare-ups.

Premenstrual Syndrome (PMS)

A woman’s period acts like a monthly report card about the body: when all is well, it might arrive with little fanfare or warning, but when there are imbalances in the body it can come with the dreaded entourage of PMS symptoms like headaches, irritability, food cravings and so on. Oral contraceptives can help control PMS by wiping out hormonal fluctuations, but there are plenty of natural approaches that can be tried with great success. 

Women’s cyclical pattern of hormones is purposeful. The first half of the cycle is estrogen dominant and the second half of the cycle, post-ovulation, is progesterone driven. Estrogen is considered the feel good hormone and boosts serotonin and dopamine. However, too much estrogen can cause irritability and overstimulation. Progesterone is known as the soothing and calming hormone and is anti-inflammatory as well, and helps smooth things out when estrogen begins to fall. 

PMS affects about 40% of women of reproductive age, and  is composed of a wide range of both physical and emotional symptoms in the week or two leading up to  a menstrual period. Symptoms can include breast discomfort, fluid retention, food cravings, abdominal bloating, back pain, headaches, acne, anxiety, depression, feeling overwhelmed, irritability, mood swings, tearfulness, and lack of concentration. The precise etiology of PMS is not known but some theories have to do with hormone imbalance, issues with neurotransmitters, prostaglandin dysregulation, nutrient deficiencies, stress and inappropriate cortisol response, inflammatory diet, and environmental and psychosocial factors. I like to take a multifactorial approach when treating PMS and start off by looking at hormonal modulation, diet, stress, and inflammation.

Hormonal modulation usually involves enhancing progesterone production, detoxifying estrogen properly, and reducing inflammation. Having an anti-inflammatory diet full of whole, fresh foods with a reduction in wheat, dairy, and sugar leads to less body inflammation. This enables better ovulation and better progesterone production, as well as better functioning receptors for progesterone and GABA, the calming neurotransmitter. Alcohol can interfere with the calming effect of progesterone, so the less the better. Inflammation also blocks progesterone receptors and makes estrogen more stimulating. Supplements like chaste tree, selenium, vitamin B6, and magnesium can also help with progesterone production. Evening primrose oil may be helpful in reducing inflammatory prostaglandins. Preventing a build of up estrogen by helping the body detoxify and get rid of it can really help with PMS symptoms too. Reduce alcohol, avoid chemicals that are estrogen mimickers that are often found in plastics and pesticides, ensure a healthy gut and microbiome, work on any constipation issues, and eat phyto-estrogens (a weaker plant form of estrogens) such as ground flaxseeds, chia seeds, and brightly colored veggies. B vitamins, black cohosh, probiotics, and occasionally calcium-glucarate are helpful supplements for balancing out estrogen.

Stress plays a large role in PMS. Stress hormones like cortisol and adrenaline block receptors for progesterone. Stress reduction techniques and using adaptogens, stress modifying herbs like rhodiola, ashwagandha, ginseng, and eleuthero, can balance out the stress response. 

Don’t feel that PMS has to be a monthly occurrence. It is a condition that responds wonderfully to nutritional and lifestyle changes coupled with certain supplements and herbs. It may take a few cycles to see results, but when that next period appears with little fanfare, the only warning will be the one in your calendar.

Adaptogens

Feeling anxious, stressed, fatigued, or over it all? You’re far from alone. The pandemic, the “new” normal that’s anything but, our current political climate, along with everyday stressors have taken their toll in more ways than we could have imagined. As we head into the colder, darker days of winter it’s impossible to overstate the importance of checking in with ourselves to see what we need during this time. Maybe it’s more sleep, keeping a healthier diet, exercising, staying connected to loved ones, or taking a sliver of time to read a good book. Herbal adaptogens are another way to provide some much needed stress relief.

Adaptogens are types of herbs that help us deal with the stress and demands of life, and literally help us adapt to different situations. They increase endurance and maintain a state of balance during physical or emotional stress, thereby improving our health and well being. Unlike pharmaceuticals, adaptogens are not used as “a pill for an ill”. They do not simply alleviate symptoms, but act like a general tonic for the mind and body, promoting health by countering the negative effects of stress and improving resistance. Adaptogens can have different properties, from soothing to more stimulating, and can be blended with different herbs and nutrients for the best results. Let’s take a look at a few of these amazing herbs.

Ashwagandha (Withania somnifera) is a calming and deeply relaxing herb. It helps decrease anxiety, improve cortisol levels, and can help with falling asleep. It also helps with musculoskeletal pains including achy joints and chronic muscle tension. It can help to decrease inflammation, as well as improve blood glucose and cholesterol levels. It is very safe, but caution is advised if sensitive to nightshade plants because it is in the same family.

Reishi (Ganoderma) is another calming and relaxing adaptogen that is a medicinal mushroom. It is known for its immune boosting capability. It’s also good for anxiety and feeling overwhelmed. This adaptogen will help to improve the quality of sleep and help with detoxification as well.

Holy Basil (Ocimum sanctum), aka Tulsi, is a neutral herb that acts as a gentle tonic for the mind, mood, and boosts immunity. It elevates mood, helping with anxiety and mild depression. It reduces stress and fatigue. Holy basil is also helpful to motivate a person to make changes. Lowering blood sugar and cholesterol can result as well with this adaptogen.

Eleuthero (Eleutherococcus senticosus) is the most extensively studied adaptogen. It’s a stimulating adaptogen—think a performance- enhancer both in the physical body and mental work capacity. It increases stamina and energy as well as focus and alertness. It can be especially helpful for people who work night shifts or very long hours that interfere with sleep. It also has an immune-enhancing antiviral effect. If you have insomnia, better to take before noon or skip this one. And not suitable for those with high blood pressure.

Rhodiola (Rhodiola rosea) is also a stimulating herb that is very good for anxiety. It induces a sense of well being with decreased anxiety and improvement in depression. It is also known for its ability to enhance mental and physical performance and can help with exercise recovery and exercise induced muscle damage and inflammation. It can improve immunity as well as libido. Rhodiola should be avoided if you have bipolar depression with mania.

If you are new to adaptogens, start with something gentle and that can be incorporated in all circumstances, like ashwagandha. Many adaptogens work well together and can be purchased as a combination product. I think of adaptogens as an extra layer to be added in while covering the basics of health—nutrition, sleep, exercise, stress, and sense of purpose and community. 

Small Intestinal Bacterial Overgrowth (SIBO)

Complain about ongoing gut issues like bloating, chronic constipation, diarrhea, or a seemingly unending cycle of gastrointestinal malaise, and after months of poking around without a definitive culprit, you’re likely to be told you have Irritable Bowel Syndrome (IBS). You may be given medications, supplements, told to eat more fiber, less fiber, avoid gluten—sometimes this works, and sometimes your symptoms don’t budge at all. Up to 25% of the worldwide population has IBS, making it the most common gastrointestinal (GI) disorder, but there’s a tendency to throw hard-to-pin-down stomach ailments into this bucket without further diagnosis. Good news: Research has now shown that a condition called SIBO is the underlying cause for the majority of IBS, and on average 60-70% of people with IBS have SIBO—and may not have to live with it.

SIBO is a condition where normal gastrointestinal (GI) bacteria accumulate in the small intestine at havoc-wreaking levels. Normally, the small intestine (SI) has very low bacterial counts, and goes about its job digesting food and absorbing nutrients. But when too many bacteria accumulate in the SI, they harm its structure and function. These bacteria compete for food, chowing down on fermentable carbohydrates, which produces lots of gas - enter bloating, pain, gas, belching, nausea, reflux, constipation, diarrhea or both. The bacterial overgrowth also damages the SI tissue, causing food intolerances and malabsorption, which can show up as nutrient deficiencies and anemia.

In functional medicine we are always looking for the cause of the cause of the cause-and this applies to SIBO as well. While we naturally want to alleviate symptoms, we also want to get closer to the root cause to help prevent recurrence. About one-third of SIBO cases are gone for good after one treatment, but two-thirds of SIBO cases are considered chronic and need some sort of periodic treatment to keep symptoms at bay. There are myriad causes of bacteria build-up in the SI: slow motility, structural issues in the GI tract that can block or trap bacteria; back migration of bacteria into the SI from the large intestine;  or incoming bacteria that are not being killed by normal paths like stomach acid, enzymes, bile or the immune system. One of the most common underlying causes is food poisoning (could look like the stomach flu) which damages the nerves that sweep bacteria down through the SI. Other causes include hypothyroidism; abdominal adhesions from previous surgeries, infection or endometriosis, low stomach acid; medications like opiods, proton pump inhibitors or antibiotics; or certain disease states such as scleroderma, diabetes or Crohn’s disease. 

I know that’s a lot to digest (pun intended). But here’s the easy part: SIBO is diagnosed by a non-invasive breath test that can be done at home (some gastroenterologists perform it in the office). Patients consume a lactose containing solution and then collect breath samples every half hour for about 3 hours. These samples are analyzed for the presence of gases made by the overgrowth of bacteria: hydrogen, methane, and hydrogen sulfide.

The treatment for SIBO depends on what type of gas is produced and can consist of antibiotics, herbal antimicrobials, or an elemental liquid diet. A SIBO diet is also initiated to help with symptom relief by decreasing the type of food the bacteria “eat” to produce gas. There are a few different types of diets, but all are low in FODMAP foods (fermentable types of food, like beans and onions for example). A promotility agent is then started to help keep the SI bacteria moving down the SI instead of setting up camp.

Although SIBO has been around for a while, it is just starting to gain more attention in the medical community.. If you have symptoms consistent with IBS or SIBO, bring it up with your doctor or find a one who specializes in its treatment. And if you’re unsure, my best advice is to follow your gut.

What is a Healthy Diet?

Food is more than the thing we simply reach for when we are hungry. Food is information for our bodies. Every morsel we put into our mouths can turn on or off different genes that have an impact on health. For instance, apples and onions contain quercetin,  a substance that can activate a protein turning on genes that encode many antioxidants and detoxifying enzymes. Food can nourish our bodies by providing a multitude of vitamins and nutrients that are essential for our bodies to work properly. Improvements in diet have been associated with lengthening of lifespan and major decreases in the risk of most chronic diseases. 

In my practice, I think about diet in a very holistic way—from what we eat to how we eat, as we can reap more health benefits when we take into consideration the whole experience of eating.

So what exactly does a healthy diet consist of and how can we optimize it? I am using diet here as a term we are all familiar with, but it’s not a term I love because it often connotes a restrictive way of eating and we are solely talking about the kinds of food a person eats. We are continuously bombarded with contrasting versions of “the best diet”—low fat, high fat, low carb, vegan, vegetarian, Mediterranean, paleo—all of which makes it very confusing when knowing what to eat for healthier outcomes. There have been no good comparative scientific studies to conclude one diet is superior to others, but there are common themes that have been found across different diets that have shown to promote health. The author Michael Pollan sums it up perfectly, “Eat food, not too much, mostly plants.” Eating a diet that consists of minimally processed foods that are close to nature and the majority of which are plants has been associated with disease prevention and health promotion. Another way to say this is cut out the boxed and processed crap and eat real food with a whole lot of vegetables and some fruits. Do I advise all my patients to follow the same diet? Yes and no. I encourage a whole foods, heavily plant based, diverse diet and then depending on the individual’s needs, I’ll  make specific changes.

There are also other aspects to a healthy diet that are not as obvious. Eating quality food goes a long way in terms of health. Not only do we want our food to be real, but organic and as free of human-made toxins as possible. Fresh, locally produced, nutrient dense, and tasteful also fall in the quality category. We can also think about how our food was grown and harvested and the impact on the environment and farm workers. How we eat is another important part of a healthy diet. For example, when we rush through a meal and eat in a stressed state, digestion goes out the window, leading to sub-optimal nutrient absorption and digestive upset. Although we get our nutrients from eating, which is crucial, we can’t forget about the pleasure and connectedness that can come when sharing a meal or appreciating the meal in front of us. This is nourishment for both the body and the soul.

My advice is simple: eat real food with plenty of vegetables while having a mindset of relaxation, appreciation, and love. This will put you on the path to improving your overall health and decreasing your lifetime risk of chronic disease. Bon appetit!

The Sunshine Vitamin

Vitamin D, aka the Sunshine vitamin, is actually considered a hormone. Although it is well known for its positive effect on bone health by helping the intestine absorb calcium and promoting bone mineralization, it has many other roles in the body. It enhances the secretion and action of insulin, the hormone that regulates blood sugar. It plays a part in the functioning of the neuromuscular system and cardiovascular system, it reduces inflammation, regulates cell growth, and sensitizes tissues to be more responsive to thyroid hormone. Vitamin D is also very involved in immune function. Receptors for vitamin D are expressed on the majority of immune cells. 

Vitamin D is made in our skin after exposure to sunlight, specifically UVB light. It becomes active after enzymatic reactions in both the liver and kidney. A small amount of vitamin D can also be consumed in the diet from oily fish like salmon and sardines, cod liver oil, beef liver, and vitamin D fortified foods. However, it is hard to get enough vitamin D in the diet alone. 

Vitamin D deficiency in kids results in a softening and deformity of the bones called rickets. Adults can get a similar softening of the bone called osteomalacia, which can be accompanied with bone pain, and muscle weakness and impairment. Vitamin D deficiency impairs immune function. There is an association between low vitamin D levels and several autoimmune diseases such as lupus, inflammatory bowel disease, rheumatoid arthritis, autoimmune thyroiditis, multiple sclerosis and type I diabetes. Poor vitamin D status has also been associated with increased susceptibility to viral and bacterial infections. Studies have shown that vitamin D supplementation can prevent acute respiratory infections, especially in very vitamin D deficient people. Observational studies have reported associations between poor vitamin D status and increased risk of developing colorectal and breast cancer. A study that was just released showed that high dose vitamin D given to patients hospitalized with COVID-19 significantly reduced ICU admissions and reduced the severity of the disease. Although this was a small study and needs to be carried out in larger trials, this is a pretty impressive result for our sunshine vitamin.

This brings us to the question  - should I be taking vitamin D, and if so, at what dose? There is no one answer to this since everyone is different. There are certain factors that lead to vitamin D deficient or insufficient states that need to be taken into account. These include where you live, your age, the color of your skin, your weight, your sun exposure, genetic mutations in the vitamin D receptor, medications, as well as malabsorptive conditions of the gut. The only way to know how much to take is to check a blood level of vitamin D - 25(OH)D. There is some controversy on what the ideal level should be, but studies have shown that the sweet spot is somewhere between 40-60ng/mL. Levels in that range have been shown to decrease all-cause, cardiovascular, and cancer mortality in a recent study. Some feel higher levels are needed for certain conditions. There is a risk of toxicity if you do take too much - more is not always better. 

Most people will not go wrong taking 2000IU of vitamin D3 daily, however many will need a larger dose. Getting some sunshine would be ideal and sneaking in some foods higher in vitamin D as well. Although there is just a small study showing a possible relationship between COVID-19 prevention and vitamin D, given its track record with other viral illnesses and its performance with hospitalized COVID patients, it is certainly in my regimen for keeping healthy in these crazy times.

Vitamin C: the nutrient of the day

Since COVID-19 hit back in March, Vitamin C has been flying off the shelves and production has been having a hard time keeping up with demand. People are tuned-in to the immune supporting aspects of Vitamin C. Although in high demand now, Vitamin C has been a key nutrient since it was first isolated in 1923, and has been recognized for its important roles in many metabolic functions in the body. 

Vitamin C is a water soluble vitamin that is essential to life. It doesn’t accumulate in our fat to toxic levels like fat soluble vitamins can. Unlike most mammals, us humans have lost the ability to synthesize vitamin C and we depend on external sources of vitamin C from our diet and supplements. Citrus fruits, red and green peppers, strawberries, tomatoes, broccoli, brussel sprouts, turnips, and cantaloupe, amongst other fruits and vegetables are all high in the vitamin C department. When we don’t get enough vitamin C we can become insufficient and eventually become vitamin C deficient. This is a disease called scurvy. It is not super common in developed countries, but can happen. An increased need for vitamin C and/or decreased intake or absorption can lead to vitamin C deficient states. It can manifest as fatigue, easy bleeding and bruising, poor wound healing, hair and tooth loss, and joint pain and swelling due to weakening of blood vessels, connective tissue and bone - all of which need Vitamin C. Vitamin C deficiency also contributes to decreased immune responsiveness and increased susceptibility to infection.

Vitamin C is a powerful antioxidant. It is an electron donor and can directly donate electrons and neutralize harmful free radicals. Free radicals are generated from normal metabolism such as active immune cells, as well as through exposure to toxins. Free radicals are molecules that are missing an electron and can damage structures they come in contact with like proteins, lipids, DNA, and cell membranes in our bodies, in order to gain another electron. Neutralizing these free radicals is protective and prevents damage that can lead to inflammation, aging and disease. Vitamin C also acts as a cofactor for many different enzymatic reactions. These reactions can’t go forward without vitamin C present.

Vitamin C is a cofactor for collagen, the basic building block of connective tissues like the skin, teeth, bones, blood vessels, and tendons. It is an important nutrient in wound healing. It is involved in making norepinephrine, one of the main neurotransmitters in the sympathetic nervous system. During stressful times we make more of this neurotransmitter, and use up more vitamin C. Vitamin C also has many positive effects in cardiovascular disease, cancer, allergies, cataracts, and high blood lead levels.

In terms of immunity, vitamin C upregulates the production of white blood cells, enhances the microbial killing by neutrophils while protecting tissues from collateral damage, and reduces proinflammatory molecules. Regular use of vitamin C has been shown to shorten the duration and severity of the common cold, but has not been shown to reduce the risk of becoming ill. It did however halve the incidence of getting a cold for people undergoing heavy physical stress, like intense athletic or military training. Vitamin C has been shown to shorten intensive care unit (ICU) stays, shorten the duration of mechanical ventilation needed in ill patients, and decrease the death rate in patients with sepsis. Studies are underway looking at Vitamin C as part of treatment for hospitalized patients with COVID-19, but anecdotally high dose intravenous vitamin C has been successfully used in the treatment of moderate to severe COVID-19 patients. 

Vitamin C is truly a powerhouse nutrient and is definitely on my short list of go tos for helping to improve immunity. I recommend 1-2 grams daily in divided doses and increasing that dose multiple times throughout the day at the onset of illness. One of the signs that you have overdone it is diarrhea and you would then cut back a bit on the dose. Caution is advised in those with G6PD deficiency, kidney disease and kidney stones.

Clean Air: the connection between environmental racism and COVID-19

As COVID-19 cases continue to soar across much of the country, we are beginning to learn about some of the factors that increase one’s susceptibility to the virus, as well as the morbidity and mortality associated with it. According to recent studies, air pollution, especially from fine particulate matter (PM2.5), has been linked with an increase in the COVID-19 death rate. One researcher stated that long term exposure to air pollution may be one of the most important contributors to deaths caused by the virus. It has also been shown that racial and ethnic minorities are exposed to 35% more air pollution than the average person in the US, and black people specifically are exposed to 54% more air pollution than the average person. Data compiled from hospitals in 14 states show that black people account for 33% of COVID-19 deaths when they make up only 18% of the total population in those same states. This pandemic highlights the connection between environmental stressors, like air pollution, disease, and the toll it takes on minority communities. This phenomenon is known as environmental racism, which is a form of social inequity which subjects minority communities to disproportionate impacts from environmental hazards. Recent examples include lead contamination in the municipal drinking water in Flint and Newark.

I trained in a hospital in the South Bronx where I spent countless nights clocking the respiratory rates of children, watching their chests move up and down and looking for any signs of respiratory distress, while the nebulizers buzzed and the coughs and audible wheezing filled the air. Pediatric asthma rates in the Bronx far exceed the national average rates and Bronx children are twice as likely to be hospitalized for asthma and more likely to die of asthma than other US children. Black and Latino people make up the majority of the population there. Although there are many factors that contribute to these statistics, air pollution is a major one. I never really took that into account. We focused on the inhalers and steroids, talked about environmental allergies, all important, and even life-saving, but we did not address one of the major root causes - air pollution.

The WHO places air pollution among the top global risks to health. Thought sitting was the new smoking? Nope, it’s air pollution. PM 2.5 stands for particulate matter that is 2.5 micrometers or smaller and is inhaled into the lungs and can also be absorbed into the bloodstream and causes not only respiratory diseases, but cardiovascular diseases as well. Both of these are factors that increase the morbidity and mortality from COVID-19. Long term exposure to PM 2.5 can play a role in high blood pressure, diabetes, heart failure, and increased infant mortality. It is also a known carcinogen and can cause reproductive and central nervous system dysfunction, as well as have implications in neurodegenerative diseases like Alzheimer’s and Parkinson’s. The majority of environmental pollutants come from industrial machinery, power-producing stations, refineries, chemical and fertilizer industries, combustion engines and cars. Other sources include dry cleaners, gas stations, and natural sources like forest fires.

Communities of color have been experiencing environmental racism for decades, increasing the risk of disease burden from environmental toxins like air pollution. Preliminary studies show that many of these diseases increase the risk of death in those with COVID-19. This is likely a major contributor to the disproportionate amounts of deaths from COVID-19 in communities of color. Racist and exclusionary policies have led to underinvestment in communities where many people of color live. This manifests as housing discrimination, lax legislation, corporate greed, and insufficient community representation. Lower property values lead to increased industrial acquisition, often the initial step in the cycle. Adding fuel to the fire is the weakened EPA which has reduced enforcement of environment regulations during this pandemic.

Environmental racism was not a concept I was aware of nor taught in my training. Knowledge and awareness of the issue is a start to change. Local, state, and federal laws need to be put in place to begin to reverse environmental racism. Residents need to be protected from industries that directly pollute neighborhoods. Environmental justice needs to be a priority.

The Importance of the Gut in Immunity

Gastrointestinal (GI) health has always been the cornerstone of health in the integrative medicine world and it is even more important these days as we continue to face COVID-19. If you want to get your immune system in shape, focus on your gut. The gut houses 70% of the immune system, making it a huge player in optimizing immune function. It can be a major source of systemic inflammation, and getting rid of non- purposeful inflammation is a priority for health, especially in light of COVID-19 which can cause an enormous inflammatory response. A healthy GI system is also key to proper digestion and absorption of food, which is needed to obtain many of the nutrients for the immune system.

The gut can be detrimentally affected in many different ways: overuse of antibiotics and steroids, proton pump inhibitors, frequent use of NSAIDS, a poor diet containing many processed and inflammatory foods, nutritional insufficiencies, impaired digestion, over use of alcohol, smoking, food sensitivities, toxins, infections, stress, head trauma, and even over-exercising. These factors, amongst others, can lead to an imbalance of the microbes in the gut called dysbiosis, and all of these can cause intestinal permeability, or leaky gut. 

A leaky gut can manifest with digestive issues like gas, bloating, diarrhea or constipation, but it can also cause symptoms unrelated to GI issues such as food intolerances, autoimmune diseases, chronic fatigue, brain fog, and skin issues. The main concern with having a leaky gut is that it leads to activation of the immune system, which causes chronic inflammation. With a leaky gut, substances that are not normally seen by the immune system, including certain bacteria and foods, travel from the gut into the bloodstream, are seen as invaders by the body and trigger an immune response.

Having a well balanced GI microbiome and fixing any dysbiosis is super important in supporting the immune system. It helps with leaky gut, leading to decreased immune activation. The beneficial microbes produce short chain fatty acids (SCFAs) like butyrate that support immune cells in the gut and decrease inflammatory cytokines. They also produce many vitamins and activate plant compounds we consume so we are able to reap their benefits. And an optimized GI microbiome can induce the secretion of the immunoglobulin secretory IgA (sIgA) from immune cells in the gut. sIgA acts as the first line of defense against bacteria, viruses, toxins, and food allergens by preventing these substances from binding to epithelial cells and getting into the body, thereby halting a potential infection or inflammatory response.

So what do you need to do to make your gut healthy? The number one priority is to clean up the diet. Take out the junk food, the sugar, the processed foods, the non-organic grain fed meats, the alcohol, and any foods you may be sensitive to and eat a nutrient dense, whole foods diet. Give the vegetables a whole lotta love. The more diverse, the better. Add in probiotic foods such as sauerkraut and kimchi and feed the good bacteria in the gut with prebiotic foods like asparagus, jerusalem artichoke and jicama. The microbiome can change within days based on what you eat. Changing the diet can be much more powerful than popping a probiotic. Rest and digest while you eat. Sit down, take a few breaths, and slowly enjoy your food. Think twice about whether you really need that NSAID and use antibiotics judiciously. Manage your stress. Stress can absolutely tank your sIgA. Starting with these tips will get you well on your way to a healthy gut and improved immunity, and you can find a functional medicine provider to further help you along the way.

What the Heck is an Antibody Anyways?? The Basics of COVID-19 testing

Testing around COVID-19 has been a mess. Tests have not been available, tests have not been reliable, which test do you get? It is all pretty confusing. Let’s lay out some ground work to help understand some of the testing for SARS-CoV-2, the virus that causes COVID-19.

When our bodies are exposed to a virus we first try to fight it off with our innate immune system. This includes substances such as our skin, mucous on our membranes, and non-specific types of white blood cells. These defenses are ready to go immediately whenever there is an invader. If the invader is not dealt with by our innate immune system, about 4-7 days later our adaptive immune system kicks in. Our cells start to make proteins that can attach to the invader, such as a virus, and tag them so that other cells can come and destroy the tagged invader. These proteins are called antibodies and are very specific to the invader they are trying to have killed. 

When a person is thought to have the virus, whether they are acutely ill or asymptomatic, they need to have a test that will look for the actual virus itself. This is most commonly done via a nasopharyngeal swab that collects the RNA - the genomic blueprint of the virus. There is also a saliva test that has just been FDA approved. This small bit of RNA that is collected is then amplified by a method called polymerase chain reaction (PCR) so that there is enough material for a test to detect it. If this test is positive, the person has COVID-19. If this test is negative, the person could be negative. There also could be false negatives where the test is negative but the person really does have the disease. This could happen if there was a sampling error (did the swab get enough material?), a processing error (was the swab kept at the correct temperature?), or a timing error (too late in the disease process?). It is thought that the amount of virus tends to peak at or just before symptom onset followed by a rapid decrease. This means that the earlier this test is done, the more likely it is to be positive. Less than 7 days after the onset of symptoms is ideal, but can go out to 21 days after exposure.

When a person wants to know whether they have had the virus or not, regardless of whether they were symptomatic, they need to have an antibody test done. This is a blood test that checks if a person has antibodies to specific portions of the virus. This test is not used to diagnose someone with COVID-19. The antibodies start to rise about 5 days after an infection begins and lasts for likely months or more, but it is not known how long. The best time to test for antibodies is at least 15 days after exposure to the virus so the body has had time to mount an adequate antibody response. If a person has a positive antibody test it means that they have most likely had COVID-19. These antibody tests seem to be pretty specific, meaning if they are positive they are positive to the SARS-CoV-2 virus and not some other coronavirus they may have had in the past. The higher the prevalence of the disease in the community, the more likely the test is a true positive. There could be some false negatives with this test as well. The test could have been performed too early, a person may have an immune deficiency and not have an antibody response, or not have a robust enough antibody response to the particular viral protein to be detected by the test.

There are still lots of unknowns around this virus and testing. The biggest question is does having antibodies mean that a person is immune to the virus and won’t get reinfected? A recent study in monkeys shows that this is the case. It's yet to be determined in humans. And if it is true - how long does this immunity last? Only time and more scientific research will tell, but in the meantime we can support our immune system by having a nutrient dense diet, getting some exercise, a good night’s sleep, and managing our stress. 

COVID-19 - some facts and some thoughts

I’ve been reluctant to write anything at all about Covid-19 because we just don’t know much about it. The scientific studies we normally turn to in order to help guide us with strategies for prevention and treatment are pretty much non-existent for this novel virus, especially in terms of natural supplements. So I would like to put a huge disclaimer here stating that the information below is based on extremely limited data and the prevention and treatment protocols are based on theoretical mechanism of action, and/or studies in animals, cells or with different types of viruses. And much of it gleamed from webinars and articles from some very smart people.

Here goes….

How do we think SARS-COV-2 works?

COVID-19 is a disease caused by the new coronavirus (SARS-COV-2) that is thought to have come from animals, likely bats. Viruses can not reproduce by themselves and need the host body to help them. They attach to cell surfaces by way of receptors, make their way into the cell and basically hijack the cell to make more virus particles. These new virus particles then spread to infect other cells. Our bodies respond to the viral illness by activating the immune system to try and kill the virus, pouring out cytokines, protein messengers that direct the immune system, causing fever and inflammation. Cell damage and tissue destruction are collateral results of trying to kill the virus. It is not the virus that is doing the damage, it is the over response of the immune system.

The coronavirus binds to a cell receptor on a cell called the ACE2 receptor, which is found mainly in the lungs, kidneys, vasculature, and gastrointestinal tract, and likely the brain. It seems to bind very tightly to these receptors. In order for the virus to then get into the cell, it needs to fuse with the host cell membrane. Research has also shown that this coronavirus, unlike other coronaviruses, allows the virus to get into the cell more easily. 

Once the virus is in the cell it activates a very strong immune response and produces the inflammasome. This is a collection of receptors, mediators, and proteins involved in an inflammatory response. Normally, when we are infected, we have an inflammatory response, kill the pathogen, and resolve the inflammation. But with this coronavirus we are seeing a huge inflammatory response and inability to turn off the inflammation, resulting in a “cytokine storm” with lots of inflammation and tissue damage, ultimately culminating in ARDS - acute respiratory distress syndrome, which requires ICU care and intubation.

What can we do about it?

I am not going to dwell upon what has already been beaten into our heads about staying home, social distancing, and washing our hands. Just do it.

I am going to talk about other possible ways to help prevent the infections and possibly things that could help if we have it. Functional Medicine really shines here because focusing on lifestyle and inflammation is so important.

Overall it is a good idea to work on decreasing our baseline inflammation so that we are in a better place inflammatory wise if we do get the coronavirus.

Lifestyle:

Sleep 

-Get enough of it. Turn off the news and get to bed on time. We know that lack of sleep is actually a source of inflammation and that sleep is the time our body repairs and detoxifies, so make it a priority. Also limit night time artificial light that can be problematic for our sleep because it decreases melatonin, which we do not want to do. See below for melatonin info.

Stress

-There is no doubt about it that these are extremely stressful times. Even going to the store, if that is a possibility, is a giant source of stress. Stress can make our immune system take a hit, so take the time to breathe, meditate, and exercise. There are a ton of online resources out there, many for free, such as apps like headspace, 10% happier, calm, and Peloton is free for 90 days.

Exercise

-We know low to moderate intensity exercise decreases cortisol, our stress hormone, and improves immunity. Although we are limited in what we can do right now (I so miss my swimming), find new ways to move your body. Walk or jog, videos for strength training, high intensity interval training, yoga and the like are all over the internet.

Diet

-This is major. We want to keep ourselves nourished with as nutrient dense a diet as we can to provide the vitamins and minerals we need. Taking out inflammatory foods like gluten, dairy, and sugar can help us decrease our baseline of inflammation which can be very beneficial. Increase fruits to 2-3 servings a day and 5-7 servings of veggies/day. I know this is easier said than done when access to food is somewhat limited, but try to make good choices for your body.

Connection 

-We are all in this together, even though we are not physically together. We can reach out by phone, or internet to friends and family and still stay connected during this time. We can look out for those in need and help where we can, even if it’s just checking in on someone to say hello.

Supplements:

Vitamin C

-can decrease the inflammasome and thereby decrease inflammation

-increases immune cells and is directly antiviral

-antioxidant

-supports Vitamin E and Glutathione - other antioxidants

-it is best taken in 500-1000mg increments every few hours. 1 gram 2x/day is good for prevention

-if sick - 1 gram every HOUR to bowel tolerance. If you take too much you can get loose bowel movements and then can cut back

-caution to people with kidney stones - can exacerbate

Vitamin D

-large role in preventing respiratory infections

-helps balance out the immune system

-5000IU - 10,000IU/day possibly more- depends on your vitamin D level

-high dose Vitamin D can be helpful at initial signs of symptoms, especially if not already taking vitamin D, this would be 50,000IU Vitamin D 1-2x/day x 3 days and then stop and reduce to 5000-10,000IU/day

-caveat: Vitamin D has been found to increase one of the inflammatory cytokines, and there is thought that maybe it should be discontinued with active infection. My feel is that it does more good than bad, but the jury is out.

Vitamin A (not beta carotene)

-enhances immune function

-reduces morbidity and mortality in different infectious diseases

-5,000-10,000 IU/day

-do not take Vit A without taking Vitamin D - we need a balance

Zinc

-extremely helpful for general immune support and an antioxidant

-increased intracellular zinc concentrations may inhibit viral replication

-chloroquine enhances cellular zinc uptake - may be why it is possibly effective in coronavirus

-lack of smell and taste are classic signs of zinc deficiency

-prevention 20-30mg/day with food

-active infection 20 - 30 mg 2x/day, take with food

-after infection, decrease dose and balance with copper 15mg zinc/1 mg copper

-too much can actually be immunosuppressive

Melatonin

-not just for sleep, but that’s a bonus

-a potent anti-oxidant and has been shown to shut down the inflammasome and inflammation.

-it is interesting that young children and pregnant women get less COVID-19 disease, and they both have high melatonin levels.  Melatonin does decrease as we age

1-3mg at night could be helpful. More if sick - upwards of 10mg

Quercetin 

-may prevent the virus from binding to and entering the cell.

-It is also an antioxidant

-can bind to zinc and increase the amount of zinc in cells

-helpful in allergies

-up to 500mg 2x/day 

-clinical trials are scheduled to start in China in a few weeks using Quercetin with the coronavirus

Resveratrol

-shown to inhibit the MERS virus in cells

-it is a great antioxidant and can help with inflammation

-200-400mg 2-3x/day

N-Acetyl Cysteine - NAC

-precursor to out master antioxidant, glutathione

-shown to inhibit viral replication in influenza

-can thin out thick mucus secretions

-likely helpful for lungs

-taking tylenol depletes glutathione which can be a real problem, NAC helps replete it

-at least 900mg 2x/day

Glutathione

-master antioxidant in our bodies and protects against oxidative stress

-low glutathione will equal a low antiviral response

-can have worse respiratory disease with low lung glutathione

-500/mg day in divided doses if ill, or 100mg 2x/day for prevention

Stinging Nettle Root

-has shown to have decreased lung disease in SARS-COV in mice models

-antiviral activity in other viruses

Other supplements to increase our immune response:

-Astragalus 500mg 2x-3x/day

-Reishi 400mg 2-3x/day

-Andrographis - 400mg 2-3x/day

-Echinacea 500mg 2-3x/day

-Beta -glucans

If someone is infected and not improving - these immune support options listed above should likely be stopped and emphasis placed on dealing with inflammation rather than ramping up immune system

Fish Oil

-anti-inflammatory

-thought it gives omega 3 fatty acids to make pro-resolving mediators

-2-3 grams/day would be a good starting dose

Specific Pro-Resolving Mediators (SPMs)

-help to reduce inflammation in active stage of disease to help deal with overactive, nonresolving inflammation

-we make SPMs but not all can make them well, especially in chronic inflammation where there is failure to resolve inflammation

-Metagenics SPM active - 2 caps 2-3x/day with active infection

Early on in the process we are concerned with enhancing our immune activation so we can better fend off and fight this disease. If we become infected, we become concerned about too much inflammation and want strategies to help deal with that.

What is a good plan for prevention?

-Vitamin D - 5,000-10,000 Iu daily

-Vitamin C - 1 gram 2x/day

-Vitamin A - 5000IU daily

-Zinc 20-30mg/day with food

-melatonin 1-3mg at night 30 min before bed

-NAC 900mg 2x/day

What is a good plan if I get the virus?

-continue Vitamin D, A, NAC

-increase Vitamin C 1 gram every hour or to bowel tolerance

-increase zinc to 20-30mg 2x/day with food

-increase melatonin 6-10mg at night 30 minutes before bed

-add Quercetin 500mg 3x/day

-add Resveratrol 200-400mg 2-3 x/day

What is a good plan if I am getting really sick?

-consider stopping Vitamin D?

-continue Vit A, C, zinc, quercetin and melatonin

-increase Resveratrol to 400mg 3x/day

-add glutathione 500mg/day

-add stinging nettle root

-add Specific Pro-resolving mediators -Metagenics SPM active - 2 caps 2-3x/day 

A COVID-19 protocol should be tailored to the individual person and there is no one plan fits all. Speak with your healthcare provider

These are not FDA approved and are only suggestions that could possibly help

Be safe and stay healthy!

“5G done right” - really?

If you want to worry about something other than Covid-19….

Electromagnetic fields (EMFs) are all around us - home, school, the office, the coffee shop. Our modern technology is a huge source of these EMFs. It’s hard to imagine life without all this technology - but are we paying a price for it? Lets get some facts on the health dangers of EMFs and tips on how best to protect ourselves

Electromagnetic fields (EMFs) are radiation-invisible fields of energy that are produced by electricity. We have had natural EMFs coming from the sun and the earth since the beginning of time. Our modern world is full of man made EMFs in the form of technology and our exposure to EMFs has skyrocketed. Cell phones, computers, microwaves, TVs, power lines, Wi-Fi, bluetooth, smart meters, UV lights, x-rays, and MRIs all generate EMFs.

High-level ionizing radiation, such as from x-rays and sunlight, is an EMF known to cause harmful health effects. Low level non-ionizing radiation, such as those from our cell phones and computers, has been accepted as safe, however, there is research showing otherwise and there is serious concern over the safety of continuous exposure to this multitude of low level non-ionizing radiation.

EMFs can cause oxidative stress in cells, which can damage proteins, lipids, and DNA. Low level non ionizing radiation has been linked to cancer. EMFs have been classified by the World Health Organization as a possible carcinogen. Studies have been done that link prolonged exposure to brain cancer, childhood leukemia, vestibular nerve tumors, and breast cancer to name a few. EMFs have also been linked to neurological symptoms: fatigue, headache, insomnia, depression, anxiety, and impaired memory, as well as neurodegenerative disorders like Parkinson’s and Alzheimer’s disease. EMFs can impact the reproductive system, causing reduced quality of sperm and increased risk of miscarriage. People can also experience EMF hypersensitivity. 

5G technology will eventually overtake existing technology with its ability to rapidly transmit large amounts of data. This network will require more cell towers to do its job, which means more unavoidable EMF exposure. The 5G network will use higher frequencies than previous technology, exposing the public to much broader spectrum of frequencies. These new frequencies have not been studied.

Technology is here to stay and will only become more prevalent in our lives, so I recommend being proactive and taking steps to protect ourselves from the onslaught of EMF exposure. Decrease exposure to EMFs at home:  unplug Wi-Fi router at night, use ethernet cords instead of Wi-Fi, keep devices in airplane mode when not in use, keep devices away from your body, use EMF shields, use a plugged in headset or speaker phone when talking on a cell phone, don’t sleep with cell phone next to your head, wait for a good signal to use the phone, avoid baby monitors, make sure your smart meter is not on a wall where you spend a lot of time. All EMFs become weaker with distance. It is also important to make sure your body is at its best to deal with the oxidative stress of EMFs. Decrease your overall toxic load and have a healthy diet full of antioxidant foods, including deeply colored berries and vegetables, nuts, and dark chocolate.

Let’s do our best to live a healthy life with modern technology as we learn more about the effects of EMFs on our health. Now go turn off that wi-fi and eat some dark chocolate!

Toxic Mold

Sometimes a patient will come in with a multitude of symptoms, but none of which fit together to form a possible diagnosis. I then need to dig deeper into the history and gather more information. Maybe their house was flooded not so long before they became sick, or they feel better when they are on a business trip or vacation. Often a light bulb will go off: Could this patient be mold toxic?

Many people know that molds can cause allergies, with symptoms like hay fever, or that they  can irritate the lungs and other parts of the body. But most are not aware of the toxic effects molds can have. Molds produce toxins known as mycotoxins, which can cause a wide range of troubling symptoms such as joint and muscle pains, fatigue, night sweats, leaky gut, trouble sleeping, poor memory, word finding problems, brain fog, depression, skin rashes, numbness and tingling of extremities, tremors, unexplained weight gain or loss, unusual pain, and static shocks. It doesn’t end there -- molds can also cause cancer, kidney disease, and suppress the immune system, and have been linked to Alzheimer's disease, multiple sclerosis, asthma, and obesity.

So, where are all these molds lurking? Molds are part of the environment; when found outdoors, they are helpful by breaking down dead organic matter like fallen leaves. Indoor mold growth, however, can cause real health problems when inhaled, ingested, or via direct skin contact. Mold needs moisture to grow so if there is any water damage in a building, like a leak, mold can start to take over. Building materials like drywall provide nutrition for the mold, and poor ventilation does not allow for dilution or dehumidification to help prevent mold growth. Sometimes the mold can be hidden on places like the backside of wall paper, the underside of carpets, or around a pipe with condensation located inside a wall. Often mold gives off a musty odor--which tips us off--but other times a patient’s history and exam coupled with some lab tests will point towards mold exposure, and then we need to look for the source. Not everyone exposed to mold will have the same reaction. Many times one family member can be affected while the others have no symptoms. There is a genetic susceptibility to mold illness. 

Diagnosing toxic mold illness is not straightforward or standardized. We may run blood and urine tests, among others, for signs of mold and markers of inflammation. As with most environmental illnesses, the most important part of treatment is getting away from the source of toxicity. Find the source of the mold, get away from it and remediate it if possible. It is also extremely important to help the body detoxify the mycotoxins and eliminate them. This can include nutrients and supplements to support detoxification, like glutathione, as well as binders that escort toxins out of the body, and making sure there are daily bowel movements. Infra-red sauna is another way to get toxins out.  Here they exit the skin through sweat. In some cases antifungals are necessary.

Prevention is truly key. Start by keeping humidity indoors low.  Clean up any leaks or water damage within 24-48 hours to prevent mold growth. Trust your nose and deal with that musty basement. Mold toxicity is a serious illness, but once recognized, a person can start down the road to recovery.

The Elimination Diet - New Year, New You!

The New Year is a time for new beginnings and possibilities. Many people write new years resolutions to help get these thoughts on paper to make them a reality. Let this year be the year to take control of your health and figure out a way to feel better. If this resolution fits your list, the Elimination Diet may be the perfect start.

The Elimination Diet consists of taking out common foods in the diet for a period of time and then carefully reintroducing each food while being very mindful of how one feels during both the elimination and reintroduction phases. It also focuses on eating a whole foods diet and taking out the packaged and processed foods, the crap. Foods that we eat everyday determine how we feel. Food can make us feel great or make us feel unwell, both physically and mentally. These symptoms can run the gamut, from acne, bloating, heartburn, headaches, sinus issues, weight gain, joint pain, and fatigue, to depression, mood swings, anxiety, and brain fog. People may suffer from symptoms for years without realizing they can be connected to the food they are eating. Your body could be fighting a battle every time you eat. It isn’t until the food is removed that the connection between symptoms and food can be made. Some food sensitivity reactions can occur within a few hours and others can happen up to a few days after the food has been eaten, making it tricky to make that connection. The Elimination Diet helps identify foods that irritate our system and trigger symptoms. Symptoms that have not responded to conventional medical treatment may just improve or resolve with the Elimination Diet.

Food reactions of any kind - a sensitivity, an allergy, or an intolerance - can cause low-grade inflammation in the gut, causing the intestinal wall to become permeable, also known as a “leaky gut”. This breakdown of the gut wall allows for substances such as undigested food particles, bacteria, yeast, and chemicals to enter the bloodstream, causing the immune system to jump into action upon seeing these foreign invaders and ultimately cause more inflammation. Taking away problem foods decreases the immune response and the inflammation. 

The Elimination Diet takes some work, but with a little planning and determination, it can be done with relative ease. Since planning and prepping for the diet are key, it is best to start the Elimination Diet during a routine period in your schedule. I wouldn’t start the Elimination Diet when there are holidays and parties on the horizon, or when you know you will be traveling. Shopping and preparing some snacks and meals ahead of time really helps one stick to the diet and prevent grabbing that candy bar when you are starving and need to reach for something. The first few days of the Elimination Diet are the hardest and some people can experience withdrawal symptoms from foods, such as headaches, low energy, irritability, and food cravings. However, these symptoms usually pass after about a week and you begin to notice you are feeling pretty good. 

If you are sick and tired of feeling sick and tired and ready to tackle your new year’s resolution of taking care of your health - try the Elimination Diet. 

5 Tips to De-Stress This Holiday Season

Did you send in the school permission slip, buy the dog food, change the oil in the car, make sure there is breakfast, lunch and dinner for everyone, and snacks of course, pay the bills, do the wash (and fold and put it away), call the gutter guy, at least vacuum the house, and get to work on time? And with the holidays coming, we can layer on more expectations and family stress too. 

Stress has a huge impact on our health and contributes to many illnesses including gastrointestinal problems, immune issues, heart disease, insomnia, depression, and cancer. When we are stressed, our body releases hormones such as cortisol and epinephrine, which put us in a state of heightened alertness, increasing both our heart rate and blood pressure. The stress response can be triggered by both physiologic factors, like an illness, pain or lack of sleep, as well as psychological factors like constant worry, feeling threatened, traffic, bad relationships, or whatever is perceived by a person as stressful. Ideally, we have a stressor, we have a stress response, and then our bodies return to a normal state of balance after that stressor passes. However, in our modern world, often the stressor does not pass and we are left in a chronic state of increased stress, which can majorly contribute to and perpetuate illness. Now is the time to think about ways in which we can lower our stress and bring our bodies and mind back into balance.

• Meditate - even short, daily meditation has been shown to decrease negative mood and anxiety, as well as enhance attention and memory. This can consist of doing some deep breathing, saying a mantra, or listening to a guided meditation from one of the many great apps out there (insight timer and calm are two apps that I like).

• Technology Timeout - give yourself a screen holiday. Turn off the news, put facebook on hold, don’t respond to that email right away. Even an hour a day can provide a break that is beneficial. Think of the time you have just earned, a perfect opportunity to do some meditation!

• Just say no - there are only 24 hours in a day, and adding to our already overly full schedules is a big stressor. It’s alright to say no. Saying no to more obligations will allow you to say yes to activities that are relaxing or rejuvenating for you. It’s also alright to purposefully put down one of the balls we are juggling before it comes crashing down. 

• Reframe - although some stressful situations cannot be avoided, we can change our response to the situation. NJ Transit cancelled another train home? Maybe this is an opportunity to listen to those podcasts you have been meaning to get to, or connect with a friend you have been wanting to touch base with. 

• Good Enough - remove some of the stress we place on ourselves by accepting that good enough is indeed good enough. The kids are fed and clothed, but the house is a mess - good enough. 

• Clean up the diet  - stress can deplete our bodies of essential nutrients, making a nutrient dense diet important. Increase your intake of magnesium and some B vitamins with dark leafy greens vegetables, as well as nuts and seeds.  Add in good fats such as those found in olives, avocado, and wild-caught salmon. Don’t reach for the simple carbohydrates like pretzels, chips, and candy because that will cause your blood sugar to rise and subsequently crash, increasing physiologic stress and anxiety. 

We live in a hectic world and have hectic lives which translates into lots of stress. Try and incorporate a few of these stress lowering strategies into your life and see how small changes can make a big difference - but don’t stress about it!