Nitric Oxide: The Molecule Of Life

Didem Miraloglu, MD, MS

Nitric oxide (NO) is a remarkable molecule that plays a crucial role in various physiological processes within the human body. Discovered in the late 18th century, and its importance has been extensively studied and recognized in the fields of medicine, biology, and biochemistry. In fact in 1998 Nobel Prize in Physiology or Medicine was awarded to Robert Furchgott, LouisIgnarro, and Ferid Murad, for their discoveries of NO as a signal molecule in the vasculature and specifically in the control of blood pressure. NO is a unique signaling molecule that influences numerous cellular pathways, contributing to cardiovascular health, immune function, neurotransmission, and even cellular defense against pathogens.
The synthesis of nitric oxide is achieved through the enzymatic action of nitric oxide synthase (NOS) on L-arginine, a semi-essential amino acid found in the body. There are three isoforms of NOS: endothelial NOS(eNOS), neuronal NOS (nNOS), and inducible NOS (iNOS). Each isoform is expressed in specific tissues and cells and responds to different stimuli. eNOSis predominantly present in endothelial cells, contributing to vasodilation and regulating blood flow. nNOS is found in neurons and plays a role in neuro transmission, while iNOS is induced in response to inflammation or immune challenges.

The regulation of nitric oxide production is a tightly controlled process. Various factors, including calcium ions, cofactors like tetrahydrobiopterin, and the availability of L-arginine, affect NOS activity. This precise control ensures that NO is produced when needed, preventing excessive generation and potential cellular damage.

Nitric oxide is a key player in cardiovascular health. It acts as a vasodilator, relaxing the smooth muscles in blood vessel walls, which leads to increased blood flow and improved oxygen and nutrient delivery to tissues. Dysfunction in the NO pathway is associated with numerous cardiovascular diseases, including hypertension, atherosclerosis, and heart failure. Pharmaceutical agents that enhance NO production or mimic its actions, such as nitroglycerin and sildenafil (Viagra), have become essential treatments for these conditions.

The immune system relies on nitric oxide to fight off pathogens and defend against infections. When activated by cytokines and other immune molecules, iNOS produces NO in macrophages and other immune cells. Nitric oxide acts as a potent antimicrobial agent by damaging bacterial DNA, proteins, and lipids. Furthermore, it helps regulate the immune response and plays a role in resolving inflammation after an infection has been controlled.
In the nervous system, nitric oxide is a critical neurotransmitter involved in various processes, such as learning and memory, synaptic plasticity, and neuronal communication. It modulates the release of neurotransmitters like dopamine, serotonin, and glutamate, contributing to mood regulation and cognition.

Moreover, NO has been linked to neuroprotection by its ability to act as an antioxidant and counteract oxidative stress-induced damage. Neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, involve oxidative stress, and researchers are exploring the potential of NO-based therapies to mitigate neuronal damage.

Due to its diverse roles in numerous physiological processes, nitric oxide has garnered significant interest as a potential therapeutic agent. Researchers are exploring its use in various medical applications, including wound healing, erectile dysfunction, and respiratory disorders like pulmonary hypertension. Additionally, NO-based therapies are being investigated in the context of cancer treatment, where NO has shown potential to inhibit tumor growth and sensitize cancer cells to radiation and chemotherapy.

Nitric oxide, once regarded merely as an air pollutant, has emerged as a fundamental molecule essential for life and well-being. Its roles in cardiovascular health, immune function, neurotransmission, and neuroprotection highlight its significance in maintaining the body’s delicate balance.

As our understanding of this remarkable molecule deepens, we are likely to witness further advancements in medical therapies that harness the potential of nitric oxide for improving human health and well-being.

To schedule a new patient appointment, please call our office at 919-999-0831.

Your Partner In Health,
Didem Miraloglu, MD, MS

What Is REM Sleep?

Clarissa A. Kussin, ND, FMCHC, ERYT-500

Did you know that REM (Rapid Eye Movement) sleep is a game-changer for your overall health and well-being? Let’s dive into the incredible benefits of REM sleep and discover some tips to enhance your dreamy slumber!

Benefits of REM Sleep:

  1. Brain Restoration: REM sleep is crucial for cognitive function and memory consolidation. It’s during this phase that your brain processes information, strengthens neural connections, and helps you wake up feeling mentally refreshed.
  2. Emotional Resilience: Ever notice how a good night’s sleep improves your mood? REM sleep plays a vital role in regulating emotions, contributing to better stress management and emotional resilience.
  3. Learning and Creativity: If you’re looking to boost your creativity and enhance learning, prioritize REM sleep. It’s during this stage that your brain synthesizes information and forms connections, leading to improved problem-solving skills and creativity.
  4. Physical Restoration: While deep sleep is essential for physical restoration, REM sleep also plays a role in muscle recovery. It contributes to maintaining a healthy balance between mind and body.

Tips to Maximize REM Sleep:

  1. Consistent Sleep Schedule: Aim for a consistent sleep routine by going to bed and waking up at the same time every day. This helps regulate your body’s internal clock, promoting better REM sleep. Watching the sunrise and sunset daily.
  2. Create a Relaxing Bedtime Ritual: Wind down before bed with calming activities such as reading, gentle stretching, a warm shower, diffuse lavender/spray it on your sheets, or practicing mindfulness. This signals to your body that it’s time to transition into a restful sleep.
  3. Limit Stimulants Before Bed: Minimize caffeine and screen time before bedtime. The stimulating effects can interfere with the quality of your sleep, including REM cycles. Eliminate caffeine after Noon.
  4. Optimize Sleep Environment: Ensure your bedroom is conducive to sleep – comfortable mattress and pillows, cool temperature, and minimal light and noise. I like to add red ight bulbs for evening use and transition.
  5. Stay Active During the Day: Regular physical activity can contribute to better sleep quality, including more time spent in REM sleep. Aim for at least 30 minutes of moderate exercise most days of the week.

Prioritize your sleep, and watch the positive impact on your overall well-being!

If you’re ready to experience the transformative benefits of health coaching, reach out to us today! Our team of experienced health coaches is here to guide you on your journey to optimal health. Call 919.999.0831 to get scheduled.

Remember, investing in your health is an investment in a brighter and more fulfilling future.

To your health and happiness!

Clarissa A. Kussin, ND, FMCHC, ERYT-500

Low SIgA- Part 1

Shane Hemphill, MD

Say your functional medicine provider ordered a stool test and it showed Low SIgA- what does that mean and how did it develop?

The immune system makes T cells and B cells. The B cells produce secretory IgA (SIgA) which acts as a first line of defense against the entry of foreign substances into the body.  These foreign substances include many things such as undigested proteins from the foods that we eat, bacteria, viruses, parasites, or even molds.  In essence SIgA gives us insight into what is happening at our mucosal surfaces.

The body’s mucosal surfaces – located at the eyes, ears, nose, throat, sinuses, gastrointestinal and genitourinary tracts, and skin are all entry points for potential disease-causing pathogens.

Our body’s way of protecting these entry points is done with the release of SIgA.  B-cells present within the mucosa are activated upon exposure to pathogens and allergens and thus produce SIgA in response.  The SIgA then attaches itself to the invading bacteria, virus or other foreign substance, traps it in the mucosal surface and then neutralizes it.

So what does it mean if your SIgA is low?
If your SIgA is low, this means that you are less able to prevent invaders from getting into your gut mucosal lining. This lining can become inflamed and tight junctions that ordinarily keep toxins and undigested food particles out – break down. This causes havoc as now toxins and undigested substances are able to get access to our blood stream, causing inflammatory and immune reactions that lead to systemic symptoms throughout the body.
Patients with low SIgA levels  generally have increased risk of food sensitivities, irritable bowel syndrome (IBS),  inflammatory bowel disease (IBD), intestinal permeability also known as ‘leaky gut’,  autoimmunity,  and other gastrointestinal infections.

What causes low SIgA levels?
Chronic infections are commonly associated with low SIgA.  Assessing for problematic bugs including H pylori, Candida, Blastocystis Hominis, H. Pylori, Clostridium difficile are essential in this evaluation. Do keep in mind that many of these normally can exist in the bowel at low levels and not cause harm. Some of them only become problematic depending on their level in the body and others do it based on virulence. These can be assessed via a functional stool test. One interesting note is that these ‘infections’ are opportunistic by nature, meaning they also come about when SIgA levels reduce. Therefore it is not uncommon to see development of Candida in SIgA compromised clients.

Medications are another cause of low SIgA. Anti-inflammatories, antibiotics and antidepressants are some examples. Studies have even shown an association between low SIgA and people that suffer from depression.

Stress is another cause of low SIgA through increased cortisol levels. Stress can be in any form, including mental, emotional or even physical. One study has even demonstrated that persistent negative thoughts about ourselves can lower our own SIgA levels. Lowering stress and introducing stress reduction techniques is vital in maintaining this protector.

Finally, poor dietary choices are another contributor to low SIgA. Certain nutrients such as Vitamin D, Vitamin A, Zinc and Glutathione are instrumental in supporting healthy SIgA levels.  A good intake of dietary fiber and phytonutrients can also play a role in supporting a healthy gut microbiome. This can lead to the development of beneficial bacteria that promote healthy levels as well.

Stay tuned for my next article which will discuss how we treat low SIgA.

To schedule a new patient appointment, please call our office at 919-999-0831. 

Your Partner in Health!
Shane Hemphill, MD

PALESTINIAN ZA’ATAR AND IT’S BENEFITS

Didem Miraloglu, MD, MS

Za’atar is a Middle Eastern spice blend that typically includes a mix of dried thyme, oregano, marjoram, sumac, sesame seeds, and salt. It’s a staple in Palestinian cuisine and is used in various dishes, such as meats, salads, bread, and dips. While specific health benefits can vary based on individual ingredients and their proportions in the blend, here are some potential health benefits associated with Palestinian za’atar:

1.   Rich in Antioxidants: Thyme, oregano, and sumac, commonly found in za’atar, are rich in antioxidants that help fight oxidative stress and reduce the risk of chronic diseases.

2.   Anti-inflammatory Properties: Many of the herbs in za’atar, like thyme and oregano, contain compounds that possess anti-inflammatory properties, potentially aiding in reducing inflammation in the body.

3.   Digestive Health: Some of the herbs in za’atar, like thyme and oregano, are believed to have digestive benefits, aiding in digestion and potentially soothing digestive issues.

4.   Possible Antibacterial and Antifungal Effects: Some studies suggest that certain compounds in thyme and oregano may have antibacterial and antifungal properties, which could help infighting off infections.

5.   Improved Cognitive Function: Rosemary, sometimes included in za’atar blends, has been linked to improved cognitive function and memory.

6.   Rich in Nutrients: Sesame seeds in za’atar provide healthy fats, protein, and important minerals like calcium, magnesium, and zinc.

                      It’s incredibly versatile and can be used in various recipes.

Here are a few ideas:

1.   Za’atar Hummus:

Blend chickpeas, tahini, garlic, lemon juice, olive oil, and a generous amount of za’atar until smooth. Adjust seasoning to taste. Serve with pita bread or vegetable sticks.

2.   Za’atar Roasted Vegetables:

Toss vegetables like cauliflower, carrots, and zucchini in olive oil, sprinkle with za’atar, salt, and pepper. Roast in the oven until golden brown and tender.

3.   Za’atar Grilled Chicken:

Marinate chicken breasts or thighs with olive oil, lemon juice, garlic, and za’atar. Grill until fully cooked and serve with a side of yogurt sauce mixed with a bit of za’atar.

4.   Za’atar Flatbread:

Mix za’atar with olive oil and spread it over flatbread dough. Bake until golden and crispy. Enjoy it as a side to dips, soups, or salads.

5.   Za’atar Salad Dressing:

Whisk together olive oil, lemon juice, a dash of honey, salt, pepper, and za’atar. Drizzle over a mixed green salad or a chickpea salad for added flavor.

6.   Za’atar-Crusted Fish:

Mix za’atar with breadcrumbs or almond meal. Coat fish fillets in the mixture and bake or pan-sear until the crust is crispy and the fish is cooked through.

7.   Za’atar Focaccia Bread:

Add za’atar to the dough when making focaccia bread. Sprinkle extra on top along with olive oil before baking.

8.   Za’atar Popcorn:

Sprinkle popped popcorn with melted butter or olive oil and za’atar for a unique and flavorful snack.

9.   Za’atar Potatoes:

Toss potato wedges with olive oil and za’atar. Roast them until crispy on the outside and tender on the inside.

10. Za’atar Yogurt Dip:

Mix za’atar into Greek yogurt along with a little garlic powder, lemon juice, salt, and pepper. Serve as a dip for veggies, pita chips, or crackers.

Feel free to adjust the quantities of za’atar based on your taste preferences. It’s a versatile spice blend that can add a unique and delicious flavor to various dishes!

It’s essential to note that while these herbs and spices offer potential health benefits, they are typically consumed in small amounts as part of a larger diet. The overall health effects will also depend on an individual’s diet and lifestyle. Additionally, the specific composition of za’atar can vary, so the health benefits might differ accordingly.

As with any food or spice, moderation is key. Incorporating za’atar into a well-balanced diet can be a flavorful way to potentially enjoy some health benefits, but it should be part of an overall healthy lifestyle. If you have specific health concerns or conditions, it’s advisable to consult with a healthcare professional for personalized advice.

Your Partner In Health,

Didem Miraloglu, MD, MS

Camu Camu the Superfood

Clarissa A. Kussin, ND, FMCHC, ERYT-500

Lets dive into the powerful benefits of a superfood called Camu Camu. Known for its exceptional nutritional profile, Camu Camu offers a wide range of health benefits. Additionally, we’ve included a delightful smoothie recipe to help you incorporate this fantastic fruit into your daily routine.

Understanding Camu Camu
Camu Camu (Myrciaria dubia) is a small berry native to the Amazon rainforest in Peru and Brazil. It has gained popularity worldwide due to its extraordinarily high vitamin C content, containing up to 60 times more vitamin C per serving than an orange. However, Camu Camu offers more than just vitamin C. It also contains antioxidants, vitamins, minerals, and phytochemicals that support overall well-being.

The Health Benefits of Camu Camu

Immune Support: Camu Camu’s exceptional vitamin C content plays a crucial role in supporting a healthy immune system. Vitamin C is known for its antioxidant properties, which help protect the body against oxidative stress and strengthen immune defenses.

Antioxidant Powerhouse: In addition to vitamin C, Camu Camu contains a range of antioxidants, such as flavonoids and ellagic acid. These compounds combat free radicals, reducing the risk of chronic diseases and promoting overall health.

Collagen Formation: Vitamin C is essential for collagen synthesis, which supports healthy skin, joints, and connective tissues. Regular consumption of Camu Camu can contribute to the maintenance of youthful skin and overall joint health.

Mood Enhancement: Some studies suggest that Camu Camu may have mood-enhancing properties due to its high levels of antioxidants and other beneficial compounds. Including Camu Camu in your diet may help support mental well-being.

Anti-Inflammatory Effects: Camu Camu contains natural anti-inflammatory compounds, including anthocyanins and catechins. These compounds may help reduce inflammation in the body, supporting overall health and reducing the risk of chronic diseases.

Here’s a refreshing smoothie recipe that combines the goodness of Camu Camu with other nutritious ingredients:
Camu Berry Blast Smoothie: 2 servingsIngredients:1 cup frozen mixed berries (strawberries, blueberries, raspberries)1 small frozen banana1 /2 teaspoon Camu Camu powder1 cup unsweetened almond milk (or milk of your choice)1 tablespoon chia seeds1 tablespoon honey, date paste or maple syrup (optional, for added sweetness)A few ice cubes IF your berries are not frozen

Instructions: Place all the ingredients in a blender. Blend on high until smooth and creamy. Taste and adjust sweetness if desired by adding honey or maple syrup. Pour into a glass and enjoy this antioxidant-rich, vitamin C-packed smoothie.
Note: You can customize the smoothie by adding spinach, kale, or your favorite protein powder for an extra nutritional boost.

Where to Find Camu CamuCamu Camu is available in various forms, including powder, capsules, and freeze-dried berries. Look for organic and sustainably sourced Camu Camu products from reputable health food stores, online retailers, or local farmers’ markets.
Consider adding Camu Camu to your daily wellness routine by incorporating it into smoothies, juices, yogurt bowls, or even homemade energy bars. Experiment with different recipes to explore the unique tangy flavor and reap the numerous health benefits.

Your Partner In Health,
Clarissa A. Kussin, ND, FMCHC, ERYT-500

Unlock Your Best Health with a Personal Health Coach!

Clarissa Kussin, ND, FMCHC, ERYT-500

New Year’s is the time when everyone is looking toward the year ahead and all that they want to achieve. While people make resolutions with the best of intentions, few follow through and achieve their goals. This is where health coaching comes in handy.

Health coaches help support clients as they work toward making sustainable lifestyle changes. They are passionate about helping others live happier and healthier lives. This includes helping them stick to New Year’s resolutions. Whether you want to reduce stress, eat better, or move more, health coaches can guide the way.

The Power of Personalized Guidance:

A health coach is your dedicated partner on your wellness journey, offering personalized guidance that goes beyond generic advice. They work with you to create a tailored plan based on your unique needs, preferences, and health goals.

Medical Benefits of Having a Health Coach:

  1. Weight Management: Numerous studies have shown that individuals working with health coaches are more successful in achieving and maintaining a healthy weight. A health coach helps you develop sustainable habits, making weight management more than just a short-term goal.
  2. Chronic Disease Prevention and Management: Health coaches play a crucial role in preventing and managing chronic conditions such as diabetes, hypertension, and heart disease. Their guidance extends beyond conventional medical advice, focusing on lifestyle changes that can have a profound impact.
  3. Stress Reduction and Mental Well-being: Mental health is an integral part of overall well-being. Health coaches help you navigate stressors, offering support and strategies to enhance mental resilience. This holistic approach contributes to improved mental well-being.
  4. Improved Physical Fitness: A health coach can assist in developing personalized guidelines to follow that can help your fitness professional tailor your fitness routine to suit your lifestyle and preferences. Regular physical activity is linked to numerous health benefits, including improved cardiovascular health, increased energy levels, and better mood.
  1. Improved Sleep: Getting quality sleep is crucial for our physical and mental well-being. It affects our mood, concentration, and overall health. From creating a bedtime routine to sticking to a sleep schedule, there are many ways you can improve your quality of sleep. Health coaches may suggest options such as avoiding screens a few hours before bed. Perhaps practicing mindfulness in the evening will quiet a busy mind. Even something as simple as lowering the light in your room at night to trigger your sleep cycle are a small change that can result in a big outcome.

How to Get Started:

If you’re ready to experience the transformative benefits of health coaching, reach out to us today! Our team of experienced health coaches is here to guide you on your journey to optimal health. Call 919.999.0831 to get scheduled.

Remember, investing in your health is an investment in a brighter and more fulfilling future. To your health and happiness!

References:

Wing, R. R., et al. (2018). Intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine.

Ockene, I. S., et al. (2007). The role of counseling in the promotion of healthy behaviors in adults. JAMA.

Huffman, J. C., et al. (2018). The role of stress and psychosocial interventions in cancer. Current Psychiatry Reports

Warburton, D. E. R., et al. (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal

Your Partner In Health,

Clarissa A. Kussin, ND, FMCHC, ERYT-500

Unlock Your Best Health With A Personal Health Coach!

Clarissa A. Kussin, ND, FMCHC, ERYT-500

New Year’s is the time when everyone is looking toward the year ahead and all that they want to achieve. While people make resolutions with the best of intentions, few follow through and achieve their goals. This is where health coaching comes in handy. 

Health coaches help support clients as they work toward making sustainable lifestyle changes. They are passionate about helping others live happier and healthier lives. This includes helping them stick to New Year’s resolutions. Whether you want to reduce stress, eat better, or move more, health coaches can guide the way. 

The Power of Personalized Guidance:

A health coach is your dedicated partner on your wellness journey, offering personalized guidance that goes beyond generic advice. They work with you to create a tailored plan based on your unique needs, preferences, and health goals.

Medical Benefits of Having a Health Coach:

  1. Weight Management: Numerous studies have shown that individuals working with health coaches are more successful in achieving and maintaining a healthy weight. A health coach helps you develop sustainable habits, making weight management more than just a short-term goal.
  2. Chronic Disease Prevention and Management: Health coaches play a crucial role in preventing and managing chronic conditions such as diabetes, hypertension, and heart disease. Their guidance extends beyond conventional medical advice, focusing on lifestyle changes that can have a profound impact.
  3. Stress Reduction and Mental Well-being: Mental health is an integral part of overall well-being. Health coaches help you navigate stressors, offering support and strategies to enhance mental resilience. This holistic approach contributes to improved mental well-being.
  4. Improved Physical Fitness: A health coach can assist in developing personalized guidelines to follow that can help your fitness professional tailor your fitness routine to suit your lifestyle and preferences. Regular physical activity is linked to numerous health benefits, including improved cardiovascular health, increased energy levels, and better mood.
  1. Improved Sleep: Getting quality sleep is crucial for our physical and mental well-being. It affects our mood, concentration, and overall health. From creating a bedtime routine to sticking to a sleep schedule, there are many ways you can improve your quality of sleep. Health coaches may suggest options such as avoiding screens a few hours before bed. Perhaps practicing mindfulness in the evening will quiet a busy mind. Even something as simple as lowering the light in your room at night to trigger your sleep cycle are a small change that can result in a big outcome. 

How to Get Started:

If you’re ready to experience the transformative benefits of health coaching, reach out to us today! Our team of experienced health coaches is here to guide you on your journey to optimal health. Call 919.999.0831 to get scheduled.

Remember, investing in your health is an investment in a brighter and more fulfilling future.

To your health and happiness!

References:

Wing, R. R., et al. (2018). Intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine.

Ockene, I. S., et al. (2007). The role of counseling in the promotion of healthy behaviors in adults. JAMA.

Huffman, J. C., et al. (2018). The role of stress and psychosocial interventions in cancer. Current Psychiatry Reports

Warburton, D. E. R., et al. (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal

Your Partner In Health,

Clarissa A. Kussin, ND, FMCHC, ERYT-500

The Weakest Leak :

Autoimmunity and Leaky Gut Explained

They say that any system is only as strong as its weakest link. It turns out, our digestive and immune systems are only as strong as their weakest leak.

Imagine your gut as the body’s security guard. The tight junctions between the cells of your intestines decide who gets in and who doesn’t. But what happens when the gut becomes too permissive and allows unwanted guests through? That’s where “leaky gut” comes into play.

Leaky gut, or intestinal permeability, is a condition where the lining of the intestines becomes more porous than it should be. Instead of acting like a strict bouncer to the coolest club in town, the tissue starts allowing substances that shouldn’t enter your bloodstream. This includes undigested food particles, bacteria, and toxins.

When the gut barrier is compromised and unwanted intruders enter the bloodstream, your immune system, which usually only targets harmful invaders, can get confused and launch a response against your body’s own tissues instead.

It’s like friendly fire within your body! According to the NIH (National Institutes of Health) around 23.5 million (7%) Americans suffer from an autoimmune condition. And 75% of those affected are women.

Hashimoto’s thyroid disease, ulcerative colitis, rheumatoid arthritis, psoriasis, vitiligo and multiple sclerosis are some of the more than 80 known autoimmune diseases commonly seen at Carolina Total Wellness.

Three Steps to Preventing or Reversing Autoimmune Disease:
Not every autoimmune disease is curable or reversible but there are some proven steps you can take to reduce the effects on your health.

1. Manage Your Stress Stress isn’t just in your mind; it affects your gut, too. When we are facing a perceived physical or emotional threat, our bodies are wired to respond by directing resources to your vital organs and away from your digestive and reproductive functions. When you don’t have sufficient digestive enzymes and gastric acid to break foods down, they may be more irritating to your gut lining and/or penetrate the lining as larger particles than your blood stream knows how to handle. It’s not always possible to avoid stress but you can practice strategies to help you minimize the effects. Get 8 consistent hours of sleep each night. Practice saying ‘no’ – it is a full sentence. Go outside and take a walk – without devices. Laugh with a good friend.

2. Eat Gut-Healing Foods Eating a balanced diet is crucial for maintaining gut health. A diet rich in fiber, fruits, and vegetables promotes a diverse gut microbiome and a healthier gut lining. Use the rainbow as a template to guide your shopping list and eat foodsof every color several times per week. Probiotics, found in foods like yogurt, sauerkraut and kimchi help eliminate toxins and aid the digestion of nutrients from the foods you eat. Eat fermented foods several times each week to strengthen the lining of your digestive tract. Bone broth has proteins and gelatin to soothe the inner lining of the gut. Sip on some bone broth instead of coffee in the morning if you’re trying to kick the caffeine habit.

3. Fasting Fridays Once a week, skip breakfast (and the coffee/creamer.) An occasional, extended break from the hard work of digestion, also known as intermittent fasting, lets your gut clean out old debris and calms the immune system. You may discover improved mental clarity and energy, too. In fact, you may like it so much that you decide to skip breakfast two or three days a week. Healing the Gut.

If you suspect you have a leaky gut or an autoimmune disease, consult afunctional medicine practitioner. They can recommend personalized approaches like dietary changes, supplementation, and lifestyle modifications to heal your gut and reduce inflammation.

Autoimmunity and leaky gut are two puzzle pieces that fit together more than we once thought. Maintaining a healthy gut through a balanced diet, managing stress, and seeking professional guidance when needed can be your key to preventing or managing autoimmune diseases.

Remember, the journey to optimal health is unique for everyone. Keep exploring, learning, and making choices that support your well-being.  

Your Partner In Health,
Erica Nelson, MSPH, NBC-HWC

Foods for Menopause and Perimenopause

The hormonal shifts that accompany perimenopause and menopause lack a clear instruction manual, often leaving many women in a continuous cycle of trial and error when it comes to managing their symptoms. Fortunately, one of the most potent tools available for regaining control of your hormones is the food you consume. Certain foods contribute to hormone balance and can help alleviate perimenopause and menopause symptoms, while others can disrupt your body’s hormonal equilibrium.

When essential nutritional elements are lacking, hormonal imbalances can arise, leading to mood swings, weight gain, hot flashes, and reduced libido. The primary hormones affected during perimenopause and menopause are estrogen, progesterone, insulin, and testosterone, and your dietary choices can significantly impact these hormones. For instance, excessive sugar consumption can elevate insulin levels, trigger inflammation, and exacerbate nearly every perimenopausal symptom. On the other hand, incorporating vegetables, fruits, nuts, and seeds into your diet can provide phytonutrients and healthy fats that aid in managing even the most challenging menopause symptoms.

While there’s no one-size-fits-all diet, several foods have proven beneficial for most people seeking to balance their hormones:

1. Brassica (aka cruciferous) Vegetables: These include broccoli, cauliflower, kale, and cabbage, which contain indole-3-carbinol—a compound that helps metabolize estrogen in the gut and liver. This can be particularly helpful in addressing estrogen dominance.

2. Healthy Fats: Avocados, nuts, seeds, and fish are rich inomega-3 fatty acids and other fats crucial for reducing inflammation and supporting hormone production, especially progesterone.

3. Fiber-Rich Foods: Fiber is essential for gut health, which plays a critical role in hormone balance. Low-starch fruits and veggies, nuts, seeds, and whole grains can boost your fiber intake, aiding in estrogen metabolism and blood sugar regulation.

However, there are also foods and drinks that should be limited or avoided:

1. Caffeine: Excess caffeine can lead to increased stress hormone production and elevated cortisol levels, potentially exacerbating fatigue and estrogen levels.

2. Processed Carbs and Sugar: As tolerance to sugar decreases with age, limiting simple carbohydrates and sugars (like table sugar, baked goods, and packaged foods) becomes crucial for managing blood sugar and insulin levels.

3. Alcohol: Even moderate alcohol consumption can disrupt hormones, affect brain aging, and lead to elevated insulin levels and estrogen dominance.

4. Gluten: Gluten sensitivity can contribute to gut issues, thyroid problems, and autoimmune conditions, making it advisable to assess its impact on your health

Balancing your diet can ease the transition into perimenopause and menopause, regardless of whether you’re just beginning to experience symptoms or are already in the midst of them. By making thoughtful dietary choices, you can navigate this phase of life with greater vitality and well-being.

Your Partner In Health,

Sara Yadlowsky, FMHC

Concussion Care 2023

Frances Meredith, MD

Concussion is so much more common than we realize, a frequent occurrence in kids and teens, especially athletes, and increasing frequency in the elderly and unstable of gait.  The fact that memory loss can be associated creates a scenario where concussions are simply not recalled, but can lead to long lasting symptoms and deterioration in quality of life.   Most people do not seek care, and when they do, they are usually given out dated advice unless seen at a dedicated concussion center or provider. Sadly, most medical professionals, even in an urgent care or ER, are not trained in current cutting edge acute concussion care. Concussion centers have only come into existence since 2000, and active research has been lacking until recently.

What is very clear is that with any symptoms suggestive of concussion (including loss of consciousness, dizziness, or feeling “detached”, vision changes, headache, nausea), physical activity must stop immediately. Theon field symptom that best predicts a longer recovery is dizziness followed by “fogginess”. Estimates according to Dr Michael Collins, head of the concussion center at UPMC University of Pittsburgh Medical Center, are that for every minute a player is back on the field, his/her recovery time is lengthened by7-8 days (1). The average recovery time for a mild concussion is 18 days, with15 minutes back on the field prolonging this to 44 days.  What is not widely recognized is that immediate evaluation, a graded exercise and brain rehab plan, and supplement support can greatly speed recovery.   
           
EVALUATION

An evaluation by a doctor familiar with concussion is essential after head trauma. Assuming the doctor feels you can be monitored at home, someone should stay with you and check on you for at least 24 hours to make sure symptoms are not worsening. This should be followed be evaluation by a true concussion expert as soon as possible. Evaluation should include an assessment of the mechanism of injury itself(video very helpful if available), vestibular ocular motor screening, balance and autonomic nervous system testing, and can include more sophisticated testing including a qEEG brain scan and Right Eye testing. An assessment of preconcussion risk factors which might delay recovery is important as well as a determination of the type of concussion. There are, according to current research, six types of concussion: cognitive fatigue, vestibular, ocular, migraine, anxiety, and neck based. These can overlap, and these different types are treated with different therapeutic modalities guided by testing.

MANAGEMENT

Mental rest and eye rest are essential in the early days after concussion. How long you’ll need to rest your brain and body will depend on the severity of your concussion and rapidity of resolution of symptoms. Your concussion specialist will help you to create a plan to allow the brain to heal. This will include lots of rest, optimizing hydration, and initially completely avoiding activities requiring mental concentration including homework, watching TV, playing video games, texting and using computers. These activities should be avoided for at least the first 48 hours after concussion, then gradually brought back incrementally as tolerated. Physical activity should also be limited in the first few days to mild activity such as walking that does not trigger symptoms. At that time exercise becomes essential in the healing process. Previously recommended complete bedrest, in darkness avoiding all stimuli, is no longer recommended.  A structured, gradually progressing exercise plan should be created with your concussion specialist. Exercise programs after concussion often consist of 45-90 min daily of intense activity to increase blood flow to brain. Exercise is the best way to increase Brain Derived Neurotrophic Factor (BDNF), essential in neuroplasticity and brain healing.  Optimal sleep is essential, with experts recommending at least 8 hours nightly with consistent bedtime and awakening times, taking only short naps when needed during the day in order to ensure optimal nighttime sleep. Your doctor may recommend, as screentime and mentally focused activities are reintroduced, a lightened work/school schedule, and spacing out screentime such as homework in short blocks. Your doctor will likely recommend other modalities to “rebab” the brain including a combination of exercises for vision and balance, Neurofeedback, autonomic nervous system retraining, and laser therapy. Often chiropractic care will be advised to reestablish alignment in the neck as misalignment in the neck gives the brain incorrect information about where you are in space.  For pain relief discuss with your doctor whether Tylenol is right for you as NSAIDS such as Ibuprofen or Aspirin can increase risk of bleeding and actually prolong inflammation. As the brain is working hard to clear out damage, it is essential to abstain from other toxins to the brain such as alcohol, and lay off cigarettes if you smoke.

   “Energy Crisis”

Optimal nutrient support at the onset of concussion may have an impact on speed of recovery.  To understand why, it is key to understand what is happening in the brain in the minutes after concussion. The brain depends on glucose for energy.

Following concussion, an “energetic crisis” occurs in the first 24 hours after injury where the brain can no longer easily metabolize glucose. Just when the brain needs more energy to heal, it has much less. This is followed by neuroinflammation at the site of injury that can further impair metabolism and energy production in the brain. Neuronal damage is also accompanied by vascular damage in which the pumps that keep nerves stable begin to fail. Then glutamate, a neurotransmitter toxic when in high amounts, can leak out and create inflammation and cell death. The goal is to decrease energetic demands on the brain and provide an alternate source of fuel other than glucose: ketones. Ketones serve as an alternate fuel source for the brain, typically created from fat stores while fasting. There is limited research in this area but animal studies are supportive and human studies are ongoing.  The mechanisms of injury above guide treatment options that can be helpful in the hours to days after concussion. These can include:

 –Ketogenic diet: Ketones created in a low carbohydrate “ketogenic diet” support brain energy and can be supported by “exogenous ketones” in powder form.  Studies in rodents show therapeutic benefit(4,5); studies in humans are lacking and ongoing but safety of ketogenic diet has been established.

Anti-inflammatory nutrients and anti-inflammatory diet:  Nutrients such as fish oil, DHA, Vitamin D,NAC, Vit C, and curcumin have growing research to support their therapeutic benefit.

Phospholipid Support: Phospholipids, the main component of cell membranes, are made up of fats and phosphate. Studies suggest phospholipid support can help repair a damaged blood brain barrier and reduce tissue damage with traumatic brain injury (TBI)(8,9)

Hyperbaric oxygen treatment: Research suggests hyperbaric oxygen may be beneficial in both acute and chronic concussion or CTE (chronic traumatic encephalopathy) (6,7) however more research is needed.
 
As the research grows, our approach to concussion will be fine tuned in the years to come.

Please spread this information to family and friends as this knowledge can be the difference between return to play with speedy recovery and a lifetime of frustrating neurologic and psychologic symptoms that can be the result of poorly managed concussion. With expert management, top practitioners in the field firmly believe that complete healing is possible.

Your Partner In Health,
Frances T. Meredith, MD