Magnificent Magnesium

Frances Meredith, MD

In the times of COVID, so many nutrients seem to be in the news these days from quercetin to Zinc, to Vitamin D.  Overlooked I believe is the nutrient essential for every cell and every process in our body including immune readiness: Magnesium!

Magnesium is a cofactor for over 300 enzymatic reactions, supporting DNA and RNA synthesis, cell growth and reproduction. Magnesium enters the energy cycle as a cofactor in at least 12 different steps in the process, and is essential for the little batteries in every cell, our mitochondria, to transport electrons and create energy. It is necessary for bone growth and strength, stabilizing the cell membrane, and maintaining normal nerve and muscle function.

Magnesium sits within the cell, balancing all of our cells, keeping calcium outside the cell from overstimulating cellular activity in all parts of the body. For example, Mag balances Calcium in the NMDA glutamate receptor, controlling its opening, avoiding “neuroexcitation”.  Thus, lack of Magnesium sets the stage for nerve overactivation, hyperexcitability (think chronic anxiety, chronic pain, chronic states of inflammation created by lack of Magnesium). When we are Mag deficient this NMDA glutamate receptor activates. This is good for survival when we are under intense stress, but not something we want to live with on a day in and day out basis.

Low Magnesium can express itself in so many ways including fatigue, muscle cramping/tension, PMS, headaches, especially migraines, constipation, insomnia, tinnitus, brain fog, heart arrhythmias, anxiety and depression, TMJ, ADHD, and blood sugar issues. Sound familiar?  If that’s not enough, Magnesium deficiency is implicated in diabetes, osteoporosis, and hypertension. It is a natural “calcium channel blocker” (think drugs that do this such as amlodipine used for hypertension). The lower the Magnesium levels the greater the progression of Alzheimer’s. Fibromyalgia improves with Magnesium treatment. Increasing Magnesium intake is correlated with a decrease in stroke, diabetes, heart failure, fracture risk and all-cause mortality. Sounds like we all need more, yes?

Why are we so deficient? The answer lies both in the disruption of our food chain and the breakdown of our food choices. The soil is now deficient in Magnesium due to lack of crop rotation, pesticide use and overproduction; in addition, the use of fertilizer heavy in nitrogen and phosphate blocks the plants’ ability to absorb Magnesium.  Further, as foods are processed, Magnesium is leached out. The end product: less for us.

Testing for Magnesium is easy, with red blood cell levels being the most accurate form of testing. Body signals, however, are much more important than a test result. Symptoms such as myofascial and muscular tightness/tension/cramping, sluggish bowels, and low energy point to low Magnesium and a trial of Magnesium is warranted even without checking a blood level.

So how can we optimize Magnesium for all of the cells in our body to “sing”? It is clear that plant-based Magnesium is much more effective than the mineral in supplement form. This is due to the fact that Magnesium is at the heart of chlorophyll, responsible for the green pigment in our green foods. Plant based Magnesium is very absorbable and is already charged, essential for its function. The big winners for high magnesium are pumpkin seeds, spinach, almonds and cashews. This great link from Cleveland Clinic lists the magnesium content of many foods.

https://my.clevelandclinic.org/health/articles/15650-magnesium-rich-food

 Magnesium in supplement form can be very helpful, and must be attached to a “chelator” to get across the intestinal border. They are best taken with food to improve stability. Magnesium comes in forms including glycinate, citrate, theonate, asparate, orotate, and oxide, with different benefits associated with the specific chelators.

For example, the Mag oxide form is only minimally absorbed and very unstable, drawing water into the intestinal tract, helpful for severe constipation or impaction but not helpful to get Magnesium into cells elsewhere in the body. In contrast the Magnesium glycinate is more stable, better absorbed and better for anxiety or insomnia. Mag citrate is helpful for intestinal motility/constipation as well as energy as it plugs directly into our “Krebs cycle” to create energy.

In addition, optimal intestinal absorption is necessary, with Magnesium absorbed mostly in the ileum of our small intestines. Therefore, if things go awry in the ileum, our ability to absorb Magnesium (as well as other nutrients) will be impacted (think leaky gut, small intestinal bacterial or fungal overgrowth).

Sounds like most everyone would be better off with a little more Magnesium! If any of the above-mentioned symptoms or conditions apply to you, your functional medicine provider at Carolina Total Wellness would be most happy to discuss this with you.

Your Partner In Health

Frances T. Meredith, MD

PEDIATRIC COVID-19 Vaccination Prep

 Supporting Resiliency for Children 5 years – 11 years

The Centers for Disease Control (CDC) and American Academy of Pediatrics (AAP) have announced recommendations for COVID-19 vaccination in children 5 years and older, who do not have contraindications.

At Carolina Total Wellness (CTW), we seek to empower our patients and their families with up to date information and provide medical recommendations through our personalized approach.

If you have questions regarding vaccinations, please reach out to your established medical provider.
 
PEDIATRIC COVID-19 Vaccination prep:
Supporting resiliency for children 5 years – 11 years
 
Start 2 weeks BEFORE and continue for 1 week AFTER vaccination:
 
1. Clean water: ½ body weight in ounces
2. Vitamin C: 125-500mg two times a day
3. Daily Multivitamin (ActivNutrients chewables)
4. Daily Probiotic (Ther-biotic complete chewables)
5. Vitamin D: 1000IU per 25 lbs, daily (CTW Liquid D3)
6. Zinc 7.5mg daily (Zinc Drink liquid)
7. SPM Active 1 caps daily: cut/puncture the softgel and squeeze out contents onto spoon, ok to take/mix with food.
 
In the days leading up to your vaccination, fuel your child’s immune system with healthy, organic colorful foods that are nutrient dense. Avoid pro-inflammatory junk foods and sugary foods. Stick to sleep schedules/healthy sleep hygiene and aim for quality sleep the two nights before the vaccination.
 
*Day of and day after vaccination, add extra C to above protocol:
Vitamin C: 500mg two times a day
 
After your vaccination, think muscle, immune and lymphatic system support:
 
Engage your deltoid! This is the shoulder muscle which received the vaccine. Movement and engagement of the muscle will reduce the tenderness and soreness which can start setting in a few hours later. Example exercises include arm circles, push-ups, patty-cake!
 
Run around! Walk, run, play after the vaccination to provide a healthy stimulus for the immune system for optimal response and reduce side effects.
 
Stimulate lymphatic system! After the vaccine, you can begin gentle skin brushing of the vaccinated arm. When able, incorporate whole body lymph support with options like whole body dry skin brushing, gentle rebounding (jumping, hopping), or deep breathing (blowing bubbles, square breath). 
  
AAP statement:
https://www.aap.org/en/pages/covid-19-vaccines-in-children-and-adolescents-policy/
 
CDC statement:
https://www.cdc.gov/vaccines/covid-19/planning/children.html

  
Please contact our office for an appointment to further support and personalize your path to wellness.
 

Your Partner In Health!

Blair Cuneo, PA-C

Tips for Healthy Eating for Busy Families

Does the back-to-school season of busy weeknights filled with extracurricular activities have you relying on take out for dinners?  Here are some tips to keep meals at home that are healthy and easy. 

TIP #1
~ Keep freezer stocked with proteins to limit daily trips to the store.  Grass fed beef, organic ground turkey, organic chicken breasts, wild caught salmon, and Aidell’s chicken sausage.  Instacart has been a time saver for my family and Costco will deliver all of these protein options. 

TIP #2
~ Keep the pantry stocked with staples. Beans, GF Pasta (we love Jovial,) Tomato sauce (Rao’s,) Chicken and Bone broth, rice, quinoa, nut butter.

TIP #3
~ Use a crockpot or instant pot to cook meals and/or meat ahead of time.  One great way to cook chicken is to add a few chicken breasts, taco seasoning and a few scoops of your favorite salsa.  Cook for 3 hours in the crockpot.  This chicken can be used for many meals!

BONUS TIP
~ CHANGE YOUR MINDSET TO MAKE SIMPLE, HEALTHY DINNERS
This might be the most powerful secret of all. The best way to make simple, healthy dinners is to change your thinking on what dinner should look like. This means that not everything is gourmet, but the upside is now meals are much simpler while still being healthy.

TWO easy “on the go” meals:

1) Burrito Bowls or Taco salad in a Jar
~ Chopped up greens as the base
~optional rice, black beans, chicken, beef or turkey, guacamole, salsa, sour cream or Tessemae’s Avocado Ranch dressing. 
~ Prepare in a bowl or in jars to take in the car. 

2) Aidells Chicken Sausage & Roasted Vegetables

~ Aidells Chicken sausage – sliced
~ Broccoli, zucchini, mushrooms, potatoes or sweet potatoes, or whatever else you have on hand.
~Roast in the oven and enjoy!

For more tips on how to conquer healthy eating during the busy school season, contact our office at 919.999.0831 to schedule an appointment with one of our Health Coaches. 

Your Partner in Health!
Caroline Wilson, M.Ed., FMHC

5 Strategies For Stress Eating

Stress eating occurs when we eat in response to a stress signal instead of a hunger signal.  It is reaching for food to calm our nerves, soothe our sadness, chase away boredom or buffer against other emotions we are uncomfortable with.
 
When we stress eat we are usually reaching for sugary and/or salty foods.  It’s often food we eat with our hands.  Hand to mouth eating frequently occurs without much awareness or mindfulness.

 
Tips to Help Decrease Stress Eating:
 

1) Being Body Aware – This means getting in touch with your body.  Get back into your body, get grounded, get centered.    Are you truly hungry?  Pay attention to what sensations are going on in your body.  Has your heart rate increased?  Do you have butterflies in your stomach?  Are you feeling fragmented and disassociated in your body?  Feeling out of sync between body and mind?
 
You can bring yourself back to center by concentrating on your breath.  Put one hand on your chest and one on your belly and breathe in deeply.  Is the breath going to the upper chest area or the belly?  You want the breath to go into the low belly.  By doing this you engage the parasympathetic system (aka rest and digest) and reduce the sympathetic system (aka fight or flight).
 
2) Exercise your emotional muscle – Emotions are energy in motion.  Don’t be afraid to show your emotions.  We need to let emotions flow and we need to express them.  When we don’t do this we “eat our emotions” with food.  Emotional eaters tend to eat foods that are nutrient poor (junk food) instead of nutrient rich (veggies, fruits, healthy fats, lean proteins).
 
Keep a check on your feelings.  One way to do this is to check in with family and friends.  Be real about your emotions as this allows others to feel comfortable to open up with you as well.  Journaling is also a great tool for expressing your emotions. 
 
3) Developing alternatives – Rather than engaging in stress eating come up with alternatives.  Make a list of 5 things that you can do instead of eat when you are not really hungry but are craving food due to emotions.  Some ideas:  call a friend, physical movement, journaling, nap, read a good book, organize a drawer in your kitchen or bathroom.
 
4) Having healthy foods available – If you can’t fight the urge to eat, make the best choices with the cravings you have.  Ideas:  avocado for someone who craves fat, fruit for someone that craves sugar, cacao powder in water for someone who craves chocolate, olives for someone who craves salt. 
 
5) Fueling your body with real food – Be sure you are getting lots of nutrients so you are not vulnerable to the effects of stress.  Food modulates our mood and if we stick with whole unprocessed foods our mood will be better and we won’t feel as stressed.


Your Partner In Health!
Sara Yadlowsky, FMHC

A NEW take on an OLD favorite: a COLD soup for those last HOT days of summer!

Like so many of us with food sensitivities or allergies, the necessity of creativity in the kitchen has now become a joy. That said, I do not relish hours of prep time in the kitchen.  This new version of my old favorite gazpacho, has replaced the tomato I can no longer eat with cucumber! It is gluten, dairy, nightshade free, full of nutrients, yummy and so easy, done in 15 minutes in the blender.

Cucumber Gazpacho: serves 4
2 cucumbers (unwaxed/organic if possible to be able to use the peels; if waxed, peel first)
2 T shallots (or onion if you don’t have shallots)
2 small garlic cloves
1 cup cilantro leaves
4 T lime juice
2 cups coconut unsweetened yogurt
½ teaspoon salt

½ teaspoon black or white ground pepper
2 t coriander ground
2 T olive oil

1 handful arugula or baby kale or baby spinach
 
For garnish consider:
Lime zest (my favorite)
Diced avocado
Poached shrimp drizzled with lime, olive oil

Directions:

Put all ingredients in blender.
Chill in fridge.
Make sure it is REALLY cold so best to make ahead of time.
Enjoy!

Your Partner in Health!
 Frances Meredith, MD

Dry Needling with Dr. Kari Smith, PT, DPT

At Carolina Total Wellness we understand that our services and support are sometimes only part of the solution in optimizing our patients’ health.  We have worked over the years with various medical providers in our community to establish a base of high-quality clinicians who are able to meet the various health needs of our patients.  This is the first in a series of guest blogs from one of our community providers.  Dr. Kari Smith, PT, DPT, describes one of her approaches to treating pain – dry needling.

 
What is dry needling?
Dry Needling is a soft tissue manual therapy technique performed by a certified clinician with a professional degree in the medical field. The clinician safely guides a sterile monofilament needle into dysfunctional muscle tissue to aid in pain reduction and restoration of proper movement patterns. This technique involves identifying and treating a muscle trigger point (a collection of muscle fibers that lack healthy blood supply, have a higher resting electrical state and contain pain-generating chemicals). Left untreated, muscle trigger points can lead to altered joint movement, as well as increased stress on surrounding soft tissue.

A clinician may also use dry needling with electric stimulation to release overactive primary muscles, or to wake up dormant stabilizing muscles by improving their neural response. Primary muscle groups are comprised mostly of fast-twitch muscle fibers, so they fatigue quickly and require de-activation to recover. Stabilizing muscles contain more slow-twitch fibers and can withstand longer bouts of activation. Our bodies experience pain or movement dysfunction when the stabilizing muscles are inactive, and the larger muscle groups work over-time. Through dry needling with electric stimulation, the clinician activates these stabilizing muscles so that stress is taken off primary muscle groups, allowing these larger muscle groups to function optimally, but also have time for recovery.

Does it hurt?
The needles are much smaller than ones used for an injection, so often patients do not feel the insertion of the needle in the skin. There is also nothing injected (as the needle is solid), so patients do not experience the burning sensation that is commonly felt when a fluid is injected into the body. The most common sensation is a light cramping when the needle activates a deep twitch response in the trigger point. This is an effective response that is documented in the literature that indicates that the trigger point has been released and immediate changes in muscle length are observed. Some patients feel soreness after the treatment, similar to muscle fatigue after a strenuous workout. Your therapist will be in constant communication with you throughout the procedure to alter or cease treatment as needed.

How will I know the treatment is effective?
Your therapist will perform a series of pre-treatment tests to determine areas of pain, movement dysfunction, or loss in strength. Following treatment, these areas will be re-assessed for improvement, and often there are immediate results. Your therapist will then recommend corrective exercises to maintain the gains made during the manual therapy session.

If you are suffering from pain and feel that dry needling may be of benefit to you, feel free to discuss this with your functional medicine physician at Carolina Total Wellness or contact Dr. Smith at Prevail physical therapy.
 

 Dr. Kari Smith, PT, DPT
Founder, Owner, Physical Therapist, Prevail

919-482-9648 | f 919-589-4839 
kari@prevailphysio.comwww.prevailphysio.com
100 Keybridge Dr., Morrisville, NC 27560

 

   Supplement “TAKEOUT” Option

By: Ashley Beurer, Office Manager
 

In person supplement pick up includes a 10% discount on all supplements ordered. If you prefer shipping, we will continue to provide free direct shipping for online orders.
 
• Place your order for supplements through the “Online Store” on the home page of your patient portal.
• At check out, use the promo code TAKEOUT, Click APPLY and then complete your payment
• If you use the TAKEOUT promo code, we will NOT ship your supplements. We will ready them for office pick up.
• Supplements must be ordered by 5 pm the day BEFORE you would like to pick up. The order will be ready by 9 am the next day and you may pick up anytime Monday -Thursday from 9 am to 5 pm or Friday from 9 am to 12 pm.
• Please do NOT call the practice to place your order on the phone or request via messages.
• When you come to the office to pick up your supplements, they will be ready for you by the front office door on our pick-up shelf.

Please contact our office for an appointment to further support and personalize your path to wellness.
 

Your Partner In Health!

Ashley Beurer, Office Manager

Five Tips to Get Back on Track with Exercise

Sara Yadlowsky, FMHC

There are many reasons exercise may fall to the wayside:  injury, surgery, a major life event such as a divorce or death, demands of work or simply losing interest in an exercise routine can all disrupt your exercise schedule.  Life is full of ups and downs and sometimes things gets in the way of consistent exercise and movement.

Here are five tips to help you get back on track: 

Choose a Type of Movement
You don’t have to stick with the same type of exercise you have done in the past.  Perhaps it’s time to try something new – maybe something you’ve always wanted to try but haven’t.  Think about your current lifestyle and what exercise would suit you best.  There are so many different types of exercise.  You may want to sample a few before you decide on an exercise plan.

 Set Realistic Expectations
Don’t attempt to go from the couch to exercising 7 days a week overnight.  This will often end up in injury and put you BACK on the couch.  Instead come up with a plan that eases you back into consistent movement such as walking 2-3 days a week for 15-20 minutes.  This primes your muscles and joints more effectively.   It also gives you a “win” because it is manageable and you will succeed.  This is great for your mindset and will keep you moving forward with your goals.

Focus on Consistency
One of the most important aspects of forming a new habit is to be consistent.  So rather than working out once a week for 2 hours (and ending up sore and possibly injured) it is much better to exercise 5 days a week for 30 minutes.  Make a commitment to yourself to exercise a specific number of days a week and keep that commitment.  

Get Support from Family and Friends
Let your family know what your new fitness goals are so they can support you.  You may need others to take over some of the tasks around the house so you have time to exercise. Enlisting a friend to exercise with you can help keep you focused and can make exercise more fun.

 Fuel Your Body with Nutritious Foods
You’ll need to make sure you are fueling yourself well when adding exercise back into your routine.  Depending on what type of exercise you are doing you may need more protein than you are currently eating.  Focusing on whole foods with adequate protein, lots of veggies and healthy fats will give you the energy you need to get through your workouts. Exercise is hard sometimes but it should be fun!  Find something you enjoy doing and see how good it makes you feel to move.
 
 Your Partner In Health!
Sara Yadlowsky, FMHC

Gluten in Medication

Frances Meredith, MD
“What? There’s gluten in my Advil?” 

Those with food sensitivities are always on the lookout to avoid exposure to foods we know cause trouble for us. As someone with food sensitivities myself, I was horrified to discover that a migraine medication I was taking contained food proteins to which I knew I was sensitive. How could that be?

Medications, both over the counter (OTC) and prescription, need to have “fillers” to hold the tablets together. These often come from corn or potato starch, but can also have ingredients that contain gluten or soy as well.

Most prescription medications now are gluten free though not all are certified as such by the manufacturer. Several blood pressure medications contain gluten. Gluten containing OTC medications include Advil Liquid Gel and Advil Liquigel Migraine Caps.    
“Red flag” Ingredients in medications that can have gluten hidden within include:- modified starch, pregelatinized starch (can be derived from potato, corn, tapioca or wheat)
-dextrate and dextrin (can be derived from potato, corn, tapioca, or wheat)
– dextrimaltose (may be derived from barley malt)
-Maltodextrin (may be derived from potato, corn, tapioca, or wheat)
– sodium starch glycolate (usually derived from potato, but may come from corn, tapioca, or wheat)
-caramel coloring (when barley malt is used).
-All of above are suspect if the source is not specified
 
Now, let’s talk more about “inactive” ingredients.  Ingredients such as corn starch or potato starch may be labelled as “inactive”, however, for some of us they can certainly trigger some very “active” immune responses.

Corn starch is a frequent filler in many OTC meds as well as prescription meds. These include multiple forms of Advil, blood pressure medications such as amlodipine, birth control pills, cholesterol medicines, such as atorvastatin, and common antibiotics such as azithromycin.

Other inactive ingredients may be important, causing immune reactions in some people. For this reason, I always advise choosing the cleanest version of a medication possible when needed. An example of this is the difference between NP Thyroid and Armour. Armour contains inactive ingredients which may be reactive for some, including sodium starch glycolate (gluten free), a food coloring, and microcrystalline cellulose.  NP Thyroid contains maltodextrin (gluten free), mineral oil, calcium stearate, and dextrose monohydrate as inactive ingredients. These tend to provoke fewer immune reactions.
 
Often the “inactive” ingredients are not evident on the label.  For over the counter medications you will need to peel back the label and look underneath. If there is no information on ingredient sources, call the 1-800 number on the label to be certain.

A most helpful resource is  www.glutenfreedrugs.com  On this website, kept up to date by a pharmacist, you can look up most drugs to find whether gluten, potato, corn, or soy are within. Another helpful resource is  www.beyondceliac.org.

Your most valuable resource is your pharmacist. Speak to them personally to get them on your team, letting them know your particular food sensitivities. They will add this to your profile and double check any medication to make sure it is absent of your food triggers. They can also be helpful checking ingredients on any over the counter product you might consider using. Though they cannot do this on the spot, they can research the ingredients and get back to you. My pharmacist at Publix has been an immense help to me. I am so grateful to have her on my “team”.
 
Your Partner in Health!
 Frances Meredith, MD

Kids and Mindfulness

Caroline Wilson, M.Ed., FMHC
 You may be thinking that kids and mindfulness are not two things that naturally go together. But as anxiety continues to become an epidemic for our children and teens, we must find ways to help them make mindfulness a part of their lives.

So, what is mindfulness? 

A great definition by Jon Kabat-Zinn, the founder of Mindfulness-Based Stress Reduction describes it well:

 Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally. 

Stopping, paying attention, and noticing what’s happening around you, and everything you’re feeling, thinking and doing in that particular moment with honesty and without judgment is being mindful.  Sounds easy enough, right?

Actually, this Harvard study found that we spend almost 50% of our time thinking about something else and NOT what we’re actually doing!

Here are just a few of the health benefits of mindfulness that have been researched:
Increased focus and attention
Improved memory and learning
Less anxiety and depression
Better emotional self-regulation
Stronger immune system
Reduced inflammation 

Here are a couple of my favorite mindfulness exercises that you can do with your kids:
 
STOP, LOOK, and LISTEN
 
You and your kids can practice mindfulness anywhere and anytime.  A great way for kids to learn how to be mindful is by using the STOP, LOOK, and LISTEN method.  This involves, STOPPING what you are doing, LOOKING around you and using all 5 senses (what are you seeing, hearing, feeling, smelling, and even tasting) and LISTENING (listen to your body and mind and how it feels in that moment).

THE FIVE SENSES EXERCISE

Another quick exercise that can be done anywhere is the 5 senses exercise.  Notice 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.  This exercise can bring you to a mindful state quickly.
These are just a couple of examples of how you can practice mindfulness with your kids.   

Your Partner in Health!
Caroline Wilson, M.Ed., FMHC