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Chocolate: The Good, The Bad, and The Ugly

Frances Meredith, MD

For many Valentine’s Day brings with it thoughts of chocolate. February is both American Heart Month and National Chocolate Lovers Month, a brilliant combination as the nutrients within chocolate can help to improve heart health. Let’s dig into the good, the bad, and the ugly of chocolate.

Dark chocolate is rich in polyphenols, specifically flavonoids, the substances that have a wide range of health benefits. These include lowering blood pressure, improving the function of our vascular endothelium (the inner walls of our arteries), protecting skin against sun damage, improving blood flow to the brain, and reducing the risk of cardiovascular damage. Dark chocolate has also been proven to help with mood. These benefits come from chocolate’s ability to promote production of the vasodilator Nitric Oxide as well as the anandamide within, a cannabinoid compound (like CBD) that binds to receptors in the brain to alter mood and brain activity. In addition, methylxanthine compounds, such as theobromine and caffeine, are powerful antioxidants. Remember that these are stimulants as well and should be kept far from your bedtime.

As milk chocolate has a much higher sugar content and lower flavonoid content, dark chocolate, at least 70%, is the best choice.  Know that white chocolate has no flavonoids, and hot chocolate mixes have very low amounts. As even dark chocolate has sugar, limiting daily intake to 1 oz of at least 70% dark chocolate is the best choice.

There is however, a DARK side to chocolate: heavy metals. Lead and cadmium have been known for many years to be elevated in chocolate. Consumer reports has recently reported their results of batch metals testing of multiple brands of chocolate. They have confirmed levels of metals in many brands of chocolate that exceed California Proposition 65 standards, specifically for lead and cadmium. These metals are associated with multiple health issues in both children and adults. The risk is highest for young children and pregnant women as metals have a negative effect on brain development and IQ. However, even outside this patient population, accumulation of metals in the body can cause a wide range of health conditions including kidney damage, elevated blood pressure, immune and hormonal disruption, and central nervous system dysfunction.

Now why would metals be in our chocolate? For cadmium, the cacao plant absorbs the metals from the soil and levels accumulate in the beans. Lead, however, gets in after harvesting, with levels rising as the beans dry and are processed. Highest levels are found on the outside of the bean, consistent with environmental contamination.

So…. should we give up chocolate? My vote is a resounding NO! The “Yum” and “Aaaaah” response to chocolate are undeniable, and the health benefits are substantial and backed by science. The Consumer Reports study gives us guidance as to which brands of dark chocolate are lowest in metals. See the report for details where one bar each from Mast, Tatza, and Valrhona, and two bars from Ghirardelli have relative low levels of both cadmium and lead

https://www.consumerreports.org/health/food-safety/lead-and-cadmium-in-dark-chocolate-a8480295550/

From the Functional Medicine perspective, food is medicine. But the devil is in the details where purity, dose and timing make it medicine or poison. Choose your brand wisely, be moderate in your amount, and time your chocolate well away from your bedtime. And most of all: ENJOY!

Your partner in health,
Frances T Meredith, MD

A FUNCTIONAL MEDICINE APPROACH TO OSTEOPOROSIS

Didem Miraloglu, MD, MS


Osteoporosis refers to a condition where bones become brittle.  A report from the Surgeon General states in the US 54 million Americans are at risk for osteoporosis, and 10 million Americans already have osteoporosis. Although women make up 80% of osteoporosis cases, men still get osteoporosis. Each year 1.5 million people suffer a fracture from bone loss, and if this is a hip fracture, mortality in the first year can be as high as 40%, with higher mortality rates in men than in women.
Starting in childhood, there is a fine balance between the building up and breaking down of bones coordinated beautifully between cells named osteoblasts and osteoclasts, respectively.  If there is too much osteoclast activity, then there is an increased amount of breakdown of bone as seen in inflammation. There is also this misconception that it is the lack of calcium causing osteoporosis. It is actually calcium balance and not the total calcium which is important in osteoporosis. 

Risk factors for osteoporosis include:
1)         Aging: Inflammation is a normal process of aging, which increases with age, in functional medicine, this is termed “inflamm-aging”.
2)         Diet- SAD: Diet (Standard American Diet) is very inflammatory, upregulating the immune system. Consumption of excess amounts of sugar, alcohol, caffeine, salt, and soda all can lead to bone loss due to demineralization of the bones. A leaky gut can drive inflammation to the point of bone resorption.
3)         Lifestyle: Stress, smoking, inactive lifestyle can all contribute to an increased rate of breakdown of bone compared to a build-up of bone.
4)         Genes: For instance, Celiac disease predisposes to osteoporosis due to poor absorption of minerals.
5)         Gender: Being a female increases the risk, since it is usually seen after menopause because estrogen is protective for the bones as well as the brain and the heart. During menopause estrogen declines and there is no further protection for the bones.
6)         Medications: Steroids, proton pump inhibitors (omeprazole, pantoprazole, esomeprazole), cancer drugs, thyroid hormone, cyclosporine, heparin, and warfarin.

Testing for osteoporosis is done thru a DEXA scan. It is also known as a Dual Energy X-ray Absorptiometry, or Bone Density scan, a simple X-ray where the hip and the spine bone density are measured. T-score represents the difference in your bone density from the average bone density of healthy young adults. If the T-score is -1 to -2.5 it is considered osteopenia, if <-2.5 osteoporosis. Osteopenia refers to the beginning of osteoporosis, meaning “bone poverty”.

Treatment of osteoporosis by conventional medicine involves using strong drugs, sometimes too strong which may even cause a break in the bones.

1.         Bisphosphonates: i.e., Fosamax, Boniva, Actonel, and Reclast target areas of high turnover where the osteoclasts, cells which break down old bone, absorb bisphosphonate and hence their activity is slowed down and there is a reduction in bone breakdown.
Side effects: bone, joint, muscle pain, nausea, gastric ulcer, stress fracture of the thigh bone

2.         SERM: Selective estrogen receptor modulator- i.e.Raloxifene, acts like estrogen in some parts of the body but blocks the effects of estrogen in other parts. Increases bone density and reduces the risk of spine fractures, but it has not been shown to decrease the risk of non-spinal fractures. Raloxifene also decreases the risk of invasive breast cancer. 
Side effects: hot flashes, leg cramps, or blood clots in the legs or lungs. Raloxifene is not recommended for premenopausal women.

3.         Parathyroid hormone molecule: i.e. Teriparatide, abaloparatide stimulates new bone formation, rather than preventing bone breakdown. Because of potential safety concerns, particularly an increased risk of bone cancer in rats, the use of this drug is restricted to men and women with severe osteoporosis—who have a high risk of a fracture—and can be given for no more than two years.
Side effects: uncommon but may include leg cramps, headaches, dizziness, high blood calcium, and high urinary calcium (with an increased risk of kidney stones). This medication is not recommended for premenopausal women.

4.         Romosuzumab: Bone-building medication that is given once a month as pair of injections by a doctor or nurse. Treatment is given once a month for twelve months and is then followed by another medication to prevent bone loss. Romosozumab reduces the risk of spine fractures and non-spine fractures, including hip fractures. Romosozumab may increase the risk of heart attack or stroke—including fatal heart attack or stroke—and it should not be given to women who have had a heart attack or stroke in the past year. It is approved for the treatment of osteoporosis in women past the time of menopause who are at high risk for fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or failure or intolerance to other available osteoporosis therapies. It may cause side effects such as headaches or joint pain.

5.         Estrogen hormone therapy: Prevents bone loss and reduces the risk of fracture in the spine and hip. It can also relieve other symptoms of menopause, such as hot flashes and vaginal dryness. Estrogen is usually given in pill form, although it is also available in other forms such as a skin patch or gel. Studies show that the risks of oral estrogen therapy—including heart attack, stroke, blood clots, and breast cancer—may outweigh its benefits in many older women, depending upon the dose and specific preparation. For this reason, estrogen therapy is not usually prescribed solely for fracture prevention.

A comprehensive functional medicine approach to the evaluation of osteoporosis takes the form of blood, saliva, stool, and urine testing. Low-grade inflammation can be assessed thru blood work by checking hs-CRP, HgA1C, ESR, CMP, CBC, and essential fatty acids. Blood work for vitamin D and osteocalcin is necessary since vitamin D helps absorb calcium into the bones and osteocalcin is a biomarker for functional vitamin K deficiency. Bone resorption can be evaluated by urine N-telopeptide. Stool analysis to evaluate the gut is also important since calprotectin in stool provides information about inflammation in the gut. Gut microbes are responsible for making vitamin K, which is necessary for having better bone density. Saliva testing for hormones would provide information about the levels of estradiol, testosterone, DHEA, cortisol, and progesterone.

A comprehensive functional medicine approach to the treatment of osteoporosis is first and foremost prevention.  It is recommended by conventional doctors to get a DEXA scan once a woman turns 65, however, it may be too late for some since many risk factors play a role in developing osteoporosis. It is ideal to have a DEXA scan around ages 30-35 as a baseline since this is the time of peak bone mass, and then another one a year after menopause to compare the degree of bone loss to get ahead of the condition.



Osteoporosis refers to a condition where bones become brittle.  A report from the Surgeon General states in the US 54 million Americans are at risk for osteoporosis, and 10 million Americans already have osteoporosis. Although women make up 80% of osteoporosis cases, men still get osteoporosis. Each year 1.5 million people suffer a fracture from bone loss, and if this is a hip fracture, mortality in the first year can be as high as 40%, with higher mortality rates in men than in women.

Starting in childhood, there is a fine balance between the building up and breaking down of bones coordinated beautifully between cells named osteoblasts and osteoclasts, respectively.  If there is too much osteoclast activity, then there is an increased amount of breakdown of bone as seen in inflammation. There is also this misconception that it is the lack of calcium causing osteoporosis. It is actually calcium balance and not the total calcium which is important in osteoporosis. 

Risk factors for osteoporosis include:
1)         Aging: Inflammation is a normal process of aging, which increases with age, in functional medicine, this is termed “inflamm-aging”.
2)         Diet- SAD: Diet (Standard American Diet) is very inflammatory, upregulating the immune system. Consumption of excess amounts of sugar, alcohol, caffeine, salt, and soda all can lead to bone loss due to demineralization of the bones. A leaky gut can drive inflammation to the point of bone resorption.
3)         Lifestyle: Stress, smoking, inactive lifestyle can all contribute to an increased rate of breakdown of bone compared to a build-up of bone.
4)         Genes: For instance, Celiac disease predisposes to osteoporosis due to poor absorption of minerals.
5)         Gender: Being a female increases the risk, since it is usually seen after menopause because estrogen is protective for the bones as well as the brain and the heart. During menopause estrogen declines and there is no further protection for the bones.
6)         Medications: Steroids, proton pump inhibitors (omeprazole, pantoprazole, esomeprazole), cancer drugs, thyroid hormone, cyclosporine, heparin, and warfarin.

Testing for osteoporosis is done thru a DEXA scan. It is also known as a Dual Energy X-ray Absorptiometry, or Bone Density scan, a simple X-ray where the hip and the spine bone density are measured. T-score represents the difference in your bone density from the average bone density of healthy young adults. If the T-score is -1 to -2.5 it is considered osteopenia, if <-2.5 osteoporosis. Osteopenia refers to the beginning of osteoporosis, meaning “bone poverty”.

Treatment of osteoporosis by conventional medicine involves using strong drugs, sometimes too strong which may even cause a break in the bones.

1.         Bisphosphonates: i.e., Fosamax, Boniva, Actonel, and Reclast target areas of high turnover where the osteoclasts, cells which break down old bone, absorb bisphosphonate and hence their activity is slowed down and there is a reduction in bone breakdown.
Side effects: bone, joint, muscle pain, nausea, gastric ulcer, stress fracture of the thigh bone

2.         SERM: Selective estrogen receptor modulator- i.e.Raloxifene, acts like estrogen in some parts of the body but blocks the effects of estrogen in other parts. Increases bone density and reduces the risk of spine fractures, but it has not been shown to decrease the risk of non-spinal fractures. Raloxifene also decreases the risk of invasive breast cancer. 
Side effects: hot flashes, leg cramps, or blood clots in the legs or lungs. Raloxifene is not recommended for premenopausal women.

3.         Parathyroid hormone molecule: i.e. Teriparatide, abaloparatide stimulates new bone formation, rather than preventing bone breakdown. Because of potential safety concerns, particularly an increased risk of bone cancer in rats, the use of this drug is restricted to men and women with severe osteoporosis—who have a high risk of a fracture—and can be given for no more than two years.
Side effects: uncommon but may include leg cramps, headaches, dizziness, high blood calcium, and high urinary calcium (with an increased risk of kidney stones). This medication is not recommended for premenopausal women.

4.         Romosuzumab: Bone-building medication that is given once a month as pair of injections by a doctor or nurse. Treatment is given once a month for twelve months and is then followed by another medication to prevent bone loss. Romosozumab reduces the risk of spine fractures and non-spine fractures, including hip fractures. Romosozumab may increase the risk of heart attack or stroke—including fatal heart attack or stroke—and it should not be given to women who have had a heart attack or stroke in the past year. It is approved for the treatment of osteoporosis in women past the time of menopause who are at high risk for fracture, defined as a history of osteoporotic fracture, multiple risk factors for fracture, or failure or intolerance to other available osteoporosis therapies. It may cause side effects such as headaches or joint pain.

5.         Estrogen hormone therapy: Prevents bone loss and reduces the risk of fracture in the spine and hip. It can also relieve other symptoms of menopause, such as hot flashes and vaginal dryness. Estrogen is usually given in pill form, although it is also available in other forms such as a skin patch or gel. Studies show that the risks of oral estrogen therapy—including heart attack, stroke, blood clots, and breast cancer—may outweigh its benefits in many older women, depending upon the dose and specific preparation. For this reason, estrogen therapy is not usually prescribed solely for fracture prevention.

A comprehensive functional medicine approach to the evaluation of osteoporosis takes the form of blood, saliva, stool, and urine testing. Low-grade inflammation can be assessed thru blood work by checking hs-CRP, HgA1C, ESR, CMP, CBC, and essential fatty acids. Blood work for vitamin D and osteocalcin is necessary since vitamin D helps absorb calcium into the bones and osteocalcin is a biomarker for functional vitamin K deficiency. Bone resorption can be evaluated by urine N-telopeptide. Stool analysis to evaluate the gut is also important since calprotectin in stool provides information about inflammation in the gut. Gut microbes are responsible for making vitamin K, which is necessary for having better bone density. Saliva testing for hormones would provide information about the levels of estradiol, testosterone, DHEA, cortisol, and progesterone.

A comprehensive functional medicine approach to the treatment of osteoporosis is first and foremost prevention.  It is recommended by conventional doctors to get a DEXA scan once a woman turns 65, however, it may be too late for some since many risk factors play a role in developing osteoporosis. It is ideal to have a DEXA scan around ages 30-35 as a baseline since this is the time of peak bone mass, and then another one a year after menopause to compare the degree of bone loss to get ahead of the condition.

Once you have osteoporosis then the treatment is as follows:

  1. Exercise: At least 3 days a week, if you don’t use your bones you will lose them. Weightlifting, bands, core strengthening, and yoga all help with building up bone mass and also help preserve balance.
  1. Optimize vitamin D levels: In osteoporosis, you need higher levels of vitamin D, ideally 80-100. This usually amounts to 5000 IU daily and needs to be taken along with vitamin K2 which helps absorb the Calcium into the bones in place of the arteries.
  1. Diet: Eliminate “bone dissolvers”: excess protein, SAD processed diet, excess salt. Obtain Calcium from your diet as much as possible and not supplements. Add more greens to your diet, herring, mackerel, sesame seeds, and chia seeds are all excellent sources of calcium.
  1. Hormones: Low testosterone and low estrogen can cause bone loss, and higher levels of FSH in menopause are associated with higher osteoclast activity. Hormone supplementation may help.
  1. Nutraceuticals: Trace minerals are extremely important in building bone, such as magnesium, zinc, boron, manganese, copper, and silicon. If you are taking Calcium then make sure it’s in a microcrystalline hydroxyapatite complex which provides bone-enhancing factors such as growth factors, peptides, and mucopolysaccharides.

Your partner in health,
Didem Miraloglu, MD, MS

Autoimmunity: Why is my immune system attacking me?

Frances Meredith, MD

All of us either have a family member or friend who suffers with autoimmunity, a condition where our immune system wrongly targets us. Perhaps you yourself are part of this very popular club, affecting people at younger and younger ages. Generations ago there might have one uncle with “rheumatism” in your family, or a grandmother whose “joints hurt when it rains”. Today these cases are commonplace, as are the many other faces of autoimmunity from Hashimoto’s hypothyroidism, to lupus, to multiple sclerosis. So what is autoimmunity, why is it affecting so many of us, and what can we do to stop the “self-attack”?

Autoimmunity occurs when our finely tuned immune system, designed to defend against foreign invaders ranging from food borne bacteria to pandemic viruses, turns against us. Unfortunately, many with autoimmunity are frustrated with lack of a clear diagnosis. Traditional medicine looks to fit us into neat diagnostic boxes, which frequently do not apply. It is clear to those who see many autoimmune patients that the majority of those who suffer from chronic illness over years, feeling unheard by their providers, searching for answers from multiple doctors who scratch their heads, represent this type of self-attack.

Why would such an intelligent immune system turn against us?  Imagine the confusion of your protective army as it heeds the call to attack its own castle. And how do we bring our defense system back to its original function: to make decisions as we interact with our environment, deciding what is friend vs what is foe and mounting an appropriate response, but not to attack us?

A more esoteric view of autoimmunity emphasizes that we are not separate from our immune systems. You are your immune system. You are creating it, and impacting its ability to function optimally every day by the choices you make. The salient question is “If I am my immune system, where did the communication go wrong? What messages am I sending to make me turn upon myself?”

The answers to these questions are complex, and very individual. Autoimmunity, first, requires susceptible genetics. These genetic vulnerabilities are then activated by certain lifestyle triggers. Your Functional Medicine provider assesses this by creating a “Personal Autoimmune Trigger Blueprint”. These triggers range from reactive foods to infections, toxins, vaccines, childhood trauma, concussion, blood sugar, high stress, lack of sleep such as with sleep apnea, and low levels of key nutrients for optimal immune function. Addressing these triggers while optimizing immune nutrients and plant based supportive supplements allow the immune system to regain balance. The goal is to get our autoimmunity into remission. We see patients achieve remission every day as they address their triggers, support their body, and see the results in declining antibody levels and, more importantly, in feeling better.

We at Carolina Total Wellness are experienced in a broad range of autoimmunity, not only the ones with names you recognize, but also those not yet defined by a lab test from a Rheumatologist. We would be honored to walk with you on this journey of understanding and regaining immune balance.

Your Partner In Health,

Frances Meredith, MD

CGM’s

Sara Yadlowsky, FMHC

Many of us have too much glucose (blood sugar) in our system and are not aware of it.  Glucose enters our bloodstream mainly through the sweet or starchy foods we eat.  The conventional medicine community has taught for many years that unless you are diabetic or pre-diabetic your blood sugar levels are not important.  However, more recent, cutting-edge science and the increased use of continuous glucose monitors (CGM’s) have proven that everyone needs to pay more attention to glucose levels.   A CGM is a small device that attaches to the back of your arm and monitors blood glucose on a continuous basis.  You can obtain a CGM through a prescription or purchase one online through websites such as Signos, Veri and Nutrisense.  I wore a CGM for several weeks recently and found it very informative in understanding how my food choices affect my blood sugar levels.  For example, I realized how breaking my fast with a low carb meal was very helpful in avoiding the spike that can occur after fasting for 16 hours.
 
Symptoms of uncontrolled glucose can include fatigue, food cravings and brain fog.  Long term effects of uncontrolled glucose can include hormonal dysfunction, acne, wrinkles and infertility.  Over time the development of type 2 diabetes, cancer, dementia, PCOS and heart disease can occur.
 
There are several easy modifications you can make to your diet that flatten the glucose curve that occurs after eating.  These modifications include:

  • Eating fiber first.  Have your vegetables before your protein and/or starch.
  • Ingesting apple cider vinegar before eating carbs
  • Avoiding sugar on an empty stomach.  Have it after a meal instead.
  • Getting some type of movement in after eating a meal high in carbs.  A walk or even just some air squats will do.

 
There is a new book out about blood glucose called The Glucose Revolution written by Jessie Inchauspe.  The author goes into depth about the huge impact glucose has on our health.  She then presents several ways to control our blood sugar more effectively.  The book also includes tips on how to handle cravings, better choices in alcohol and how to read ingredient labels.
 
Jessie Inchauspe has an Instagram account (glucosegoddess) that continues the education on controlling glucose and gives lots of actional advice. This may help provide you with some motivation to jump start a healthier lifestyle in 2023.  Our health coaches and physicians at Carolina Total Wellness are also always available to provide you with personalized advice on improved blood sugar control.
 


In health,
Sara Yadlowsky, FMHC

Leaky Gut

Susan Denny, MD, MPH

Do You Have Leaky Gut?

If you suffer from a chronic health condition and have been researching how to improve your health, you may have heard of leaky gut.  If that conjures up an unpleasant image of gut materials leaking in to your bloodstream, you are not far off.  Leaky gut happens when contents from the small intestine spill into the sterile bloodstream from a damaged or “leaky” gut wall.   This contamination of the bloodstream by digested foods as well as bacteria, yeast, and other pathogens is often the foundation for chronic inflammatory and autoimmune health disorders. 

Leaky gut is referred to as increased intestinal permeability in scientific research and is increasingly being recognized as a common underlying factor in most inflammatory symptoms and disorders.  As our body’s largest immune organ, the gut powerfully influences the rest of the body. Importantly, this includes the brain. Current scientific studies link intestinal permeability with inflammatory bowel disorders, gluten sensitivity, celiac disease, Crohn’s disease, type 1 diabetes, depression, anxiety, psoriasis, and many other chronic conditions.

Given what we know about the connection between gut health and immunity, it is vital to include a gut repair protocol in the treatment of inflammatory and autoimmune disorders. Repair of leaky gut begins with understanding why it developed in the first place.   Reasons for leaky gut can include over the counter or prescription medications, antibiotic use, toxin exposure, hormonal changes, food intolerances, poor diet and others.  After root causes are identified, a leaky gut protocol can help you improve your health, relieve symptoms, boost energy, make you happier, and clear your brain fog. Ask our office for advice on improving your overall health through a personalized leaky gut evaluation and treatment plan.

Your Partner in Health!

Susan Denny, MD, MPH

Healthy Work Ergonomics

Ergonomics

Ergonomics is the study of people’s efficiency in their work environment. The position of your monitor, how you sit, how long you sit, and many other variables can affect your work efficiency. It is also important to consider the impact that working in front of a computer can have on your mental and physical health. Here are several suggestions for making your work environment  more productive, enjoyable, and healthier.

Computer and Visual Ergonomics

  • Choose a chair or standing position that supports your back. Make sure that you are not sitting for prolonged periods of time. Stretch your fingers, hands, and arms periodically.
  • Be aware of your head tilting forward or backward as this can cause neck strain and headaches. Your computer display should be located just below eye height, about 4-5 inches as measured from the center of the monitor.
  • When typing, make sure that your hands are at, or below your elbows. Your knees should be level with your hips.
  • Position your computer monitor 20-28 inches away from your eyes.
  • Refrain from prolonged periods of working on a mobile device, as this can create eye strain.
  • After 2 hours of continuous computer use, rest your eyes for 15 minutes.
  • Follow the “20-20-20 rule” to reduce eye strain: every 20 minutes, look at an object at least 20 feet away from your computer monitor for at least 20 seconds.
  • Set the default font size on digital devices to 3.6mm.
  • Use a blue-light filter on electronic devices to block the blue light emitted from digital screens.


Mental and Physical Health

  • Move around during breaks and stand during conference calls to reduce your overall time spent sitting. A 2-3 minute activity break every 30 minutes has been shown to improve blood sugar health.
  • Make time for a lunch break away from your desk. Plan 1 non work related lunch date per month. 
  •  Set wellness boundaries between your work and personal life by keeping a regular work schedule and routine. Turn off your computer after hours.
  • When working from home create a designated workspace separate from your living space as much as possible. When not working, close the door or hide your workspace using a partition.
  • Your office should be comfortable. It should support feelings of ease and help create a smooth work flow. Have tools  kept in your office that can help you decompress the body. Some suggestions are a yoga mat, foam roller, lacrosse ball or acupressure mat. Take mini breaks and use them.
  • Use lamp lighting vs overhead lighting and an essential oil diffuser. 
  • Practice 2-3 minutes of deep breathing or mindfulness meditation a few times each day. 
  • Use a sound machine.
  • Have a yearly Postural assessment done. 

Call our office and schedule and appointment with one of our Health Coaches to learn more about ways to support a healthy mind and body while managing a robust work schedule. 

Yours in health,
Clarissa A. Kussin, ND, FMHC, ERYT-1000

References:
1. Long J, Richter H. The pitfalls of the traditional office ergonomics model in the current mobile work environment: Is visual ergonomics health literacy the remedy? Work. 2019;63(3):447- 456. doi:10.3233/WOR-192937
2. Randolph SA. Computer Vision Syndrome. Workplace Health & Safety. 2017;65(7):328-328. doi:10.1177/2165079917712727
3. Chantal Coles-Brennan. Management of digital eye strain. Clin Exp Optom. 2019;102(1):18-29. doi.org/10.1111/cxo.12798
4. Dempsey PC, Larsen RN. Benefits for Type 2 Diabetes of Interrupting Prolonged Sitting With Brief Bouts of Light Walking or Simple Resistance Activities. Diabetes Care. 2016 Jun;39(6):964-72. doi: 10.2337/dc15-2336
5. Peddie MC, Bone JL. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: a randomized crossover trial. Am J Clin Nutr. 2013;98(2):358-366. doi:10.3945/ajcn.112.051763
6. De Couck M, Caers R. How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. Int J Psychophysiol. 2019 May;139:1-9. doi: 10.1016/j.ijpsycho.2019.02.011.

Fall Detox

Susan Denny, MD, MPH

Hello Fall! It’s Time to Detox!
 

While consistent Fall weather arrives a little later in our area than the Autumnal Equinox, the lower temperatures and falling humidity have thankfully begun to emerge.  This is one of my favorite times of year and one in which I reflect on the past year and look forward to the year ahead.   In many cultures this changing of seasons is a time for celebration and reflection.  It is also a great time for detoxification to help cleanse our bodies of unwanted toxins and prepare ourselves for the year ahead. 

I have completed many different detoxification regimens over the years but one of the easiest and most effective ones I have tried is the Mung Bean Detox.  This simple detox was shared with me by one of my favorite local chiropractors, Dr. Thomas Mitchell.  Dr. Mitchell practices Ayurvedic medicine as well as chiropractic medicine at Mitchell Chiropractic Healing Center in Raleigh. The following information, instructions and recipes are from Dr. Mitchell and his wife, Lisa.

If you have questions about whether or not this diet or another detoxification program is right for you, please contact us at Carolina Total Wellness.
 
Yours in health,
 
Susan Denny, MD, MPH

The Fall Detox Plan:
By: Tom Mitchell, DC

Detoxification is one of the pillars of Ayurveda, the ancient medical system of India that is more than 5,000 years old.  Whole mung beans are a legume that is common in Asia but is also widely available now in the US. Whole (green) mung beans. Whole mung beans have a scraping action, which supports the detoxification process. More specifically, they cleanse the colon, liver, kidneys, and lymph system. Mung beans are also much easier to digest than other legumes such as lentils and hard beans, which include pintos, black beans, and chickpeas.
 
The Benefits of a Mung Soup Food Plan
 

  • Improved digestion
  • Reduced inflammation
  • Pain reduction
  • Strengthened metabolism and weight loss
  • Improved energy, enthusiasm, and stamina
  • Reduced congestion
  • Greater mental clarity
  • You never go hungry!

 
Many patients lose 6 to 8 pounds in one week. Follow-up labs often show measurable improvement in cholesterol, triglycerides, and blood sugar/insulin resistance. Many patients experience lowered blood pressure as a result of the program.
 
 
The Food Plan
 
The simplest form of the food plan is to make a pot of Mung Soup daily cooked with vegetables right in the same pot. You can make this dish in a standard pot, standard pressure cooker or Instant Pot. Eat this food for five to seven days, at least two times a day (lunch and dinner) but preferably three times. (If you don’t enjoy a savory breakfast, it’s fine to have some organic cooked oatmeal, but not the instant variety.) Focus on easy-to-digest foods such as squashes and greens of all kinds. A little bit of green beans and a little sweet potato is also fine. A small amount of white basmati rice is considered better for a detox than brown rice; just eat enough to complete the protein of the beans and ensure that you feel adequately fed.
 
During the detox it is essential to avoid gluten, dairy, and refined sugar as well as all animal foods. The major emphasis is staying on a plant-based diet (except for the use of ghee, clarified butter). Plant-based meals are easier to digest, which supports the detoxification process. We also recommend that you avoid inflammatory vegetables such as nightshades (tomatoes, eggplant, peppers, chilies, white potatoes) and gassy vegetables such as the cruciferous vegetables and okra.
 
For people who can make a little extra time to cook—and who want a more diversified diet—we offer some delicious vegetable soup and side dish recipes to complement the mung soup. You can make Quick Sauteed Asparagus in about 5 minutes, or a luscious Asparagus Soup with leeks and fresh tarragon. One of our favorites is a Vegan Collards recipe with smoky salt. You will find all these recipes on Lisa’s Sacred & Delicious Blog. You can also buy a copy of her cookbook Sacred & Delicious: A Modern Ayurvedic Cookbook, with 108 gluten-free recipes at Amazon, only available today in Kindle (reprint date TBA). The book won five national book industry awards in 2019. You can sign up for Lisa’s blog to receive new recipes at www.sacredanddelicious.com/blog.
 
 

ANTIBIOTICS AND THE GUT MICROBIOME

Didem Miraloglu, MD, MS

Since their discovery, antibiotics have been a godsend in terms of eradicating infections and saving millions of lives. Without antibiotics, common infections and minor injuries used to be life-threatening, and surgeries and chemotherapy were nearly impossible. Today the tables have turned on us, whereas, 50 years ago we were reaping the benefits of antibiotics, in the past 2 decades antibiotic resistance has become one of the leading causes of death in the world for people of all ages.

To comprehend the weight of this problem, we must first understand what the gut microbiome is and the role it plays in human health and disease. The gut microbiome is comprised of almost 40 trillion bacterial cells and has anywhere from 500-1000 bacterial species comprising nearly 2 million genes. The gut microbiome contributes to human body functions such as digestion, metabolism, protection from pathogenic microbes, production of vitamins, as well as the regulation of the immune system and inflammatory reactions.

A healthy gut microbiome has high diversity, and any kind of disruption may lead to dysbiosis, an imbalance between the commensals (those bacteria which normally reside in and on us without harming us) and the pathogenic bacteria. Antibiotic use can reduce the diversity of the species in the gut microbiome, alter their activity and select and breed antibiotic-resistant organisms. Short term effects of antibiotic use include diarrhea, Clostridium Difficile infection, and antibiotic resistance, whereas long terms effects can be the development of allergic conditions, such as asthma, food allergies, and obesity.

The problem of antibiotic overuse and misuse does not only stem from treatment of human infections but mainly from their use within the animal industry. The amount of antibiotics used for human infections is four times less than the quantities used for breeding livestock. Antibiotics in the animal industry are added to the feed of animals to improve their growth. They accomplish this by inhibiting the growth of microbes in the gastrointestinal tract which triggers immune responses in the host. This in turn is cost-effective to the producer since more meat can be produced with the usage of less feed.

Antibiotic misuse in both animals and humans has led to a significant increase in antibiotic-developed resistance.  This is where a particular antibiotic is no longer effective in treating an infection. The consequences are anywhere from increased human illness, suffering and death, increased cost and length of treatments, and increased side effects from the use of more powerful medications.
 
There are many suggested solutions to alleviate this ongoing health crisis. Some things you can consider to prevent further antibiotic resistance are:
 

  • Don’t rush to treat your runny nose or cough. Be sure that the antibiotic is necessary and not just convenient to use for shortening the duration of the infection. In up to 95% of the cases, bronchitis is viral and there is no cure for the common cold, it gets better on its own with over-the-counter remedies.
  • Consume antibiotic-free dairy and meat products, pasture-raised farm animals rather than factory-farmed animals
  • Ask your doctor to use a narrow spectrum antibiotic if possible to treat the most common organism causing that particular infection rather than a “shotgun” approach, using an antibiotic that kills all
  • Shortest effective duration of antibiotics (this does not mean discontinuing the antibiotics once feeling better, there are specific guidelines for a minimum duration of use for certain infections)
  • Adhere to the antibiotic prescription
  • Take a high-quality daily probiotic while on an antibiotic

 
Taking a high-quality probiotic as soon as you start antibiotics is another way to counteract the side effects of antibiotics. If you are able to, start taking probiotics a week before taking the antibiotics. Separate them out by two hours while on the antibiotics and continue for 3-4 weeks from the start of the antibiotics. After a month you can decrease the dose to your minimal effective dose for your optimal health outcomes. The probiotics help to restore some of the healthy gut microbiomes lost through antibiotic therapy. Strains of Lactobacillus and Saccharomyces (a beneficial yeast) can help mitigate antibiotic side effects. This in turn contributes to better adherence to antibiotic prescription thereby reducing the evolution of resistance.

Generating and maintaining diversity in the microbiota is a new clinical target for health promotion and disease prevention.

Fecal Microbiota Transplantation FMT) is a  therapy and is one of the main treatments against antibiotic-resistant infections.  This is whereby stools either from the same individual before the antibiotic use or from a healthy donor are introduced orally or via enema or probiotics. This stems from the premise that the gut microbiota in healthy donors is dominated by a large number of probiotics. Many studies have shown that FMT restored both the gut microbiota composition and function in patients who suffered from recurrent Clostridium Difficile-associated diarrhea. Some studies have shown that the worldwide mean cure rates of FMT for diarrhea are approximately 91%.  To date, this is better than any other treatment we have for antibiotic-associated C.Diff colitis.

We can envision in the not too distant future, antimicrobials and therapies which will be prescribed for their direct anti-pathogen benefit while simultaneously limiting collateral damage to the microbiome. Until then it is essential to keep our bodies healthy by taking good care of our gut microbiome.

 
Contact our office to schedule an appointment  to learn more about optimizing your health.

Your Partner in Health!
Didem Miraloglu, MD, MS

The Vagus Nerve: Not All Who Wander are Lost

Erica Nelson, MSPH, NBC-HWC

Practical Strategies for Managing Anxiety and Improving Digestion

Who’s the Boss?

They say the mind is a wonderful servant but a terrible master. Are you in charge of your mind and body? Or do you feel like you are at the mercy of your thoughts and feelings (physical and emotional)? This article shares cost-free and drug-free practical strategies to take back control of your physical and emotional feelings and make your mind your servant.

Your nervous system is complicated but you do not need to know all of the details to have a significant impact on its function. In this article you will find a very simple description of how one specific nerve, the Vagus, connects your physical and emotional feelings. You will also learn practical things you can do to reduce anxiety, improve digestion and overall wellbeing.

A (Very) Brief Neuroanatomy Lesson

Starting from the top, the brain branches out from your skull through 12 cranial nerves (and their branches) known as the peripheral nervous system.

Starting from the ‘bottom’ the gastrointestinal ‘mind’ is called the enteric nervous system (ENS.) The ENS has more nerve cells than the rest of the entire nervous system combined (more than 100 million!) and is capable of functioning independently of the rest of the nervous system.

The Vagus nerve is one of the 12 cranial nerves. It connects your brain to your digestive system and vice versa. It sends and receives both motor (movement) and sensory (feeling) signals. Beyond the digestive system, it touches nearly every major organ and plays a role in heart rate, respiration, facial expression, inflammation, sweating, reproduction and more.
Photo courtesy:
www.drarielleschwartz.com

The word ‘Vagus’ comes from the Latin for ‘wander’ but, as Tolkien wisely said, ‘Not all who wander are lost.’ This nerve, and its branches serve as the information super highway in your body and provide the early warning system for threats, internal and external.

Most of these functions are reflexes that happen without you thinking about them to keep you alive. Can you imagine if you had to decide to shunt blood supply from your stomach to your heart and lungs to run from danger? But sometimes the reflexes are not actually helpful in the moment and we are left feeling like our stomachs have minds of their own – because they kind of do. But when we know what the reflexes respond to, we can take steps to trigger a more desirable response.


Toning the Vagus for Stress Resilience

Have you ever felt your mouth go bone dry just as you are about to begin a presentation or performance? Or worse, maybe you feel like you are going to throw up? Or need to go to the bathroom RIGHT NOW. This is your reflexive response to stop bodily secretions and smooth muscle contractions in your GI tract so you can spend your resources elsewhere.

When you perceive a threat, your brain and body make preparations to respond and additional resources – oxygen, fluids, etc. – are diverted from digestion and reproduction until you are physically and psychologically safe again. Your heart rate, blood pressure and breathing increase, your pupils dilate, your mouth may go dry, your muscles may begin to tremble all of these are signs of activation of your sympathetic nervous system.

It is the job of the parasympathetic nervous system, including the Vagus nerve, to restore resources to ‘rest and digest’ once the threat (perceived or real) is passed. Depending on the duration and intensity of the threat, it may take 20 minutes or 20 years to return to a healthy resting state. When left unattended, chronic stress or PTSD can have long-term effects on your physical, cognitive and emotional health.

Techniques to Build ‘Stress Resillience’ and Facilitate the Job of the Vagus Nerve

Daily Habits to Support Stress Resilience:

  • Cat/Cow stretching with a Lion’s Roar

This exercise lengthens and contracts the Vagus nerve to activate it. Get on your hands and knees on the floor. Begin with a neutral spine and then press down through your hands and knees to arch your back upwards like a cat. Inhale while doing this. Then drop your belly down towards the floor and lift your breastbone forward and up. Exhale loudly while you do this, sticking your tongue out and even roaring like a lion.

  • Laugh

Laughter really is one of the best medicines. Real laughter is best but even fake laughter will engage the Vagus nerve through contraction of the diaphragm.

  • Hugs

A warm embrace, ideally 20 seconds or longer, will stimulate the part of the Vagus nerve that runs down your back and can trigger the release of a hormone called oxytocin, known as the feel-good hormone.

  • Singing, humming, chanting, gargling

The Vagus nerve is connected to your vocal cords and the muscles at the back of your throat. All of these activities activate the muscles around the nerve and can stimulate it. Choose one or more and find time for it each day.

In-the-Moment Strategies to Get Back to Rest and Digest:

  • 4-7-8 breathing

Place the tip of your tongue against the ridge of tissue just behind your upper front teeth, and keep it there through the entire exercise. Exhale completely through your mouth, making a whoosh sound. Close your mouth and inhale quietly through your nose to a mental count of four. Hold your breath for a count of seven. Exhale completely through your mouth, making a whoosh sound to a count of eight. This is one breath. Now inhale again and repeat the cycle three more times for a total of four breaths.

  • Go outside for a walk

This works for a couple of reasons. First, when you are walking, your eyes naturally move side-to-side and trigger a response in your brain that distracts it from threat. Second, you are using up some of the ‘energy hormones’ that were dumped into your system to respond to the threat and may be making you feel ‘jittery.’

  • Self-massage

Stroke your neck from your ear to your clavicle 10 times on each side. Again, your Vagus nerve is connected to these muscles. Moderately intense massage to the area will stimulate the nerve and help to restore a resting state.
 
You do not have to be at the beck and call of your body’s reflexes. Choose one or two of the strategies above and integrate them into your day to improve your ability to respond the way you want to – instead of simply reacting – the next time you are faced with a stressful situation.
 

Call our office and schedule an appointment with one of our health coaches to learn more healthy strategies to reduce and respond to physical, emotional and cognitive stress. 

Your Partner in Health!
Erica Nelson, MSPH, NBC-HWC 

TOXINS… Mercury, phthalates, and lead, oh my!

Frances T Meredith, MD

We are swimming in toxins every day from the water we drink, the air we breathe, the food we eat, and the products we use on our bodies, and in our homes and yards. We have all heard the story of Flint Michigan. But lead exposure is just the very tip of the iceberg of our daily toxin exposure.

Toxins now are well established to impair the ability of our mitochondria, the batteries in every cell, to create energy. That has downstream effects in every organ system. Many studies clearly establish that toxins underlie many chronic diseases including neurogenerative disease (think Parkinson’s, Alzheimer’s, ALS), autoimmunity, hormone disruption (think thyroid and endometriosis) and > 50% cases of gout. Did you know toxins often lurk beneath depression, anxiety, and ADHD?

There are simple things we can all do to both decrease our exposure and assist our body in moving out toxins. The first step is a good look at where the toxins are coming from. Stop the inflow! Environmental toxins include chemicals, metals, mold, particulate matter in the air, ozone, radiation, and EMF. And don’t forget those ever-present psychic toxins that have escalated in the past few years: toxic relationships, social media, and news. Toxins also can come from within, in the byproducts created by intestinal bacteria, our own hormone processing, and our own natural detox pathways. Then we often “choose our poisons”, drinking that evening wine to wind down, vape, diets that are too acidic, or choosing non pure forms of hemp, and often using them for the wrong reasons.   

I’d like to take a bit of time to dig into environmental toxins. First, metals. We all know about lead exposure, but did you know that our city water has arsenic? Kale is often filled with thallium? Do you have mercury fillings? If so, are they stable or are they leaking low level mercury into your body every day?

Next, a bit more focus on chemicals. Many chemicals are known to be “gender benders”, disrupting our hormone pathways, plugging into the estrogen receptors and not letting go, decreasing fertility in women, sperm counts in men. The big offenders on the “gender bender” list are phthalates, bisphenols, parabens, triclosan in antibacterial soap, and PCBs. Below is a list of chemicals to which we are frequently exposed, creating buildup over time.

  • Polycyclic aromatic hydrocarbons (PAHs): burning of tobacco, oil, coal, gas, garbage
  • Plastics (phthalates): from plastics and from anything with “fragrance” or “parfum” not labelled as organic (think Bath and Body Works); microplastics are also in our water
  • Phenols, particularly bisphenol, (BPA); found in hard plastics, sippy cups, linings of beverage/food containers, transferring through the skin of your hands on your Publix receipt.
  • Parabens: in many cosmetics, creams, medications etc
  • Organochloride pesticides: DDT is still  in soil from use 1940s-1960s
  • Organophosphate pesticides: RoundUp etc
  • Polychlorinated dibenzo-dioxin and furan (dioxins): exposed in high fat dairy/meat/FISH
  • Polychlorinated biphenyls (PCBs): illegal 1979, but we are still exposed in high fat dairy/meat/FISH
  • Polybrominated diphenyl ethers (PBDEs): flame retardants, FATTY FISH     
  • Polyflourinated compounded (PFCs): stain, grease, water resistant products

So how can we help our body deal with this onslaught of chemicals? First, stop the inflow:

  • Clean Air: Create a “scent free zone” in your home. Avoid living near highways if possible. Add plants that absorb toxins (ficus, mums, gerber daisies). Leave shoes at the door. Just 2 days with clean air improves health
  • Clean Water: Quality water filtration is essential, such as Aquasana, or Zero Water
  • Clean Food: Organic where possible using Clean 15 Dirty Dozen list; grow your own food where possible; wash chemically grown food in acidic solution such as vinegar, no plastic for food storage, no perflouride based nonstick pans
  • Clean up household, lawn, personal hygiene products using www.ewg.org and the Think Dirty Shop Clean app to guide product choice. No RoundUp.
  • Clean frequently, especially with crawling children in the home.

Then we can get the body ready to move toxins out. This will take guidance from your Functional Medicine provider and will include essential nutrients, balancing the intestinal bacterial microbiome, an “oil change” to remove and replace damaged oils in cellular membranes where toxins reside, adding binders to catch and remove toxins as they are excreted by liver/gallbladder into the intestinal tract. The “prep” also includes many pieces to get liver and kidneys ready. Then, and only then, can we proceed to escort the toxins out without creating further damage. “Detox” without this prep is very dangerous.

Once we move into the process of escorting out the toxins, we choose supplements, foods, and sometimes medications to grab and move toxins out of tissues. At the same time, we use many modalities including lymphatic massage, infrared sauna, castor oil packs, and CranioSacral therapy to support the lymphatic system whose job it is to move those toxins through and out.

Unfortunately, we no longer live in an organic world as did our predecessors. We are swimming in toxins every day and all have a role to play in the cleanup and healing of our planet. As we set this intention, we must support the beautiful creation that is our body in order to survive and thrive in this toxin filled world.

“Detox your mind, body, AND your contact list”

-Supa Nova Slom

Your provider at Carolina Total Wellness would be happy to discuss strategies to better optimize your body’s ability to thrive in this world of toxins.

Your partner in health,

Frances T Meredith, MD

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