Carolina Total Wellness - Carolina Total Wellness

September 9, 2022November 28, 2022

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

August 26, 2022November 28, 2022

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

August 25, 2022August 25, 2022

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

July 29, 2022August 2, 2022

Toothpaste: What should I use?

Caroline Wilson, M.Ed., FMHC

Do you ever wonder if the toothpaste you and your kids are using is toxic? Let’s take a look at some ingredients of concern that are in most conventional toothpaste brands.

Artificial Colorings – Linked to ADHD & hyperactivity in children.

Titanium Dioxide – It’s just there to make toothpaste white. EWG has a list of safety concerns, including possibly a carcinogen when ingested.

Sodium Lauryl Sulfate (SLS) – Causes canker sores for many people.

Triclosan – A pesticide and hormone disruptor.

Glycerin – It isn’t toxic, but ideally has no place in the mouth as it’s a soap that can strip your body’s natural oral mucosa and leaves a film. This could alter the microbiome in the mouth.

Ingredients we love:
Hydroxyapatite (HAp) – is a naturally occurring mineral that makes up 97% of our tooth enamel and has been scientifically-proven to strengthen and protect your teeth without fluoride. While Hydroxyapatite is not as well-known in the US, it’s been the gold standard in Japan for over 40 years.
TIP – Don’t rinse your mouth after brushing with HAp.

Bentonite Clay – A natural polisher that is rich in minerals and not too abrasive. It’s alkaline and helps reduce acidity in the mouth.
TIP – Make sure it’s “lead-free” clay.

Xylitol – Reduces cavity causing bacteria in the mouth.

Approved Hydroxyapatite containing toothpaste: Boka, Risewell, Wellnesse, Karex

Find these approved non-toxic brands in our clinic: Dentalcidin and Hyperbiotics Probiotic Toothpaste.

Call our office and schedule and appointment with one of our Health Coaches to learn more about non-toxic personal care products.

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

July 15, 2022August 2, 2022

Travel Tips

Sara Yadlowsky, FMHC

Summer is in full swing, which means weekend getaways and road trips. While for some a trip to the beach can help deter the stress associated with day-to-day life, for others it might spark a pang of anxiety. One of the most common questions we get as the weather gets warmer is: “how do I stay on track with my wellness goals while I am on vacation?” For so many of us, the excitement of being on a much-needed vacation coupled with an environment of food options that we do not usually indulge in creates a perfect storm of bloat, fatigue and overall unhappiness.

Here are some tips on how to stay on track while on vacation while still be able to enjoy yourself.

Bring Along Some Food From Home
Stay on track with your diet by bringing some food from home. Whether that mean fresh veggies and fruit, gluten-free bread, your favorite protein powder or organic meat, make sure that you are sticking with your routine from home to not only encourage healthy eating while away, but also to avoid temptations of food items that may cause unpleasant side effects.

Drink Lots of Water
Drinking lots of water daily is critical to your wellbeing and it’s even more important while you’re on vacation. Making sure that you are staying hydrated can help aid in digestion and prevent constipation while you are traveling. If you are indulging in alcoholic beverages while on vacation, this tip is even more crucial. It’s an excellent idea to alternate between alcohol and water in order to avoid dehydration.

Prioritize Whole Foods
Eating an adequate amount of vegetables and fruit while on vacation will keep your fiber intake up during vacation. An easy way to get lots of whole foods is to make a superfood green smoothie for breakfast with plenty of fruits and veggies added in. Continue to prioritize whole foods throughout the day by getting veggies and/or fruits at every meal.

Get Plenty of Sleep
Being on a vacation always couples with being out of your normal routine; which is typically a good thing unless it interferes with your sleep. As tempting as it is to stay out later, getting a couple hours of sleep in before midnight will provide you with enough restorative sleep to help maximize your sleep and, in turn, stay on track with your wellness goals.

Don’t Stress
You’re on vacation after all! After navigating through the stress of daily life, this is your chance to lower your cortisol levels and spend quality time with loved ones. Don’t let your fear of losing traction on your goals interfere with your ability to truly enjoy yourself. If you backtrack a bit take it easy on yourself. Rather than beating yourself up for indulging in dessert the night before, celebrate yourself for going on a run the following morning.

Wherever your travels make take you this summer, I hope that these insights give you peace of mind to relish in the calm and come back feeling rejuvenated and ready to continue your wellness journey. Safe travels!

In health,
Sara Yadlowsky, FMHC

July 8, 2022August 2, 2022

Back To School Checklist

Blair Cuneo, PA-C

While the family is enjoying the downtime from school break, the upcoming school year is in the back of my mind. I’m slowly starting to make lists for updating lunch boxes, checking clothing sizes, gathering school supply items, all the while wondering what the next grade level will be like for my kids.

“Preparation clears a pathway for success.” ~ Ron Kaufman

As a pediatric functional medicine provider, I recognize that each child has unique needs to optimize their mental and physical wellness. However, there are several general recommendations from which many children and families can benefit.

Specific to academic performance, here are some fundamentals for your “Back to School” checklist:

– Honor the importance of sleep for body and brain.

Lack of sleep impacts production of neurotransmitters like dopamine, crucial for its role in attention and focus. School aged children should be getting 10-12 hours of restorative sleep. Restless sleep, teeth grinding, snoring, and waking up tired after adequate hours, are all signs that the sleeping hours are not “quality”. Without quality sleep, the body has not had the restorative opportunity to repair, heal and learn.

– Check in on screen time.

Prolonged screen time is associated with increased difficulty in attention, focus, emotional regulation and anxiety. Take into account screen time needed for school and set boundaries for when and what type of screen time is allowed in the home.

– Clean up the pantry, stock the fridge.

Artificial foods and dyes have a direct, negative relationship to behavioral health and cognitive performance. When hungry, go the fridge first, aim for rainbow whole foods, read labels and avoid eating what you can’t pronounce.

Many patients and families notice improvement in mood, energy, digestion, pain and school performance by integrating the above considerations. If needed, there are more areas to investigate with a pediatric functional medicine provider.

In the functional medicine approach, we evaluate metabolic, nutritional, environmental and genetic contributors to your child’s symptoms or medical conditions. We want to understand “root cause” and not rely solely on band-aids to suppress or mitigate symptoms. We want to support the body and mind in need, while also shifting towards fundamental healing and prevention.

Some major contributors to impaired school performance include nutrient needs, like zinc and magnesium. If nutritional needs are found, we can directly support, but let’s also consider why the needs are there! Is the diet lacking? Does the digestive system have trouble absorbing nutrients adequately?

Speaking of the digestive system, the gut-brain axis is a recognized, bidirectional communication mechanism between the gut and brain. The gut microbiota affect the production and breakdown of neurotransmitters like dopamine, serotonin and GABA. These neurotransmitters are responsible for mood and academic performance. Dopamine is a key neurotransmitter for attention and focus.

When the body is under stress, dopamine production is hindered. Areas of stress include poor sleep, inflammatory foods/chemicals, food sensitivities, nutritional needs, yeast overgrowth, inflammatory bacteria.

Objective testing can be helpful in creating a personalized plan for our young patients. Less guessing, with more targeted interventions and support, can help you and your child experience enjoyment and success in their academic programs.

Call Carolina Total Wellness to schedule with our pediatric functional medicine provider.

Your Partner In Health!

Blair Cuneo, PA-C

June 17, 2022August 25, 2022

Lithium

Blair Cuneo, PA-C

Lithium…a little goes a long way in cognitive and emotional health

Popular nutrients that make the major headlines for supporting cognitive wellness include magnesium and zinc, but how’s your lithium?

Lithium is an essential micro-nutrient with chemical properties similar to calcium and magnesium. It is present in all organs and tissues of the body.

The US Environmental Protection Agency estimates the daily lithium intake of an average adult ranges from 0.65 mg to 3 mg. Foods higher in lithium include grains, vegetables, eggs and milk. The most frequent source of lithium is tap water. Depending on where you live, there can be lithium deficiencies in your soil and with increased bottle water and home filtration use, we are filtering the lithium right out of our water.

Supplementing with low-dose lithium aims to support the body’s daily nutritional need for lithium. This is very different than the dosage of lithium as medication. Lithium carbonate is a well-established, effective medication therapy for mood disorders like bipolar disorder. Whereas lithium carbonate dosing can be in the hundreds of milligrams, low-dose lithium can range from micrograms to low milligram amounts.

How does lithium benefit brain health?

It is NEUROPROTECTIVE, shielding neurons from biological stress and toxins.

It promotes NEUROGENESIS, leading to increased numbers of neurons and brain volume.

It regulates NEUROTRANSMITTERS, helping to balance the mood.

Studies continue to accrue demonstrating improvement in mood and cognitive performance for patients with ADD, depression and Autism Spectrum Disorder. More recently, studies highlight the role lithium can play in prevention and treatment of Alzheimer’s disease, by inhibiting plaque formation and aiding in growth and repair of damaged neurons.

Screening for nutritional lithium deficiencies can be performed by hair trace mineral analysis, as blood testing is not sensitive enough to detect nutritional levels.

Talk with your functional medical provider about your cognitive and emotional health and find out if low dose lithium can further support your wellness goals.

Your Partner In Health!

Blair Cuneo, PA-C

June 3, 2022August 2, 2022

Health Coaching

Erica Nelson, MSPH, NBC-HWC

The legendary basketball coach, John Wooden once said, “A good coach can change a game. A great coach can change a life.” At Carolina Total Wellness, our coaches help our patients change their lives every day.Every patient at Carolina Total Wellness that sees a doctor or physician assistant is paired with a health coach. Some patients may also choose to work solely with a health coach to achieve their dietary and lifestyle goals. This article will help you know what to expect when you work with a health coach.

Here are 3 key aspects of the health coaching experience at Carolina Total Wellness:

The Space Between
Health coaches hold space for you to pause… and decide how you want to respond to your circumstances. The world today is a seemingly relentless onslaught of stimulation, and it can feel like there is an urgency to react to all of that stimulation.

George Mumford, meditation coach to Michael Jordan, LeBron James, Kobe Bryant and other world-class athletes offers another way, ‘Think about the eye of a hurricane.’ He says, ‘No matter how intense the storm or what’s swept up in its gale-force winds, that calm, blue center is always there. We all have this quiet center within us.’ Your CTW coach will help you respond from that quiet center within, rather than reacting from the chaos of the storm.

In our office, health coaches hold space for you to make sense of what is going on in your world and in your body and decide how you want to respond. Health coaches always honor the fact that you are the expert on your own life and display unconditional positive regard for you and whatever lifestyle decisions you choose. They pay attention to what matters to you and may offer suggestions for adjustments that fit into your life.

Translator
The science of the body and its systems are the physician’s expertise. Science of behavior change is the coach’s expertise. Our coaches help you translate medical science you discuss with your doctor or PA into evidence-based behavioral change strategies to optimize your health. When you combine the medical knowledge of our physicians and PA with your coach’s expertise in the science of motivation, habits, and change, many of the barriers to experiencing health fall away.

Each of the coaches at CTW has at least a bachelor’s degree from an accredited university and training in coaching from either the Functional Medicine Coaching Academy or Duke University. Some of them also have master’s degrees and other specialized training in nutrition, exercise, counseling, and other relevant fields. Unless otherwise specified, CTW coaches are not registered dietitians, licensed mental health professionals or certified fitness professionals.

Guide
In the words of Michael Jordan, ‘A coach is someone that sees beyond your limits and guides you to greatness!’ CTW coaches come to the table with empathy for whatever you are facing and feeling and confidence in your ability to overcome. Each coach has faced their own struggles in life and knows what it is like to work hard to overcome. However, coaches never replace you as the expert on you; they serve as your guide on your journey to health. Coaches can help you understand all the different ways you can try intermittent fasting or yoga or what, exactly, is ‘glycemic index.’ Maybe our most important job, though, is to help you get very clear on your vision of the healthiest version of you. Once you decide where it is you want to go, coaches provide education, support and accountability to knock down any stumbling blocks that may come up along the way.

Call us today to schedule your appointment with one of our health coaches.

Erica Nelson, MSPH, NBC-HWC

May 20, 2022August 25, 2022

Heart Rate Variability

Didem Miraloglu, MD, MS

DO YOU KNOW HOW TO MEASURE YOUR WELL-BEING?

Ever heard of Heart Rate Variability (HRV)? Exactly as its name states, heart rate variability is a measure of the variability between heartbeats. Your heart beats a specific rate, anywhere from 60-100. There is a variation in this rate, depending on whether you take a deep breath, exercise, are under stress or are at rest. HRV is dependent on our nervous system to pick up cues from our environment. In order to understand how these cues are translated into physiological response, we first need to understand how the nervous system works.

Our nervous system controls our heart rate in two opposing directions.

One is the sympathetic nervous system, “fight or flight.” It is responsible for increasing the heart rate when we are stressed, like running away from a saber tooth tiger. In our present world since we are not normally faced with tigers, sympathetic drive kicks in during other emergency situations. This is exactly when you want more blood pumped from the heart to your muscles so you can fight or run. The blood pressure and heart rate increase as a normal response to the feedback from our environment.

Its counterpart is the parasympathetic nervous system, which is the “rest and digest” system. When our senses detect the emergency is all clear, our parasympathetic system takes the lead and tells our heart rate to slow down and lowers the blood pressure. Our body starts to relax.

This is the normal sequence of events that occurs by increasing and decreasing the heart rate appropriately according to the environmental cues. Studies have shown people with high heart rate variability are usually less stressed and are happier.

The problem occurs when there is low heart variability. This means the nervous system is not responding adequately to the environmental cues and hence your body is less resilient and struggles to handle changing situations. This may occur with diabetes, asthma, anxiety, depression and high blood pressure. This is also seen as we age.

You can improve your heart rate variability by taking care of your body and mind. Regular exercise along with a healthy diet, staying hydrated, avoiding alcohol, getting a good night sleep, being exposed to natural light, taking a cold shower and mindfulness, all help with reduction in HRV. Controlled breathing has also been shown to boost HRV and help fight stress which can decrease HRV.

The gold standard for measuring HRV is an EKG. But you don’t have to buy an EKG, since there are smaller and more affordable gadgets on the market with which you can measure HRV in the comfort of your home. Here are some of those:

Apple Watch – Uses an optical sensor (green light) to record heart rate automatically, however, you need to obtain the Health app on iPhone to look at the data.

Oura Ring – A sleep tracker, takes the mean of all 5-minute samples measured while you are sleeping. The changes in your HRV are accounted for every 5 minutes throughout the night which makes it one of the most accurate devices out there to measure HRV. This is in comparison to other wearables that only take HRV measurement at a single point during the night.

Fitbit – Heart rate tracker automatically measures the HRV and sends stats to the Fitbit app. The only problem is that the technology used in Fitbit does not accurately record or report heart rate.

AIO (All in One) Smart Sleeve – It is a sleeve you wear that can measure your EKG real time. It also does sleep analysis, workout optimization and stress level monitoring.

Frontier X – Worn directly over your heart, like a chest belt, provides continuous ECG monitoring.

There are also apps that help you increase your HRV. They do this thru teaching breathing techniques via biofeedback, which changes the heart rhythm to create a physiological balance in physical, mental and emotional systems. Some of these include HeartMate, HeartRate + Coherence Pro and HeartMath. HeartMath is the gold standard in the industry for coherence and the one with the most science behind it.

So, how do you measure your well-being? Mainly with tools that provide feedback on your heart rate variability. But remember, your well-being does not have so much to do with what is going on in your environment, as it does with how you perceive and react to your environment. And working on those factors will in long term help with your well-being.

“You have power over your mind – not outside events. Realize this, and you will find strength.”

Marcus Aurelius – Roman Emperor and Stoic philosopher (161-180 AD)

Didem Miraloglu, MD, MS

May 16, 2022May 16, 2022

Welcome to Tick Season

Frances T Meredith, MD

We are all familiar with Lyme disease and likely know someone who has had to deal with this incredibly complex, and sometimes debilitating disease. Lyme, caused by multiple species of the Borrelia bacteria, is not new, the Borrelia bacteria having coexisted with humans for thousands of years. What is new is that our immune systems are increasingly compromised by the stressful and no longer organic world in which we live. In addition, ticks that most often carry Lyme disease are now all over the United States. Lyme is now endemic EVERYWHERE in the US, though the species of the Borrelia bacteria vary in different areas of the county. And thanks to global warming, tick season is now all year round in many areas, though certainly numbers increase as temperatures warm in the spring.

To make things more complicated, Lyme disease, most often spread by hard Ixodes ticks, is also carried by other ticks as well including several soft ticks. Lyme bacteria are also found in mites, fleas, mosquitoes, biting flies and in tick feces (and those little suckers poop continuously while feeding; think bite, itch, scratch, I’m in!). Other infections often travel along with Lyme including Babesia and Bartonella. These little suckers are smart and know how to evade our immune systems to become “baggage for life” and create havoc all over our bodies.

Prevention is indeed the best medicine with avoidance and early detection of tick bites the goal. According to Stephen Buhner, an internationally renowned expert on Lyme and coinfections, a blend of essential oils is about 99% effective for repelling the major tick species that carry the many Borrelia species that carry Lyme and coinfections (Healing Lyme, 2015)

Here is his recipe: Take ½ teaspoon of each of the below essential oils, add the oils (4 tspn total volume) to 8 oz pure grain alcohol (95%), blending well and storing in a brown glass bottle out of sun. Subdivide this into 1-2 oz brown herb bottles with spritzer/spray attachment, using this to apply liberally and often during tick season when going outdoors.

-Rhododendron tometosum (Labrador tea; NOT Rhododendron anthopogon)
-Tagetes minuta
-Chamaecyparis nootkatensis
-Artemisia absinthium
-Myrica gale (bog myrtle)
-Juniperus Virginia
-Eucalyptus citriodora (lemon eucalyptus)
-Origanum majorana (marjoram)

I have just ordered these myself, most of them very cheap on Amazon, though several more expensive and coming from Canada. The bottles are also available on Amazon. The total price was $152 which should provide a family with several seasons of protection.

In addition Stephen Buhner suggests Andrographis tincture applied to tick bite site, covering with a “moistened glob of bentonite clay, cover with thin cotton, and leave on for 12-24 hours)”. This tincture is also easily available on Amazon.

This will make for a fun and fragrant home chemistry session! Time to get out there and enjoy some gorgeous spring weather, safely.

Your partner in health,
Frances T Meredith, MD

Author: Carolina Total Wellness

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Practical Strategies for Managing Anxiety and Improving Digestion

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A (Very) Brief Neuroanatomy Lesson

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

Daily Habits to Support Stress Resilience:

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

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

Toothpaste: What should I use?

Travel Tips

Back To School Checklist

Lithium

Health Coaching

Heart Rate Variability

Welcome to Tick Season

Functional Medicine

Allergy Testing & Drops

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