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How does Acupuncture work, and what can it treat?

Katie Depre LAc, LMBT, FABORM, NCCAOM

Though often described as traditional or ancient medicine, research has proven that Acupuncture has its place alongside modern medical practices. Hair-thin needles are placed in precise and therapeutic point locations along meridians. Meridians have been shown to mirror the fascial network of the body. Fascia surrounds all of the organs, muscles, bones, and nerve fibers. These points are located alongside nerve endings and blood vessels, thereby directly influencing blood flow and sensory nerves in the area (2,3). Functional brain imaging has shown changes in the brain when these points are needled (1). Since the brain controls the systems of the body (hormones, blood flow, stress responses, organ function, reproduction, etc.), influencing the brain and nervous system with Acupuncture will impact our health. Treatment encourages the body’s own systems of balance, commonly known as homeostasis.

The National Center for Complementary and Integrative Health outlines many of the researched treatable conditions (4); these include: pain management, osteoarthritis, sciatica, fibromyalgia, cancer pain, irritable bowel syndrome, asthma, depression, allergies, infertility, and menopause symptoms. Though more chronic conditions will require a series of treatment for complete resolution, I have personally witnessed immediate relief from insomnia, digestive complaints, anxiety, and pain in my clinic.  Especially because it is a non-pharmaceutical approach, many patients search out Acupuncture for treatment to acute and chronic conditions.

As a Fellow of the Acupuncture and Traditional Chinese Medicine Board of Reproductive Medicine, FABORM, I treat many patients with their fertility goals. By regulating the menses, we can prepare the body for pregnancy. Fertility work is best done weekly for three months prior to conception, as it takes three months for the egg to develop in the ovaries. During times of sympathetic stress (the flight or fight response), blood is shunted away from the ovaries and uterus. This can negatively impact egg quality and the thickness of the uterine lining.  By encouraging blood flow to these reproductive organs, switching the nervous system into a parasympathetic state (rest, digest, and repair), and regulating the Hypothalamic-Pituitary-Ovarian Axis, we set the body up for success.

For patients undergoing IVF, the Paulus Protocol is utilized. This is a series of points done before and after an embryo transfer. “Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas the pregnancy rate was only 26.3% (21 out of 80 patients) in the control group (5).”

Please reach out today if you have specific questions on how Acupuncture can help you realize your health goals!

Warmly,

Katie Depre LAc, LMBT, FABORM, NCCAOM

Sacred-sea.com

(919) 808-2638

  1. Huang W, Pach D, Napadow V, Park K, Long X, Neumann J, Maeda Y, Nierhaus T, Liang F, Witt CM. Characterizing acupuncture stimuli using brain imaging with FMRI–a systematic review and meta-analysis of the literature. PLoS One. 2012;7(4):e32960. doi: 10.1371/journal.pone.0032960. Epub 2012 Apr 9. PMID: 22496739; PMCID: PMC3322129.
  2. Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec. 2002 Dec 15;269(6):257-65. doi: 10.1002/ar.10185. PMID: 12467083.
  3. Bai Y, Wang J, Wu JP, Dai JX, Sha O, Tai Wai Yew D, Yuan L, Liang QN. Review of evidence suggesting that the fascia network could be the anatomical basis for acupoints and meridians in the human body. Evid Based Complement Alternat Med. 2011;2011:260510. doi: 10.1155/2011/260510. Epub 2011 Apr 26. PMID: 21584283; PMCID: PMC3092510.
  4. Acupuncture: What You Need to Know. National Center for Complementary and Integrative Health. (2022, October). https://www.nccih.nih.gov/health/acupuncture-what-you-need-to-know
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What Exactly Is Applied Kinesiology?

Richard A. Laviano, DC, ND, FSBCT(c)



My doctor has recommended applied kinesiology to rebalance my vagus nerve.
Sounds like voodoo to me…. What exactly is applied kinesiology?

The importance of the vagus nerve for so many of our bodily function has been proven again and again in multiple medical studies. The vagus nerve runs from your brainstem down to your intestinal tract and is the ringmaster of your autonomic nervous system, all things “rest and digest”. When the vagus nerve is out of balance, it has the potential to create widespread dysfunction from intestinal motility (think small intestinal bacterial overgrowth) to quick “fight or flight” reactivity, anxiety, and even panic attacks.  A simple PubMed search of vagus nerve pops up34,789 results! We at CTW have come to rely on the finely tuned skills of practitioners expert in using modalities to rebalance the vagus. One of the most powerful, only in very experienced hands, is applied kinesiology (AK). Dr Rick Laviano of Falls Chiropractic and Injury in Raleigh explains below the role of AK.

Applied Kinesiology (AK) is a neurological rehabilitation therapy. At the International College of Applied Kinesiology in 2005 (1) Dr. Walter Schmitt eloquently presented a model that thoroughly explains it. He explains AK as an assessment and therapy that positively affects neurological function. We quote it here and explain it more simply below.

AK is a series of sensory receptor based diagnostic challenges followed by monitoring of manual muscle testing outcomes. All AK techniques are about creating sensory receptor stimulation that results in a net effect of excitation and inhibition leading to more optimal neurological function. These positive changes can be observed through somatic windows by changes toward normal in muscle facilitation and inhibition(muscle balance, range of motion, deep tendon reflexes) and through various autonomic windows that can also be monitored (pupil light response, blood pressure, heart rate, etc.) (pg. 1)

AK uses muscle tests as well as other neurological tests to assess the state of your nervous system. When there is poor neurological function discovered, the doctor tries his or her best to find the neurological therapy that will improve it. For example, the brainstem (area of the brain just above your neck), controls most of the things in your abdominal cavity subconsciously like your heartrate, blood pressure, gut motility, gut valves, and liver detox. We can see how healthy the brainstem is by looking at reflexes that live there, like how fast your pupils react to a shining light, or how your jaw moves, or how your balance is, or how your blood pressure compares from one side to another (2,4).

A physician trained in AK will use these nerdy tools to pinpoint what part of the nervous system may be dormant or over-excited. Then they will wake it up or calm it down through a targeted therapy such as rubbing, tapping, stretching, manipulation, eye movements, muscle/fascial work etc. AK specialists can be considered your body electricians! The ultimate goal is to improve function in the nervous system to thus improve total body health and wellness.

Since the nervous system controls every function in our bodies, there have been many types of cases Applied Kinesiologists have seen over the years. Cases that are often seen include gut/microbiome issues. It is important that these patients understand that the gut microbiome is STRONGLY influenced by the state of their gut nervous system. Improving the integrity of the nervous system in these patients can greatly improve their quality of life.

Another point worth mentioning regarding gut issues includes the trigeminal nerves. The largest cranial nerve in our brain is the trigeminal nerve. This nerve coordinates information regarding the teeth, jaw, head, and even your posture (3)!This nerve integrates (strongly connects) with the vestibular, ocular, and cerebellar reflexes that affect the health of the brainstem, even the health of the vagus nerve. By keeping the trigeminal nerve and its connections in the brainstem healthy, vagal tone is optimal! In treating gut problems, the priority is making sure that trigeminal, head, eyes, and balance organs are in tune with one another for the health of the autonomic nervous system including the vagus nerve and ultimately the gut.


References:
1.      Schmitt, Walter H., The Neurological Rationale for a Comprehensive Clinical Protocol Using Applied Kinesiology Techniques. Proceedings of the I.C.A.K. – U.S.A. Annual Meeting, Volume 1,2005-2006. p. 157-191.
2.      Monaco, A., Cattaneo, R., Mesin, L., Ciarrocchi,I., Sgolastra, F., & Pietropaoli, D. (2012). Dysregulation of the autonomous nervous system in patients with temporomandibular disorder: a pupillometric study.
3.      Cuccia, A., & Caradonna, C. (2009). The relationship between the stomatognathic system and body posture. Clinics, 64(1),61-66.
4.      Applied Kinesiology Synopsis: David S. Walther. 1988.


Your Partners In Health,
Richard A. Laviano, DC, ND, FSBCT(c) and Ana Dávila, DC Falls Chiropractic and Injury, Raleigh NC

Frances T Meredith, MD Carolina Total Wellness
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Sip On Serenity With Rose-Infused Green Tea!

Are you ready for a delightful and soothing beverage that combines the elegance of roses with the goodness of green tea? Introducing Rose-Infused Green Tea, a recipe that nourishes both your senses and your well-being!

Why Rose-Infused Green Tea?

🍵 Green Tea Goodness: Green tea is packed with antioxidants and boasts numerous health benefits. From boosting metabolism to supporting heart health, green tea is a fantastic addition to your daily routine.

🌹 Rose Essence: Roses not only add a delicate floral aroma but also offer their own set of benefits. Rose petals contain antioxidants, vitamins, and minerals that promote skin health, aid digestion, and even have mood-enhancing properties.

Recipe for Rose-Infused Green Tea:

Ingredients:

  • 1 teaspoon organic loose green tea leaves or 1 green tea bag
  • 1 tablespoon dried rose petals (food-grade and organic)
  • 1 cup hot water
  • Optional: Honey or lemon for sweetness and flavor

Instructions:

  1. In a teapot or mug, add the green tea leaves and dried rose petals.
  2. Pour hot water over the tea and petals.
  3. Allow it to steep for 3-5 minutes, depending on your preferred strength.
  4. Strain the tea leaves and petals, or remove the tea bag.
  5. Add honey or lemon to taste, if desired.
  6. Sit back, relax, and enjoy the gentle aroma and soothing flavor of Rose-Infused Green Tea!

Benefits of Rose-Infused Green Tea:

1️⃣ Antioxidant Power: Both green tea and rose petals are rich in antioxidants that help combat free radicals, protect cells from damage, and support overall well-being.

2️⃣ Skin Glow: The combination of green tea and rose can promote healthy skin. Antioxidants in green tea and the anti-inflammatory properties of rose petals contribute to a radiant complexion.

3️⃣ Mood Booster: The aroma of roses has been known to uplift the spirit and reduce stress levels. Sipping on Rose-Infused Green Tea can bring about a sense of tranquility and relaxation.

4️⃣ Digestive Aid: Green tea is gentle on the stomach and can support healthy digestion. Combined with the soothing properties of rose petals, it can help alleviate digestive discomfort.

Treat Yourself to a Cup of Bliss… Indulge in the delicate flavors and therapeutic benefits of Rose-Infused Green Tea. This calming and revitalizing beverage is perfect for moments of self-care, relaxation, or whenever you need a little pick-me-up.

Your Partner In Health,

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

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Hormesis: The Beneficial Type of Stress

Sara Yadlowsky, FMHC

What doesn’t kill you makes you stronger.  We’ve all heard the saying before.  Science has revealed it is surprisingly accurate when it comes to our health and longevity.

Hormesis is the idea that short, intermittent bursts of certain stressors can start a cascade of cellular processes that slow aging, improve overall health and make you more resilient, both physically and mentally.  It is a hot topic in longevity research right now.

We all know that chronic stress caused by relationship issues, financial problems and working too many hours is detrimental to our health.  However, hormetic stressors are controlled and acute, triggering healthy adaptive responses.

What does all this mean in real life?  Hormesis is the common thread found in some popular health and fitness trends such as HIIT (high intensity interval training), cold exposure, heat therapy and intermittent fasting.  Prolonged doses of these behaviors are not healthy or sustainable.   For example, if you spend too much time in a sauna you will become dehydrated.  But, in short bursts, the bodily stress caused by these practices are enough to bring about health benefits such as reducing inflammation, supporting elimination of toxins, repairing DNA, combatting oxidative stress, repairing cellular damage and reducing risk of cancer.

Here are three ways to strategically stress your body and reap the rewards:

  1. HIIT – Do a HIIT workout 1-3 times a week.  HIIT workouts are intermittent bursts of intense effort for 30 seconds, followed by 15 seconds of rest.  These workouts are usually short, around 15-20 minutes.  You can easily find these HIIT videos on YouTube.
  2. Hot or Cold Therapy – Infrared sauna is a great way to heat up and sweat out some toxins.  It also reduces inflammation and pain.  In contrast, ice baths, cold showers and the new cryotherapy chambers that are popping up everywhere will cool you down quicky.  Cold therapy is also known for reducing inflammation and pain.  Both types of therapies may help strengthen the immune system.
  3. Intermittent Fasting – Fasting triggers a cellular “clean up” response called autophagy.  Autophagy results in several health benefits such as lowered cholesterol, reduced blood pressure and reduced inflammation.  For many, a 16:8 intermittent fasting schedule (16 hours of fasting followed by an 8 hour feeding window) works well.  However, we recommend that you experiment with the timing to see what works best for you.

Be aware that adding stress (even the good type!) to our lives can backfire if done at the wrong time.  When life is already very stressful, it is best to wait until a better time when you are more relaxed to try out these new practices.

Your Partner In Health,

Sara Yadlowsky, FMHC

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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 

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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

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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 

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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

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Long COVID

Susan D. Denny, MD, MPH

Over the past year I have seen an increasing number of patients with symptoms of post-acute sequelae of Covid 19 (PASC), also known as long Covid. 

What is long Covid?  As defined by the CDC, long Covid is a range of new, returning or ongoing health problems people can experience four or more weeks following SARS-COV-2 (Covid 19) infection.  Symptoms can vary significantly by person and can include fatigue, brain fog, memory loss, anxiety, disturbed sleep, joint pain, gastrointestinal symptoms, loss of taste or smell or shortness of breath.  Most of the patients I have seen with long Covid suffer from fatigue and brain fog and many have other accompanying symptoms.

In a recent systematic review of 57 studies comprising more than 250,000 survivors of Covid 19, most symptoms included mental health, pulmonary and neurologic disorders which were present 6 months after SARS-Cov-2 exposure. 1

How many people are suffering from long Covid?  Clinical trials have shown anywhere from 31% to 69% of people who have had Covid infection will suffer from long Covid. This is a present and emerging health care crisis with tens of millions of Americans currently suffering and millions more at risk of developing this syndrome. Chances are that you or someone you know has long Covid.

How long does long Covid last?  This appears to vary significantly by person.  Some clinical trials have shown average length to be about 3 months while others have shown that symptoms may last more than a year. An emerging consensus is that most people have symptoms for 6 months or more.

Who gets long Covid?  While some clinical trials show a relationship to acute disease severity, others have shown a significant risk for long Covid even in mild or asymptomatic cases.  In other words, it is possible to develop long Covid even if you had no symptoms of acute Covid infection.

A study just published in Cell on January 24, 2001 followed 200 patients over two to three months following their COVID-19 diagnoses. The researchers determined four biological factors that they say are associated with whether a person will develop long COVID.

The first factor is the level of viral RNA in the blood at diagnosis. The second is the presence of autoantibodies—those that attack the patient’s own body. Third is the reactivation of the Epstein-Barr virus, a common virus that most people are infected with and recover from early in life. The last is Type 2 diabetes. Interestingly, the most predictive factor for long Covid was the presence of autoantibodies in the blood. 2

Several other studies have found significant autoantibody levels in patients with long Covid.  In one study just published this month, researchers found signals of autoantibody activity that are usually linked to chronic inflammation and injury involving specific organ systems and tissues such as the joints, skin and nervous system in patients with long Covid. 3 We know that certain viruses can trigger the body’s immune system to begin attacking itself through a process called molecular mimicry.  That appears to be a significant source of cellular damage and inflammation in patients who develop long Covid.

Another study published in Gut examined changes in the gut microbiome in patients with long Covid.  They found that an altered gut microbiome composition is strongly associated with persistent symptoms in patients with COVID-19 up to 6 months after clearance of SARS-CoV-2 virus. 4

Can long Covid be treated?  Yes.  While conventional medicine has yet to find a medication to treat long Covid, a functional medicine approach to this illness works well.  Addressing the root cause(s) of ongoing inflammation in the body from the viral over stimulation of the immune system is a top priority.  Evaluation and treatment of increased intestinal permeability (leaky gut), gut dysbiosis and a disrupted adrenal axis works well to help rebalance the immune system, calm inflammation and improve symptoms. 

If you or someone you know is suffering from long Covid, please contact our office to make an appointment with one of our functional medicine providers.

In health,

Susan D. Denny, MD, MPH

References:

  1. JAMA Netw Open. 2021;4(10):e2128568. doi:10.1001/jamanetworkopen.2021.28568
  2. Su  Y, et al. Cell. 2022;doi:10.1016/j.cell.2022.01.014.
  3. Liu Y, et al. J Transl Med. 2022;doi:10.1186/s12967-021-03184-8.
  4. Gut (2022). DOI: DOI: 10.1136/gutjnl-2021-325989
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Neurofeedback Therapy

Robert Baric, DC

We have invited several expert practitioners to educate our practice community on approaches to healing that are complementary to Functional Medicine. Our expert this week is Robert Baric, DC who will educate us on Neurofeedback. Neurofeedback is quite different from “biofeedback” with which you may be familiar. Dr. Baric is board certified in neurofeedback and has over 26 years of clinical experience. His passion for health and wellness has emerged throughout the years as he continues to deliver the most up to date knowledge to his patients, while providing them with impactful treatment in addition to neurofeedback, including nutrition, acupuncture, chiropractic techniques, and other applied therapies. I will hand off the microphone to Dr. Baric.
 


 
 Neurofeedback Therapy: A Compliment to Traditional Medicine
Amidst 56 years of positive research and clinical trials in neuropsychology, neurofeedback has emerged as a modality of complementary therapy that is “evidence based”. Neurofeedback therapy has gained increasing popularity due to its non-invasive properties and the sizable body of research supporting its efficacy, along with it being an alternative to traditional pharmacological treatment. Essentially, neurofeedback is EEG-biofeedback, where a method of retraining brain waves through operant conditioning is utilized. Various conditions like ADHD, depression and anxiety, addiction, and insomnia are all cognitive disorders that can negatively impact an individual’s brain waves.

 The first step to neurofeedback therapy is an initial brain scan that determines if a patient is a suitable candidate for neurofeedback therapy. A quantitative electroencephalogram (qEEG) shows brain activity and function allowing professionals to understand what ailments may be present and what can be done to mitigate symptoms at the root of the problem. The qEEG process takes just 45 minutes, recording brain waves with the eyes closed and opened. The results are then analyzed and a customized training protocol is created specifically tailored to the patient. Treatment includes monitoring the dysfunctional area while rewarding the preferred wave formation, with the reward being a TV show of the patient’s choice.  Brain waves are monitored, and using operant conditioning, stimuli are adjusted to guide the brain waves back into a healthy pattern.  If accepted as a patient, most individuals experience a marked improvement by sessions 10-15, most conditions requiring 40 sessions to finalize neuroplastic changes.
  
There are multiple conditions for which neurofeedback is impactful, with few being the most prominent throughout my years of experience. 
 
 Depression and Anxiety
The zeitgeist proves the need for complementary treatment options for individuals suffering with depression and anxiety. Approximately 33.7% of the population suffers with anxiety related disorders in their life, often comorbid with depression (1).  The Journal of Clinical Psychopharmacology yielded results showing significant improvement in patients symptoms of depression with neurofeedback (2). Similar results were shown in patients with anxiety disorders, with the Journal of Industrial Psychology exhibiting results where neurofeedback therapy was deemed essentially as effective in reducing symptoms of anxiety as medication (3). 
 
 ADHD 
Children and adults suffering with ADHD recognize notable improvements in their focus and attention after a series of neurofeedback treatment. When a group of students received either neurofeedback or pharmacological support, evidence showed those in the neurofeedback group improved in executive control to a greater extent than the pharmacological support group (4). A plethora of research supports the decrease of ADHD symptoms in both children and adults. 
 
 Insomnia
Brain waves play a significant role in the ability to sleep. If a patient is unable to enter into a restful and deeply restorative state, there could be a misalignment in brain waves causing a patient to feel unwell and never feel rested. Medications can be utilized to aid in sleep, but frequently result in a feeling of grogginess upon waking. Neurofeedback actually tackles the problem at hand at the root by retraining the brain waves in order to get quality sleep without the use of medications. 
 
For issues involving the brain and cognition, it is essential to tackle the issue from multiple directions, utilizing multiple forms of treatment.  As a pain-free and relaxing process, neurofeedback will maximize its growth throughout the coming years. Neurofeedback will continue to provide millions of individuals with a fully customized treatment plan to ensure optimal brain health, and alleviate years of morbid symptoms.

If there are any questions about neurofeedback please reach out through email or phone and MyBrainDr would be happy to discuss any inquiries. 
 
Email: admin@mybraindr.com
Phone: 919-721-4800
Website: www.MyBrainDr.com