The Weakest Leak :

Autoimmunity and Leaky Gut Explained

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Concussion Care 2023

Frances Meredith, MD

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

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

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

MANAGEMENT

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

   “Energy Crisis”

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

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

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

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

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

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

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

Your Partner In Health,
Frances T. Meredith, MD

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

How to Talk About Food

Erica Nelson, MSPH, NBC-HWC

Here, at Carolina Total Wellness, we often recommend dietary adjustments to treat a wide variety of symptoms. Many of our patients come to us for guidance, asking ‘What is the healthiest diet?’ And the truth is, the ‘healthiest diet’ is unique to the person eating it.

One patient may get itchy and congested when they eat and need to reduce or eliminate foods that may increase or contain histamines like leftovers and peanuts. Another patient may have intestinal permeability and need to eliminate identified sensitives to gluten, oats and eggs. Yet another may be concerned about their family history of Alzheimer’s disease or cancer and need to make a variety of other adjustments.

Regardless of health status and dietary needs, most of us prefer sharing meals with our friends, family and coworkers over dining alone. Sometimes even a simple lunch can be a source of concern when a well-meaning aunt or friend asks about your ‘crazy diet.’

Over and over again, patients tell me that eating with their families is a barrier to successfully making the adjustments necessary to improve their health. Here are some strategies to enjoy eating the food that nourishes your body with the people that nourish your soul (and even some people that don’t):

Know your why. Get clear on why you are making the changes. And practice your responses ahead of time. When you know exactly what you are trying to accomplish with your food, it is easier to make good choices and much harder for someone else to convince you otherwise.

Have a short ‘elevator pitch’ prepared. Something like, ‘I wasn’t feeling my best recently and, after talking to my doctor, I am focused on eating foods that nourish my body and soul like (name a few key foods you’re enjoying eating.)’ And then mention a positive outcome like. ‘You wouldn’t believe how much better I am sleeping!’

Have at least one person fully in your corner. As part of your preparation for making these changes, make sure you talk to a trusted friend or partner that will be your support-person when the going gets tough. No matter how committed you are to health changes, there will be days when you don’t get enough rest or you have a bad day at the office. On these days, even strong-willed, prepared ‘you’ can have a tough time remembering your ‘why’ and the ‘Can’t you have just one bite?’ question may be coming from inside your own head. On these days, call this person and tell them that you are considering deviating from your plan.

Project confidence. Add a big smile to your ‘No thank you’ and you’re less likely to get pushback or hear ‘Can’t you have just one?’ Know your restaurant order before you go and say it confidently. ‘I’ll have the burger, no bun, no cheese, extra lettuce and the spinach salad on the side, please.’

“Girl (or boy,) stop apologizing.”  Rachel Hollis made this phrase famous with her book by the same name. She was right, though. There is no need to apologize for doing what is right for your health and/or sanity. Try replacing ‘I’m sorry’ with ‘Thank you.’ For example, instead of ‘I’m sorry to inconvenience you,’ try ‘Thank you for accommodating for my gluten/dairy/egg/sugar sensitivity.’

Boundaries. Some people have no trouble with the sentence ‘no.’ But for many, it is easier to please the people around you and silently suffer your own consequences later. This can be exhausting and lead to difficulty knowing what you wanted in the first place. Know where your line is and don’t let anyone tempt you to cross it. Remember that everything you say ‘yes’ to is a ‘no’ to something else.

It is okay to make inappropriate people uncomfortable. If, for example, someone makes a comment about your body composition or fertility, it is not only okay to make them uncomfortable, but also brave and good. Saying ‘That’s inappropriate’ could keep them from bestowing their judgement on another undeserving person.

The health coaches at Carolina Total Wellness are here to support you in your personalized health care journey.

Your Partner In Health,

Erica Nelson, MSPH, NBC-HWC

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

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

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.
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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 

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