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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

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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

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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

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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.
 
 

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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

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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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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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LENTILS “THE POOR MAN’S MEAT”

Didem Miraloglu, MD, MS



 Lentils are known to be one of the most nutritious plant based proteins. Lentils date back to 8000 B.C where it was found on the banks of the Euphrates River, what is now northern Syria. There are many different preparation of lentils throughout the Middle East as well as the rest of the world. Each region adds part of its heritage where the lentil meal becomes richer and more flavorful.  Lentils are part of the legume family. Most of world’s lentil production comes from India and Canada. Lentils can lower cholesterol, and protect against diabetes and colon cancer. They are known as “Poor Man’s Meat”, since they are rich in nutrients and low in price. 1 cup of lentils provides 16 grams of fiber, 18 grams of protein, 38 mg Calcium, 40 grams of carbohydrates, 6.6 grams of iron , 71 mg of Magnesium and 0 gram fat. Since they are high in net carbs, they need to be avoided in a strict keto diet. With their low glycemic index, they are a good nutritional source for diabetics. There are brown,  green and red lentils. There are also those that are in between these colors. Here is one kind of Turkish recipe for red lentil soup. 

TURKISH RED LENTIL SOUP
 
INGREDIENTS:
 
2 cups red lentils
6-7 cups vegetable or meat stock
1 medium onion
1 medium carrot
1 tablespoon pepper/tomato paste
2 tablespoons butter
1 teaspoon pepper flakes
1 teaspoon black pepper
1 tablespoon dried mint
Salt to taste
Lemon juice
 
Wash the lentils and place in a pot. Slice the onions and carrots into small pieces and place in the pot with lentils.  Add stock and cook on medium heat until it boils. When it starts to boil add the paste and continue to cook for another 30-40minutes on low heat. Once all the ingredients are well cooked, use a hand blender to homogenize the soup.
 
Melt the butter or ghee in a small skillet, then add mint and pepper flakes. Stir for a minute then add to the soup and boil it for another 2 minutes. Add salt to taste. It is now ready to be served with lemon juice. Afiyet olsun!
 

Contact our office to schedule an appointment with one of our Health Coaches to learn more about healing with foods that can help you along in your journey to optimal health. 
 
Your Partner in Health!
Didem Miraloglu, MD, MS

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Food and Mood

Blair Cuneo, PA-C

I think about many things this time of the year with seasons changing and holidays approaching. As a functional medicine provider, I consider how changing landscapes not only affect my patient’s physical health, but also their emotional health. This landscape or “environment” of less direct sunlight, more time indoors, increased celebratory food and drink and increased holiday stress has a major impact on mental health for many of us.

Our relationship with food is complex, as is our body’s response to our culinary selections. We hope that our bodies can effectively digest food and absorb its nutritious content, but how do we know if it doesn’t? We hope the foods we are eating are contributing to healthy neurotransmitter production, healthy immune system messaging, but what does it feel like if that’s not the case?

You’d think that your stomach would definitely let you know if any of the above was amiss, but consider this: approximately 30% of us will have a gastrointestinal/gut symptom if there are imbalances in digestion or immune activation, while the majority of us will have a “beyond the gut” symptom first, such as headaches, mood changes, sleep disruptions, fatigue and pain. Thus, the majority of people may not be thinking of a direct relationship between green bean casserole and their anxious or sad days.

Several things need to happen when we eat a meal. First, we need to be in a “rest and digest” state. This signals to the body it’s time to produce digestive acids, enzymes and bile to sterilize the food, break it down and absorb it well. Next, we need healthy proteins that can be broken down by these digestive supports to become the basic amino acids that our body will use as the building blocks to create neurotransmitters like dopamine and serotonin. Neurotransmitters are signaling molecules, providing communication between nerves. The balance of neurotransmitter production, absorption and clearance, affects mental and physical health. Further, this building of neurotransmitters requires cofactors of several micronutrients like zinc, vitamin B6, magnesium and vitamin D.

To cap things off, there can be immune system reactions to foods, allergies and/or sensitivities that are contributing to inflammatory messaging that starts in the gut, but travels “beyond the gut”, affecting our emotional state.

In my practice, I regularly see low levels these cofactors, low levels of digestive enzymes and gastric acid, high stress and of course, the daily challenge in regularly making healthy eating and drinking choices.

In order for a body and mind to be healthy, each of these areas needs to be considered, evaluated and addressed.

While there are objective tests available for providers to check your nutrient and digestive status, there are also excellent lifestyle supports to begin making a shift in your wellness today.

-Eat at regular intervals. It is less stressful for the body when it knows it can count on you to feed it. This also helps the timing of the digestive acids/enzymes release where there are patterns in meal timing.

-Whole foods. Limit processed foods. Head to the refrigerator, before you head to the pantry. Each meal should contain a protein, small amount of fat, and colorful fruits and vegetables.

-Mindful eating, not distracted eating. Try to avoid multitasking while eating. As often as you can, eat at a table, focused on your food and the company that you share. Look, smell, taste and chew well! Even the process of chewing is signaling release of enzymes.

-Connect with your healthcare provider to review your micronutrient and vitamin status. You might discuss multivitamin, magnesium and/or zinc supports and also test your vitamin D to help assign dosing recommendations.

Remember, Food can be medicine! Make sure you use it wisely!

Your Partner in Health!

Blair Cuneo, PA-C

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What Leaky Gut Is and Why Should You Care

919 why you should care about leaky gut

If you have been researching how to improve your health, you may have heard of leaky gut, also known as intestinal permeability. If that conjures an unpleasant image of your gut contents leaking into the rest of your body — that’s not too far off the mark.

Leaky gut happens when contents from the small intestine spill into the sterile bloodstream through a damaged and “leaky” gut wall. This contamination of the bloodstream by not only partially digested foods but also bacteria, yeast, and other pathogens begins to create a foundation for chronic inflammatory and autoimmune health disorders.

Symptoms and disorders linked to leaky gut include fatigue, depression, brain fog, skin problems, joint pain, chronic pain, autoimmune disease, puffiness, anxiety, poor memory, asthma, food allergies and sensitivities, seasonal allergies, fungal infections, migraines, arthritis, PMS, and many more. Basically, your genetic predispositions will determine how leaky gut manifests for you.

Leaky gut is referred to as intestinal permeability in the scientific research. It means inflammation has caused the inner lining of the small intestine to become damaged and overly porous. This allows overly large compounds into the small intestine. The immune system recognizes these compounds as hostile invaders that don’t belong in the bloodstream and launches an ongoing attack against them, raising inflammation throughout the body. Also, some of these compounds are very toxic (endotoxins) and take up residence throughout the body, triggering inflammation wherever they go.

At the same time, excess intestinal mucous and inflammation from the damage prevents much smaller nutrients from getting into the bloodstream, which can lead to nutrient deficiencies and poor cellular function.

Leaky gut is increasingly being recognized as a common underlying factor in most inflammatory symptoms and disorders.

Medicine finally recognizes leaky gut

Conventional medicine has long ridiculed leaky gut information and protocols as quack science and alternative medicine folklore, but newer research now establishes it as a legitimate mechanism. In fact, pharmaceutical companies are even working on drugs to address leaky gut.

Research has established links between leaky gut and many chronic disorders. It’s good this long-known information is finally being validated in the dominant medical paradigm as the gut is the largest immune organ, powerfully influencing the rest of the body, as well as the brain.

Current studies link intestinal permeability with inflammatory bowel disorders, gluten sensitivity, celiac disease, Crohn’s disease, type 1 diabetes, depression, psoriasis, and other chronic and autoimmune conditions. Given what we know about the connection between gut health and immunity, it’s vital to include a gut repair protocol in overall treatment of inflammatory and autoimmune disorders.

How to mend leaky gut

Sometimes, repairing leaky gut can be as simple as removing inflammatory foods from your diet. Other times it’s more complicated. Most importantly, you need to know why you have leaky gut. Either way, however, your diet is foundational.

Many cases of leaky gut stem from a standard US diet of processed foods and excess sugars. Food intolerances also contribute significantly, especially a gluten intolerance. A leaky gut diet, also known as an autoimmune diet, has helped many people repair intestinal permeability. Keeping blood sugar balanced is also vital. If blood sugar that gets too low or too high, this promotes leaky gut. Stabilizing blood sugar requires eating regularly enough to avoid energy crashes. You also need to prevent high blood sugar by avoiding too many sugars and carbohydrates. Regular exercise is also vital to stabilizing blood sugar and promoting a healthy gut.

Also, failure to eat enough fiber and produce leads to leaky gut by creating a very unhealthy gut microbiome, or gut bacteria. Our intestines (and entire body) depend on a healthy and diverse gut microbiome for proper function. A healthy gut microbiome comes from eating at least 25 grams of fiber a day and a wide and rotating variety of plant foods.

Other common things that lead to leaky gut include antibiotics, NSAIDs such as ibuprofen, excess alcohol, hypothyroidism, and autoimmunity.

A leaky gut protocol can help you improve your health, relieve symptoms, boost energy, make you happier, and clear your brain fog. Ask my office for advice on improving your well being through a leaky gut diet and protocol.