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Functional Flips for a Healthier Summer Cookout

Summer cookouts are a time for connection, sunshine, and great food—but they’re often filled with processed meats, sugary desserts, and disposable, well, everything. Traditional menus can leave us feeling bloated, fatigued, or inflamed. This season, choose nourishing, sustainable swaps that taste amazing and help you feel even better. 

SWAP #1: Kabobs Instead of Burgers or Hot Dogs 

Skip the heavy burger buns and enjoy colorful protein-packed skewers that are naturally gluten-free and customizable. 

Build-your-own kabob ideas: 

Marinade: olive oil + lemon juice + garlic + oregano or rosemary 

Proteins: wild-caught salmon or shrimp, organic chicken, grass-fed steak, marinated tofu or tempeh 

Veggies & Fruit: zucchini, red onion, bell peppers, cherry tomatoes, pineapple, mushrooms 

SWAP #3: Grilled Fruit Instead of Cobbler 

Ditch the sugary, gluten-heavy desserts and grill up nature’s candy for a fiber-rich, antioxidant-packed, naturally sweet treat without the crash. 

Easy grilled fruit ideas: 

Top with coconut whipped cream, chopped toasted nuts, or a sprinkle of cinnamon 

Peaches or nectarines: halved, brushed with coconut oil, grilled 2–3 mins per side 

Pineapple rings or watermelon slices: caramelize for a smoky-sweet flavor 

SWAP #4: Corn-Based or Bamboo Plates Instead of Plastic 

Did you know plastic plates and utensils can leach hormone-disrupting chemicals, especially when exposed to heat and sunlight?  

Here are some better options to support hormone health and reduce landfill waste: 

  • Compostable corn-based or bamboo plates and flatware 
  • Enamel or stainless steel reusable sets 
  • Cloth napkins for a zero-waste, elegant upgrade 

 Takeaways 

Enjoy real food. Celebrate connection. Support your health—naturally. 

Summer cookouts don’t have to derail your health goals. It IS possible to avoid gluten, dairy, and highly processed foods without missing out on celebrations with friends and family.  

Perfection is not the goal. Choose one swap that sounds good to you and let yourself enjoy the rest, if it won’t make you feel terrible afterwards.   

Subtle changes add up over time – and are more likely to be sustainable.  

Advanced Heart Risk Predictor: Coronary Artery Calcium Scoring

Coronary artery calcium scoring is a medical test used to assess the risk of cardiovascular disease (CVD). It measures the amount of calcium in the coronary arteries, which supply blood to the heart. Calcium buildup in the arteries is a sign of atherosclerosis, a condition in which plaque builds up in the arteries and can cause heart disease.

Coronary artery calcium scoring is an important tool for identifying individuals who are at risk for heart disease. The test can help us doctors predict the likelihood of a heart attack or stroke and determine the best course of treatment. By detecting calcium buildup in the arteries, we can assess the severity of atherosclerosis and develop a plan to reduce the risk of cardiovascular events.

The test typically involves a computed tomography (CT) scan of the heart and arteries. The CT scan takes images of the heart and arteries, which are then used to calculate the calcium score. The calcium score is a measure of the amount of calcium in the arteries and can range from 0 to over 400. The results of coronary artery calcium scoring can help us determine the risk of heart disease. A score of 0 indicates no detectable calcium, while a score of 1-100 indicates minimal calcium buildup. Scores above 100 indicate more significant calcium buildup and a higher risk of heart disease.

Coronary artery calcium scoring is an important tool for identifying individuals who are at risk for heart disease. By detecting calcium buildup in the arteries, we can assess the severity of atherosclerosis and develop a plan to reduce the risk of cardiovascular events. The test can also help identify individuals who may benefit from preventive measures, such as lifestyle changes or medication, to reduce their risk of heart disease.

Think of coronary artery calcium scoring like a snapshot of your heart’s health.

It helps us see if there’s any buildup of calcium in your arteries, which can increase your risk of heart disease. By detecting calcium buildup early, we can help you take steps to reduce your risk and prevent cardiovascular events.

Here at Carolina Total Wellness we can order this scan for you alongside other markers to determine your risk of coronary artery disease.

If you have high blood pressure, diabetes, high cholesterol, and family history of heart disease or you are just interested in getting a scan, seek out one of our providers to get started on mitigating your risk of heart disease.

Nitric Oxide: The Molecule Of Life

Didem Miraloglu, MD, MS

Nitric oxide (NO) is a remarkable molecule that plays a crucial role in various physiological processes within the human body. Discovered in the late 18th century, and its importance has been extensively studied and recognized in the fields of medicine, biology, and biochemistry. In fact in 1998 Nobel Prize in Physiology or Medicine was awarded to Robert Furchgott, LouisIgnarro, and Ferid Murad, for their discoveries of NO as a signal molecule in the vasculature and specifically in the control of blood pressure. NO is a unique signaling molecule that influences numerous cellular pathways, contributing to cardiovascular health, immune function, neurotransmission, and even cellular defense against pathogens.
The synthesis of nitric oxide is achieved through the enzymatic action of nitric oxide synthase (NOS) on L-arginine, a semi-essential amino acid found in the body. There are three isoforms of NOS: endothelial NOS(eNOS), neuronal NOS (nNOS), and inducible NOS (iNOS). Each isoform is expressed in specific tissues and cells and responds to different stimuli. eNOSis predominantly present in endothelial cells, contributing to vasodilation and regulating blood flow. nNOS is found in neurons and plays a role in neuro transmission, while iNOS is induced in response to inflammation or immune challenges.

The regulation of nitric oxide production is a tightly controlled process. Various factors, including calcium ions, cofactors like tetrahydrobiopterin, and the availability of L-arginine, affect NOS activity. This precise control ensures that NO is produced when needed, preventing excessive generation and potential cellular damage.

Nitric oxide is a key player in cardiovascular health. It acts as a vasodilator, relaxing the smooth muscles in blood vessel walls, which leads to increased blood flow and improved oxygen and nutrient delivery to tissues. Dysfunction in the NO pathway is associated with numerous cardiovascular diseases, including hypertension, atherosclerosis, and heart failure. Pharmaceutical agents that enhance NO production or mimic its actions, such as nitroglycerin and sildenafil (Viagra), have become essential treatments for these conditions.

The immune system relies on nitric oxide to fight off pathogens and defend against infections. When activated by cytokines and other immune molecules, iNOS produces NO in macrophages and other immune cells. Nitric oxide acts as a potent antimicrobial agent by damaging bacterial DNA, proteins, and lipids. Furthermore, it helps regulate the immune response and plays a role in resolving inflammation after an infection has been controlled.
In the nervous system, nitric oxide is a critical neurotransmitter involved in various processes, such as learning and memory, synaptic plasticity, and neuronal communication. It modulates the release of neurotransmitters like dopamine, serotonin, and glutamate, contributing to mood regulation and cognition.

Moreover, NO has been linked to neuroprotection by its ability to act as an antioxidant and counteract oxidative stress-induced damage. Neurodegenerative diseases, such as Alzheimer’s and Parkinson’s, involve oxidative stress, and researchers are exploring the potential of NO-based therapies to mitigate neuronal damage.

Due to its diverse roles in numerous physiological processes, nitric oxide has garnered significant interest as a potential therapeutic agent. Researchers are exploring its use in various medical applications, including wound healing, erectile dysfunction, and respiratory disorders like pulmonary hypertension. Additionally, NO-based therapies are being investigated in the context of cancer treatment, where NO has shown potential to inhibit tumor growth and sensitize cancer cells to radiation and chemotherapy.

Nitric oxide, once regarded merely as an air pollutant, has emerged as a fundamental molecule essential for life and well-being. Its roles in cardiovascular health, immune function, neurotransmission, and neuroprotection highlight its significance in maintaining the body’s delicate balance.

As our understanding of this remarkable molecule deepens, we are likely to witness further advancements in medical therapies that harness the potential of nitric oxide for improving human health and well-being.

To schedule a new patient appointment, please call our office at 919-999-0831.

Your Partner In Health,
Didem Miraloglu, MD, MS

Unlock Your Best Health With A Personal Health Coach!

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

New Year’s is the time when everyone is looking toward the year ahead and all that they want to achieve. While people make resolutions with the best of intentions, few follow through and achieve their goals. This is where health coaching comes in handy. 

Health coaches help support clients as they work toward making sustainable lifestyle changes. They are passionate about helping others live happier and healthier lives. This includes helping them stick to New Year’s resolutions. Whether you want to reduce stress, eat better, or move more, health coaches can guide the way. 

The Power of Personalized Guidance:

A health coach is your dedicated partner on your wellness journey, offering personalized guidance that goes beyond generic advice. They work with you to create a tailored plan based on your unique needs, preferences, and health goals.

Medical Benefits of Having a Health Coach:

  1. Weight Management: Numerous studies have shown that individuals working with health coaches are more successful in achieving and maintaining a healthy weight. A health coach helps you develop sustainable habits, making weight management more than just a short-term goal.
  2. Chronic Disease Prevention and Management: Health coaches play a crucial role in preventing and managing chronic conditions such as diabetes, hypertension, and heart disease. Their guidance extends beyond conventional medical advice, focusing on lifestyle changes that can have a profound impact.
  3. Stress Reduction and Mental Well-being: Mental health is an integral part of overall well-being. Health coaches help you navigate stressors, offering support and strategies to enhance mental resilience. This holistic approach contributes to improved mental well-being.
  4. Improved Physical Fitness: A health coach can assist in developing personalized guidelines to follow that can help your fitness professional tailor your fitness routine to suit your lifestyle and preferences. Regular physical activity is linked to numerous health benefits, including improved cardiovascular health, increased energy levels, and better mood.
  1. Improved Sleep: Getting quality sleep is crucial for our physical and mental well-being. It affects our mood, concentration, and overall health. From creating a bedtime routine to sticking to a sleep schedule, there are many ways you can improve your quality of sleep. Health coaches may suggest options such as avoiding screens a few hours before bed. Perhaps practicing mindfulness in the evening will quiet a busy mind. Even something as simple as lowering the light in your room at night to trigger your sleep cycle are a small change that can result in a big outcome. 

How to Get Started:

If you’re ready to experience the transformative benefits of health coaching, reach out to us today! Our team of experienced health coaches is here to guide you on your journey to optimal health. Call 919.999.0831 to get scheduled.

Remember, investing in your health is an investment in a brighter and more fulfilling future.

To your health and happiness!

References:

Wing, R. R., et al. (2018). Intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine.

Ockene, I. S., et al. (2007). The role of counseling in the promotion of healthy behaviors in adults. JAMA.

Huffman, J. C., et al. (2018). The role of stress and psychosocial interventions in cancer. Current Psychiatry Reports

Warburton, D. E. R., et al. (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal

Your Partner In Health,

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

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

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

A FUNCTIONAL MEDICINE APPROACH TO OSTEOPOROSIS

Didem Miraloglu, MD, MS


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

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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

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

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

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

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

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

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

Once you have osteoporosis then the treatment is as follows:

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

Your partner in health,
Didem Miraloglu, MD, MS

CGM’s

Sara Yadlowsky, FMHC

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

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

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


In health,
Sara Yadlowsky, FMHC

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