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

Heart Rate Variability

Didem Miraloglu, MD, MS

DO YOU KNOW HOW TO MEASURE YOUR WELL-BEING?

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

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

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

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

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

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

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

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

  • Apple Watch – Uses an optical sensor (green light) to record heart rate automatically, however, you need to obtain the Health app on iPhone to look at the data.
  • Oura Ring – A sleep tracker, takes the mean of all 5-minute samples measured while you are sleeping. The changes in your HRV are accounted for every 5 minutes throughout the night which makes it one of the most accurate devices out there to measure HRV. This is in comparison to other wearables that only take HRV measurement at a single point during the night.
  • Fitbit – Heart rate tracker automatically measures the HRV and sends stats to the Fitbit app. The only problem is that the technology used in Fitbit does not accurately record or report heart rate.
  • AIO (All in One) Smart Sleeve – It is a sleeve you wear that can measure your EKG real time. It also does sleep analysis, workout optimization and stress level monitoring.
  • Frontier X – Worn directly over your heart, like a chest belt, provides continuous ECG monitoring.

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

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

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

 Marcus AureliusRoman Emperor and Stoic philosopher (161-180 AD)

Didem Miraloglu, MD, MS

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

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

A Guide To Grilling Food

Clarissa A. Kussin, ND, RYT-500
 
 Grilling or barbecuing meat at high temperatures leads to the production of heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs), compounds known as “mutagens” which damage DNA and may increase risk for developing cancer. HCAs are formed when amino acids and sugars present in meat react under high temperatures. Additionally, liquid fat drips into the flame of a barbeque and creates smoke filled with PAHs, coating the surface of the meat. While the best solution is to use other cooking methods when possible, there are several simple ways to balance the effects of grilling your favorite foods.

Choose meat wisely
Emphasize leaner cuts of meat. Less fat drippings means less smoke and less exposure to PAHs. Further, removing the skin from poultry before cooking will reduce HCA formation.

Marinate
Not only does marinating meat impart more flavor, it can also be protective against carcinogenic compounds. Acid-containing marinades (e.g., those containing vinegar or lemon/lime juice) are best to reduce formation of HCAs. It is also important to note that traditional barbeque sauces, which tend to have a high sugar content, can increase formation of HCAs. If using these sauces, they should be added to foods after they have been cooked.

Add herbs and spices
Herbs and spices have been shown to reduce formation of HCAs when meats are grilled. Mint, onion, turmeric, garlic, rosemary, ginger, thyme, and red chili pepper are all great choices. These herbs can be used in marinades, mixed into ground meats, or used as a dry rub.

Avoid over-cooking or charring
The amount of time your meat contacts the grill makes a difference. Try quicker -cooking proteins like fish or shrimp, or cut your meats into smaller pieces to reduce cooking time (meat and vegetable kebabs are a great solution). Rotate meat frequently to allow the center to fully cook without overheating the surface. Blackened or charred areas of meat can be removed to reduce exposure to HCAs and PAHs.

Try grilling other food groups
Fruits and vegetables have been shown to inhibit activity of HCAs and reduce DNA damage caused by these compounds. Fortunately, antioxidant rich produce can also be delicious when grilled. Try zucchini, bell peppers, sweet potatoes, apples, peaches, pineapple, or even watermelon for a unique addition to your meal.
 
Your Partner in Health!
Clarissa A. Kussin, ND, RYT 500

Health Benefits of Napping

Susan D. Denny, MD, MPH
“No day is so bad it can’t be fixed with a nap.” — Carrie Snow

With the hectic pace of day-to-day life, many people don’t get the recommended amount of sleep each night. According to the National Sleep Foundation, adults typically need between seven and nine hours of sleep per night in order to function at their best. Getting a few less hours for even a few nights in a row can have the same effect as staying awake for 24 hours straight. And, over time, chronic sleep debt can contribute to fatigue, increased stress levels, reduced attention span, and declined cognitive performance.

One way to combat the effects of sleep deprivation—and repay some sleep debt—is to incorporate daytime napping into your schedule. The length of the nap and type of sleep you get during that nap help determine its potential health benefits. The table below identifies these benefits.

Nap Duration  and  Potential Health Benefits

10-20 minutes:
 Reduces sleepiness; improves cognitive performance; increases alertness, attention, and energy levels; improves mood; improves motor performance; reduces stress levels

20-30 minutes:
Enhances creativity; sharpens memory

30-60 minutes:
Sharpens decision-making skills, including memorization and recall; improves memory preservation

60-90 minutes:
Rapid eye movement (REM) sleep, which is critical for problem solving; helps make new connections in the brain; enhances creativity; reduces negative reactivity; promotes happiness

  The following is a list of tips and tricks to help you make the most of naptime:

Choose a dark, quiet, comfortable place where you can relax. Try to limit the amount of noise and light in the room, and make sure the temperature is comfortable. Choose a time that works for you, and aim to nap at that time each day to establish a routine. You may find that restricting your naps to early afternoon (between 1:00 pm and 3:00 pm, or an hour or two after lunch) is less likely to interfere with your nighttime sleep patterns. Set an alarm on your cell phone, watch, or computer so you don’t sleep for too long. If you’re napping at the office, try closing your door and hanging a sign that says, “will return in 20 minutes.” Alternatives to this are napping in your car or on an outdoor bench.

Wherever you nap, bring along something that you associate with sleep. Some ideas include a sleep mask, neck pillow, relaxing playlist and headphones, cozy blanket, warm socks, and lavender essential oil to dab on your pulse points.

Keep in mind that longer naps may be accompanied by sleep inertia, or a period of grogginess that sometimes follows sleep. Give yourself time to wake fully before returning to any activity that requires a quick or sharp response. 

Your Partner In Health!
Susan D. Denny, MD, MPH