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Aging Gracefully

Sara Yadlowsky, FMHC

Aging is inevitable. Irrespective of our efforts to appear youthful or feel younger, aging will catch up with us eventually. However, vitality is the key to aging gracefully.

Vitality embodies an energy of involvement, appreciation, and liveliness. It represents a harmonious blend of pleasure, purpose, and significance. When we are full of these feelings, we experience a vibrant, open responsiveness.

An excellent question to ask yourself is: How vibrant am I? Vitality manifests as an ability to openly express profound emotions. It’s evident in hearty laughter, streams of tears, and a willingness to engage fully without concerning oneself with outcomes, approval, or social media “likes.”

The most vibrant individuals:

  • Seek opportunities to make a positive impact and follow through with action
  • Dedicate themselves to continuous learning from others
  • Exemplify remarkable generosity and openness
  • Embrace both laughter and tears with equal intensity
  • Share a deep connection with the spiritual realm
  • Are willing to be authentic even if it means being unpopular

This level of aliveness represents soulful fitness, which is not tied to appearing younger than our years. Soulful fitness results from a stead fast commitment to and consistent practice of the vitality-enhancing measures mentioned above.

An excellent idea is to meditate daily with the thought that this could be your last day alive, and let this awareness guide you to fully embrace and cherish each day.

Aging can be viewed as a profound opportunity to establish deeper roots and witness more abundant blossoms. We can perceive the beautiful trajectory from innocence (youth) to ambition (productive years) to wisdom (later years)as a magnificent symphony, with each phase a complete and essential component of a breathtaking unity.

Aging is not an error or shortcoming, but an invitation to embrace life more fully.

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

Your Partner in Health!
Sara Yadlowsky, FMHC

Foods for Menopause and Perimenopause

The hormonal shifts that accompany perimenopause and menopause lack a clear instruction manual, often leaving many women in a continuous cycle of trial and error when it comes to managing their symptoms. Fortunately, one of the most potent tools available for regaining control of your hormones is the food you consume. Certain foods contribute to hormone balance and can help alleviate perimenopause and menopause symptoms, while others can disrupt your body’s hormonal equilibrium.

When essential nutritional elements are lacking, hormonal imbalances can arise, leading to mood swings, weight gain, hot flashes, and reduced libido. The primary hormones affected during perimenopause and menopause are estrogen, progesterone, insulin, and testosterone, and your dietary choices can significantly impact these hormones. For instance, excessive sugar consumption can elevate insulin levels, trigger inflammation, and exacerbate nearly every perimenopausal symptom. On the other hand, incorporating vegetables, fruits, nuts, and seeds into your diet can provide phytonutrients and healthy fats that aid in managing even the most challenging menopause symptoms.

While there’s no one-size-fits-all diet, several foods have proven beneficial for most people seeking to balance their hormones:

1. Brassica (aka cruciferous) Vegetables: These include broccoli, cauliflower, kale, and cabbage, which contain indole-3-carbinol—a compound that helps metabolize estrogen in the gut and liver. This can be particularly helpful in addressing estrogen dominance.

2. Healthy Fats: Avocados, nuts, seeds, and fish are rich inomega-3 fatty acids and other fats crucial for reducing inflammation and supporting hormone production, especially progesterone.

3. Fiber-Rich Foods: Fiber is essential for gut health, which plays a critical role in hormone balance. Low-starch fruits and veggies, nuts, seeds, and whole grains can boost your fiber intake, aiding in estrogen metabolism and blood sugar regulation.

However, there are also foods and drinks that should be limited or avoided:

1. Caffeine: Excess caffeine can lead to increased stress hormone production and elevated cortisol levels, potentially exacerbating fatigue and estrogen levels.

2. Processed Carbs and Sugar: As tolerance to sugar decreases with age, limiting simple carbohydrates and sugars (like table sugar, baked goods, and packaged foods) becomes crucial for managing blood sugar and insulin levels.

3. Alcohol: Even moderate alcohol consumption can disrupt hormones, affect brain aging, and lead to elevated insulin levels and estrogen dominance.

4. Gluten: Gluten sensitivity can contribute to gut issues, thyroid problems, and autoimmune conditions, making it advisable to assess its impact on your health

Balancing your diet can ease the transition into perimenopause and menopause, regardless of whether you’re just beginning to experience symptoms or are already in the midst of them. By making thoughtful dietary choices, you can navigate this phase of life with greater vitality and well-being.

Your Partner In Health,

Sara Yadlowsky, FMHC

Sleep and CBD

Full-spectrum CBD (cannabidiol) is derived from the cannabis plant and contains various compounds, including cannabinoids, terpenes, and trace amounts of tetrahydrocannabinol (THC). While research on the specific effects of CBD on sleep is ongoing, some studies and anecdotal evidence suggest potential benefits for sleep, and full-spectrum CBD may offer additional advantages due to the entourage effect, where different cannabis compounds work together synergistically. Here are some potential benefits of full-spectrum CBD for sleep:

  1. Regulation of Sleep-Wake Cycles: CBD may interact with the endocannabinoid system, which plays a role in regulating sleep-wake cycles. It could potentially help individuals with sleep disorders like insomnia by promoting a more regular sleep pattern.
    • Reference: Babson, K. A., Sottile, J., & Morabito, D. (2017). Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Current Psychiatry Reports, 19(4), 23.
  2. Anxiety and Stress Reduction: Anxiety and stress are common culprits of sleep disturbances. Full-spectrum CBD may have anxiolytic (anxiety-reducing) effects, which could indirectly improve sleep by calming the mind.
    • Reference: Shannon, S., Lewis, N., Lee, H., & Hughes, S. (2019). Cannabidiol in Anxiety and Sleep: A Large Case Series. The Permanente Journal, 23, 18-041.
  1. Pain Relief: Full-spectrum CBD has anti-inflammatory properties that may alleviate chronic pain conditions. Improved pain management can lead to better sleep quality for individuals who suffer from pain-related sleep disturbances.
    • Reference: Russo, E. B. (2008). Cannabinoids in the Management of Difficult to Treat Pain. Therapeutics and Clinical Risk Management, 4(1), 245–259.
  1. Relaxation and Sedation: Some terpenes found in full-spectrum CBD, such as myrcene, have sedative properties. These compounds, in combination with CBD, may promote relaxation and sedation, making it easier to fall asleep.
    • Reference: Russo, E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology, 163(7), 1344–1364.
  1. Reduced Nightmares: For individuals suffering from nightmares or post-traumatic stress disorder (PTSD), full-spectrum CBD may help reduce the occurrence of distressing dreams.
    • Reference: Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics, 12(4), 825–836.

Remember – just because a company advertises ‘full-spectrum CBD’ does not mean that it’s what we are discussing here. It’s similar to the caution you need when buying eggs, and you see ‘cage-free’ or ‘free-range.’ Thanks to clever and deceptive marketing strategies, those phrases do not indicate that the chicken was allowed to roam on open pastures eating grass and bugs – that’s exclusive to ‘pasture-raised.’

The CBD market is far more unregulated than an established product like eggs, so it’s essentially the Wild Wild West, and it’s up to you to be informed and do your homework.

What authentic full-spectrum CBD indicates is a product that includes the full range of beneficial cannabinoids, terpenes, and other unique phytonutrients found in hemp. The best way to verify this claim is by looking at the company’s COA, and check to make sure a variety of cannabinoids and terpenes are present.

It’s important to note that while there’s promising research and anecdotal evidence, individual responses to CBD can vary.

It’s advisable to consult with a healthcare professional before starting any new supplement, including CBD, especially if you have underlying medical conditions or are taking other medications.

Always check for recent research and consult with a healthcare provider for personalized guidance.

Your Partner In Health,

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

Metformin Beyond Diabetes: Exploring Longevity Benefits

Susan D. Denny, MD, MPH

Welcome to this month’s Functional Medicine newsletter, where we delve into the fascinating topic of Metformin, a medication commonly used for diabetes management, and its potential benefits for longevity. While Metformin has long been recognized as an effective treatment for diabetes, recent research suggests that it may have broader implications for promoting overall health and extending lifespan. Join us as we explore the scientific evidence and discuss the exciting possibilities surrounding Metformin’s role in longevity.

Metformin and Diabetes Management

Metformin is a medication primarily used to manage type 2 diabetes. It works by reducing glucose production in the liver and increasing insulin sensitivity, leading to improved blood sugar control. However, emerging studies indicate that Metformin’s benefits extend far beyond diabetes management alone.

Metformin and Longevity Research

  1. Metformin and Aging Markers: Numerous studies have explored the effects of Metformin on various markers of aging, including cellular senescence, inflammation, and oxidative stress. Research suggests that Metformin may have anti-aging properties by modulating these processes and promoting healthier cellular function.
  2. Metformin and Lifespan Extension: Animal studies have demonstrated promising results regarding Metformin’s potential to extend lifespan. Researchers have observed increased lifespan in various organisms, including worms, flies, and mice, when treated with Metformin. While human studies are still ongoing, these findings offer intriguing insights into the possibility of Metformin as an anti-aging intervention.
  3. Metformin and Age-Related Diseases: Metformin’s potential to mitigate age-related diseases, such as cardiovascular disease, cancer, and neurodegenerative disorders, has been a subject of interest. Research suggests that Metformin may exert protective effects on these conditions by influencing key pathways involved in aging and disease development.
  1. References and Further Reading:
    1. Barzilai, N., et al. (2016). Metformin as a Tool to Target Aging. Cell Metabolism, 23(6), 1060-1065.
    2. Martens, C. R., et al. (2018). Metformin as a Tool to Target Aging. Cell Metabolism, 27(4), 758-775.
    3. Hsu, C. C., et al. (2018). Metformin Use and Risk of Cancer in Patients with Type 2 Diabetes: A Nationwide Cohort Study. The Oncologist, 23(7), 859-865.
    4. Foretz, M., et al. (2014). Metformin: From Mechanisms of Action to Therapies. Cell Metabolism, 20(6), 953-966.

We encourage you to explore these references to gain a deeper understanding of the research surrounding Metformin’s potential benefits for longevity and age-related diseases.

Consulting a Healthcare Professional

It is important to note that while Metformin shows promise in longevity research, its use beyond diabetes management is still being investigated. Before considering Metformin or any other interventions for longevity purposes, it is crucial to consult with a healthcare professional who can assess your individual circumstances and provide guidance based on the latest scientific evidence.

Remember, longevity is a multifaceted topic, and adopting a comprehensive approach to healthy living, including balanced nutrition, regular physical activity, stress management, and maintaining a supportive social network, is key to promoting overall well-being and healthy aging.

Wishing you a vibrant and resilient journey towards optimal health and longevity!

Yours In Health,

Susan D. Denny, MD, MPH

Get Ready For Fall Allergies

Allergies don’t only crop up in the spring. The persistent sniffles, clogged nose, itchy eyes and sneezing also happen in the fall — and, experts say, they are getting more common, and more intense.

Don’t Wait For Fall Allergy Symptoms!

“What a lot of people don’t realize is that the allergy seasons have almost doubled in length and gotten more intense because of climate change,” said Kenneth Mendez, the president and chief executive of the Asthma and Allergy Foundation of America. Higher carbon dioxide emissions spur plants to release larger amounts of pollen, he said. “That’s why allergies are feeling a lot worse.”

Common Fall Allergens

The most common culprit for fall allergies is ragweed, a plant that grows wild almost everywhere, but especially on the East Coast and in the Midwest. Ragweed blooms and releases pollen from August to November. In many areas of the country, ragweed pollen levels are highest in early to mid-September.

Other plants that trigger fall allergies include:

· Burning bush

· Cocklebur

· Lamb’s-quarters

· Pigweed

· Sagebrush and mug wort · Tumbleweed and Russian thistle

Allergy Drops at Carolina Total Wellness

Carolina Total Wellness offers effective allergy treatment for both indoor and outdoor allergies through sublingual immunotherapy drops formulated just for you to safely and conveniently treat the cause of your allergies.

How Allergy Drops Work

Sublingual immunotherapy, also called allergy drops, works similar to allergy shots by gradually helping your body build tolerance to the substance(s) causing your allergies. The difference is that the antigen is placed under your tongue in a liquid drop form instead of an injection.

What kind of allergies can be treated with allergy drops?

One of the benefits of sublingual immunotherapy is that it can treat a broad range of allergies, including those caused by:

· Dust mites

· Mold

· Animals

· Foods

· Seasonal pollens such as grass, trees, ragweed, and mountain cedar, etc.

Who should take Allergy Drops?

Anyone interested in treating the cause of their allergic disease, instead of just temporarily managing symptoms, can consider allergy drops.

· Infants and children*

· Asthmatics

· People with highly sensitive conditions including EoE

· Those who don’t like needles

· Those with chronic conditions including sinusitis and eczema

· Those with food and mold allergies

· Those with multiple allergies including dust mites, pollen, foods, and animals

* Allergy drops have proven especially helpful for children with eczema and recurrent ear infections, which often have underlying allergic causes. Research shows that many children with untreated eczema and allergies often develop asthma and other chronic conditions later in life, so treating them early can have life-long benefits and may prevent development of other allergies and asthma.

What are the advantages to Allergy Drops?

In addition to being a viable option for people of all ages and conditions, there are more advantages:

Lower cost, fewer clinic visits. Compared to shots and many medications, allergy drops typically cost less over time. Most patients receiving allergy drops need only a few clinic visits the first year, and then once every 6-12 months thereafter until visits are no longer needed. That can also mean a lot less time away from work or school.

More convenient. You can take allergy drops at home or wherever you are, making it much easier to stay with your treatment.

Less medication. Our patients report, and research confirms, that they typically need less medication to control symptoms after beginning allergy drops.

Enjoy healthier days. The end benefit of taking drops consistently? Feeling better, more productive and better able to enjoy life and activities that allergies once made it hard to enjoy.


Please allow 45 minutes for your initial visit which will include consultation with your physician or physician assistant, physical exam and discussion of allergy testing. Skin prick testing will be performed at this visit and results and interpretation will be discussed. Prescription will be provided for allergy drops and we will review how to administer these at home.


Please allow 15 minutes for your follow up allergy visits. This will include review of your allergy symptoms and immunotherapy plan of treatment as well as new 3-month prescription for allergy drops. Follow up visits are recommended every 3 months for the first year and then every 6 to 12 months for the subsequent 2 to 4 years, depending on your response to treatment.


We recommend follow up skin prick testing for environmental allergies every 12 months to assess progress of immunotherapy and adjust your prescription allergy drops as needed.

To schedule, please call us at 919-999-0831

Homemade Paleo Ice Cream Delights – Strawberry, Peach, And Honey Lavender Flavors

Dear Ice Cream Lovers,

Get ready to indulge in the delightful world of homemade Paleo ice cream! With summer in full swing, what better way to beat the heat than with these three tantalizing flavors: Strawberry, Peach, and Honey Lavender. Whether you follow a Paleo lifestyle or simply enjoy natural, wholesome treats, these recipes are sure to satisfy your sweet cravings. Let’s dive in and discover how to make these delicious frozen delights right in the comfort of your own kitchen!

1. Strawberry Paleo Ice Cream:


  • 2 cups frozen strawberries
  • 1 can (13.5 oz) full-fat coconut milk
  • 1/4 cup honey or maple syrup (adjust to taste)
  • 1 teaspoon pure vanilla extract


  1. In a blender or food processor, combine the frozen strawberries, coconut milk, honey or maple syrup, and vanilla extract.
  2. Blend until smooth and creamy, ensuring all ingredients are well combined.
  3. Pour the mixture into an ice cream maker and churn according to the manufacturer’s instructions.
  4. Transfer the churned ice cream into an airtight container and freeze for at least 2 hours or until firm.
  5. Serve the strawberry Paleo ice cream in bowls or cones and enjoy the fruity goodness!

2. Peach Paleo Ice Cream:


  • 2 cups frozen peaches
  • 1 can (13.5 oz) full-fat coconut milk
  • 1/4 cup honey or maple syrup (adjust to taste)
  • 1 tablespoon fresh lemon juice


  1. In a blender or food processor, combine the frozen peaches, coconut milk, honey or maple syrup, and fresh lemon juice.
  2. Blend until smooth and creamy, ensuring all ingredients are well combined.
  3. Pour the mixture into an ice cream maker and churn according to the manufacturer’s instructions.
  4. Transfer the churned ice cream into an airtight container and freeze for at least 2 hours or until firm.
  5. Scoop the peach Paleo ice cream into bowls or cones and savor the natural sweetness of summer’s favorite fruit!

3. Honey Lavender Paleo Ice Cream:


  • 1 can (13.5 oz) full-fat coconut milk
  • 1/4 cup honey or maple syrup (adjust to taste)
  • 1 tablespoon dried lavender buds (culinary grade)
  • 1 teaspoon pure vanilla extract


  1. In a saucepan, combine the coconut milk, honey or maple syrup, and dried lavender buds.
  2. Heat the mixture over low heat, stirring occasionally, for about 5 minutes to infuse the flavors.
  3. Remove from heat and let it cool to room temperature.
  4. Strain the mixture to remove the lavender buds and transfer the infused coconut milk into a bowl.
  5. Stir in the vanilla extract, ensuring it is well incorporated.
  6. Pour the mixture into an ice cream maker and churn according to the manufacturer’s instructions.
  7. Transfer the churned ice cream into an airtight container and freeze for at least 2 hours or until firm.
  8. Serve the honey lavender Paleo ice cream in elegant bowls or cones, savoring the delicate floral notes and subtle sweetness.

Enjoy Your Homemade Paleo Ice Cream Creations!

These refreshing and guilt-free ice creams are perfect for hot summer days or any time you crave a chilly treat. Experiment with different toppings or get creative by combining flavors. The possibilities are endless!

Remember to store any leftovers in the freezer, and if the ice cream becomes too firm, let it sit at room temperature for a few moments.

Your Partner In Health,

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

Dining Out With Kids


It’s tricky enough to find restaurants with healthy options for grown-ups. Here are a few suggestions for dining out with the whole family.  

Cowfish Sushi Burger Bar- With locations in Raleigh, Charlotte and Orlando, Cowfish melds the deliciousness of sushi and burgers to make sure there is something for everyone on the menu. Cowfish makes special occasions fun with their playful ambiance and noisy gong birthday song!  

With most kids’ meals priced at $8, it’s affordable for a regular dinner out, too. Their kitchen takes care to accommodate a variety of allergies. The kids’ menu is made up of Bento Boxes with main dishes including California rolls, grilled nuggets, PB&J Sushi Roll and more. Each one comes with two sides and a rice crispy dessert. Healthy side options include oranges, carrots, edamame, apples and sweet potato fries. For the grown-ups, gluten sensitive and vegetarian options are clearly marked. Try the Double Salmon Roll and the Tuna & Avocado-Tini.  

Firebirds – Okay, confession time. I am guilty of ordering from the kids’ menu at Firebirds. It’s tough to beat grilled salmon with two sides and a drink for less than $11. In my defense, I do tip generously when I go this route.  

Firebirds is a chain with locations around the country – including Raleigh, Durham, Morrisville, Winston-Salem and Charlotte. The dining room is nice enough for a special occasion dinner. 

For healthy kids’ options, try the grilled chicken breast, salmon or steak with broccoli, fresh veggies and/or fresh fruit and 1% milk or an Honest Juice Box to drink. They also have mocktails for fun, non-alcoholic drink options for the whole crew. Food allergies? Ask to see a manager to ensure your food is prepared in a way that is safe for you and your family.   

Chipotle- For a quicker meal on the go, Chipotle offers vegetarian, vegan, paleo, Whole30, gluten-free, dairy-free, soy-free and even sulphite-free options. They do not use eggs, mustard, peanuts, tree nuts, sesame, shellfish or fish as ingredients. Kids meals are less than $6 and include a fruit side and organic milk as healthy side/drink options – and I admit to ordering the kids’ meals here, too. I still tip like a grown-up, though. This is a fantastic option for tired grown-ups in the middle of a Whole30. 

Your partner in health,

Erica Nelson, MSPH, NBC-HWC

May is National Osteoporosis Month

We all want to avoid elder years of frailty, infirmity, and fractures. But did you know that it is in your power to avoid these common outcomes of old age? Bone health gets little attention in the media, much less than heart health or cancer prevention. But fractures from thin bones are so often the catalyst of infirmity and physical decline. And they are PREVENTABLE!
We at Carolina Total Wellness take a comprehensive view of bone health, with the goal of not only stopping bone loss, but actually increasing bone density and quality. This takes a very individual understanding of the many factors that can set us up for bone thinning (osteopenia) or severe bone thinning (osteoporosis). The one we all know is Vitamin D deficiency. But there are so many other impactful nutrients for bones including Vitamin K2, Magnesium, Phosphorus, Boron, and Calcium. And only certain forms of calcium are optimal, as many OTC calcium forms go where we do not want them: our arterial walls, contributing to heart disease and stroke. Milk is NOT a good source of calcium. The increased acidity in the body due to dairy actually sucks out bone mass. Did you know the “Got Milk?” campaign was actually pushed on us by the marketing folks from the cigarette industry after they lost their jobs there?  We also know that aging is a factor due to hormonal loss, earlier in women at menopause, but also in men with frequently undiagnosed low testosterone due to many reasons including statin medications, head trauma, or sleep disorders. Optimizing hormones in both men and women  Other less recognized factors leading to bone loss that we see often in our practice include chronic inflammation, acidic diets, alcohol use, smoking, and high stress related cortisol levels. Addressing root cause is essential as is careful monitoring of interventions over time.

Here is where we would like to introduce you to Dr Andy Bush. He is a board certified Orthopedic Surgeon who says “I used to operate on fractures. Now I want to prevent them.”

Please read on for an education in the most cutting edge imaging techniques to monitor bones over time.
Osteoporosis – a silent epidemic
Andy Bush, MD, Central Carolina Orthopedics, Sanford, NC
Rates of osteoporosis and fractures associated with poor bone quality, which are known as fragility fractures, are at epidemic levels. It is estimated that osteoporosis affects approximately 200 million people world-wide. Currently, it is also estimated that 10 million individuals over age 50 in the United States have osteoporosis. Each year an approximately 2 million individuals suffer a fracture due to osteoporosis. The risk of a fracture increases with age and is greatest in women. Approximately 1 in 2 women and 1 and 5 men age 50or older will experience a hip, spine, or wrist fracture sometime during their lives. Approximately 40% of individuals are unable to return to their homes following a fragility fracture and require relocation to a nursing facility. As many as 20% of individuals will die within 6-12 months of a fragility fracture. Also, an additional 33.6 million individuals over age 50 have low bone density or “osteopenia” and thus are at risk of osteoporosis and fragility fracture.

Osteoporosis and osteopenia are not painful conditions. Most people are unaware that they have any problems with their bones – that is until that one day when our foot gets caught on the edge of the carpet, or we forgot to wipe up the spilled water on the kitchen floor or our little dog or cat gets in between our feet making us fall and we hear that loud and dreaded “CRACK!!”. Often, after that fateful event, life changes dramatically and then the importance of bone healthcare and not having a healthy skeleton becomes a very painful and life-altering reality.
Monitoring of the bone health is the foundation of fracture prevention in the way monitoring blood pressure is to stroke prevention and mammograms are to breast cancer prevention. The early detection of any of these conditions, allows for early treatment to be instituted to prevent the long-term consequences of the disease. Bone health assessment is looking for osteopenia or osteoporosis and determining fracture risk. Although, some may still consider developing osteoporosis an unfortunate part of growing older, it is now understood that fractures due to bone loss are not an inevitable part of aging but a potentially preventable disease process. Nutrition and exercise fight against osteoporosis – monitoring makes sure that they are working.
The term for bone monitoring is known as bone densitometry – the measurement of bone density. Determining bone mineral density (BMD) by using Dual Energy X-ray Absorptiometry (DXA) has been the traditional method of diagnosing osteoporosis and predicting fracture risk. It is a method of measuring BMD by using low-energy x-ray and has been considered reasonably reliable for measuring BMD and diagnosing and treating osteoporosis.
There is another method of bone densitometry that not only determines BMD but also give a measure of the Bone Quality. Radiofrequency Echographic Multi Spectrometry (REMS) is a newer method of performing monitoring bone health that has been used in Europe for almost a decade and has replaced DXA as the official method of bone densitometry in Italy. REMS uses ultrasound to measure BMD. However, the ultrasound is also capable of measuring Bone Quality and therefore when REMS is used to assess bone, more information is obtained. It is a more reliable method to predict fracture risk. REMS is still very new in the United States but its popularity is growing as more people are learning about it.

In conclusion, it is important to remember that your bones need to be monitored and cared for like any other part of you. Bone healthcare is an issue for everyone and something that we all need to be aware of because everyone has a skeleton. And we need to pay attention to and take care of our skeletons because…………

If you ignore your bones, they will go away!
Your Partner In Health,
Frances T Meredith, MD


Didem Miraloglu, MD, MS

Since their discovery, antibiotics have been a godsend in terms of eradicating infections and saving millions of lives. Without antibiotics, common infections and minor injuries used to be life-threatening, and surgeries and chemotherapy were nearly impossible. Today the tables have turned on us, whereas, 50 years ago we were reaping the benefits of antibiotics, in the past 2 decades antibiotic resistance has become one of the leading causes of death in the world for people of all ages.

To comprehend the weight of this problem, we must first understand what the gut microbiome is and the role it plays in human health and disease. The gut microbiome is comprised of almost 40 trillion bacterial cells and has anywhere from 500-1000 bacterial species comprising nearly 2 million genes. The gut microbiome contributes to human body functions such as digestion, metabolism, protection from pathogenic microbes, production of vitamins, as well as the regulation of the immune system and inflammatory reactions.

A healthy gut microbiome has high diversity, and any kind of disruption may lead to dysbiosis, an imbalance between the commensals (those bacteria which normally reside in and on us without harming us) and the pathogenic bacteria. Antibiotic use can reduce the diversity of the species in the gut microbiome, alter their activity and select and breed antibiotic-resistant organisms. Short term effects of antibiotic use include diarrhea, Clostridium Difficile infection, and antibiotic resistance, whereas long terms effects can be the development of allergic conditions, such as asthma, food allergies, and obesity.

The problem of antibiotic overuse and misuse does not only stem from treatment of human infections but mainly from their use within the animal industry. The amount of antibiotics used for human infections is four times less than the quantities used for breeding livestock. Antibiotics in the animal industry are added to the feed of animals to improve their growth. They accomplish this by inhibiting the growth of microbes in the gastrointestinal tract which triggers immune responses in the host. This in turn is cost-effective to the producer since more meat can be produced with the usage of less feed.

Antibiotic misuse in both animals and humans has led to a significant increase in antibiotic-developed resistance.  This is where a particular antibiotic is no longer effective in treating an infection. The consequences are anywhere from increased human illness, suffering and death, increased cost and length of treatments, and increased side effects from the use of more powerful medications.
There are many suggested solutions to alleviate this ongoing health crisis. Some things you can consider to prevent further antibiotic resistance are:

  • Don’t rush to treat your runny nose or cough. Be sure that the antibiotic is necessary and not just convenient to use for shortening the duration of the infection. In up to 95% of the cases, bronchitis is viral and there is no cure for the common cold, it gets better on its own with over-the-counter remedies.
  • Consume antibiotic-free dairy and meat products, pasture-raised farm animals rather than factory-farmed animals
  • Ask your doctor to use a narrow spectrum antibiotic if possible to treat the most common organism causing that particular infection rather than a “shotgun” approach, using an antibiotic that kills all
  • Shortest effective duration of antibiotics (this does not mean discontinuing the antibiotics once feeling better, there are specific guidelines for a minimum duration of use for certain infections)
  • Adhere to the antibiotic prescription
  • Take a high-quality daily probiotic while on an antibiotic

Taking a high-quality probiotic as soon as you start antibiotics is another way to counteract the side effects of antibiotics. If you are able to, start taking probiotics a week before taking the antibiotics. Separate them out by two hours while on the antibiotics and continue for 3-4 weeks from the start of the antibiotics. After a month you can decrease the dose to your minimal effective dose for your optimal health outcomes. The probiotics help to restore some of the healthy gut microbiomes lost through antibiotic therapy. Strains of Lactobacillus and Saccharomyces (a beneficial yeast) can help mitigate antibiotic side effects. This in turn contributes to better adherence to antibiotic prescription thereby reducing the evolution of resistance.

Generating and maintaining diversity in the microbiota is a new clinical target for health promotion and disease prevention.

Fecal Microbiota Transplantation FMT) is a  therapy and is one of the main treatments against antibiotic-resistant infections.  This is whereby stools either from the same individual before the antibiotic use or from a healthy donor are introduced orally or via enema or probiotics. This stems from the premise that the gut microbiota in healthy donors is dominated by a large number of probiotics. Many studies have shown that FMT restored both the gut microbiota composition and function in patients who suffered from recurrent Clostridium Difficile-associated diarrhea. Some studies have shown that the worldwide mean cure rates of FMT for diarrhea are approximately 91%.  To date, this is better than any other treatment we have for antibiotic-associated C.Diff colitis.

We can envision in the not too distant future, antimicrobials and therapies which will be prescribed for their direct anti-pathogen benefit while simultaneously limiting collateral damage to the microbiome. Until then it is essential to keep our bodies healthy by taking good care of our gut microbiome.

Contact our office to schedule an appointment  to learn more about optimizing your health.

Your Partner in Health!
Didem Miraloglu, MD, MS

The Vagus Nerve: Not All Who Wander are Lost

Erica Nelson, MSPH, NBC-HWC

Practical Strategies for Managing Anxiety and Improving Digestion

Who’s the Boss?

They say the mind is a wonderful servant but a terrible master. Are you in charge of your mind and body? Or do you feel like you are at the mercy of your thoughts and feelings (physical and emotional)? This article shares cost-free and drug-free practical strategies to take back control of your physical and emotional feelings and make your mind your servant.

Your nervous system is complicated but you do not need to know all of the details to have a significant impact on its function. In this article you will find a very simple description of how one specific nerve, the Vagus, connects your physical and emotional feelings. You will also learn practical things you can do to reduce anxiety, improve digestion and overall wellbeing.

A (Very) Brief Neuroanatomy Lesson

Starting from the top, the brain branches out from your skull through 12 cranial nerves (and their branches) known as the peripheral nervous system.

Starting from the ‘bottom’ the gastrointestinal ‘mind’ is called the enteric nervous system (ENS.) The ENS has more nerve cells than the rest of the entire nervous system combined (more than 100 million!) and is capable of functioning independently of the rest of the nervous system.

The Vagus nerve is one of the 12 cranial nerves. It connects your brain to your digestive system and vice versa. It sends and receives both motor (movement) and sensory (feeling) signals. Beyond the digestive system, it touches nearly every major organ and plays a role in heart rate, respiration, facial expression, inflammation, sweating, reproduction and more.
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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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