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

Non-Toxic Cleaning Recipes


Whether you’re a new parent, someone with sensitivities to chemicals, or just looking to create a healthier home environment, the Non-Toxic Home Guide will help you tremendously.

I hope this guide is informative and helpful in your journey toward a healthier home. If you have any questions , please don’t hesitate to contact your functional medicine health coach at CTW.  We are always here to help.

RECIPES:

All-Purpose Cleaner: Mix equal parts white vinegar and water in a spray bottle. Add a few drops of your favorite essential oil for a pleasant scent.

Glass Cleaner: Mix equal parts white vinegar and water in a spray bottle. Spray the solution onto your mirrors or windows, and use a microfiber cloth to wipe them clean.

Mirror and Glass Cleaner: Mix equal parts white vinegar and water in a spray bottle. Spray the solution onto the mirror or glass surface and wipe with a clean cloth or newspaper.

Tile and Grout Cleaner: Mix 1/2 cup of baking soda with1/4 cup of hydrogen peroxide and 1 tablespoon of dish soap. Apply the solution to the tile and grout using a spray bottle or a sponge. Let it sit for 5-8 minutes before scrubbing with a soft-bristled brush. Rinse thoroughly with water.

Carpet Stain Remover: Mix 1/4 cup of white vinegar, 1 tsp of dish soap, and 1 cup of warm water in a spray bottle. Spray the mixture on the stain, let it sit for 5-10 minutes, then blot with a clean cloth.

Toilet Bowl Cleaner: Pour 2 cups of white vinegar and then 1 cup of baking soda into the toilet bowl. Let it sit for15-20 minutes before scrubbing it with a toilet brush. Flush the toilet to rinse.

Oven Cleaner: Mix 1 cup of baking soda with a small amount of water to form a paste. Apply the paste to the inside of the oven, avoiding heating elements. Let it sit for a few hours or overnight, then wipe it clean with a damp cloth.

Grease Cutter: Mix 1 cup of warm water with 1/3 cup of white vinegar, 1/8 teaspoon of dish soap, and 1 teaspoon of baking soda. Apply the solution to greasy surfaces with a sponge or cloth and wipe clean with a damp cloth.

Floor Cleaner: Mix ¼ cup of castile soap with a gallon of warmwater. Use a mop to clean your floors as usual.

Stainless Steel Cleaner: Mix 1/2 cup of olive oil with 1/2 cup of white vinegar. Add 10-20 drops of citrus essential oil. Spray onto stainless steel surfaces and wipe clean with a micro fiber cloth.

Shower and Tub Cleaner: Mix 1/2 cup of white vinegar with 1/2cup of Sal Suds. Apply the solution to the shower or tub using a spray bottle or a sponge. Let it sit for 3-5 minutes before scrubbing with a soft-bristled brush. Rinse thoroughly with water.

Basic Laundry Detergent: Mix 1 cup of washing soda, 1 cup of baking soda, 1/4 cup of Epsom salt, and 25 drops of essential oil in a large bowl. Store in a glass jar and use 1-2 tablespoons per load.

Vinegar Fabric Softener: Mix 1 cup of white vinegar with 20-30drops of essential oil in a spray bottle. Spray onto clothes before putting them in the dryer


Your Partner In Health,
Clarissa A. Kussin, ND, FMCHC, ERYT-1000

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

Chocolate: The Good, The Bad, and The Ugly

Frances Meredith, MD

For many Valentine’s Day brings with it thoughts of chocolate. February is both American Heart Month and National Chocolate Lovers Month, a brilliant combination as the nutrients within chocolate can help to improve heart health. Let’s dig into the good, the bad, and the ugly of chocolate.

Dark chocolate is rich in polyphenols, specifically flavonoids, the substances that have a wide range of health benefits. These include lowering blood pressure, improving the function of our vascular endothelium (the inner walls of our arteries), protecting skin against sun damage, improving blood flow to the brain, and reducing the risk of cardiovascular damage. Dark chocolate has also been proven to help with mood. These benefits come from chocolate’s ability to promote production of the vasodilator Nitric Oxide as well as the anandamide within, a cannabinoid compound (like CBD) that binds to receptors in the brain to alter mood and brain activity. In addition, methylxanthine compounds, such as theobromine and caffeine, are powerful antioxidants. Remember that these are stimulants as well and should be kept far from your bedtime.

As milk chocolate has a much higher sugar content and lower flavonoid content, dark chocolate, at least 70%, is the best choice.  Know that white chocolate has no flavonoids, and hot chocolate mixes have very low amounts. As even dark chocolate has sugar, limiting daily intake to 1 oz of at least 70% dark chocolate is the best choice.

There is however, a DARK side to chocolate: heavy metals. Lead and cadmium have been known for many years to be elevated in chocolate. Consumer reports has recently reported their results of batch metals testing of multiple brands of chocolate. They have confirmed levels of metals in many brands of chocolate that exceed California Proposition 65 standards, specifically for lead and cadmium. These metals are associated with multiple health issues in both children and adults. The risk is highest for young children and pregnant women as metals have a negative effect on brain development and IQ. However, even outside this patient population, accumulation of metals in the body can cause a wide range of health conditions including kidney damage, elevated blood pressure, immune and hormonal disruption, and central nervous system dysfunction.

Now why would metals be in our chocolate? For cadmium, the cacao plant absorbs the metals from the soil and levels accumulate in the beans. Lead, however, gets in after harvesting, with levels rising as the beans dry and are processed. Highest levels are found on the outside of the bean, consistent with environmental contamination.

So…. should we give up chocolate? My vote is a resounding NO! The “Yum” and “Aaaaah” response to chocolate are undeniable, and the health benefits are substantial and backed by science. The Consumer Reports study gives us guidance as to which brands of dark chocolate are lowest in metals. See the report for details where one bar each from Mast, Tatza, and Valrhona, and two bars from Ghirardelli have relative low levels of both cadmium and lead

https://www.consumerreports.org/health/food-safety/lead-and-cadmium-in-dark-chocolate-a8480295550/

From the Functional Medicine perspective, food is medicine. But the devil is in the details where purity, dose and timing make it medicine or poison. Choose your brand wisely, be moderate in your amount, and time your chocolate well away from your bedtime. And most of all: ENJOY!

Your partner in health,
Frances T Meredith, MD

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

Autoimmunity: Why is my immune system attacking me?

Frances Meredith, MD

All of us either have a family member or friend who suffers with autoimmunity, a condition where our immune system wrongly targets us. Perhaps you yourself are part of this very popular club, affecting people at younger and younger ages. Generations ago there might have one uncle with “rheumatism” in your family, or a grandmother whose “joints hurt when it rains”. Today these cases are commonplace, as are the many other faces of autoimmunity from Hashimoto’s hypothyroidism, to lupus, to multiple sclerosis. So what is autoimmunity, why is it affecting so many of us, and what can we do to stop the “self-attack”?

Autoimmunity occurs when our finely tuned immune system, designed to defend against foreign invaders ranging from food borne bacteria to pandemic viruses, turns against us. Unfortunately, many with autoimmunity are frustrated with lack of a clear diagnosis. Traditional medicine looks to fit us into neat diagnostic boxes, which frequently do not apply. It is clear to those who see many autoimmune patients that the majority of those who suffer from chronic illness over years, feeling unheard by their providers, searching for answers from multiple doctors who scratch their heads, represent this type of self-attack.

Why would such an intelligent immune system turn against us?  Imagine the confusion of your protective army as it heeds the call to attack its own castle. And how do we bring our defense system back to its original function: to make decisions as we interact with our environment, deciding what is friend vs what is foe and mounting an appropriate response, but not to attack us?

A more esoteric view of autoimmunity emphasizes that we are not separate from our immune systems. You are your immune system. You are creating it, and impacting its ability to function optimally every day by the choices you make. The salient question is “If I am my immune system, where did the communication go wrong? What messages am I sending to make me turn upon myself?”

The answers to these questions are complex, and very individual. Autoimmunity, first, requires susceptible genetics. These genetic vulnerabilities are then activated by certain lifestyle triggers. Your Functional Medicine provider assesses this by creating a “Personal Autoimmune Trigger Blueprint”. These triggers range from reactive foods to infections, toxins, vaccines, childhood trauma, concussion, blood sugar, high stress, lack of sleep such as with sleep apnea, and low levels of key nutrients for optimal immune function. Addressing these triggers while optimizing immune nutrients and plant based supportive supplements allow the immune system to regain balance. The goal is to get our autoimmunity into remission. We see patients achieve remission every day as they address their triggers, support their body, and see the results in declining antibody levels and, more importantly, in feeling better.

We at Carolina Total Wellness are experienced in a broad range of autoimmunity, not only the ones with names you recognize, but also those not yet defined by a lab test from a Rheumatologist. We would be honored to walk with you on this journey of understanding and regaining immune balance.

Your Partner In Health,

Frances Meredith, MD

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

Leaky Gut

Susan Denny, MD, MPH

Do You Have Leaky Gut?

If you suffer from a chronic health condition and have been researching how to improve your health, you may have heard of leaky gut.  If that conjures up an unpleasant image of gut materials leaking in to your bloodstream, you are not far off.  Leaky gut happens when contents from the small intestine spill into the sterile bloodstream from a damaged or “leaky” gut wall.   This contamination of the bloodstream by digested foods as well as bacteria, yeast, and other pathogens is often the foundation for chronic inflammatory and autoimmune health disorders. 

Leaky gut is referred to as increased intestinal permeability in scientific research and is increasingly being recognized as a common underlying factor in most inflammatory symptoms and disorders.  As our body’s largest immune organ, the gut powerfully influences the rest of the body. Importantly, this includes the brain. Current scientific studies link intestinal permeability with inflammatory bowel disorders, gluten sensitivity, celiac disease, Crohn’s disease, type 1 diabetes, depression, anxiety, psoriasis, and many other chronic conditions.

Given what we know about the connection between gut health and immunity, it is vital to include a gut repair protocol in the treatment of inflammatory and autoimmune disorders. Repair of leaky gut begins with understanding why it developed in the first place.   Reasons for leaky gut can include over the counter or prescription medications, antibiotic use, toxin exposure, hormonal changes, food intolerances, poor diet and others.  After root causes are identified, a leaky gut protocol can help you improve your health, relieve symptoms, boost energy, make you happier, and clear your brain fog. Ask our office for advice on improving your overall health through a personalized leaky gut evaluation and treatment plan.

Your Partner in Health!

Susan Denny, MD, MPH

Healthy Work Ergonomics

Ergonomics

Ergonomics is the study of people’s efficiency in their work environment. The position of your monitor, how you sit, how long you sit, and many other variables can affect your work efficiency. It is also important to consider the impact that working in front of a computer can have on your mental and physical health. Here are several suggestions for making your work environment  more productive, enjoyable, and healthier.

Computer and Visual Ergonomics

  • Choose a chair or standing position that supports your back. Make sure that you are not sitting for prolonged periods of time. Stretch your fingers, hands, and arms periodically.
  • Be aware of your head tilting forward or backward as this can cause neck strain and headaches. Your computer display should be located just below eye height, about 4-5 inches as measured from the center of the monitor.
  • When typing, make sure that your hands are at, or below your elbows. Your knees should be level with your hips.
  • Position your computer monitor 20-28 inches away from your eyes.
  • Refrain from prolonged periods of working on a mobile device, as this can create eye strain.
  • After 2 hours of continuous computer use, rest your eyes for 15 minutes.
  • Follow the “20-20-20 rule” to reduce eye strain: every 20 minutes, look at an object at least 20 feet away from your computer monitor for at least 20 seconds.
  • Set the default font size on digital devices to 3.6mm.
  • Use a blue-light filter on electronic devices to block the blue light emitted from digital screens.


Mental and Physical Health

  • Move around during breaks and stand during conference calls to reduce your overall time spent sitting. A 2-3 minute activity break every 30 minutes has been shown to improve blood sugar health.
  • Make time for a lunch break away from your desk. Plan 1 non work related lunch date per month. 
  •  Set wellness boundaries between your work and personal life by keeping a regular work schedule and routine. Turn off your computer after hours.
  • When working from home create a designated workspace separate from your living space as much as possible. When not working, close the door or hide your workspace using a partition.
  • Your office should be comfortable. It should support feelings of ease and help create a smooth work flow. Have tools  kept in your office that can help you decompress the body. Some suggestions are a yoga mat, foam roller, lacrosse ball or acupressure mat. Take mini breaks and use them.
  • Use lamp lighting vs overhead lighting and an essential oil diffuser. 
  • Practice 2-3 minutes of deep breathing or mindfulness meditation a few times each day. 
  • Use a sound machine.
  • Have a yearly Postural assessment done. 

Call our office and schedule and appointment with one of our Health Coaches to learn more about ways to support a healthy mind and body while managing a robust work schedule. 

Yours in health,
Clarissa A. Kussin, ND, FMHC, ERYT-1000

References:
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2. Randolph SA. Computer Vision Syndrome. Workplace Health & Safety. 2017;65(7):328-328. doi:10.1177/2165079917712727
3. Chantal Coles-Brennan. Management of digital eye strain. Clin Exp Optom. 2019;102(1):18-29. doi.org/10.1111/cxo.12798
4. Dempsey PC, Larsen RN. Benefits for Type 2 Diabetes of Interrupting Prolonged Sitting With Brief Bouts of Light Walking or Simple Resistance Activities. Diabetes Care. 2016 Jun;39(6):964-72. doi: 10.2337/dc15-2336
5. Peddie MC, Bone JL. Breaking prolonged sitting reduces postprandial glycemia in healthy, normal-weight adults: a randomized crossover trial. Am J Clin Nutr. 2013;98(2):358-366. doi:10.3945/ajcn.112.051763
6. De Couck M, Caers R. How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. Int J Psychophysiol. 2019 May;139:1-9. doi: 10.1016/j.ijpsycho.2019.02.011.