When Supplements Matter

When Supplements Matter

Many people take supplements because they believe that it will improve their health. This is particularly true for the ‘One-A-Day’ Multivitamin. I believe that the average “One-A-Day” multivitamin does little to improve health. People take it as an act of faith and as a sort of talisman to ward off bad things. Ideally, you should be able to get the nutrients you need from a well-balanced diet. However, augmenting your daily diet with supplements can help provide nutrients when your diet is lacking or when certain health conditions cause you to develop an insufficiency or a deficiency.

 Many consumers self-prescribe supplements based on information they have gathered from online articles or from word of mouth. Collaborating with a qualified health practitioner can help streamline a protocol of quality supplements to your unique needs. Your practitioner can recommend specific brands to help ensure the supplements you add to your daily regimen are optimized for potency, purity and the best bio-availability. For many people the less expensive forms of vitamins are poorly absorbed. In addition, some people are unable to convert certain vitamins to their active form necessary for the body to benefit. The value of a good multivitamin is to enhance health on top of a well-balanced diet. Taking a multivitamin and not eating well is not a good thing to do.

My preferred multivitamin is Multi t/d by Pure Encapsulations which provides core essential nutrients and minerals. The therapeutic dose of this multivitamin/mineral is 2 capsules per day; however, benefit can be had from only 1 capsule per day. I vary the number of capsules I recommend based on background factors such as age, sex and underlying health problems. This formula combines active vitamin co-factors for optimal bio-availability with additional antioxidants that help with detoxification, prevention of inflammation and support of our ability to manage oxidative stress. In addition, this product is free of binders, excipients, flow agents and non-nutritive fillers, as well as wheat, casein and yeast. It does not contain copper or iron. Copper can increase the risk of chronic degenerative diseases such as Alzheimer's and cancers. Iron supplementation is not necessary for most people; dosing should be individualized when iron supplementation is necessary.

There are individuals who have a problem with a process called methylation. Methylation is facilitated by enzymes through a series of biochemical processes, altering the chemical makeup of various compounds within the body. Methylation is involved with detoxification, regulation of gene expression, protein function, RNA processing and healthy cellular function. Methylation is a biochemical process that helps to facilitate health. It is a necessary function for our physical, emotional and mental well-being. Without proper methylation, we are at increased risk for:

  • Cardiovascular and Cerebrovascular Diseases
  • Cancers
  • Neurologic Diseases (neuropathy, dementia)
  • Psychological Problems

I recommend Methyl Assist by Pure Encapsulations, 1-3 capsules when there is evidence of inadequate methylation. Methyl Assist provides activated B vitamins to support healthy methylation, cardiovascular, neuronal and emotional well-being.

Homocysteine tests may be used to screen individuals at high risk for coronary artery disease as well as cases of suspected malnutrition. This is an inexpensive marker to evaluate methylation support. The homocysteine level can be followed over time to determine the adequacy of supplementation and proper nutrition through diet.

A daily supplement program should not be static and will change according to the body’s demands. Adjustments can be made based on the level of stress we are experiencing and the laboratory tests that have been recommended by your practitioner. A supplement program is not a substitute for reasonable efforts at optimizing lifestyle. One should still pay attention to diet, exercise, sleep hygiene and healthy relationships.

Support for Cardiovascular Benefits:

Many individuals believe that in order to lose weight, one must eliminate fat from their diet. This belief can be very harmful to the body as certain types of beneficial fats (essential fatty acids) are critical for proper function of the body. These essential, (“good”), fats must come from your diet; your body can not produce them on its own.

Two products that contain beneficial fats I often recommend include:

  1. Complete Omega Essential by Natura Health Products, dosed 4 capsules each day. Complete Omega Essential combines fish oil and select plant oils to provide optimal ratios of Omega-3,6,7, and 9 fatty acids along with naturally occurring carotenoids.
  2. EPA/DHA by Pure Encapsulations, dosed 2 capsules per day.

Both of these products support healthy cardiovascular, neurological, skeletal and the immune system while promoting a healthy inflammatory response.

Recent studies have shown that there is an inverse relationship between the level of DHA (docosohexanoic acid) in the blood and Alzheimer’s disease. The higher the level of DHA the lower the incidence of Alzheimer’s. Supplementing with adequate beneficial fats has been shown to have anti-inflammatory activity and cardio-protective activity, as well as, to provide cognitive and memory support.

Supplements that Reduce Inflammatory Stress:

Simple and inexpensive serum tests can be used to measure inflammation. Several tests I use in practice include C reactive protein, Sedimentation Rate and Ferritin. I will use other measures in people with more complex problems such as TGF beta1, C4a and MMP9.

 Botanical supplements are best at reducing inflammatory stress. One of my favorite formulas is Inflammaway by Natura Health Products. The botanical herbs in Inflammaway; boswellia, feverfew, magnolia, andrographis, chinese skullcap, ginger and bromelain modulate the inflammatory response. A recommended dose is 3 capsules once or twice daily.

Support for Osteoporosis:

In women or men who may be at risk of osteoporosis, I recommend supplementing with a small amount of extra calcium. It is best to get as much of your daily calcium requirements from the foods you eat. The general recommendation is to get 600-1,200mgs of calcium per day. This requirement may be increased during rapid growth, trauma and wound healing, pregnancy and lactation. Most people think that dairy products are the only, or, best source of calcium, but Table I provides a list of non-dairy sources of calcium.

Essential bone enhancing nutrients also include Vitamin D and Vitamin K which work synergistically to support bone health. A product I use most often is Vitamin D-A-K by Natura Health Products, dosed one capsule per day. This balanced formula improves calcium absorption by the gut and inhibits calcium loss from the bone.

Table I: Calcium Sources in foods in milligrams per 8-ounce cup of the food.

DARK GREEN LEAFY VEGETABLES:

  • Arugula, raw; 125 mgs/cup
  • Cooked turnip greens; 450 mgs/cup
  • Cooked bok choy; 330 mg/cup
  • Broccoli cooked; 180 mgs/cup
  • Cooked collards; 300 mgs/cup
  • Cooked kale; 200 mg/cup
  • Parsley; 200 mgs/cup
  • Cooked mustard greens; 180 mgs/cup
  • Dandelion greens; 150 mg/cup
  • Romaine lettuce; 40 mgs/cup
  • Spinach cooked 240 mgs/cup
  • Head lettuce; 10 mg/cup

SPROUTS:

  • Soy; 50 mg/cup
  • Mung; 35 mg/cup
  • Alfalfa; 25 mg/cup

SEA VEGETABLES: (seaweed),

  • Nori; 60 mg/cup
  • Kombu; 60 mg/cup
  • Wakame; 60 mgs per cup

BEANS: (cooked, ready to eat)

  • Navy beans; 140 mg/cup
  • Pinto Beans; 100 mg/cup
  • Garbanzo Beans; 95 mg/cup
  • Black Beans; 60 mgs/cup
  • Lentils; 50 mgs/cup
  • Split Peas; 20 mgs/cup           

GRAINS:

  • Tapioca (dried); 300 mg/cup
  • Brown Rice, cooked; 20 mgs/cup
  • Quinoa, cooked; 80 mgs/cup
  • Oats; 40 mgs/cup, tortillas

 SEEDS:

  • Almonds 750; mg/cup
  • Hazelnuts; 450 mg/cup
  • Walnuts; 280 mgs/cup
  • Sesame Seeds (whole, unhulled); 2,100 mgs/cup
  • Sesame Tahini; 130 mgs/oz
  • Sunflower Seeds; 260 mgs/cup

SEAFOOD:

  • Oyster (raw); 260 mgs/cup
  • Shrimp; 300 mgs/cup
  • Salmon (canned with bones); 490 mgs/cup
  • Mackerel (one can with bones) 600 mgs
  • Sardines (one can with bones); 1,000 mgs

SPECIALTY FOODS:

  • Canned Salmon eaten with bones; 440mgs
  • Canned Sardines or Mackerel eaten with bones; 569 mgs
  • Sesame Butter, (unhulled sesame seeds); 1022 mgs/cup, 64 mgs/TBS
  • Tofu (regular, soft); 260 mgs/cup
  • Tofu (firm, calcium set); 500 mgs/cup

DAIRY PRODUCTS:

  • Milk, (skim, low fat, whole); 300 mg/cup
  • Buttermilk; 300 mg/cup
  • Cottage Cheese; 130 mgs/cup
  • Yogurt; 450 mgs/cup
  • Brie Cheese; 50 mgs/oz.
  • Hard Cheese; 200 mgs/oz.
  • Parmesan Cheese; 70 mgs/Tbsp

Source: http://www.integrativemedcrossroads.com/education/calcium_in_foods.php

Support for Energy:

Mitochondria are the organelles within our cells that are responsible for producing energy. As we age, the number of mitochondria per cell decline and their ability to produce energy declines. Researchers have demonstrated that certain nutrients can reverse this process in animals. They have started to study this phenomenon in aging humans. The nutrients they use are Acetyl-L-Carnitine, Alpha Lipoic Acid and Coenzyme Q10 (Ubiquinol). I have found that adding these supplements to a health regimen can improve one’s sense of well-being and improve the ability to recover from vigorous exercise. Dosing is dependent on an individual’s history and condition.

Power Adapt is a potent adaptogenic tonic designed to enhance endocrine function. It nourishes the spleen, kidneys and adrenal glands to support the Hypothalamic-Pituitary Adrenal (HPA) Axis.  The HPA axis is an intrical relationship that exists between our pituitary gland, hypothalamus and adrenals. This system helps regulate levels of cortisol, nervous system activity and energy expenditure, as well as modulating the digestive and immune system. I recommend 1 to 3 capsules twice daily between meals. This is a great product for people who experience lagging energy in the mid-afternoon, as well as symptoms associated with physical or mental stress.

Supplements that Reduce Oxidative Stress:

One of the areas I address is a patient’s level of oxidative stress. This information can be obtained from simple and inexpensive serum measures of Ferritin, GGT, Homocysteine and Uric Acid.

Vitamins that reduce oxidative stress include:

  • Carotenoids found in products such as Vitamin D-A-K by Natura Health Products
  • Vitamin C by Pure Encapsulations
  • Multi t/d by Pure Encapsulations
  • Vitamin E as mixed tocopherols or mixed tocotrienols or Vitamin E succinate by Pure Encapsulations.

A Herbal/Botanical blend with strong anti-oxidant properties, I often use:

  • Botanical Treasures by Natura Health Products is a concentrated food supplement that contains turmeric, green tea, Japanese knotweed, quercetin, grape seed and grape skin extracts, holy basil, rosemary, ginger and luo han. A preferred dose is 3 capsules once or twice per day.

The typical American diet primarily consists of processed foods, refined grains and added sugars. This increased consumption of unhealthy foods and sedentary lifestyle is linked to inflammation and chronic disease. Even if you are eating a well-balanced diet, you may still fall short of needed nutrients. Adding quality supplements can help fill the dietary gaps.

When choosing supplements be sure to carefully read the labels of all ingredients and pick a reputable brand that test via U.S. Pharmacopeia or USP, NSF International and Consumerlab. These agencies test and audit to ensure that supplements meet strict standards of quality. In addition, these regulatory organizations offer an array of resources to help protect public health and promote sustainable living.

To effectively achieve optimal health and strive for “vitality,” it is most advantageous to partner with a qualified healthcare provider.

Warren M. Ross, M.D.

 

What is Integrative Medicine?

What is Integrative Medicine?

Integrative Medicine is the application of conventional medical practices and non-conventional medical practices in the service of optimal health outcomes.

Conventional medical therapies typically involve the use of prescription medications/drugs and surgery. It also includes physical therapies and psychological therapies. Dietary advice is often provided but typically under-emphasized, unlike integrative medicine.

Conventional diagnostic techniques include laboratory and imaging/radiology. Invasive techniques such as gastrointestinal endoscopy and cardiac catheterization are both diagnostic and therapeutic.

Non-conventional therapies are widely varied. They include a general emphasis on the effort that the individual makes to improve their health. This includes dietary therapies, avoidance therapies, exercise therapies and psychological therapies, (mindfulness meditation). The Non-Conventional therapies draw on traditional practices such as acupuncture, herbal medicine, massage, and naturopathy. They also integrate techniques that have developed in parallel to conventional medicine such as chiropractic therapy, electrical stimulation therapy, exercise therapy, neural therapy, and nutrient therapy.

Integrative medicine is evolving continuously.

An example of integration that is now quite common in our area is the use of Acupuncture Therapy to help control the side effects that people with cancer experience from chemotherapy and radiation.

The increasing emphasis on the importance of dietary practice and exercise in the management of diabetes is another example. Integrative medicine, attempts to implement these practices instead of merely giving lip service to their importance.

Integrative medicine places an emphasis on the idea that we are unique in every way. Factors, which are considered in the development of a therapeutic regimen, include:

  1. Genetic variations that effect background metabolic processes, thus affecting our susceptibility to illness and our ability to regain our health.
  2. Total toxic load: The toxins acquired in utero, in our home environment and in our work place can cause us to be ill or impair our ability to regain our health.
  3. The psychological and social events of our lives: Events that occur in our past may have an adverse effect on our health in the present. Stress related to family and work issues are considered in understanding a health problem and planning therapy.

In the end, best practice is what produces a desirable outcome for the individual seeking health care, their family and for the society at large. Integrative medicine attempts to bring together the best aspects of conventional and non-conventional medicine to achieve this end.

The History

Integrative medicine has been developing and moving into the medical mainstream over the last 40 years.

In the 1970s there were reports of ‘Mind-Body’ Therapies, such as the ‘Relaxation Response’ introduced by Herbert Benson, M.D. Such therapies were promoted as useful for stress related health problems. Specialized dietary therapies were introduced such as the Protein Sparing Modified Fast. Often there were positive unintended effects of such dietary therapies such as a reduction in blood pressure, blood sugar and pain. Acupuncture received attention when Richard Nixon visited China. Acupuncture began to be practiced in the cities and then smaller communities of America. The idea of energy became part of the vocabulary and thinking of a critical mass of people. The more extreme ‘non-conventional’ approaches evolved at the periphery of the conventional medicine community.

The Holistic Medical Association was started in the 1970’s. It was a society that was primarily for medical doctors. There was a small but growing realization among the medical doctors that non¬medical practitioners with complementary skills had a great deal to offer.

The 1980s and 1990s saw a small but steady collaboration of MDs with dietician/nutritionists, chiropractors, herbalists and other complementary alternative practitioners. Most important, there was a growing scientific literature created by dieticians, nutritionists, herbalists and psychologists, as well as medical doctors, showing the efficacy of non-traditional therapies for a variety of chronic health problems.

In the new millennium we have seen public funding for CAM/Integrative Medicine. This has led to the creation of departments of Integrative Medicine at many medical schools. The idea of Integration has grown to be more and more inclusive of practitioners from many disciplines; mostly to the benefit of the public.

Conventional medicine often takes a linear, cause and effect approach to illness and disease. It rarely looks at the person in whom an illness arises as it attempts to create precise diagnostic categories that lead to treatments involving medications and surgery.

Integrative medicine is interested in the background milieu upon which the foreground event of an acute or sub-acute illness occurs. The premise is that by recognizing imbalance caused by dietary, environmental and emotional/societal issues and correcting them, disease can be prevented and suffering improved.

The two systems really do complement each other.

The United States has seen a decline in primary care and an associated increase in specialty medicine with ever-greater costs to the consumer and the country. The integrative medicine movement provides an important new avenue for primary care services that promises to be an effective means of delivering on the goal of health improvement and disease prevention.

Integrative medicine.jpg

Integrative Medicine at Crossroads Teaching Kitchen… Learning to Eat a As if Your Life Depended on It

Integrative Medicine at Crossroads Teaching Kitchen… Learning to Eat a As if Your Life Depended on It

Integrative medicine is a combination of conventional medicine and complementary alternative medicine (CAM).

Conventional medicine often takes a linear, cause and effect approach to illness and disease. It rarely looks at the person with the illness as it attempts to create a precise diagnosis that leads to treatments involving medications and surgery.

Complementary alternative medicine is interested in the background milieu upon which the foreground event of an acute or sub-acute illness occurs. By recognizing imbalance caused by dietary, environmental and emotional/societal issues, and correcting them, vitality can be optimized, leading to health improvements.

Health care is optimized when integration of these two perspectives occur.

Integrative medicine therapies include the following areas:

*Diet

*Nutritional Supplement Therapies

*Herbal Therapies

*Exercise

*Physical Therapies

*Energetic Therapies

*Self-Regulation Therapies

Diet is a very important component of integrative medicine and conventional medicine. Public interest in diet is evidenced by the publication of new books and magazine articles touting a solution to health problems from a newly created dietary program. It is very difficult to make sense of the constant stream of new information and recommendations.

Interestingly, conventional medical researchers have spent a great deal of effort trying to determine the health benefits of various diets. Their conclusion is that the Mediterranean diet produces the most reliable benefit in individual and population health.

An article in the prestigious New England Journal of Medicine noted that when a population of people changed their dietary patterns and increased from 5 to 7 points on the Mediterranean diet, all causes of morbidity (death) and mortality (illness) decreased by 20 percent.

We created the Teaching Kitchen because we wanted to create an atmosphere where health transformation could occur. We wanted to do more than just talk about good dietary practice. We wanted to provide a place where people saw healthy food, learned how to procure it, watched its preparation, and ate it in the company of others with laughter and light-heartedness.

Our integrative medical program promotes the Mediterranean diet (with individual adjustments) as an optimal maintenance diet. The Mediterranean diet is characterized by a diet that emphasizes whole grains (2 to 4 servings per day), legumes (1-2 servings per day), nuts and seeds (1-2 servings per day), vegetables (4-6 servings per day), fruits (2-4 servings per day), dairy products (1-2 servings per day), fish (2-4 servings per week), healthy oils (such as olive oil), and wine (1-2 servings per day, although not essential). Red meats, poultry and sweets are eaten only occasionally.

We emphasize the importance of obtaining foods that are fresh, preparing them in a way that preserves the nutritional value, paying attention to portion control, and eating in a pleasant environment with friends and family.

The maintenance diet is adjusted for individual health issues such as obesity, hypertension, high blood fats, diabetes, inflammatory problems and cancer. Our patients can work with a licensed nutritionist on an individual basis as well as take classes in our Teaching Kitchen.

The Teaching Kitchen at Integrative Medicine holds classes on different aspects of the Mediterranean diet, as well as classes for special therapeutic diets such as Anti-inflammatory, Detoxification and Low FODMAP.

The Low FODMAP diet is a diet designed to help people with Inflammatory Bowel Disease and Irritable Bowel Syndrome.

FODMAP: Fermentable, the process through which gut bacteria ferment undigested carbohydrates to produce gases; Oligo-saccharides, (found in “gassy” vegetables such as Brussel sprouts and beans); Disaccharides, (lactose in dairy products); Mono-saccharides, (fructose as in fruits such as apples); Polyols, (sugar alcohols such as artificial sweeteners).

This diet can be very effective and is commonly recommended for people with Inflammatory Bowel Disease and Irritable Bowel Syndrome. The ability to create and maintain such a diet can be daunting. Our licensed nutritionists work with patients individually. More importantly the Teaching Kitchen provides a real experience of how to make this difficult diet work and work well.

For more information about working with our licensed nutritionists and our Teaching Kitchen at Integrative Medicine, please visit our website, www.crossroadsteachingkitchen.com or call 410-992-4747.

Diet, Inflammation and Breast Cancer and Join us for The Anti- Inflammatory Diet Series in our Teaching Kitchen

Diet, Inflammation and Breast Cancer and Join us for The Anti- Inflammatory Diet Series in our Teaching Kitchen

Diet, Inflammation and Breast Cancer.  Inflammation is a complex process that is necessary for health maintenance. Its response to injury is part of the reparative process and its response to infection is life-preserving. Inflammatory surveillance cells are constantly detecting and eliminating threats from infectious, toxic agents and abnormal cells (cancer precursor cells). This said, the inflammatory process does have its downsides.  It can become excessive and lead to illness and chronic disease.

Toxic agents come from two main areas: our environment and the foods we eat. The most obvious forms of toxicity through diet come from food contamination, inappropriate preparation, preservatives, and residual pesticides.  Examples of foods that support this pro-inflammatory (toxic) state include those high in saturated fats, trans-fats, refined carbohydrates (sugars), alcohol, and processed or conventionally raised animal products. Just as unhealthy foods can cause inflammation, the lack of healthy foods in our diet contributes as well.

A normal inflammatory response is typically short-lived and diminishes once a threat is resolved. However, chronic inflammation develops when an acute inflammatory problem is inadequately resolved. It is a process that usually takes place outside of our awareness. One example of this, an infection, can become chronic and recurrent.

Toxic burden, in general, can be excessive and persistent and is important to be able to measure. If not, cancer cells can break through the restraining mechanisms and proliferate. Some of the problems that are related to chronic inflammation include atherosclerosis (hardening of the arteries with consequent heart attack and or stroke), dementia, Alzheimer’s, diabetes, and cancer.

One of the many markers for inflammation that we can measure is C-reactive protein (CRP).  CRP is the easiest and least expensive marker to measure and is elevated in both acute and chronic inflammation. Ferritin is another easily accessible marker. Measured level elevations typically suggest injury to cells.

Chronic inflammation creates an environment permissive to cancer initiation and growth, and spreads through a variety of mechanisms:

  • Inflammatory messenger molecules trigger cell proliferation in a primitive attempt to repair a perceived injury. An increase in cell division increases the chance that there will be an error in the genetic material that a new cell acquires.
  • Inflammatory molecules suppress the surveillance mechanism of the immune system that would typically destroy abnormal cells.
  • Apoptosis (programmed cell death) is a mechanism that destroys abnormal cells. This mechanism is suppressed in an environment of chronic inflammation.
  • Inflammation supports new blood vessel growth (angiogenesis) that may allow a small tumor to grow.

Inflammation has been shown to be an important factor in the initiation, growth and spread of breast cancer. Cyclooxygenase-2 enzyme (COX-2) is one of the inflammatory markers used by researchers. Research supports that COX-2 has been over-expressed in more than 40% of human breast cancer cases. In addition, it is over-expressed in up to 70% of pre-invasive ductal carcinoma in situ, (thought by many to be a pre-cancer). This suggests the potential benefit of strategies to reduce this aspect of inflammation in order to prevent breast cancer. The common drug that inhibits COX-2, Celebrex, has adverse effects on heart and blood vessel health. Thankfully, dietary changes, nutritional supplements and herbal therapies provide a beneficial alternative to dealing with chronic inflammation.

There is one more component of this complex process that is worth mentioning because it is pertinent to aging, chronic inflammation, and chronic degenerative diseases including cancer. Advanced-Glycation-End-Products (AGES), are formed when carbohydrates complex with protein are created through a passive chemical reaction. This causes stiffening and decreased function of the proteins involved in energy production and repair. AGES attach to receptors on cells in our body and initiate the complex response that leads to chronic inflammation. This is a normal part of aging. It is accelerated when we eat too many sugars and simple starches.

The Mediterranean diet remains the model for healthy eating in general. It is the framework on which we build an Anti-Inflammatory diet.

  • Whole grains over refined grains are recommended except when an individual has a history of health problems related to certain grains, such as those containing gluten, or difficulty digesting the disaccharides in the grains.
  • Fruits and vegetables are broadly recommended and, most important, color and variety are emphasized. Sulphorophanes that come from the cruciferous family of vegetables have an anti-COX-2 (anti-inflammatory) effect.  Plants with red, purple, and blue hues are rich in anti-inflammatory anthocyanins. Modifications in fruit and vegetable recommendations are made for people who have problems such as Inflammatory Bowel Disease or Irritable Bowel Syndrome (i.e. low fermentable fibers, “low FODMAP”)
  • Healthy fats are very important in an anti-inflammatory diet. Mono-unsaturated fats found in olives and omega-3 fatty acids found in fish are the preferred fats. Omega-3s derived from marine sources and some nuts like walnuts have an anti-COX-2 effect. These sources of fat are shown to have cholesterol-lowering effects as well.
  • Healthy dairy products are recommended in moderation for those who can tolerate them. Aged cheeses, yogurt and kefir are emphasized due to their probiotic content. Probiotics have the ability to modulate inflammation and are often recommended in inflammatory bowel diseases.
  • Animal protein raised on grass, (i.e. grass-fed) is recommended in moderation. General recommendations include 1-2 servings of lean red meat, 1-2 servings of poultry, and 2-4 servings of fish per week. Grass fed animal protein contains lower levels of saturated fats and higher levels of anti-inflammatory omega-3s. Processed meats are strongly discouraged.
  • Nuts, seeds, and legumes are non-animal protein sources and are encouraged daily. Walnuts, flax, and chia are especially high in anti-inflammatory compounds. Legumes contain a significant portion of dietary fiber, which also has anti-inflammatory potential.
  • Red wines with a high proanthocyanidin content are included in the Mediterranean diet. The anti-oxidant resveratrol, also found in concord grapes, provides cardiovascular and anti-inflammatory benefits. The daily intake is 4 ounces per day for females and 4-8 ounces per day for males to achieve the benefits from the polyphenols. Consulting with your physician before enjoying this perk is recommended.

Supplements that have an anti-inflammatory effect include bromelain, sulphorophane, fish oil, pine seed oil, grape seed extract and zinc.

Herbs that have an anti-inflammatory effect include curcumin (derived from turmeric), ginger, rosemary, oregano, American ginseng, scutellaria, pau d’arco, propolis, licorice, honokiol, (magnolia), quercetin, sage (ursolic acid) and white willow bark.

Creating an anti-inflammatory program that is right for you is not easy. Our licensed nutritionists at Crossroads , Keri Connell and Sara Cooper are available for one-on-one consultations in addition to our group cooking demonstrations held regularly in our teaching kitchen.  We are offering a brand new 7-session course on the Anti-Inflammatory diet. Each class in the series highlights a component of balanced diet and shows you how to increase the anti-inflammatory potential via herbs, spices, color, variety, and healthy fats. Learn everything from breakfast to dinner.

JOIN US for

The Anti- Inflammatory Diet Series

in our Teaching Kitchen

Creating an anti-inflammatory program that is right for you is not easy. Our licensed nutritionists at Crossroads Teaching Kitchen, Keri Connell and Sara Cooper are available for one-on-one consultations in addition to our group cooking demonstrations held regularly in our teaching kitchen.  We are offering a brand new 7-session course on the Anti-Inflammatory diet. Each class in the series highlights a component of balanced diet and shows you how to increase the anti-inflammatory potential via herbs, spices, color, variety, and healthy fats. Learn everything from breakfast to dinner. Visit our Crossroads Teaching any time or sign up today for the one or all of the different cooking classes below. Please visit us at our website:  www.crossroadsteachingkitchen.com for more information and to register for classes or call 410-997-5191.

The Autonomic Nervous System and its Effects on Health and Vitality

The Autonomic Nervous System and its Effects on Health and Vitality

The nervous system is a complex network of nerves and cells that carry messages to and from the brain and spinal cord based on sensory input from our external and internal environments. Our understanding is growing about the interplay between these two settings and the effects they have on our health and vitality.

The voluntary nervous system is the part of the peripheral nervous system associated with skeletal muscle activity and voluntary control of movement, including facial expression, typing, writing, walking and moving in general.

The autonomic nervous system (ANS) is the part of the nervous system that controls functions that occur below our level of consciousness. These functions include sleep/wake cycles, level of arousal/alertness, heart rate, respiratory rate, endocrine function, immune function, digestive function and energy production and utilization.

The ANS is divided into two broad categories: sympathetic and parasympathetic.

  • The sympathetic component has to do with our relationship to the external environment. This is the hunter-gatherer orientation which corresponds to our level of alertness to the external environment in order to acquire things necessary for survival. It also relates to protection, self-preservation, and the fight or flight response.
  • The parasympathetic component has to do with our internal states. It is involved with restoration and repair, nourishment and detoxification, immunologic balance, and our innate sense of vitality and well-being.

Our level of awareness, ability to focus and intelligence reflect a complex interaction between the sympathetic and parasympathetic components of the ANS. Optimal health is associated with a dynamic, ever-adapting balance conditioned by the demands we face from moment to moment. When we are in good health, we experience flexibility and resilience in relation to the outer and inner environment and experiences.

Stress is a concept that has several different types of interpretations. Hans Selye, a noted physician and researcher, developed the concept that stress can be both positive (eustress) and negative (distress.)  Stress can be viewed as a physiological response to the demands put upon the body, but it can also mean the physical, societal or environmental factors impacting the individual (See Table I below.)  Moreover, stress can also be viewed as the individual’s own psychological perception of short- or long-term stress that challenges the individual’s coping abilities. Learning how to perceive stress differently can help divert the negative stress response. It is not essential to eliminate stress but to ensure sufficient recovery.

Sympathetic dominance occurs when the sympathetic nervous system activity predominates over parasympathetic activity. It is the normal state for most people in the modern world. We are constantly pulled to focus our attention on the outside environment where we attend to our families, our jobs and the concerns of our community. We lose our flexibility and resilience and cannot find our way back to a restorative, reparative inner world that is so necessary for optimal health and well-being.

Chronic stress is associated with sympathetic dominance and ANS dysfunction. This can occur as a result of stressful situations in our families, our workplaces and our communities. This is a common syndrome in people who are predisposed to illness or who have chronic illnesses. When we lose the skills to maintain the balance between sympathetic and parasympathetic states, we develop a rigidity that leads to chronic disease.

Anxiety and depression are obvious consequences of this phenomenon. Other health problems include:

  • Cardiovascular diseases such as hypertension and hardening of the arteries (atherosclerosis).
  • Endocrine/metabolic problems such as metabolic syndrome and diabetes
  • Immunologic problems such as autoimmune disease and arthritis
  • Neurological diseases such as memory disturbance and chronic pain syndromes
  • Neoplastic diseases/cancer has a strong relationship to autonomic nervous system imbalance
  • Sleep disorder

Sympathetic dominance is associated with decreased quality of life and decreased survival in people with diabetes, heart disease, neurological disease and cancer. It is associated with an increased chance for reoccurrence in people who have been treated for cancer.

The loss of parasympathetic function is associated with age-related sleep disorders. The restoration of parasympathetic function will improve sleep quantity and quality. It produces the environment that allows for detoxification, restoration and repair that occur when we are experiencing a healthy sleep pattern.

Table I:  Different Stress Factors

The following is an abstract from a medical journal that speaks to the importance of autonomic nervous dysfunction in chronic disease:

 

Conditions of aging as manifestations of sympathetic bias unmasked by loss of parasympathetic function

We propose a unifying hypothesis that many clinical consequences of aging are pleiotropic manifestations of the loss of parasympathetic function that occurs during post-reproductive senescence. The loss of parasympathetic function unmasks the baseline sympathetic bias inherent in the end-organs, resulting in the familiar signs of aging including tachycardia, constipation, insomnia, erectile dysfunction, fluid retention, and systemic inflammation. These consequences in turn may contribute to many of the common diseases associated with aging including type-2 diabetes, Alzheimer’s, atherosclerosis, and cancer. Maintenance and restoration of parasympathetic function may enable upstream control over the deleterious aspects of inherent end-organ adrenergic bias.

Medical Hypotheses

Volume 62, Issue 6, June 2004, Pages 868–870

One strategy for quantifying sympathetic dominance is through heart rate variability (HRV). HRV means the variation in time between consecutive heartbeats. HRV increases during relaxing and/or recovering activities and decreases during stress. Typically, there is an inverse relationship. There is more variability when the heartbeat is beating slow compared to fast. People with sympathetic dominance have reduced HRV, which is associated with an increased incidence of chronic disease.

We use two different technologies to measure HRV in our office. The first is a six-minute finger screen, but this is not a definitive measure. The second is a 72-hour test by FirstBeat Technology that is a more conclusive measure of HRV and our ability to manage stress. The data is acquired from a small, innocuous device, with electrodes that are applied to your body for three days. The information gathered is uploaded to a computer software program for an individualized analysis. It provides valuable information about the events of the day and time of the day when stressful events are having the most significant impact. More importantly, it tells us whether the individual is developing an adequate parasympathetic tone at night, a critical time when repair and restoration occurs. The results are interpreted by a wellness professional and a plan of action is created for improvements in stress management, exercise, and/or quality of sleep.

Sympathetic dominance can be improved by applying the principles of integrative medicine. This includes diet and nutrition, activity and exercise, herbal therapies and self-regulation therapies such as mindfulness, open-focus and EEG biofeedback. Committing to a healthier lifestyle can shift how we experience and respond to stress.

Our practitioners support patients in creating individualized programs with regular feedback to help them reach their health goals. To find out more about FirstBeat HRV and to set up an evaluation, please contact our wellness professional Sara Cooper, MS, LDN, CNS, CSCS at:

Better GI Health through Nutrition and Lifestyle Medicine (GI Tract)

Better GI Health through Nutrition and Lifestyle Medicine (GI Tract)

Gastrointestinal Tract Function (GI Tract)

The gastrointestinal tract (GI Tract) is an organ system responsible for turning food into small molecules that our cells can use for energy, maintenance, growth, repair and waste products. Optimal function of these processes is the basis for good health. We assess the GI Tract function through history, physical examination and laboratory testing. The intensity of laboratory testing is driven by the person’s symptoms and health background.

“All disease begins in the gut”- Hippocrates

The human gut contains 10 times more bacteria than all human cells in the entire body. It is home to 100 trillion microorganisms, with colonies of bacteria found on all human surfaces such as the skin, the sinus cavities and the gums. A healthy gastrointestinal tract is important because it is the home to the “Enteric Nervous System (ENS)” commonly referred to as the “second brain.” The ENS manufactures 95% of the serotonin and 50% of the dopamine found in your body. These neurotransmitters have a profound impact on our mood and emotions. It is also home to the GALT (gut associated lymphoid tissue), which is considered to be the immune system of the gut. Two thirds of our immune system resides in our intestines. The GALT is responsible for regulating inflammation, infection and allergic reactions by determining what is friend and what is foe.
Dysbiosis occurs when the relationship between the microbe and host are impaired. Dysbiosis was coined by Dr. Elie Metchnikoff. It comes from dys-, which means “not,” and symbiosis, which means “living together in harmony.” Dysbiosis can be caused by medications like antibiotics or proton pump inhibitors, toxin exposure, endotoxins, poor diet such as excess fructose, food sensitivities and chronic stress. When the immune system is chronically activated because of dysbiosis, it weakens our ability to protect ourselves from disease promoting microbes and adversely alters our microbiome. There can be an overgrowth of unfriendly bacteria, fungi/yeast, or parasites that cause symptoms related to the GI tract.

Symptoms and Signs of Dysbiosis:

The classical symptoms are abdominal bloating, abdominal discomfort, and bowel pattern irregularity. As mentioned before, dysbiosis can contribute to health problems related to any system in the body.

• Psychological symptoms may include depression, Attention Deficit Disorder and hyperirritability.
• Neurological symptoms may include headache, dizziness and cognitive dysfunction (poor memory and or brain fog).
• Respiratory symptoms may include chronic rhinitis, chronic sinusitis, and asthma. Cardiovascular problems may include palpitations, arteriosclerosis and heart attack (the chronic inflammatory response may contribute to narrowing of the arteries or arteriosclerosis).
• Gastrointestinal (GI Tract) symptoms and diseases such as stomach ulcers, ulcerative colitis and Crohn’s disease are often associated with dysbiosis. When dysbiosis is not the direct cause of a disease, it can be a contributing factor in symptom severity and disease persistence.
• Female health problems include PMS, menstrual irregularity and infertility. There is a possibility that chronic yeast overgrowth contributes to problems such as endometriosis and fibroids. Chronic interstitial cystitis is often improved by normalizing the bowel flora.
• Male health problems such as chronic prostatitis. Abnormal growth of bacteria in the stomach may lead to stomach cancer. Abnormal patterns of bacteria in the colon may increase the risk to colon cancer, particularly if the healthy bacteria that produce a gut nutrient called butyric acid are diminished.
• Allergic illnesses such as eczema can be associated with dysbiosis.
• Musculo-skeletal problems such as arthritis, chronic myofascial pain syndrome and fibromyalgia are associated with dysbiosis.
In my clinical experience more than two thirds of people with chronic health conditions have dysbiosis and intestinal permeability disorders contributing to their problems. We can re-balance our microbiome by removing the undesirable organisms and restoring the desirable bacteria while supplying nutrients to optimize the barrier function. At an appropriate time during treatment we recommend supplementation with healthy bacteria (probiotics) and the food that feeds the bacteria (prebiotics).

Treatment Strategies:

• Remove all undesirable organisms. This may include an adverse food, parasite, or disproportionate growth of the wrong types of bacteria. This may require prescription medications or herbal products.
• Assess exposure to toxins (heavy metals such as mercury, pesticides, and herbicides) and attempt to reduce the toxic load. This results in a restoration of immune function.
• Review glucose insulin metabolism. Abnormal glucose/insulin metabolism, also termed Metabolic Syndrome, is a common contributing factor to dysbiosis.
• Assess hormonal imbalance. An estrogen dominant state can predispose to yeast overgrowth.
• Identify food intolerances, allergies or toxicities. By removing the food from the diet we can improve immune function and facilitate the resolution of dysbiosis. Adherence to the proper diet is critically important to a successful outcome. While a bacterial or parasitic infection can be treated with appropriate medication and herbal products, a yeast infection requires dietary change to be treated effectively.

 

Table I Factors Effecting the Microbiome and GI Tract Barrier

Table II Probiotics, Prebiotics, Symbiotic
Probiotics
Live microorganisms. You can take them in capsule form or by eating cultured and fermented foods

Examples: Water Kefir, Kombucha, raw apple cider vinegar Prebiotics
Non-digestible foods that promote growth of bacteria

Examples: raw garlic, raw/ cooked onion, jicama, raw asparagus, raw Jerusalem artichokes, leeks, radishes Symbiotic
Combinations of prebiotics and probiotics that are found in the same food

Examples: Kimchi, sauerkraut, pickles, dairy kefir
Tests that look for dysbiosis:
• Cultures of the stool: These tests look for parasites, abnormal bacteria and overgrowth of fungi or yeast. When abnormal organisms are identified, sensitivity testing to determine the most effective treatment can be done. The Comprehensive Digestive Stool Analysis, (CDSA, Genova Labs) is a commonly used test.
• Breath Testing: The Hydrogen Breath Test is used as a clinical medical diagnosis for people with gastrointestinal symptoms suggesting Irritable Bowel syndrome and common food intolerances. This test can look for intolerances to Lactose and or Fructose. It can also help diagnose Small Intestinal Bacterial Overgrowth (SIBO).
Intestinal Permeability
The small intestine plays a critical role in digesting proteins, starches and fat. The intestinal tract lining is as large as a tennis court and as thin as your eyelid, only one cell thick. The lining of the intestinal tract has a selective barrier to prevent undesirable substances from entering the body, such as large undigested molecules, foreign substances and pathogens. Properly deconstructed nutrients can pass through the barrier to be assimilated and utilized by the body for energy. A breach in the intestinal barrier from irritants such as excess refined carbohydrates, alcohol, medications, chemical toxins and chronic stress increases intestinal permeability (see Table I). This is known as “Leaky Gut Syndrome”. This can cause symptoms of illness, provoke immune activation, and lead to disease processes.

Factors that Suggest Leaky Gut Syndrome

Factors that may raise the suspicion of Leaky Gut Syndrome include a history of major trauma or burns, gastrointestinal infections, chronic stress, over consumption of alcoholic beverages, low fiber and highly processed diets, dysbiosis, food and environmental contaminants and medications, specifically NSAIDS. NSAIDs are the anti-inflammatory medications that include aspirin, ibuprofen, and naproxyn. A history of food allergy or sensitivity should also alert one to the possibility of Leaky Gut Syndrome in the Tract.
Leaky Gut Syndrome can be associated with a variety of illnesses and chronic health problems inn GI Tract including:
• Attention Deficit Disorder
• Autistic Spectrum Disorders
• Arthritis
• Chronic Fatigue Syndrome
• Food allergies and intolerances
• Inflammatory Bowel Disease & Irritable Bowel Syndrome
• Parasitic infection
• Mood and cognitive disorders
• Skin conditions
• Autoimmune Disease
• Chemotherapy and radiation
Symptoms and Signs of Leaky Gut Syndrome:
There are a variety of non-specific symptoms that may be associated with Leaky Gut: fatigue, malaise, abdominal pain, abdominal discomfort, bloating, diarrhea, cognitive dysfunction, joint pains and generalized weakness.
Tests that look for Leaky Gut Syndrome:
Zonulin is a protein that is found in blood tests. Elevation suggests intestinal permeability. It can be used in diagnosis and as a retestable therapy marker.
4 R Treatment for Leaky Gut Syndrome:
1. REMOVE stimulants that cause dysfunction such as offending foods, abnormal organism, medication and/or supplements.
2. REPLACE processed and adverse foods with whole foods. Hydrochloric acid and enzymes (protease, lipase, amylase and DDP IV) are necessary support for proper digestion.
3. REPOPULATE the microbiome with beneficial prebiotics, such as fructoolgiosaccharides (FOS) and probiotic bacteria.
4. REPAIR the intestinal barrier by eating foods and taking supplements that support the healing process. Food sources to reduce inflammation and promote healing include turmeric, quercetin and butyrate, aloe vera, cabbage juice, okra, slippery elm and bone broth.
Supplement Highlights
1. Metagenics Ultra-Flora Control is a new probiotic that has been shown to improve Zonulin levels and by inference, intestinal permeability. 1
2. Metagenics Ultra GI Replenish formula features a prebiotic blend of natural-identical human milk oligosaccharide (HMO), as PreBiome 2’FL and isomalto-olgiosaccahries (IMOs). These two prebiotics are non-digestible carbohydrates that act as food for beneficial microbe. 2
3. Supplements like glutamine and zinc carnosine restore the barrier integrity.
*Please come in for your free trial bottle of Metagenics Ultra Flora Control while supplies last. (GI Tract, GI Tract. GI Tract)

To optimize your health through diet and nutritional support or for more assistance, please contact Integrative Medicine at Crossroads to inquire about a consultation with our nutritionists Keri Connell, MS, CNS, LDN or Sara Cooper, MS, CNS, LDN, CSCS.

In addition, please visit www.crossroadsteachingkitchen.com to learn more about our nutrition classes.

Integrative Medicine at Crossroads410-997-5191

References (GI Tract)
1) Stennman, L., Lehtinen, M., Meland, N., et al. (2016). Probiotic with or without fiber controls body fat mass, associated with serum zonulin, in overweight and obese adults. EBioMedicine, 190-200
2) http://healthcareinstituteforclinicalnutrition.com/spotlight-articles/a-medical-food-ugir-reduces-gastrointestinal-symptoms-and-beneficially-alters-gut-microbiota-in-adults-with-ibs-and-ibd/

 

 

Exercise and Activity

Exercise and Activity

 

Youthfulness is related to activity in every model of health and aging that we study. Regular exercise and abundant activity are key elements in maintaining health and preserving the biological functions associated with youthfulness.

The issue of activity is fundamental to a healthy lifestyle. We can make choices to increase our activity level in hundreds of little ways as well as the larger more obvious ones. Parking the car at the periphery of the parking lot, taking stairs when possible and just getting up and moving around when taking a work break make a big difference when practiced regularly. Taking a pet for a walk, light gardening and housekeeping are examples of activities to improve health. Many experts believe that the increase in general activity is at least as important as the more focused types of exercise that are given more attention in the media. The individual who stays in motion is more likely to remain healthy than the one who tends to sit still.

Focused exercise includes strength training, flexibility/balance training, and aerobic/endurance training. Maintaining a balanced program is the key to maximizing benefit and avoiding injury. There is abundant scientific evidence accumulated over the last 50 years to support the value of exercise in every measured area of health promotion, disease treatment, and healthy aging.

 

Endurance or Aerobic activities are the long slow distance activities. They include walking, jogging, cycling and swimming. There are a variety of new technologies such as stair climbers and elliptical machines. There are a few key principles to consider when creating an aerobic program.

  1. Get clearance from a health professional if you have been sedentary, are over age 40, or have background health problems such as heart disease or diabetes.

  2. Plan a program that is reasonable and safe. Consider utilizing the services of an athletic trainer to start your program. This will improve the chances that you will set reasonable goals, avoid injury and stick to your program.

  3. Commit to a regular practice. Sporadic practice is not beneficial and is unsafe.

  4. Create a varied program. Doing the same type of exercise over and over will increase the chance of injury and may lead to boredom.

 

Regular aerobic training has many health benefits, which include:

  1. Control of Body Weight

  2. Improvement of Cognitive Function, (memory and thinking ability)

  3. Improvement of symptoms of Depression

  4. Prevention of Heart Attack and Stroke

  5. Lowering of Blood Pressure

  6. Improvement of Blood Sugar Metabolism and Diabetes

  7. Improvement of Anabolic, (anti-aging hormone) Hormone production.

  8. Improvement of Immune Function

  9. Supports Detoxification Activities of your body

 

Flexibility and Balance training is an important part of a health enhancement program. This is an essential skill to maintain as we age. Falling is the major cause of disability and loss of independence as we age. Falls occur from a combination of problems including visual problems, loss of strength in the muscles of the trunk and lower extremities and loss of balancing ability. Flexibility and Balance exercises will prevent falling and prevent injuries from aerobic activity and strength training exercises. A flexibility program can be initiated by the individual but is best started under the guidance of a teacher. Special types of flexibility and balance programs include Yoga practice. I think this is one of the best activities for health promotion. It includes so many of the foundation principles for health enhancement including flexibility and balance training, strength training, detoxification, participation with a community of people, (support group) and attention to the spiritual side. The key to success is regularity of practice.

Flexibility and Balance Training, particularly Yoga has many health benefits, which include:

  1. Blood Pressure Reduction

  2. Improvement in Breathing

  3. Stress Reduction

  4. Enhancement of Cognitive Function, (memory and thinking ability)

  5. Prevention of Falls

  6. Prevention of Injury

 

Strength Training is an important part of health enhancement and disease prevention programs. Strength training has been used in adults at all ages and in all states of health. When done properly, it has shown to enhance health, reduce disability and improve disease management in all conditions. It is important to initiate a program with a trainer who has been qualified by the American College of Sports Medicine or a licensed professional such as a Physical Therapist or Chiropractor. Lightweight, slow repetition patterns have been shown to be safe, highly beneficial and require a minimal amount of time. The benefits of increasing strength and muscle mass are many and include:

  1. Enhanced Well-Being and Confidence

  2. The increase in muscle mass relative to fat will result in an increase in basal metabolic rate with the consequence of a higher energy production and improvement in weight control and maintenance.

  3. Increased strength in the lower extremities and pelvic girdle muscles will result in a reduced incidence of falls. In the elderly, falls are one of the main causes of disability and dependence.

We have excellent resources for individuals who are in need of a supervised program. Age is not a limiting factor.

  • Whole Body Vibration

  • BioDensity

  • Medical Gym and Wellness

  • Physical Therapy

V1.3

SLEEP, REST, RESTORATION

SLEEP, REST, RESTORATION

 

“Now, blessings light on him that first invented this same sleep! It covers a man all over, thought and all like a cloak; it is meat for the hungry, drink for the thirsty, heat for the cold, and cold for the hot. It is the current coin that purchases all the pleasures of the world cheap, and the balance that sets the king and the shepherd, the fool and the wise man, even.” “Don Quixote” by Miguel de Cervantes Saavedra, (1547-1616).

One never thinks of sleep as a problem until one has lost the ability to sleep deeply and awaken refreshed. The ancients valued the benefits of sleep so highly that they believed it was a gift from their gods. The Greeks believed that Hypnos was the God of Sleep. He is generally depicted as a benevolent figure that brought the restorative gift of sleep to mortals and gods alike. Morpheus, the god of dreams was the child of Hypnos. There is no culture that does not have a set of beliefs about the value of sleep and the injury that occurs when it is disrupted.

In the modern age we want to feel awake, energetic and vital at all times. We want our sleep to be brief but effective. Our physicians have described a variety of sleep related disorders or diseases. We have built a technology of diagnosis and treatment that has an estimated direct cost of $14 billion in 1995. This includes the cost of visits to physicians and other health care providers, prescription and non-prescription medication. There are many indirect costs related to insomnia. School and job performance is impaired. Insomnia is associated with functional impairment such as impaired memory and concentration, decreased ability to accomplish daily tasks, and diminished capacity to solve problems. There is a strong association between Insomnia and absenteeism, increased use of medical services and poorer overall health. Insomnia is associated with emotional problems such as depression and anxiety. Chronic illnesses such as Fibromyalgia and Chronic Fatigue Syndrome are associated with insomnia. There is an increased association of insomnia and motor vehicle accident. Approximately 200,000 motor vehicle accidents occur each year because of fatigue and excessive daytime somnolence. Many industrial accidents are linked to impaired performance secondary to sleep disturbance. Major catastrophes such as the Three Mile Island Nuclear Meltdown the Challenger Space Shuttle disaster and the grounding of the Exxon Valdez have been related to the adverse effects of sleep deprivation.

People with sleep disorders have a variety of complaints. The most common complaints are insomnia and excessive daytime sleepiness, (hypersomnolence). Insomnia can be thought of as inadequate quantity or quality of sleep with the consequence of daytime fatigue. The pattern of insomnia may vary from individual to individual. Individuals may experience some or all of the common problems of insomnia. These include difficulty in initiating sleep, difficulty maintaining sleep, awakening too early or the experience of non-restorative sleep, (not feeling well rested after sleeping).

The average amount of sleep required for good health is between 7 to 8 hours per night. Some individuals will feel well rested with 5 hours while others may require 10 hours to feel refreshed and energetic through the day. The correct amount of sleep may vary with factors such as season, illness and stress. The appropriate amount of sleep is the amount that allows you to awaken refreshed and function throughout the day without excessive drowsiness and with good concentration.

In the world of Integrative Medicine Sleep Quality is an important factor in maintaining good health and restoring health in those with chronic illness. Sleep and Rest are one of the cornerstones of good health practice along with Diet, Exercise, Detoxification and Relationship. Restorative Sleep and Rest have an impact on our hormonal function and immune function. Scientists have demonstrated that sleep disturbance can cause hormonal dysregulation that may make individuals more vulnerable to developing cancer. Sleep disturbance can be associated with an increased incidence of infections due to immune disturbance, diabetes, stroke and heart disease.

Insomnia may be of short, intermediate or long-term duration. It is classified into subgroups that help health care practitioners address the problem.

Adjustment Sleep Disorder: This is typically a problem of difficulty falling asleep and staying asleep brought on by a new stress such as loss of a job or family illness. The problem will usually resolve itself. When the stressful situation persists, the sleep problem may become chronic and interfere with general health.

Psychophysiological Insomnia: This type of sleep disorder refers to a learned association between the attempt to sleep and physical or mental symptoms that prevent sleep. In a sense the individual psyches themselves out of a good night sleep. Behavioral therapies can be very effective in correcting this problem.

Sleep State Misperception: This is a condition where the individual believes they have a problem when they do not. Reassurance is often helpful in these situations.

Insomnia Associated with Medical and or Psychiatric Conditions:  Insomnia may be caused by chronic health conditions such as chronic pain, cardiac problems, asthma, gastroesophageal reflux, and neurological diseases. Day time fatigue may be part of a primary sleep disorder such as sleep apnea, narcolepsy, circadian rhythm disturbances or restless leg syndrome.   Medications used to treat health problems may cause insomnia. Non-prescription drugs such as alcohol, caffeine and nicotine may cause sleep disturbance.

Sleep deprivation: This is a phenomenon that is common in our society. There are just to many things to do in a day and the day extends itself into night. We cheat and do not get to bed at a reasonable hour. We accumulate sleep deprivation. We try to deal with the daytime fatigue that results by using stimulants such as caffeine. The treatment for this is common sense. Plan a peaceful evening and get to bed early.

Primary Sleep Disorders: Primary sleep disorder are important to diagnose since there may be specific treatment that will provide improvement in the condition and the secondary day time fatigue.

Obstructive Sleep Apnea is a condition where there is a slowing and interruption of breathing during sleep. This is often associated with snoring. This is caused by a narrowing or partial collapse of the upper airway. In most cases it is related to obesity and improves with weight reduction. The problem is suspected when the individual presents with daytime fatigue and cognitive impairment, (trouble thinking clearly), and a history of snoring with interrupted breathing. It is diagnosed in a sleep lab or with a home sleep study kit. Treatment options include weight loss, surgery and continuous positive airway,  (CPAP), masks.

Narcolepsy is a disorder characterized by excessive daytime sleepiness and disturbed nocturnal sleep. Secondary symptoms included cataplexy, hypnagogic hallucinations and sleep paralysis. We diagnose this with a Multiple Sleep Latency study. Conventional medicine treats this problem with medication quite effectively.

Circadian Rhythm Disorders refers to sleep disorders characterized by the inability to sleep at traditional times. Adolescent often experience delayed sleep phase syndrome, (sleep-onset insomnia and difficulty waking at the desired time in the morning). The elderly often experience advanced sleep phase syndrome, (excessive sleepiness in the evening and undesired early morning awakening). Shift workers who constitute 25% of our work force often experience sleep phase disorder problems.

Restless Legs Syndrome is characterized by an unpleasant sensation in the legs and feet that is improved with movement of the legs. In extreme cases there is cramping and pain. This often causes sleep disturbance.

Diagnosis

Diagnosis of persistent sleep disorders is best done with the help of a Health Professional. There are some simple questions to ask yourself that may be helpful in guiding you to a more restful sleep.

  • Do you use caffeine, tobacco, or alcohol? Is the use associated with sleep disturbance?

  • Are you using prescription medications that may interfere with restful sleep? Check with your doctor.

  • Is the sleep environment conducive to sleep? Think about noise levels, light exposure and temperature.

  • Do you awaken in the middle of the night hungry? This may be a sign of insulin resistance and secondary hypoglycemia. Dealing with these issues may improve sleep quality.

  • Does your partner observe loud snoring, gasping, and choking or excessive leg movement?

  • Do you have underlying medical problems that may interfere with sleep?

  • Do you experience excessive daytime fatigue, poor energy, impaired ability to concentrate or poor memory?

Bring your concerns to your health care practitioner.

Treatment Strategies

Sleep Hygiene Education: This is a technique to help patients with insomnia identify lifestyle and environmental factors that may interfere with sleep. The instructions include:

  • Avoid stimulants such as caffeine and nicotine 12 hours before bedtime.

  • Do not use alcohol as a sleep aid and avoid alcohol before bedtime. While alcohol may promote sleep onset it interferes with sleep quality.

  • Do not exercise closer than 3 hours before bedtime. Regular exercise is encouraged.

  • Minimize light, noise and extreme temperatures during sleep.

  • Eat a light snack before bed if hungry.

  • Do not watch the clock.

  • Do something relaxing before bedtime.

Cognitive Therapy:  Cognitive therapy attempts to identify dysfunctional beliefs about sleep and replace them with more reasonable beliefs and expectations about the sleep process.

Prescription Medications: There are a variety of sedative-hypnotic medications that are useful in promoting sleep. In general, these medications should be used for short periods of time. While they induce sleep they do not allow for the natural stages of sleep to develop. Antidepressant medications may be used long term in patients with clinical depression. In many cases there is an improvement of sleep quantity and quality with treatment depression. Sedating antidepressants include amitriptyline, doxepin, imipramine, nefazadone, trazadone, and mirtazapine.

OTC Medications: Most OTC medications that are used to promote sleep have a sedating antihistamine such as benadryl as the active ingredient. Used occasionally they are safe. There are not advised for chronic use.

Integrative Medicine Strategies: these strategies include attention to diet, exercise, stress avoidance and reduction, and detoxification. These factors form the foundation of any health-enhancing endeavor.

Dietary issues include:

  • Emphasizing high protein foods at breakfast and lunch while emphasizing high carbohydrate foods at dinner and in the evening.

  • Avoiding the stimulants such as caffeine in the evening.

  • Avoiding the sleep disrupters such as alcohol and caffeine

  • Identifying and avoiding foods that may be causing sensitivity, allergy or intolerance reactions

  • Identifying the individual with Insulin Resistance and correcting the situation. This will often manifest as awakening with hunger

Exercise issues include:

  • Getting a reasonable amount of exercise in the morning or afternoon while avoiding exercise within three hours of bedtime. This will help set the normal sleep/wake cycle.

  • Learning exercises that balance energy and reduce stress such as Yoga, Tai Chi or Chi Gong

Stress Reduction Strategies include:

  • Creating a healthful sleep environment: Ambient light and noise should be minimized. Environmental pollutants such as dust, mold, animal dander and chemical toxins should be reduced. Clothing and blanketing should be non-toxic and comfortable. Air temperature should not be excessively hot or cold. Avoid stimulants such as TV in the bedroom.

  • Developing pleasant evening routines before bedtime such as a relaxing bath or sauna

  • An Epsom Salt Bath, (2 cups of Epsom Salts in a hot bath), for 15-20 minutes will help relax muscle

  • Learning relaxation or meditation techniques to relieve stress and daytime fatigue

  • Yoga practice

  • Learning to resolve stressful situations at home or work and not letting them linger

  • Doing things for others; volunteering

Detoxification Strategies include:

  • Identifying the individuals’ burden of environmental intoxicants such as heavy metals, pesticides, and herbicides. When a toxic burden is identified steps should be taken to remove the toxin while minimizing further exposure. Chronic intoxications can be a major contributor to disturbed sleep.

  • Other sources of intoxication can be from foods we eat, (allergy, intolerance, contamination), dysbiosis, (abnormal living organisms in a bowel), or abnormal absorption of products of bacterial metabolism from our bowel due to excessive intestinal permeability. Identifying and correcting these problems can be a factor in improving general health and restorative sleep.

Nutritional Supplements that may improve Sleep:

Tryptophan is an amino acid. It had been readily available as an OTC supplement. This product was removed from the OTC market when an improperly prepared batch caused serious health problems as a result of contamination. It is still available with a physician’s prescription from a Compounding Pharmacist. It can be very effective for the individual with sleep disturbance and associated depression. It should only be used with a physician’s supervision.

5HTP is a metabolic product of Tryptophan produced in the body from Tryptophan. It is available OTC. It may be helpful in promoting sleep in a dose of 50 to 150 mgs. taken at bedtime. It can take 2-4 weeks to work. It will not work promptly. It is believed to help increase serotonin levels in the brain. In doing so it may be useful for people with depression. Since depression is so often a consideration in people with chronic sleep problems, I recommend that such individuals seek the help of a health care practitioner when using these products.

Gamma Amino Butyric Acid, (GABA), is an amino acid that can be useful in inducing relaxation and sleep. The recommended dose is 500-1000 mgs taken at bedtime. I recommend that it be taken under the supervision of a health care practitioner.

Magnesium supplementation can be useful in promoting sleep. It can be particularly useful in individuals with Restless Leg Syndrome, Nocturnal Leg Cramps or Spasms that disturb sleep. A typical dose is 300-400 mgs in the evening. Magnesium may cause a stomach upset or loose bowels. We recommend high quality Magnesium Aspartate, as it seems to be more easily tolerated. MagnaGel is a topical magnesium product that is effective in Leg Cramping and Restless Leg Syndrome

Vitamin K in a large dose may be helpful in reducing pain. In individuals who experience sleep disturbance secondary to chronic pain I may suggest Vitamin K in a dose of 5-10 mgs. This will not work quickly. It may take 4-6 weeks to create improvement.

Phosphatidyl Serine: This is a product that reduces stress response related to an abnormal circadian rhythm of cortisol production

 

Herbal Supplements that may improve sleep:

There are a variety of herbal preparations that may be useful in improving sleep quality and hygiene. These include Valerian Root, Aspirea, Indian Pipe, Snake Root, Lemon Balm, Hops, Skull Cap, and Kava.

Examples of Herbal Combinations include:

Tranquility:  A general herbal tonic that improves sleep induction, sleep maintenance and sleep architecture

Corydalis PM: A product that is useful when pain is a factor in sleep disturbance

FibroBoost:   A product that has been shown to help with sleep quality when pain is a disturbing factor.

Kavinance: A general product that is useful in improving sleep quality

Lavela, (Essential Oil of Lavender Capsules): A product that is very useful when anxiety is a factor in sleep disturbance

 

The chronic use of these products should be directed by a health care practitioner with appropriate experience.

Hormonal Supplements that may improve sleep:

Melatonin is a hormone secreted by the Pineal Gland. I refer you to the chapter on Melatonin on our web site. It can be very effective for sleep induction and quality in a dose of 0.5-3.0 mgs. I usually suggest the lower dose as it is more physiological. It can be very effective for people with sleep phase disturbances such as the elderly, teenagers, travelers or shift workers.

Progesterone is a hormone that is produced by the Adrenal Gland, Ovaries and Brain Tissue. In appropriate levels can reduce anxiety and allow individuals to relax as well as deepen sleep. Many women suffer from a phenomenon that has been described as Estrogen Dominance. The symptom complex can include insomnia, anxiety, mood lability, fluid retention and bloating.  Progesterone supplementation may be helpful in this case. Visit the chapter on Progesterone on our web site.

Hormonal therapy is best done by taking into consideration the balance of all the hormones, the interactions between the hormones, the factors that effect hormonal metabolism and activity, (diet, nutrients, exercise, detoxification process, stress).

Energetic Therapies:

Acupuncture: Acupuncture that addressed underlying energy imbalance can be very effective in restoring healthy sleep patterns.

 

Lymphatic Enhancement Therapy, (LET): This is a unique therapy that balances the autonomic nervous system, (important to healthy sleep), reduces congestion and supports detoxification. It has been very effective in improving sleep quality for my patients.

Pulsed Electromagnetic Field Therapy, (PEMF): Pulsed electromagnetic field therapy - in short PEMF therapy - is based on decades of worldwide research carried out by well-known scientists. Tens of millions of people have already received PEMF treatments, not only for pain relief but also for many other conditions like insomnia, osteoarthritis, fibromyalgia and osteoporosis.

Parmeds PEMF computerized therapy systems use advanced Frequency Modulated Pulsed Electro Magnetic Field therapy (FM PEMF), generating time variable, low frequency pulsed magnetic fields.

 

Self-Regulation Therapies:

NeurOptimial: This is an EEG Biofeedback Therapy administered at our office. It has been effective in improving sleep quality. It has been beneficial in a variety of other problems such as Anxiety, ADD, Mood Disturbance, Chronic Pain and Cognitive Dysfunction.

Attentional Flexibility Training and Brain Synchrony Training: This is a training process that allows the individual to learn the skills necessary to focus their attention in a way that will improve physical and emotional well-being. It has been shown effective in managing stress related symptoms, the reduction of anxiety and depressive symptoms and the reduction of chronic pain, as well as the improvement in sleep problems.

Simple Steps: First do the things you can do. Try the simple things we have outlined that deal with life style change. Check with a health professional to make sure that a prescription medication or OTC product is not causing sleep disturbance. You can get a consult Keri Connell our Herbalist and Health Educator. Consider non-prescription nutritional products, herbal products and hormonal products. Consider prescription medications when necessary. The use of a prescription medication should not deter you from improving lifestyle and environment to optimize their effect.

 

Remember
Sleep tight
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Basis of Healthy Eating

Basis of Healthy Eating

 

Eating a good diet is not difficult. There are several principals that are easy to apply. The same diet that is good for preventing heart disease is also good for reducing the risk to high blood pressure, stroke, cancer and osteoporosis. Here they are! Now you can evaluate all the advice you get in the magazines and television with the sense that these simple principles constitute 95% of what is important in terms of good diet.

1. Low Fat Eating: The characteristics of a low fat diet are fairly simple.

a) No more than two servings of red meat per week. This includes meat served on a sandwich at lunch, (such as a roast beef or ham sandwich), or meat served as a main course at dinner. In general it is best to purchase meat that is raised organically and free range, (not feed lot fed). The quality is better. There are fewer chemicals, (fertilizers, pesticides, herbicides, hormones and antibiotics) in organic products, and the type of fat in the animal is healthier for you.

b) Two to four servings of poultry per week. Emphasize the white meat portions. Again, emphasize organically raised birds. Avoid fried chicken. Avoid the skin, (very high in fat).

c) You can have two to four servings of seafood per week. I am happy to tell you that the cholesterol in shrimp and crab will not be a problem. Shellfish have sterols, which inhibit the absorption of the cholesterol. Studies done at NIH 20 years ago demonstrated no increase in serum cholesterol levels with shellfish ingestion. Once again avoid the fried preparations.

d) You can have one to two servings of low fat or no fat dairy products per day, (emphasize organically raised animal sources). This includes low fat yogurts, cheeses and ice creams.

e) Avoid foods high in fat such as fried foods, creamy soups and salad dressings, dairy desserts such as custard or ice cream that are not low fat, and packaged goods. In general packaged goods such as potato chips are very high in fat. Read the labels!

Reading labels is the key to avoiding foods that are high in fat. Current labeling practice is to tell you the grams of fat in a total serving. This is intentionally misleading. You want to know the percent of fat in any serving. Ideally, you would like to limit fat intake to no more than 30% of total calories. Every gram of fat has 9 calories. A label may state that the total calories in a serving are 100 calories and there are 4 grams of fat. The total calories from fat would be, (9x4=36), 36. Fat would make up 36% of the calories. This would be a high fat food.

Trans fats are processed fats added to foods to preserves shelf life. They are particularly unhealthy. Avoid foods with trans fats in them.

2. High Fiber Eating: 1-2 servings of salad per day, 1-2 servings of fruit per day, 2-4 servings of cooked or raw vegetables per day, 1-2 servings of whole grain breads or cereals daily characterize a high fiber diet. The greater your intake of fruits and vegetables, (primarily vegetables), the better your health will be; aim for 4-6 servings per day.

3. Avoid Empty Calorie Foods: Foods with empty calories include

a. Foods with refined sugar; candies, soft drinks, dairy desserts, pastry

b. Foods with excess fats; high fat red meats, dark poultry meats, packaged goods, (potato chips, etc.), high fat dairy desserts, (ice cream), high fat baked goods, creamed soups and salad dressings.

c. Alcoholic beverages.

 

4. Do not get caught in the high starch food trap! People feel that if they only avoid fats they can eat all the other foods they want: particularly starchy foods. The common high starch foods are grain products such as bread, pasta, rice, potatoes and corn. Depending on your body size and your need to lose weight or control the tendency to gain weight you will need to limit servings of high starch foods to one to four per day. A serving size is one slice of bread, one cup of pasta, one ice cream scoop of rice or a baked potato with the inner third scooped out. Avoid starches that are processed, (potato chips, corn chips, Doritos, pretzels, cheese crackers, party mix).

 

When To Use Vitamin and Mineral Supplements:

 

The World Health Organization states that starvation begins, (for an average adult), when total daily calorie intake is less than 2,100 calories per day. People who eat refined/processed foods have some degree of malnutrition at any calorie intake level. People with underlying health problems often have special needs for certain nutritional components. At different times in our lives we have different nutritional needs, (prior to conceiving, pregnancy, lactation, old age, acute and chronic illness).

 

a. To prevent osteoporosis take 1000-1500 mgs. of calcium daily. Much of the calcium can be obtained from food. Calcium supplements should account for no more than 600 mgs per day. The preferred form of calcium is calcium citrate. Capsules are better than tablets because they are more easily absorbed. Vitamin D in a daily dose of 1,000-2,000 units per day is strongly recommended. Some individuals need a higher dose of Vitamin D.

 

b. Vitamin C in a dose of 500 to 1000 mgs. taken two times daily may help prevent arteriosclerosis, (heart disease and stroke). For some people Vitamin C will improve their resistance to infectious diseases.

 

c. Vitamin E in a dose of 200-400 units daily may prevent oxidative damage. Vitamin E should be taken as Mixed Tocopherols.

A good multi vitamin forms a base that will cover any nutritional inadequacies. I vary my recommendation based on age, sex and underlying health conditions. When recommending a vitamin product I am interested in the quality control in production, post-production testing of the product to insure that the contents are accurate and bioavailabilty. The Multi-Vitamin that I commonly recommend is Multi t/d by Pure Encapsulations. This product has a good balance of B vitamins, Carotenoids and Minerals. It does not have copper which is not necessary and may contribute to chronic illness.

There are many special issues related to diet based on underlying food intolerances, sensitivities, allergies and background health problems.

People with health problems should seek the guidance of their health care provider, a qualified Nutritional Counselor or Dietician.

Foundations of Health and Healing

Foundations of Health and Healing

Overview

 

Traditional healing disciplines look at health and illness as the interplay of individual factors, environmental factors and social context. The terrain or background events, past and present, have great impact on cause of disease and outcome. Conventional Medicine has created great value by looking at disease in a very focused way. Dissecting out the contributing causes of a disease and creating focused therapies for treatment has been a very effective strategy for treatment. A treatment is developed, (medications and or surgery), that removes, suppresses or neutralized the offending factor and the disease is cured or at least held at bay. Conventional Medicine is focused on the disease and not the individual who has the disease. This approach has been accentuated by the demands for efficiency in treatment of the managed care model and its sheer profitability. This model has been very successful in treating disease. It is hampered by the uneven distribution of health care services, excessive cost to the society, and untoward side effects of the therapies. Conventional Medicine often falls short in perceiving the relationship of the disease process to the individual who has an illness, their uniqueness as regards their prior health history, biochemistry, energetics and family and community background. I believe there is an opportunity for the convergence of Conventional and Complimentary-Alternative Medicine strategies in the health care process. This convergence has emerged an Integrative Medicine.

The Foundations of Health and Healing are those aspects of our lives that contribute to our health and our ability to heal from an illness or injury. They include Diet and Nutrition, Exercise and Activity, Restorative Sleep and Rest, Detoxification and Cleansing, Individual Energetics, Community and Relationship, and Spiritual Life.

These foundation phenomena are interactive: one affects the other. They create the background warp and weave of our experience and our sense of self. We view attention to these issues as an important component of health care, treatment of illness and prevention of disease. These issues are discussed at length on the website. Practitioners of Integrative Medicine consider attention to these issues as an important component of good practice. I believe that this approach differentiates the Integrative Medicine practice and enhances its value to the individuals who choose to use our services.

I encourage you to take a journey. Examine the concepts on the Foundations of Health and Healing as described on the Website. Consider the therapeutic processes you would like to explore. Read about the diagnostic procedures we may employ to understand how background phenomena such as diet, nutritional status, gastrointestinal health, stressors, immune balance and hormonal balance may influence your health. Understand that your willingness to participate in the process of creating and maintaining good health is essential to a successful outcome. Do not expect an instant success. Healing is a process. Good luck on your journey!

Warren M. Ross, M.D.