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The New Wave of Allergens

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With more than 60 million Americans affected, allergens are an important health issue. We are seeing a new wave of allergens that are effecting more people. Compared to 1990, pollen season occurs 20 days earlier and stays around on average 8 days longer according to a 2021 study. Not only is the season longer, but the symptoms are more severe. Plants, grasses and trees are spraying 21% more pollen than they did 30 years ago. So what gives?

The cause is our ever changing climate. As temperatures go up and the CO2 in the environment increases, plants produce more pollen. The severity depends on where you live and the plant species that proliferate there according to William Anderegg, associate professor of biology at the University of Utah and the lead author of that 2021 study. His study found that Texas and the Midwest have taken the brunt of these increasing pollen hot spots. This new wave of allergens is nothing to sneeze about (sorry.. I had to say it!) Climate change is not in the future…but is here with every breath you take.

If the current trends continue, ragweed and grass pollen concentrations will significantly rise over the next 40 years, says research analyst Hannah Jaffee of the Asthma and Allergy Foundation of America (AAFA). One spokesperson from the AAFA, Neeta Ogden MD, states that allergy symptoms usually improve as we get older because our immune systems become less reactive with age. But climate change is robbing us of this natural protection. Unfortunately, some older adults are actually developing allergies for the first time in their lives. While others are suffering longer and more intense seasons. In many areas, high pollen counts can start in early March and go through late October (even through Halloween!). Microparticles of pollen can continue to linger into the winter season. Treating allergens can also keep you healthier when it comes to warding off viruses. That’s because if you have allergies, your airways are more reactive to viral illnesses. So suppressing flare-ups may improve your overall immunity keeping your defenses up to fight off colds and flu.

Here are some things you can do to help reduce your sneezing, coughing congested symptoms.

  • Start treatment early: It’s easier to prevent your immune system from getting overwhelmed and overly aroused than it is to calm it down. So for the fall ragweed season, start treatment in August. The dates differ depending on what part of the country you live in. Consider starting with a nasal steroid spray. Over-the-counter nasal sprays include fluticasone (Flonase), triamcinolone (Nasacort) or budesonide (Rhinocort). These nasal sprays reduce nasal swelling and mucous production but can take a week to work so start early. Which one to choose? Some people find Flonase irritating because it contains alcohol so you can start with Nasacort. Anti-histamine nasal sprays are also available that treat itchy, runny nose symptoms and sneezing. These include prescription azelastine (Astelin, Astepro) and olopatadine (Patanase).
  • Oral antihistamines are also effective. Most over-the-counter medications work well. They include loratadine (Claritin), fexofenadine (Allegra) which are both non-drowsy formulas. Cetirizine (Zyrtec) or levocetirizine (Xyzal) are sedating so they should be taken at night. Natural products that have antihistamine effects include Quercetin, Stinging Nettles and Vitamin C. Still suffering? Consider allergy shots or immunotherapy.
  • Mask up if you are outdoors on high allergen days. Check the pollen counts daily on apps such as pollen.com, weatherbug.com and weather.com. These resources show counts and ratings for the day. If high, then try to shift outdoor activities indoors. Or you can avoid outside activities when pollen release is at its peak especially on windy and warm days. Those are 5-10AM and after 4 PM to dusk.
  • Avoid indoor allergens too. The sheer load of allergens can make symptoms worse. Common indoor allergens include pollen, dust mites, dander and mold. Zip up box springs and mattresses with dust mite covers. Vacuum carpets frequently, and keep windows closed while setting up a HEPA air purifier if you are allergic to your pet. Make sure to get roof leaks fixed and keep the indoor humidity to 40% to reduce mold in your home.

Being aware of your allergens is the first step toward taking preventative measures. Speak to your practitioner or see an allergist for testing if you are unsure.

References: Migala, J. Allergies: The next wave. AARP Bulletin April 2022.

Extreme Allergies and Climate Change. Asthma and Allergy Foundation of America. aafa.org

 

Overuse of Proton Pump Inhibitors

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The use and availability of proton pump inhibitors (PPI) have become very convenient. The common over-the-counter names of these drugs are esomeprazole (Nexium), lansoprazole (Prevacid) and omeprazole (Prilosec). They are used to treat heartburn and recommended to be used for no more than 14 days. But there seems to be an overuse of proton pump inhibitors.  Unfortunately 1/4 of patients end up taking these drugs for over 1 year, and the majority of the time, these drugs are over-used (2/3 of patients) with no indication for treatment.

When you overuse proton pump inhibitors for the long term, you have an overproduction of acid producing parietal cells, and when these drugs are discontinued, you have a hyperacid environment and the symptoms return which is why people stay on them. There are some indications for staying on these acid blockers. They include: High grade erosive gastritis, Barrett’s esophagus, esophageal strictures from gastroesophageal reflux (GERD), gastroprotection of those at high risk for GI bleed, protection from idiopathic pulmonary fibrosis, eosinophilic esophagitis and Zollinger-Ellison syndrome. So it’s between you and your practitioner on whether long-term treatment is necessary and whether the benefits outweigh the risks. And yes…there are risks.

We need to remember that we need stomach acids for absorption of many nutrients, primarily proteins and minerals. Deficiencies include Vitamin B12, iron, calcium, magnesium, zinc, and folic acid. Other dangers associated with long-term use of PPI’s include osteoporosis, kidney disease, pneumonia, stroke and contracting Clostridium difficile (C.diff) bacterium.

The real concern of the progression to adenocarcinoma with Barrett’s esophagus would make the decision of staying on PPI’s quite easy, except for the fact that studies have found no protective effect.

The same goes for eosinophilic esophagitis which is an allergic condition that occurs in the esophagus. The esophagus becomes inflamed and has difficulty contracting properly, getting more narrow and developing rings or abscesses. Although acid suppression helps manage the symptoms of eosinophilic esophagitis, it should only be used after eliminating foods that are triggering an allergic reaction. Eliminating the triggered foods cures the problem in about 50% of patients. There is also some concern that staying on PPI’s may continue to promote the condition. Acid activates proteolytic enzymes to help break down food to make it more digestible. When acid is not available to stimulate digestion, then exposure to undigested foods can trigger eosinophilic inflammation along the gut’s immune system.

So how can we de-prescribe these medications?

  1. Identify foods that trigger your symptoms. Tomato based foods, caffeine and alcohol are common triggers I see clinically. I recommend a food list to my patients that can be found on line. Foods that cause GERD.
  2. I treat my patients naturally for a condition known as Helicobacter Pylori (H. Pylori), a bacteria that lives in the digestive tract which can cause similar symptoms as acid reflux and can lead to ulcers in the lining of the stomach. I use a combination product that has mastic gum, bismuth and zinc called “Pyloracil”. Mastic gum is a resin, or sap-like substance that comes from the mastic tree grown in the Mediterranean. It helps reduce stomach acid and protects the stomach and intestinal lining. Studies have shown it also fights bacteria including H. Pylori.  I recommend using it for 3 weeks while reducing their PPI from twice daily to once a day or if once a day use, to 1 every other day.
  3. If patients develop heartburn when reducing their PPI dose, I recommend “D-Limonene”, which is an orange peel extract on the days they are off of their medication. This can neutralize gastric acid and supports normal peristalsis. It has been used for the relief of heartburn and GERD.
  4. Deglycyrrhizinated licorice works well by soothing the stomach lining. You can find this over the counter in chewable tablets.
  5. Melatonin can help symptoms if they primarily occur at night. This sleep hormone increases the tone of the lower esophageal sphincter. Start with 1-3 mg before bed.
  6. Acupuncture can also be helpful.
  7. Stop the use of non steroidal anti-inflammatory medications (NSAID’s), which includes Naproxen, Ibuprofen and Diclofenac to name a few.

If a person has recurring symptoms that last over 3 weeks after stopping their PPI then they should contact their practitioner for possible referral to a GI specialist for an endoscopy. Make sure you discuss all your over-the-counter meds and supplements with your practitioner.

References: Rakel, D. Clinical Practice Update on De-Prescribing PPI’s. Primary Care. March 17, 2022.

Sun, J. D-Limonene: Safety and Clinical Applications. PubMed.ncbi.nlm.nih.gov. Altern Med Rev. 2007 Sept.

Aquatic Therapy for Chronic Back Pain

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floating woman on body of water

Back pain is no stranger to most of us. About 84% of adults have back pain sometime in their lives. For many people back pain is self-limiting. But it can become more of a problem if it continues more than 3 months which is considered chronic. So what about aquatic therapy for low back pain? A study based out of China randomized supervised aquatic exercise versus traditional physical therapy in 113 adults, ages 18-65 with moderate to severe low back pain (LBP). The study went on for 13 months, and participants were randomized to either supervised aquatic therapy or traditional physical therapy in twice weekly sessions for 12 weeks.

After 1 year, mean scores on a 24-point disability scale improved by about 4 points more among participants in the aquatic exercise group then among those in the traditional physical therapy group, which is a meaningful difference. The aquatic exercise group also had improvement on the pain scale vs the traditional exercise group. Significant improvements in other measures of functioning and sleep also favored the aquatic participants.

Aquatic Therapy, or hydrotherapy as it is otherwise known has been used as an alternative therapy for those with chronic pain, or recovering from an injury or surgery. The natural buoyancy of water helps to reduce weight and eases stress on joints, even those in the spine. It does offer some resistance which can increase strength without muscle fatigue. It can reduce muscular and neurological pain and improve flexibility and range of motion. Plus it can be soothing and comfortable when done in a rehab setting by a physical therapist trained in hydrotherapy.

A study in 2019 sited in Physical Therapy stated that “aquatic exercise produced sufficient muscle activation, intensity and exertion.” It also noted reduction of pain vs land exercises. Several other studies have praised its benefits, including its positive effects in those with spinal stenosis, which is a neurological condition affecting the lower back and neck.

Speak to your practitioner and physical therapist about whether this treatment is right for you. This may be an effective option for managing this very common and difficult to treat condition.

References: Thomm, M. Get in the Water: Hydrotherapy for Pain and Movement. Practical Pain Management 11/11/2021.

Peng M-S et al. Efficacy of therapeutic aquatic exercise vs physical therapy modalities for patients with chronic low back pain; A randomized clinical trial. JAMA Netw Open 2022 Jan 7; 5:e2142069.

Gut Microbiome and Medications

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There has been growing interest in the interaction between the gut microbiome (genes of gut bacteria) and medications. Some medications are known to effect the gut in certain ways. For example, antibiotics tend to change the amount and types of bacteria in the gut which can cause side effects such as nausea and diarrhea. The drugs associated with lowering stomach acids such as PPIs (protein pump inhibitors), is associated with an increase in oral bacteria (that’s right…bacteria that’s found in the mouth) and potential pathogenic bacteria in the gut. There are interactions between the gut microbiome and medications.

Researchers studied the effects of 15 drugs on 25 strains of human gut bacteria and found a variety of drug-bacteria interactions. Some bacteria store the drug without chemically changing it while other bacteria chemically modify it to make it more or less bioactive. In other words, the gut bacteria can determine the amount of a drug (or an active drug metabolite) that is available to the body.

The opposite is also true. A particular drug can also affect a patient’s gut bacteria, both the number and function of that bacteria. For example, the build-up of a drug within a strain of bacteria can change the growth rate of those bacteria. Sometimes a drug can even change the molecules that are secreted by bacteria. This doesn’t sound like a big deal until you understand that the molecules can include hormones, neurotransmitters and molecules of inflammation that effect our physiology. There are clearly interactions between the gut microbiome and medications.

The drug variability can be due to either a person’s genetics or due to the person’s gut flora. Association studies have shown changes in the abundance of various gut bacteria in individuals with inflammatory bowel disease, irritable bowel syndrome and colorectal cancer.  This has also been found in other systemic diseases such as cardiovascular, metabolic conditions, autoimmune and psychiatric disorders.

As you can see here, there is a complex bidirectional interaction between commonly used drugs and the gut microbiome. This means that among people who have the same disease, a particular drug can vary greatly in its effectiveness and adverse effects. Perhaps this will help us in finding interventions to modulate the gut microbiome and optimize effectiveness of treatment.

Reference: Klünemann, M et al. Bioaccumulation of therapeutic drugs by human gut bacteria. Nature 2021 Sep; 597:533

Weersma, R et al. Interaction between drugs and the gut microbiome. Gut 2020 Volume 69, Issue 8. gut.bmj.com

Long-Haul COVID-19 Will Be With Us For The Long-Haul

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woman sitting on floor near window

 

Viruses have a tremendous capacity to drive chronic disease and illness. COVID-19 is no exception. We now have several terms for the condition that causes lingering symptoms after recovering from SARS-CoV-2 or COVID-19 infection. You may know it as “long-term COVID”, “post-COVID syndrome” or “long-haulers”. The NIH (National Institutes of Health) refers to these symptoms as PASC, which stands for “post-acute sequelae of SARS-CoV-2”. This syndrome is getting more and more press, but I still don’t believe it’s getting enough attention. The amount of people that continue to get COVID-19 infections is staggering and is currently driven by the Omicron variant. The CDC’s summary as of January 16, 2022 reports over 800,000 new cases per day, more than doubling the January 2021 peak! The more cases…the more long-haul symptoms. And long-term COVID can occur with mild symptoms and at any age, gender or with no prior illness or health problems. What we know is that long-haul COVID-19 will be with us for the long-haul.

The reason I am harping on this matter is because I believe Long-Haul COVID will be the main health challenge for health care workers, families, our economy and the work force in decades to come. Post-COVID is a multi-system disease that includes physical, mental and emotional symptoms. There are some health care facilities that are addressing these symptoms as real and looking for causes to help treat patients. But others are brushing the symptoms off as being all in their head and “hysterical” reactions to the stress of the pandemic. After going though tens of thousands of dollars of tests, some people are just going home with an inhaler and being told the symptoms will probably “go away” and to give it some time. How frustrating is that?!!!

In a recent meta-analysis, researchers identified nearly 2000 studies that addressed persistent post-COVID symptoms. The 45 studies appropriate for analysis reviewed about 10,000 patients and 84 discrete symptoms. Nearly 3/4 of the patients reported at least 1 symptom that persisted for an average of 2-4 months and some symptoms as long as 6-8 months. The most common symptoms were fatigue (40%), shortness of breath (36%), anosmia or loss of sense of smell (24%), anxiety (22%), persistent cough (17%), ageusia or loss of sense of taste (16%), and depression (15%). So the facts are there, but without much guidance on specific treatments. And yes…you can develop post-COVID symptoms even if you have been fully vaccinated and received a booster!

Integrative medicine is the best solution to recognizing and treating post-COVID syndrome as we are seeing a significant response in improving symptoms and shortening the course of the illness. Integrative medicine prides itself in treating and helping patients when conventional medical therapies have failed. The NIH (National institute of Health) has recognized that integrative medicine can support recovery from post-COVID disease. Restoring homeostasis plays a key role in integrative medicine even when diseases have no clear treatment.

There is clear evidence (and thousands of studies) for selected integrative medicine approaches that can be used to combat inflammation, repair lung injury or dysfunction, replete nutritional deficiencies, reset autoimmune exacerbated conditions, reduce chronic stress and mitigate fatigue. A comprehensive approach combining oriental medicine, functional medicine, homeopathy, intravenous nutrient therapy, nutritional medicine and herbal medicine are introduced in providing healing support and effective treatment in recovering from COVID-19 infection. Individualizing care is essential as each persons symptoms are unique in their own way as well as their course of recovery.

Theories as to how COVID-19 causes long haul symptoms include:

  1. Persistent intermittent viremia causing inflammation resulting in lung, heart, pancreas, and liver end organ damage. Symptoms come and go of having recurring fever, chills, myalgia, fatigue and brain fog.
  2. Severe inflammation occurring outside the brain (in the lungs and elsewhere) signals through the blood-brain barrier that activates the brains immune system. SARS-CoV-2 can directly modulate human gene expression and the patterns seen in COVID-19 patients are similar to patterns seen in patients with neurodegenerative diseases (dementias and schizophrenia). Synaptic signaling are impaired in the excitatory neurons that are important in cognition. This can generate symptoms such as poor cognition, mood disorders, hallucinations and delusions.
  3. Triggers autoimmune reactions to various organs- more likely those who already have autoimmunity or undiagnosed gluten intolerance. It can attack the central nervous system and can re-activate (wake up) latent viruses such as herpes virus or Epstein Bar virus, leading to extreme fatigue.
  4. Wide spread microvascular damage causes micro-clots or endothelial dysfunction. This leads to ischemia, oxidative stress, and inflammation in the brain through the olfactory nerve (nose) where the virus can burrow into nerves and hide genetic material. These reservoirs or “anatomical sanctuaries” become the source of neuro-inflammation.
  5. The body fails to completely clear the virus which continues to cause an immune reaction where the immune system attacks healthy tissue, increasing allergies, mast cell activation, muscle and joint pain and re-activates other viruses.
  6. Neuropathic mechanisms such as autonomic denervation can cause failure of the vasculature of the lower extremities to maintain resistance while in an upright position leading to blood pooling in the lower extremities and causing unstable blood pressure and tachycardia (high heart rate). This is known as POTS (Postural orthostatic tachycardia syndrome).  This condition is thought to have an autoimmune component.
  7. Nutrient depletion occurs, especially those nutrients necessary for mitochondrial function such as glutathione, alpha lipoid acid, CoQ10 and L-carnitine.
  8. Hormonal disruption can occur due to the stress of illness which leads to increased cortisol (stress hormone), adrenal and hormone imbalance. Symptoms can be lack of sleep, and difficulty coping and adapting to stress. Pre-existing conditions start to surface such as gluten intolerance, sleep apnea, pyroluria and nutritional deficiencies.

What we know is that post-COVID will be with us for some time. The sooner we address its significance and initiate treatment, the sooner we can get people back to feeling healthy, more resilient and back to work. Integrative medicine has given us the assurance that the body’s healing system is capable of restoring wellness. It may take longer for some depending on the severity of the illness but we need to trust in the wisdom of the body and its healing power. Colorado Covid Care has experienced clinicians that focus on outpatient treatment of people recovering from acute and long-Covid infections. 

Helpful resources are: Colorado Covid Care and Survivor Corp

 

Reference: Alschuler, L, Chiasson, M petal. Integrative medicine considerations for convalescence from mild-to-moderate COVID-19 disease. www.ncbi.nlm.nih.gov.

Yang AC et al. Dysregulation of brain and choroid plexus cell types in severe COVID-19. Nature 2021 July; 595:565.

Marshall, M. COVID and the brain: Researchers zero in on how damage occurs. Nature 2021 July; 595:484.

Cline, H, Einhardt, A. Postural orthostatic tachycardia syndrome: A conundrum for patients and healthcare providers. The Nurse Practitioner.  Jan 2022: 13-19

Nasserie T et al. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: A systematic review. JAMA Netw Open 2021 May 26; 4:e2111417

 

Top 10 Health Breakthroughs of 2021

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person injecting someone on his arm

It was difficult finding the Top 10 health breakthroughs of 2021 while being inundated with constant breaking news of the COVID-19 infection. Let’s face it….it has been another exhausting year for all of us. The COVID-19 pandemic is still raging and continues to be the biggest topic in health news (as it should be). We are faced with more uncertainty as Omicron has surfaced with it’s 30 mutations and conflicting data on its severity. Let’s see if we can side step this historical pandemic and look for other inspirational discoveries of 2021. Here are your top 10 health breakthroughs of 2021:

10. New Approach for Migraine Treatment: Researchers has discovered a new cause of migraines known as CGRP (calcitonin gene-related peptide), a chemical that nerves use to talk to each other and gets released during migraine. The CGRP blocker drug, Rimegepant has been a lifesaver for many with migraines that have found no relief with other modalities.

9. Treatment for Sickle Cell Disease: This deadly genetic condition causes red blood cells to change into a sickle shape. This can cause obstruction of blood vessels or cause them to burst apart leading to infections and severe organ damage, cutting life expectancy to age 54. New drugs, Oxbryta and Adakveo, have been FDA approved and prevents hemoglobin inside the red blood cells from sticking to each other and forming sickles. Studies have shown significant improvement in fewer episodes of severe anemia and longer life expectancy.

8. First Blood Test for Alzheimer’s Disease: Now there is a prescription blood test called PrecivityAD. It measures proteins linked to amyloid plaque buildup in the brain which is a hallmark of Alzheimer’s disease. This test went public without FDA approval which drew some controversy. But the studies have been impressive showing that the test was 94% as accurate at finding brain plaque as PET brain scans that use radioactive tracer dye.

7. COVID vaccines to the Rescue: The new mRNA technology is one of the biggest advances in medicine that we have ever come across (and at warp-speed!) Expectations of the Phase 3 clinical trials on the mRNA-based vaccine was 50-60% which was hopeful. Instead it was more than 90% effective in reducing the risk of developing severe COVID, hospitalization and death. As you may be concerned that theses vaccines are too “new”, let me remind you that they were already here from decades of study.

6. First Oral Antiviral to Treat COVID-19. Paxlovir is under FDA Emergency Use Authorization for treatment of moderate to severe COVID-19. It is actually 2 drugs taken together. Two tablets of 150 mg Nirmatrelvir and 100mg Ritonavir taken twice per day for 5 days. It is indicated for those with mild-moderate symptoms but are at high risk for progressive disease that could lead to hospitalization or death.

5. Advances in Gene Therapy: Researchers successfully treated a genetic liver disease by injecting the CRISPR gene-editing tool into a person’s body. This gene-editing tool works by using enzymes that cut away portions of DNA that are responsible for DNA mutations and returns them to their normal function. This could pave the way of healing a wide variety pf genetic conditions.

4. New Oral Anti-fungal for Vaginal infections: This is for the 1.4 million women that see their doctor each year in the U.S for vagina yeast infections. This is the first new anti-fungal in more than two decades representing a new class called triterpenoids. This new drug, Brexafemme works by blocking an enzyme that creates a protective coating around Candida Fungi. Without this coating, the fungi quickly die off. The 2-tablet treatment starts working within a few days and stays in the system for up to 2 weeks to help prevent recurrence.

3. First Vaccine for Malaria (and other parasitic infections): Malaria kills about half a million people a year worldwide. A new vaccine, Misquirix, is about 50% effective against severe Malaria. Even though 50% does not sound very effective (compared to the 95% effectiveness of COVID-19 vaccines), it may save those at high risk for severe infection such as the elderly, pregnant women and children who live in countries with high numbers of Malaria cases. You can take preventative medicine before, during and after a trip to  high-risk areas, but many parasites have developed resistance to common drugs used to treat the disease.

2. Treating a Torn ACL without Surgery: The ACL, or anterior cruciate ligament is one of the  most common injuries for athletes and non-athletes. Treatment involves surgery and reconstruction using a piece of bone and tendon from another part of the body or using a donor to rebuild the ligament. Now the Bridge-enhanced ACL Restoration Implant takes the place of that material. It is FDA approved and made of bovine collagen. It is secured in place between the two torn ligaments. The patient absorbs the device and grows new, healthy tissue in its place in a few months.

1. The First At-home Test for COVID-19: The Ellume at-home COVOD-19 test was the first test of it’s kind to get FDA authorization. This allows consumers to check their COVID-19 status without going to the doctor or to a PCR testing site. It is an easy test that swabs both nostrils and gives the result in 15 minutes. It identifies positive cases 95% of the time and negative cases 97% of the time. Since that first test, a new test called BinaxNOW by Abbott has also become a common and accurate COVID-19 antigen home test.

Happy New Year! Wishing you the best of 2022!  May it be a year full of good health, joy and some certainty.

 

References: Schindler, S, Goadsby, P. Love, T. The New Health Heroes: Life-altering new treatments for heart, mind and more. Medical Breakthroughs 2021. AARP, Oct/Nov 2021.

Temte, J. Coronovirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19. Practice Update. 12/23/2021.

Maldarelli, C., Sohn, R. The Top 10 health and medicine breakthroughs of 2021. Popular Science, Dec 1 2021.

Mastroianni, B. From Vaccines and Gene Editing to Malaria Treatment: The Important Medical Innovations of 2021. HealthLine. Dec 27, 2021.

Inflammatory Foods and Risk of Dementia

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person slicing green vegetable in front of round ceramic plates with assorted sliced vegetables during daytimeCan eating a specific food or following a particular diet help prevent or delay dementia caused by Alzheimer’s disease? Many studies suggest that the choices we make in what we eat affects the aging brain’s ability to think and remember. These findings have led to research on general eating patterns and whether they might make a difference.  Studies indicate that inflammatory foods can raise the risk of dementia.

A study looked at the diets of over 1000 people, mean age 71, for an average of 3 years. Dieticians categorized an inflammatory index score based on 3 levels of inflammation: low, intermediate and high inflammatory foods. It is no surprise that the high inflammatory diet category had three times the incidence of dementia than the low category group. Those in the low category diet ate more vegetables, fish and fiber. While those in the high inflammatory food group ate more red meat,  processed meat, alcohol and sugar. Other research has shown that artificial sweeteners, such as aspartame, are associated with risk for stroke and dementia as well. So how does certain foods change our physiology and raise the risk of certain health conditions?

As humans age, the immune system gradually deteriorates, creating a pro-inflammatory state.  This process actually starts even when we are younger but is noted more clearly as we age. This pro-inflammatory state increases the risk of chronic disease, has been associated with cognitive decline and implicated in the pathogenesis of dementia. This process is called immunosenescence. The inflammatory cytokines that promote inflammation reduce brain-derived neurotropic growth factor (BDNF) and create more oxidative stress, increasing the risks for cognitive impairment or dementia. Diet can modulate systemic inflammation.

Changes in the brain can occur years before the first symptoms of cognitive decline. These early brain changes suggest a possible window of opportunity to prevent or delay dementia symptoms. Risk factors for Alzheimer’s that we can’t change are age and genetics. Research has shown that people can control lifestyle choices such as diet, exercise and cognitive training which affects biological mechanisms, such as oxidative stress and inflammation, that underlie Alzheimer’s.

Some other things to consider: perhaps diet works indirectly by affecting other risk factors for Alzheimer’s disease such as obesity, diabetes and heart disease. Secondly, more and more research is focusing on the relationship between our microbiome (microbes or small organisms that live in the digestive tract) and age related conditions that lead to Alzheimer’s.

One diet that continues to to show promise and gets very little criticism is the Mediterranean Diet. This meal plan emphasizes fruits, vegetables, whole grains, legumes, fish and other seafood and healthy fats such as olive oils, nuts and seeds. It has very low amounts of red meat, eggs and sugars. A variation of this would also incorporate the DASH Diet (Dietary Approaches to Stop Hypertension) which can also help lower blood pressure, reduce cardiovascular disease and dementia. Check out the  Mind diet to help you get started.

References:

  1. Pase MP, Himali JJ, Beiser AS, et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study. Stroke. 2017;48(5):1139-1146. https://www.ahajournals.org/doi/10.1161/STROKEAHA.116.016027
  2. https://www.practiceupdate.com/content/artificially-sweetened-beverages-strokeand-dementia/52314/62
  3. https://n.neurology.org/content/early/2021/11/10/WNL.0000000000012973

Weight Gain at Mid-life: It’s Not Calories in, Calories Out

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grayscale photo of woman holding her breast

Weight gain in middle age is challenging and very common.

I see many women over the age of 40 that are frustrated with their weight. They are eating healthy and exercising, but the extra weight just won’t come off! Some women even decide to “clean up” their diet and hit the gym even harder but still…no change. Weight gain has been said to be nothing more than your body’s chemical reaction to foods. It’s not that you’re eating too many calories or not exercising enough. It comes down to 2 things: hormones and inflammation.

As women go through their middle years, their body composition changes in proportion to fat.

The proportion of fat to body weight tends to increase (more than men), and fat storage begins favoring the upper body over the hips and thighs. In other words, your waistline starts to grow in inches as visceral fat (the fat that wraps around your abdominal organs) pushing out against the abdominal wall.

What we have learned since the mid-1990’s, is that the fat cell is an endocrine organ, secreting hormones and other molecules that have far-reaching effects on other tissues. There are a host of chemicals that link visceral fat to a wide variety of diseases.

While subcutaneous fat produces a higher proportion of beneficial chemicals, visceral fat produces chemicals that are far more harmful. Visceral fat makes more of the proteins called cytokines, which triggers low lying inflammation and is a risk factor for heart disease and other chronic conditions. It also produces a precursor to angiotensin, a protein that causes high blood pressure.

We know that there is a hormonal mechanism that perpetuates middle age weight gain (obesity) through eating high glycemic foods. Foods that have a high glycemic index pack alot of sugar into a small package. High glycemic foods cause a fast rise in blood sugar resulting in insulin release. Highly processed refined carbohydrates are absorbed quickly, increasing insulin levels that can result in rebound hypoglycemia and insulin resistance. These mechanisms increase insulin sensitivity in adipose tissue but create insulin resistance in muscle and brain. Over time, fat accumulates viscerally while less is taken up in the muscle. Your body continues to make more and more insulin which leads to metabolic dysfunction, inflammation, weight gain, fatty liver and plaque development.

Other research by Mengeste and colleagues describes the characteristics of muscle between obese and lean people.

The obese muscle changes its composition to a muscle fiber (type 2) that is less able to utilize sugar for energy. This is because the number and function of mitochondria decline. These muscle fibers fatigue more easily than the dominant type 1 found in lean people. This is where exercise is so important but initially will not result in quick weight loss because the muscles are less able to absorb and burn energy.

What Does This Mean and What Can We Do?

All calories are not the same. Carbohydrates that are refined and have less fiber get absorbed very quickly and trigger hormones that allow the accumulation of fat. This changes muscle fibers and its function, making weight loss and exercise more challenging. So eating less and exercising more just doesn’t work…especially in middle age. High quality food is key.

So what can we do after age 40 (or even after age 35!)

  1. Eat more multicolored fiber-rich whole foods
  2. Eat more fiber and protein with a carbohydrate to slow absorption
  3. Drink a glass of water with 1 tsp of psyllium husks (or any soluble fiber) before meals to help reduce the glycemic index of a meal. Here is a patient handout on glycemic index/load.
  4. Do not use artificial sweeteners. They can actually exacerbate obesity
  5. Try to sustain good nutritional and exercise habits over time to increase type 1 muscle fibers. These muscle fibers have more mitochondria to help burn sugar and fat while increasing muscle endurance.

 

References

    1. Ludwig DS, Aronne LJ, Astrup A, et al. The carbohydrate-insulin model: a physiological perspective on the obesity pandemic. Am J Clin Nutr. 2021 Sep 13. doi: 10.1093/ajcn/nqab270. Online ahead of print. https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqab270/6369073
    2. Mengeste AM, Rustan AC, Lund J. Skeletal muscle energy metabolism in obesity. Obesity. 2021;29(10):1582-1595 https://onlinelibrary.wiley.com/doi/10.1002/oby.23227
    3.  Jovanovski E, Khayyat R, Zurbau A, et al. Should Viscous Fiber Supplements Be Considered in Diabetes Control? Results From a Systematic Review and Meta-analysis of Randomized Controlled Trials. Diabetes Care. 2019;42(5):755-766. https://care.diabetesjournals.org/content/42/5/755.long

Breast Cancer Prevention – Reducing Your Risk

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Breast Cancer Prevention

There have been plenty of new medications and treatments for breast cancer. That is astounding news. Today, a woman’s overall 5-year relative survival rate for breast cancer is 90%. This means 90 out of 100 women are alive 5 years after they’ve been diagnosed with breast cancer. The 10-year breast cancer relative survival rate is 84% (84 out of 100 women are alive after 10 years). These survival rates are based on many things, most importantly the time of diagnosis. We have heard that the earlier the diagnosis, the better the prognosis. Early detection involves screening tests, most commonly a mammogram. Technological advances in imaging have created new opportunities for improvements in both screening and early detection. The problem: Breast cancer prevention has not been talked about enough.

I want to discuss prevention. What are the potential modifiable risk factors that we have control over? One thing we need to understand is that the 2 main risk factors for breast cancer is age and gender.  Clearly things we have no control over. But what can we do to be pro-active in reducing our risk as much as possible?

Approximately 67-80% of breast cancers in women are estrogen receptor (ER) positive. Also, about 90% of breast cancers in men are ER positive. So perhaps we should start there. Excess estrogen exposure can come from endogenous (what we synthesize in the body) and exogenous (environmental exposure) sources. Improving estrogen metabolism can be of benefit in reducing the risk of breast cancer. I have often said, “its not how much estrogen you have, but where is it gong…how is it being broken down?”

This brings us to the liver where the metabolism of estrogen takes place. It is complex but very important in that these metabolites vary greatly in biological activity. There is testing that can give us answers to this question of metabolites. Estrogen metabolite tests are completed through a 24-hour urine test which can personalize what your body needs to beneficially modulate estrogen metabolism. Another test that can give us insight into risks is a comprehensive stool analysis. It can identify a certain enzyme that can be modified as well as make sure you are digesting adequate fiber and nutrients that are important in affecting gene expression in the biological effects of estrogen.

Here are 10 things you can do right now to reduce breast cancer risk:

  1. Get a screening test. Talk to your provider about a breast mammogram, ultrasound or possibly a thermogram (a risk assessment tool). As I tell women…it’s important to just do something!
  2. Manage your weight and reduce your insulin level if it is high. Both estrogen and insulin are growth factors. Growth factors stimulate tumor growth and increase inflammation. Fat tissue also secretes estrogen. There are supplements that can help.
  3. Consider time restricted eating. Studies show that fasting daily for 14 hours can reduce breast cancer risk by 40%. Fasting also decreases the incidence of Type 2 diabetes, non-alcoholic liver disease and esophageal reflux. Limit or avoid alcohol.
  4. Eat plenty of fiber, especially lignin (found in flaxseeds, bran, beans and seeds). It binds to free estrogen in circulation in the digestive tract which then gets excreted in the feces.
  5. Take the supplement Bioresponse DIM. A naturally occurring compound derived from cruciferous vegetables such as broccoli, brussel sprouts and cabbage that is protective to estrogen sensitive tissues.
  6. Consume isoflavones such as soy or kudzu. Soy has gotten a “bad rap” with it’s association with breast cancer. They are phytoestrogens (plant compounds) that have the capacity to bind to estrogen receptors and appear to have both estrogenic and anti-estrogenic properties. The average daily intake of Japanese women is 20-80 mg and are associated with low rates of hormone-dependent cancers. American women consume 1-3 mg daily.
  7. Exercise everyday to reduce excess fat deposition where the enzyme aromatase converts adrenal hormones, like testosterone, into more estrogen and allows it to be more freely available.
  8. Reduce Environmental Estrogen (Xenoestrogen) Load. This includes avoiding foods and products with pesticides, herbicides, and fungicides, as well as non-organic cosmetics and soaps (which contain petrochemicals). Do not use plastic containers, especially when heating food in a microwave. For more information, check out Xenoestrogens
  9. Minimize stress: I know that is hard to do with the current state of the world. But find ways of calming the mind, such as meditation, yoga, therapy, reading books that inspire you and STOP listening/watching the news!  Chronic stress raises Cortisol and depletes Progesterone leading to estrogen dominance and excess inflammation.
  10. Get good sleep.  At least 7 hours/night is needed to clear toxic residue, repair damage from the brain and reduce cancer risk.

There are many other natural compounds and hormone-modulating herbs that have a significant benefit in promoting healthy estrogen balance. The percentage of inherited genetic mutations that cause breast cancer is less than 25%, whereas 65% -75% of breast cancers are traced to modifiable lifestyle factors. Talk to your practitioner about individual testing to identify what your risks might be in preventing breast cancer.

Reference: Cancer.gov. national cancer institute. “Hormone Therapy for Breast Cancer.

Hall, D.  Applied Nutritional Science Reports. “Nutritional Influences on estrogen metabolism”. MET451, 2001.

Lam, M. Estrogen Dominance. Preventative and Ant-Aging Medicine. www.designsforhealth.com.

COVID-19 Vaccines Benefit People with Past Infections

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People that had SARS-CoV-2 infections may think that they have “natural immunity” and are protected from getting re-infected from this COVID-19 virus. But there are 2 new studies showing evidence that vaccination generates a more vigorous B and T cell (immune memory cells) response than does natural infection. It shows that vaccination is particularly stronger in people with previous SARS-CoV-2 infections.

Researchers evaluated people who were vaccinated with the mRNA vaccine after natural infection and people who were vaccinated but had no prior infection. Memory B cells against SARS CoV-2 were 5-10-fold higher when vaccination followed natural infection than after natural infection or vaccination alone. The most surprising result was that in people who were vaccinated after natural infections, neutralizing antibodies against the beta variant were higher. They were 25 times higher than after vaccines alone and 100 times higher than after natural infection alone. This was amazing since natural infections were almost never with the beta variant and that vaccines don’t target the beta variant spike protein.

Other studies as well have shown similar results. A study in the CDC (Centers for Disease Control and Prevention) Morbidity and Mortality Weekly report shows 2.3 times the number of reinfections with natural immunity compared to breakthrough infections in those who are vaccinated. It is unclear how effective natural infection is against other variants, particularly the Delta variant. This new variant, as well as the lambda variant, may weaken the protection provided by having been previously infected by SARS-CoV-2.

People who have had COVID-19 are advised to be vaccinated. It will very likely offer better protection against symptomatic reinfections, even with the Delta and future variants.

References: Diamond, F. Kavanagh, K. Get vaccinated even if you’ve gotten COVID-19, study suggests. Infection Control Today 2021, Aug 8.

Stamatatos, L et al. mRNA vaccination boosts cross-variant neutralizing antibodies elicited by SARS-CoV-2 infection. Science 2021 Mar 25; 372: 1413.