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Your Autoimmune Disease and COVID-19

It’s September!  I don’t know about you, but this is usually this time of year I am preparing to buckle back down to work after a summer spent outdoors, with some of it on vacation. If you are raising school age or college kids, and this is usually back-to-school time.  

But, as we are in the midst of an infectious disease pandemic, these are not usual times. In fact, as we are preparing to move into fall, you might be struggling through and muddling along, coping with coronavirus and hoping not to get COVID-19, the illness that is caused by this virus.

But some of us worry more than others about what would happen if we get this virus.  I am thinking about all of my autoimmune patients, who have been writing and asking me very specific questions about how their autoimmunity might change their risk, and what to do about the supplements they should take to prevent the virus from making them very sick were they to be exposed.  I decided to write this blog to answer these questions all in one place.  For all of my autoimmune patients, clients, friends and family, this is dedicated to you!

Does my Autoimmune condition put me at a higher risk for getting very sick if I get COVID-19?

The most important thing to understand is that there are over 100 different autoimmune conditions and they are all different.  Thus, it is hard to answer this with a quick answer.  But there are some guidelines that you can follow:

FIRST: There is no evidence that your Autoimmune disease itself puts you at a higher risk for getting very sick with COVID-19.  The underlying imbalance in Autoimmunity, where the immune system is mis-directed and attacks your own body, hasn’t been identified as a risk factor. 

However, in studying the underlying mechanisms of autoimmunity in people with systemic rheumatological diseases like Lupus (SLE), Sjogren’s Syndrome, Scleroderma, Polymyositis among others, researchers have found that while part of the immune system is overactive, the lymphocytes that fight viruses might be underactive.  

Therefore, if you have one of these conditions, you might be at a higher risk of getting COVID if you are exposed.  But there are supplements you can take to boost this part of your immune system, and I will share that below. 

SECOND: If you have an Autoimmune condition, is that you might have secondary issues like weight gain, high blood pressure, or disease-specific issues, like increased risk for making blood clots, and other possible problems that would influence your risk.  To determine if your specific Autoimmune issue could be putting you at risk, you need to check with your doctor.

THIRD: If you are taking immunosuppressant medications to treat your condition, you are definitely at increased risk for getting sick because these medications can reduce your ability to fight the virus, and you should follow the strictest social distancing and mask wearing guidelines.  

That being said, never stop your medication on your own.  But it’s good to set out a goal for being able to stop.  First, meet with your doctor and see if you have any other options.  Second, from my perspective, using a Functional Medicine approach and treating the underlying issues like repairing the gut microbiome and reducing toxic load, it is possible to taper off medication as you feel better and your condition improves.  

If I get COVID-19, will my Autoimmune Disease get worse?

There is no information that I have read about people with Autoimmunity and what happens to their illness when they have COVID-19.  But based on medical logic and experience, my guess is that your current health issues are likely to flare and get worse if you were to get sick.  This might be triggered by the virus itself, but more likely from the widespread immune and inflammatory reaction the body mounts against the virus. If your Autoimmune disease is very active and you still have symptoms and are still struggling, consider yourself at high risk and practice stricter social distancing and mask wearing.

Which immune-boosting supplements are good for me and which one’s should I avoid?

I have a great Blog on supplements for boosting immunity to fight coronavirus.  You can read it HERE.  For this discussion, I want to zero in on the concerns of my patients with Autoimmunity.

GOOD FOR EVERYONE: First, here are the categories of supplements that are all completely safe for all of you, and my previous blog reviews the dosing:

  1. Antioxidants:  Vitamins A, C, Glutathione, NAC, Quercetin, EGCG
  2. Antiviral and Immunomodulators:  Zinc, Vitamin D
  3. Anti-inflammatory:  Fish oil, Curcumin.

See dosing  HERE.

IF YOU HAVE AN AUTOIMMUNE CONDITION: You need to choose supplements carefully.  The concern is that these are immune boosting, which means they stimulate an increase in your natural killer cells.  On one hand, this is a great thing for fighting viruses.  However, for some people with autoimmunity, this could conceivably make your condition worse, although this is a theoretical concern because there haven’t been any studies on this.  Therefore, I recommend you check with your health practitioner before taking these.

Immune Boosting Supplements:  take with caution

  1. Mushrooms:  maitake, reishi, shitake, beta glucan
  2. Astragalus and echinacea
  3. Elderberry and Andrographis

If you’d like to learn more about how to use supplements to protect yourself from viruses, like COVID-19, consider joining my new LIVE course, Immune System Strong, led personally by me! Learn More 

What can I do to reduce my risk of getting very sick with COVID-19?  

Let’s end this blog on a high note!  There is plenty you can do to improve your immune function and reduce your risk of getting sick with COVID.  These same steps will also help repair your immune system and reverse your Autoimmune condition.  My main focus as a Functional Medicine physician is on the foundations of a healthy immune system:  food, stress, gut health, toxin load, oxidative stress and inflammation. 

The popularity of these questions is exactly why I designed a new just-in-time, 8-week program called Immune System Strong to teach you in real time with verified, no-nonsense information on how to fortify your immune system to fight viruses, like COVID-19, as we move into winter flu season!  We begin soon! Learn More

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The #1 Thing You Can Do For Your Immune System Starting Today

So, let’s be real … with COVID still sweeping through communities, you might be wondering what you can do to protect yourself as we move into the flu and cold season. Yes, very soon, we will be moving indoors with closed windows and that begs the question, “How will I keep myself safe?”

With over 70% of your immune system living in your digestive tract (yes, that’s true!), it makes sense that the food you eat is the first stop in empowering your immune system to fight infections and keep you healthy. 

There are foods that are particularly good at boosting immunity, but the reality is the first order of business is to use “food as medicine” to reduce inflammation. Often when I talk with people about “reducing inflammation” their eyes glass over. It’s not easy to grasp.

Inflammation. When it’s on the outside, like arthritis, we can see it.  When it’s on the inside we can’t see it. And often we can’t even feel it. (Although I’ve heard so many times, “I didn’t realize I wasn’t supposed to feel that way.”) But if you get sick often, if you’ve taken lots of antibiotics in your life, if you’ve had stress or trauma, or if you eat inflammatory foods (like sugar) or the Modern American Diet, you’ve likely experienced inflammation. In fact, you’re likely inflamed right now.

Inflammation is when your immune system or other cells in your body release irritating chemicals that cause irritation on the inside.  Remember this is a normal process because this is how your body fights infections or an injury, and the inflammation resolves once the infection or injury is over.  

However, if high levels of these inflammatory chemicals are released continuously (which can happen if you are eating a lot of SUGAR), the normal functioning of your cells can be interrupted, and healthy tissue gets damaged, including your immune system. This is not so good-especially since more and more studies link inflammation in the body to many serious illnesses and conditions.

To make sure your immune system is in tip top shape, which will protect you from foreign invaders like COVID-19, influenza and the common cold, it’s important to avoid processed foods and eat an anti-inflammatory, antioxidant-rich diet, full of vegetables, fruits, cultured foods, healthy fats, planted-based proteins and minimal animal protein.  

If there’s only one diet change you choose to make it’s this: 

GET RID OF SUGAR TO REDUCE INFLAMMATION!

Sugar is inflammatory and suppresses your immune system. Sugar stimulates your immune cells to actively release inflammatory molecules that travel throughout your body causing damage and irritation. 

Avoid high glycemic foods like soda, white flour and processed sugar. When it comes to sugar, you always want to choose low-glycemic vs. high-glycemic foods. The glycemic index determines how quickly a particular food raises your blood sugar level. High blood sugar causes inflammation and damages your immune system, and puts you at risk for diabetes, high blood pressure, and cardiovascular disease. Any food processed with white sugar or white flour is high-glycemic and should be eliminated. That means bagels, breads, breakfast cereals, cakes, cookies, crackers, candy, and soda.

Avoid an over-focus on carbohydrates as the main source of calories for the day. Make your plate for lunch and dinner half vegetables — that’s a great start. Natural, unprocessed foods, like fruits, vegetables, legumes and whole grains provide health-promoting vitamins, minerals, fiber, and phytochemicals — all good for your immune system. Use rice and other grains like condiments.

Read the labels of everything that comes in a package. Food manufacturers are sneaky. They often add sugar (and a lot of sugar) to foods that need very little sugar. Yeah, I know our panels are in grams. Definitely annoying, but here’s what you need to know: We recommend keeping your added sugars at about 24 grams. And, 4 grams of sugar = 1 teaspoon. So, if that granola bar you love has 24 grams of sugar — that’s six teaspoons (and your allotment for the day).

Here are some substitution suggestions for common high glycemic foods: 

Do you like soda, fruit juice, sweetened drinks? Drink filtered water, herbal teas, mineral water, fruit-infused water.

Do you consume products with corn syrup, cane sugar, or any other added sugar (check your condiments!)? Try paleo ketchup, mustard, fancy vinegars, and herbs and spices, such as basil, cinnamon, cumin, dill, garlic, ginger, rosemary, tarragon, thyme, turmeric.

Do you eat dried fruit, frozen yogurt, ice cream, sorbet, cookies, candy or other sweets? Try coconut milk yogurt with your own fruit, dark chocolate covered almonds and carob.

Do you typically eat pretzels, potato chips, corn chips, cookies and crackers made from white flour, muffins, waffles, pancakes, popcorn or bagels? Switch to gluten-free whole grain cookies, gluten-free almond meal crackers with hummus or guacamole, nuts, seeds, fresh fruit. 

P.S. If you’re as concerned as I am about shoring up your immune system to protect yourself from infections like COVID-19, influenza and the common cold as we begin to move indoors, consider joining Dr. Blum and I for our new course — Immune System Strong. Four LIVE classes with Dr. Blum, 8 coaching calls with me, you’ll learn exactly what you need to do to fortify your immune system. We begin soon!

Meet Melissa: Melissa Rapoport is the Manager of Health Coaching and Lifestyle Programming at Blum Center for Health in Rye Brook, NY. She combines her graduate work in Developmental Psychology with her education in nutrition, health and coaching to create highly individualized programs that result in lifetime change. A contributing author to three international bestselling books, Melissa’s greatest joy is her relationship with her two daughters. To learn more about Melissa’s coaching practice at Blum Center for Health, click here.

 

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The Never Ending COVID-19 Summer and What to Expect This Fall

It’s been a while since I wrote or spoke on the Public Health issues with COVID-19 swirling around us.  When the pandemic started I held open live office hours every Friday for about 8 weeks to answer your questions, and to share my Public Health expertise to make sense out of what we were going through collectively. 

As our long summer days at home (and hopefully outside, too) come to an end, I feel the need once again to provide information and to offer my view of where we are and what to expect as we are now moving into the fall.

THE GREAT MASK DEBATE

Public health is the understanding that decisions need to be made by the government to protect the health of the public — with the known understanding, and acceptance, that these laws or rules can infringe on someone’s personal liberties. The idea is that individual people need to sacrifice some personal liberties for the sake of the community.  

Public health has always been the place where there has historically been tension between individual rights and the collective.  And nowhere has this been on grand display but in the United States for the past few months and the great debate over whether it’s ok to make people wear masks. 

While in many places in our Country you are seeing a shift toward individual sacrifice for the greater good, not everyone feels this way. I am not saying this to make a political statement, but to point out this has always been understood as a classic public health dilemma, and we are seeing it play out right before our eyes.  

Evidence continues to mount every day proving that wearing a mask slows the virus spread, and my hope is that this battle will finally end.  We seem to be moving in the right direction.  But the battle lines have already been drawn, and I expect other public health initiatives (like vaccines) to be met with resistance in many parts of the country.  Our country’s internal war has added to the stress and burden that we all carry during the pandemic.

WHEN WILL COVID-19 END?

I am not terribly optimistic. Get used to your current living situation, or make plans for the winter now, because I predict we will be living like this until Spring 2021.  Here are the various ways we will get out of the pandemic, with my rating of the likelihood of each one:

COVID-19 VACCINE

We still don’t know how long immunity lasts, which means that even if we get a vaccine, we don’t know how long it will protect you. Any early vaccines will be fought over between all the countries of the world, and in our country, it will be doled out, based on who-knows-what formula. Which means that I wouldn’t expect the general public to have anything until next spring. Which suits me just fine, because I wouldn’t recommend being the first guinea pigs to get the vaccine for the first few months anyway!  

Bottom line: Don’t count on the vaccine to save you this winter.  Hopefully there will be available vaccines that work by the spring. And…be prepared for the possibility that no vaccines will work.

BETTER COVID-19 TREATMENT 

Some promising drugs are out there, but there hasn’t been a centralized effort to get enough doses produced to distribute to everyone. Remdesivir is a good example of a drug that has been shown to work in hospitalized people to reduce virus load and decrease hospital stay.  It has been distributed to only some hospitals, and even those hospitals are now running out. Everyone is fighting for a share of the limited supply.  Without a national response, treatment is hodge-podge depending on what hospital you go to, and which state you are in.  And there is the issue of affordability now that the drug company is charging full cost going forward. This in my opinion has been a disaster.  I think we won’t get this organized until there is national leadership on this issue.  

There are some interesting new treatments in the pipeline, but I don’t expect we will see them before the winter if they even prove effective.

Here’s one:

https://www.scientificamerican.com/article/costa-rica-readies-horse-antibodies-for-trials-as-an-inexpensive-covid-19-therapy/

And this one I think is really interesting:

https://www.ucsf.edu/news/2020/08/418241/aeronabs-promise-powerful-inhalable-protection-against-covid-19

Bottom line: Don’t count on life going back to normal again this winter based on the treatments that we have so far.

HERD IMMUNITY 

Think of herd immunity as something that happens when the virus runs its course through a population.  It keeps going until it infects enough people and then fizzles out because there aren’t enough uninfected people to keep it burning.  Public health dogma has always been that at least 50% of people need to be infected for this to happen, and we are far away from this number.  Unless there is a drastic change in our approach or some big medical breakthrough (which would be GREAT), this virus will continue like a forest fire that will keep burning until it’s done.  If this is the scenario, then we will all be home perhaps longer than next spring.  

HOWEVER, cases have started leveling off in our country (probably due to more widespread mask wearing and social distancing) and some areas are doing well, like here in NY.  I am wondering if the virus might also be slowing down in some areas (like NY) because there is more immunity in the community then we think, and/or that herd immunity is being reached sooner than we expected in areas that saw the worst outbreaks. These are intriguing ideas and I am hoping these are true!  

Bottom line:  Even if there are pockets of immunity to the virus, most areas are still very susceptible and this fire will continue to burn well through the winter.

BEST CASE COVID-19 SCENARIOS

OK, now that I’ve been a real downer, I will end this blog by sharing what I hope will happen.  This is the information you should be looking for in the news to give you some optimism.  

Here is what to pray for every day:

  1. Antibodies to the Coronavirus last at least 1 year after infection or vaccine, and protects you from reinfection.  This is a requirement for almost everything else to work!  
  2. A mutation in the virus makes it less deadly (this is the one that I pray for the hardest because it doesn’t rely on humans to figure out the solution).  I think there is a fairly good chance this might happen.
  3. Herd immunity happens much sooner than anyone thinks.  Some new mathematical models suggest for this virus, it could be 20-30% of the population instead of 50-60%.  This would mean the forest fire would still rage unchecked for months, but self-extinguish sooner.  There are signs this might be happening!
  4. The people in our country unify around best public health practices to slow the spread and save lives. I pray that our internal war on Public Health will end.

WHAT YOU CAN DO TO BOOST YOUR IMMUNE SYSTEM

It is frustrating to have such little control over the world around us. But you can feel more empowered if you take control over your own health. Making sure your immune system is primed and ready to go, just in case it encounters the coronavirus, should be your number one job during the pandemic.  

I have written before in previous blogs about supplements, but my main focus as a Functional Medicine physician is on the foundations of a healthy immune system:  food, stress, gut health, toxin load, oxidative stress and inflammation.   If you haven’t read my book on this topic, The Immune System Recovery Plan, what are you waiting for?!  

I have a lot more great info coming out in the next weeks and months on this topic.  To start, check out my FREE 3-part video series!  How To Boost Your Immunity and Resiliency to Viruses: DOWNLOAD FREE NOW

Keep your eyes peeled for my new LIVE course: Immune System Strong!  Slated to start late September (it will be here before you know it!) Immune System Strong will feature 4 LIVE classes with me that feature tangible next steps that you will be able to implement immediately, as well as community, accountability, group coaching and access to the answers you need on a daily basis.

Details will be available soon! Get On The First-To-Know List (even if you’re only a little bit interested), because we’ll be rewarding with an offer that won’t be available to anyone else.) I want the special reward!

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Can Vaccine Repurposing Help During Covid-19?

With the imminent arrival of fall there are many unanswered questions about how we will be functioning in the world with COVID-19. Will schools be open? Will we have to go on lockdown again? What happens when the cold and flu season hits and we are also dealing with a variety of other common seasonal viruses? 

As I have been advising patients through this entire process, my approach has evolved: information we knew early on has drastically changed; whereas once the use of mask wearing was in question, there is now no doubt that it is essential in significantly decreasing infection from COVID-19. This has led to a lot of confusion as people try to make sense of the latest data and is complicated by some offering up doubts and conspiracy theories. This makes for a good book, but one story I would rather us not be living in.

What is quite clear to me is that we will not have a vaccine in time for the fall flu season. 

So what more can we possibly do?  

I think a reasonable possibility at this time might be the exploration of repurposing existing older vaccines. Last year, my area in Rockland county New York had a major outbreak of measles. A disease that we had not witnessed in many decades began to re-surface. 

Prior to this many susceptible populations, like newborns and infants, were protected by what is known as herd immunity. Herd immunity works only if a significant portion of the population has immunity against the disease. 

As a result, my son’s school was shut down for a period of weeks until the unvaccinated were vaccinated, and the number of cases began to significantly decline; an interesting precursor to times ahead. But now we know on a magnified scale of that event and dealing with a virus we have just started to understand.

The question now becomes: can we support our immune response in an unprecedented time like this?

I recall reading some research as early as May of this year where expert virologists had suggested that giving the Polio vaccine, one that most of us have received, may stimulate the body’s innate immune system in such a way that it could provide protection from a more severe manifestation of COVID-19*.  

Mind you, this is the live oral polio vaccine which is no longer offered in the United States but still available in other countries. We now have an injectable inactivated form of the vaccine. There is a push to do more research in this area and hopefully be able to bring this therapy available to the U.S. again. Dr. Robert Gallo, the director of the Institute of Human Virology at the University of Maryland School of Medicine and co-founder of the Global Virus Network, a coalition of virologists from more than 30 countries, is leading the push for this cheap and easily accessible preventative strategy. 

How does that information help Americans since we can’t access that easily?  Recently, another report hypothesized, with supportive rationale, similar effects from the Measles Mumps Rubella (MMR) vaccine –the same one you need to get immunity against measles. The report discussed the potential protection in dampening the severe effects associated with COVID-19 infection. And, many of us have had waning immunity to vaccines we got a lifetime ago.  

Referencing the measles outbreak last year, many people in the New York area began to look at their measles titers to see if they had immunity.  Interestingly, many found that they no longer had adequate protection against measles and sought to revaccinate again. So, a thought occurred to me: maybe this is a great time to do testing for MMR titers. If there is an indication that there is a blunted immune response, then revaccinate. It’s possible that by doing so, you may offer some level of protection against COVID-19. If you are living outside of the U.S. where the oral polio vaccine is offered, that may be yet another option you have.

As a natural “prepper” (I like planning in general and preparedness for unexpected life events like hurricanes and superstorms have led me to think more catastrophic possibilities these days), I urge you to get your MMR titers tested, and consider this possibility of re-vaccination as another layer of protection as we all prep for the coming months.

 

 

Pamela Yee, MD is an Integrative Physician at Blum Center for Health in Rye Brook, NY where she creates highly personalized treatment plans for each of her patients. Dr. Yee has a special interest in integrative cancer care, immune disorders, and lyme disease. She lives in Nyack NY where she and her husband manage their own organic micro-farm.

 

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How Your Gut Affects Your Immune System

Did you know that your biggest exposure to the outside world every day is through your mouth?  That’s why 70% of your immune system lives in your gut, lying in wait to protect you from anything that seems foreign to the body (called antigens because they stimulate the immune system), which believe it or not includes food and the toxins and microbes that ride along with the food that you ingest while eating.

Your gut, which starts in your mouth, travels through your stomach, small intestine, colon or large intestine, and ends in your rectum, is supposed to be a closed tube – with the intestinal lining creating a barrier that separates the inside of your body and immune system from these outside exposures.  When you digest your food, the intestinal lining can then selectively choose what can enter your body by opening and closing special gates called tight junctions.

In functional medicine, an intestinal barrier with damaged tight junctions that isn’t keeping antigens out of the body is known as a leaky gut.  Studies have increasingly found that a leaky gut can damage the functioning of your immune system and is also associated with arthritis, autoimmune disease, allergies, and food sensitivities.

Causes of leaky gut vary, but the most important is dysbiosis, which is an imbalance in the bacteria in the gut, also called the gut microbiome.  Dysbiosis can be an overgrowth of harmful bacteria, yeast or parasites, or not enough good bacteria, and is commonly caused by a poor diet, a course of antibiotics, frequent use of antacids, stress, and many other things like medication and toxins. These gut bacteria are important because they interact with your immune system to keep it healthy, and they turn the food we eat into healthy compounds called short chain fatty acids which heal the tight junctions between your cells and also support immune health. 

The good news is that you can rebuild your microbiome and repair your gut, and this is the best thing you can do to maintain and improve the health of your immune system. Here is how to do this:

  1. CHANGE YOUR FOOD:  has the most influence on the diversity of the microbiome, and that’s why you should always start with changing your diet by increasing fruits and veggies, especially those rich in polyphenols, bioflavonoids, and fiber because these tend to increase the good bacteria that make short-chain fatty acids and heal the gut. Also, you need to remove foods from your diet that feed the bad bacteria like sugar, processed flour products, alcohol, and too many animal products (more than 30% of your daily diet).  You also need to test yourself for food sensitivities and remove sensitive foods such as gluten, dairy, soy, corn, eggs and the nightshade vegetables. Our elimination diet explainer shows how to do this. 
  2. TREAT YOUR DYSBIOSIS:  At Blum Center for Health we start with cleansing herbs like berberine, grape seed extract, black walnut, and oregano that can clear out bad bacteria and yeast from the gut ecosystem. In fact, we created our own custom herbal antibiotic mix called Gut Cleanse, and we use this in our do-it-yourself 10 or 30-Day Gut Cleanse Program.  Once you have eliminated the bad bacteria and yeast, probiotics and the right food can help you rebuild the good stuff, repair the gut lining, reduce inflammation, and eliminate food sensitivities. 
  3. TAKE A PROBIOTIC:  These are supplements filled with different strains of beneficial bacteria that help positively influence your gut ecosystem and improve the functioning of your immune system.  We recommend probiotics as a foundation for supporting immune health.  

These simple steps will not only improve your gut function, but will also lay down a foundation for immune health that will continue to improve in the future.

 

 

Check out my FREE 3-part video series! Last month I led live classes on the immune system and I’m happy to share with you the three videos:  How To Boost Your Immunity and Resiliency to Viruses: DOWNLOAD FREE NOW

Susan Blum, MD, MPH an Assistant Clinical Professor in the Department of Preventive Medicine at the Icahn School of Medicine at Mount Sinai, has been treating, healing and preventing chronic diseases for nearly two decades. A Preventive Medicine and Chronic Disease Specialist, Dr. Blum is the Founder and Director of Blum Center for Health in Rye Brook, New York, where she leads a multi-specialty team of physicians, nurse practitioners, nutritionists and health coaches, all providing cutting edge Functional and Integrative Medicine services.

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HOW TO HANDLE CANCER DURING THE PANDEMIC

Do you have a health condition, like cancer, that you’d normally seek medical care for but you haven’t during the coronavirus pandemic?  Is this because you think you’re safer at home and going out would risk infection, or your usual physician is not available to see patients?  You aren’t alone.  

One of the most disconcerting things to me as a physician during this pandemic is that the other medical conditions people have been suffering with have mysteriously disappeared.  It makes sense that emergency rooms have noted a dip in occurrences like car fatalities and injuries since many of us are not out and about driving. However, what about heart attacks and strokes?  These are time-sensitive events that if treated early, make a significant difference in someone’s survival.  Many people are afraid to call an ambulance or go to the ER with concerning symptoms like chest pain or sudden weakness in parts of the body because they fear they will get infected with Sars-CoV2.  And unfortunately this is leaving many people to die at home or they are left with permanent disabilities because they received medical attention too late.  These are not conditions where the wait-and-see approach works.

SCREENINGS FOR CANCER DURING THE PANDEMIC

Have you been due for your regular screening colonoscopy or mammogram and have delayed calling to make that appointment because it isn’t an emergency or you decided it can wait until we have some clarity about returning to normal life? Again, you are not alone.

In a typical year, roughly 150,000 cases of cancer are detected monthly in the US population.  As a physician specializing in Integrative Oncology, I am very concerned that people with signs of cancer – a new mass or lump – are not being assessed quickly enough and that these new cases are being missed in the earliest stages when treatment is most effective.  Many people have been choosing to wait until it is “safe” to make the phone call for an appointment.  Every doctor and health system is doing their best to create a safe environment for patients, and while we don’t have all the answers, it is now time to reach out to your provider through telemedicine and share your concerns so that you can create a plan of action together.

CANCER AND COVID

As someone with cancer during the coronavirus pandemic,  are you concerned about what you can do beyond secluding yourself at home? 

During the past 3 months, I have been hearing from many of my cancer patients with concerns about what else they can do. Whether they have a past history of cancer, or are actively in treatment, these patients are looking to have an action plan in place that will help when they are going to reintegrate into the world.  

During this exceptional time, it has also been more difficult for my cancer patients to find some semblance of security in their treatment or monitoring.  Many have felt that their diagnosis has taken a backseat to the pandemic at large.  One of my patients called for a telemedicine followup with her oncologist to find that he was recruited by his hospital to work in the ER managing COVID-19 patients.  Another patient was told to forgo treatment for one month due to a high risk of exposure; her tumor markers became elevated the following month.  Others have found that when they questioned their current regimen, they were told to stay the course until things resumed to a more normal format.  And just like everyone else, those with cancer are very reluctant to go to an ER (whether for a cancer related issue or anything else like heart attack or stroke symptoms), because they are known to be a high-risk category because of a weakened immune system. 

INTEGRATIVE ONCOLOGY

I have been practicing integrative oncology for well over 15 years, helping people to navigate through conventional treatments by offering ways to naturally mitigate symptoms from chemotherapy, radiation and surgery as well as exploring other areas of evidence based treatments that lie outside of the box of their oncologist.  Often, people seek me out to support their treatment nutritionally or to “boost immunity” during treatment, and this is a good place to start.  But then most people discover there is a plethora of other adjunctive possibilities outside of what their oncology team has offered.  Cancer is a diagnosis that I hope that one would consider all angles and possibilities and various opinions to help construct the most solid plan to move forward and try to conquer the disease.

One of the areas that I focus on is supporting immunity and treating immune issues with these patients.  It is interesting to me that many of the natural herbal and nutraceutical treatments that I have used in cancer for various reasons, have activity in some format against Sars-CoV2. For example, I’ve  utilized Chinese Skullcap (also known as scutellaria baicalensis) in both breast and ovarian cancers (as well as other cancers such as colorectal and prostate cancer) because of its anti-proliferative activity against tumor cells but interestingly it has a place in combating Sars-CoV2 by enhancing not only immune function but also possessing anti-inflammatory activity for a variety of cytokines and can potentially block the virus from attaching to ACE-2 receptors that are unique to this virus.  A good review can be found HERE.

The field of integrative oncology is immense and I have always gravitated to working with cancer patients for a number of reasons.  It presents an incredibly difficult time that often necessitates a change in mindset, which allows me to show people that this challenge is an opportunity not only to make positive and sometimes radical change in one’s life. It’s also a time to take control and not always assume that there is nothing out there beyond what the oncologist or surgeon is offering.  And with over 100 peer reviewed publications that come out daily, the field is constantly evolving and my work is never “protocol.”  These are just a few reasons why I find working with cancer patients extremely rewarding. The current pandemic adds yet another layer to work through with patients and I accept the challenges ahead.

 

Pamela Yee, MD is an Integrative Physician at Blum Center for Health in Rye Brook, NY where she creates highly personalized treatment plans for each of her patients. Dr. Yee has a special interest in integrative cancer care, immune disorders, and lyme disease. She lives in Nyack NY where she and her husband manage their own organic micro-farm.

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An Update on Supplement Usage During the Coronavirus Pandemic

An Update on Supplement Usage During the Coronavirus Pandemic

As of 5.8.20

By the team at Blum Center for Health:  Susan S. Blum, MD, MPH; Pamela Yee, MD; Elizabeth Greig MSN, FNP 

As the days turn into weeks, we are learning more and more about how this virus behaves, and what we might do to support our immune system to better protect ourselves.  From a Functional/Integrative medicine perspective, thus far we have been focusing on nutrients and herbs that have been well studied, in general, for their ability to support, modify or boost the immune system.  I have been talking and writing extensively on helping people to choose the right supplements.

Today, I have updated this blog to reflect new information that I want to share with you.  

Summary of what we’ve already discussed so far:

ACE receptors:  We have learned that this virus uses the ACE receptor on cells to gain entry.  This led to alarm bells in the Integrative Medicine community because we have read that one of the many actions of Vitamins D could be to increase the number of ACE receptors on the cells.  HOWEVER, now, after reading the most recent studies on this topic, it appears that what’s more important is the level of Angiotensin Converting Enzyme 2 (ACE 2) in the blood, and NOT the amount of receptors.  And since Vitamin D might help reduce the levels of ACE 2 (a good thing), it appears that the concern about ACE receptors is a thing of the past and we can safely take Vitamin D.

Cytokine storm:  When the virus gets going in your body, it can sometimes create something called a cytokine storm, which is when your immune system reacts vigorously and releases an enormous amount of chemicals (cytokines) and free radicals to destroy the virus. Specifically, it is caused by activation of NFKB and an overacting NLRP3 Inflammasone, the system that makes these cytokines.  

There is concern that in some people, among other things, the cytokine storm contributes to the lung damage that we hear about.  We have been reading about the possibility that some immune boosting vitamins might make the cytokine storm worse by increasing the NLRP3 inflammasone system.  Many of you have been contacting us, asking for guidance on this.

Here is new information, as of May 8, 2020.  

We are changing our recommendations based on the release of a comprehensive review by the Institute for Functional Medicine, of the following supplements.

We must state that there are no studies that prove that any of the below supplements contribute to a cytokine storm, and there is now a widespread understanding that these supplements are all safe to take, and will not have a negative effect on cytokine storm, if it happens.  

**Please note that these recommendations are NOT medical advice.  Most are not safe for pregnant women, and if you are taking medication or have any serious health condition, please check with your doctor.

IMMUNE BOOSTING SUPPLEMENTS

Vitamin D:  5000 IU daily in absence of serum levels from a blood test.  

Vitamin A:  up to 10,000 – 25,000 IU/day  

Vitamin C:  1-3 grams daily

Elderberry:  500 mg daily (of USP standard of 17% anthocyanosides)

Beta Glucans:  250 – 500 mg daily

Mushrooms:  Shiitake, Lion’s mane, Maitake, Reishi.  Dose depends on preparation

N-Acetylcysteine (NAC):  600 – 900 mg twice/day

ANTIVIRAL SUPPLEMENTS

Zinc:  30 – 60 mg daily in divided doses

Licorice root:  200-400 mg/day in divided doses, standardized to glycyrrhizin.  Short term use <4 weeks.

Also Vitamin C

REDUCE CYTOKINE STORM (NLRP3 Inflammasone)

Resveratrol:  100 – 150 mg daily

Melatonin:  5-20 mg daily

PEA:  Palmitoylethanolamide:  300 mg twice/day for prevention.  600 mg 3 x daily for 2 weeks to treat infection.

ANTIVIRAL PLUS REDUCE CYTOKINE STORM

Curcumin:  500 – 100 mg twice/day.  Choose absorption enhanced.  

EGCG:  4 cups daily or 225 mg daily

Chinese Skullcap:  750-1500 mg/day.   Standardized to flavonoids baicalin or baicalein.

Quercitin:  1 gram twice/day.  Phytosome:  500 mg twice/day

PUTTING THIS TOGETHER

  • Supplements: 
    • We suggest choosing supplements from each category so that you have the broadest support possible.  
    • You don’t need to take ALL of the recommended vitamins and herbs.  
    • As a core program, make sure to take Vitamin D, C, and Zinc.
    • Next, the most common that we recommend are Vitamin A, Curcumin and Mushrooms (or Beta Glucan).
    • After that you can choose additional supplements from the list above as desired or needed.
    • You can find our COVID Immune recommendations for purchase on Fullscript.  Click here to sign up and order from that dispensary.
  • Remember, if you develop a fever, consider not taking any fever suppressing medication because fever helps kill the virus.  However, it is dangerous to let your fever go over 103, and so if you need it, consider taking Tylenol (Acetominophen) instead of ibuprofen (Advil).  It appears that ibuprofen may make things worse.  This is another area that is rapidly evolving, and if you can’t find Tylenol in the stores, you should speak to your doctor about other options.
  • Here are the things you should STILL DO for risk reduction: 
    • Good gut health: which means lots of beneficial bacteria. Take a probiotic every day with at least 20 billion cfu of mixed strains lactobacillus and bifidus species. 
    • Balanced stress hormones: Get a good night’s sleep and don’t overwork yourself during flu season. Stress harms your ability to fight viruses.  Practice some form of mediation daily.  Melissa, Blum Center’s Health Coach,  wrote a great blog with tips for managing stress during this time. 
    • Eat foods that are good for your immune system: Avoid processed foods and focus on fruits and veggies that are rich in antioxidants and vitamins. Support the removal of toxins by eating lots of cruciferous veggies, which boost the detox system in your liver.

Sending prayers and good wishes for you and all of us to stay safe and well during this challenging time. 

 

Check out my FREE 3-part video series! Last month I led live classes on the immune system and I’m happy to share with you the three videos:  How To Boost Your Immunity and Resiliency to Viruses: DOWNLOAD FREE NOW

 

 

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COVID-19 Nutrition 101: Let Food Be Your Medicine! 

A walk through the grocery aisles early this morning was a little shocking: The produce section was overflowing and the packaged processed food aisles were … empty.

The Number One thing you can do to support your immune system is: Eat Real Food

Your immune system is fueled by the food you eat. After all, over 75% of your immune system lives in your digestive tract. This means that every bite of food you eat influences your gut microbiome, which in turn determines your body’s ability to mount the appropriate immune response to invaders like COVID-19. 

Stroll on by the cookies, the sweets, the empty-calorie crackers, the high sodium frozen dinners and opt for packaged foods with minimal ingredients. Take a peek at the ingredient list and use this litmus test, “Am I willing to eat each ingredient with a spoon?”

Here are 6 no-nonsense things you can do right now to help boost your immune system and keep your body healthy.

Choose whole, nutrient-dense foods. 

Eat the rainbow! Focus on fruits and vegetables of all colors — They  are filled with antioxidants that support your immune system, and fiber that feeds your healthy gut bacteria. Choosing foods that mirror the colors of a rainbow ensures that you eat a large variety of vitamins, minerals, antioxidants, and phytochemicals that have enormous protective and healing powers.  

These rainbow foods are particularly good right now: 

Green produce helps boost the immune system and detoxify the body.

All healthy diets require green-colored produce and that is particularly true now. In fact, research suggests that green vegetables are the source of a chemical signal that is important to a fully functioning immune system. They do this by ensuring that immune cells in the gut and the skin known as intra-epithelial lymphocytes (IELs) function properly. (1)  Include green vegetables, such as arugula, asparagus, broccoli, Brussels sprouts, collard greens, green beans, kale, peas, romaine lettuce, spinach, swiss chard, and zucchini. Enjoy fruit, such as avocado, green grapes, and kiwi. 

Orange and yellow-colored produce help improve immune function.

Chock full of beta-carotene, a powerful antioxidant, vitamin A and vitamin C, these include vegetables, such as carrots, sweet potatoes, all varieties of winter squash, yellow summer squash, orange and yellow peppers and golden beets. It also includes fruits, such as oranges, grapefruit, lemons, mangoes, papayas, pineapple and peaches. 

Pro Tip: A great way to ensure you’re getting enough vegetables is to make your plate at lunch and dinner is at least half vegetables. 

Here are a few resources for getting organic, healthy foods delivered:

Check out Misfits Market — they will send you a box of seasonal produce at up to 40% less than what you would pay at the grocery store. (Use the code COOKWME-DY5XFK for $25 off.)

You might have access to a local CSA that will deliver to your door. Do a google search for your area or you can start with https://www.localharvest.org/csa/. 

Check out Butcher Box — they deliver 100% grass-fed beef, free range organic chicken and heritage breed pork directly to your door. 

Ditch sugar and processed foods.

The stress and anxiety of COVID-19, combined with “Sheltering at Home” creates the perfect recipe for craving sugary and processed foods — they temporarily make us feel energized but a big crash comes shortly afterward. Beyond that sugar and processed foods SUPPRESS your immune system. To help you kick the sugar habit, enroll in our 7-Day Sugar Detox Here

Eat high quality protein foods.

Protein is critical for immune function. What’s an adequate amount? Roughly half your bodyweight in grams a day. These include plant-based proteins, such as legumes and nuts and seeds, as well as organic, clean, humanely-sourced animal protein. 

Plant-Based Protein Superstars:

  •     1 cup cooked lentils = 18 grams
  •     3 tbsp. hemp seeds = 10 grams
  •     I cup cooked quinoa = 6 grams
  •     3 ounces extra firm tofu = 9 grams
  •     1 cup chopped broccoli = 8 grams
  •     ¼ cup raw almonds = 8 grams
  •     ¼ cup raw sunflower seeds = 7 grams
  •     2 tbsp. chia seeds = 6 grams
  •     2 cups chopped kale = 4.5 grams

Wild-caught salmon has 13 grams, chicken has 18 grams, and ground beef, 11 grams — all per 2 ounces.

Eat cultured and fermented foods to feed your microbiome and support immune health.

Include sauerkraut, kimchi, natto, chickpea miso, yogurt made from coconut or almonds. These foods give your body a dose of healthful probiotics — live micro-organisms crucial to a healthy intestinal microbiome (the microbial community in the gut) — which plays a role in supporting the immune system and warding off damaging inflammation inside the body. 

Make friends with mushrooms.

Mushrooms are medicinal!  They have immune-boosting polysaccharides that have anti-viral, antibiotic properties. Shiitake, maitake and oyster mushrooms are easy to prepare — a simple roast, sauté or simmer will do. In fact, you can throw them in everything — soups, omelettes, stir fries, stews, vegetable dishes. 

Add garlic, onions, cloves, cinnamon, ginger, turmeric, rosemary, oregano and more when cooking. 

These herbs and spices not only add flavor to your food, they are anti-inflammatory powerhouses. Add them to soups, stews, vegetables, oatmeal, or just about anything! Did you know that garlic and onions offer wide spectrum antimicrobial propertiess.

Drink plenty of fluids.

Your body depends on it, as does your immune system. Water and herbal teas,of course, but soups and broths also count! Stay away from fruit and vegetables juices — they are full of sugar (yes, even the so-called healthy ones.) 

Wondering what else you can do?

Join Dr. Blum’s FREE Friday Open Office Hours Q & A, to have all your lingering questions answered: Register Now

Schedule a 45-Minute Immune Support Consult with one of our healthcare practitioners.  Schedule an informational call here

Read my recent blog post: 10 Ways to Reduce the Coronavirus Stress Response 

 

Check out Dr. Blum’s FREE 3-part video series! Last month I led live classes on the immune system and I’m happy to share with you the three videos:  How To Boost Your Immunity and Resiliency to Viruses: DOWNLOAD FREE NOW

Meet Melissa: Melissa Rapoport is the Manager of Health Coaching and Lifestyle Programming at Blum Center for Health in Rye Brook, NY. She combines her graduate work in Developmental Psychology with her education in nutrition, health and coaching to create highly individualized programs that result in lifetime change. A contributing author to three international bestselling books, Melissa’s greatest joy is her relationship with her two daughters. To learn more about Melissa’s coaching practice at Blum Center for Health, click here.

Resources:

  1. Ying Li, Silvia Innocentin, David R. Withers, Natalie A. Roberts, Alec R. Gallagher, Elena F. Grigorieva, Christoph Wilhelm, Marc Veldhoen. Exogenous Stimuli Maintain Intraepithelial Lymphocytes via Aryl Hydrocarbon Receptor Activation. Cell, 13 October 2011 DOI: 10.1016/j.cell.2011.09.025
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Pregnancy and Pandemic

Please note: This article should NOT be considered medical advice. Information about COVID-19 is constantly evolving and subject to change. Following proper procedures for handwashing, social distancing, masking and surface cleaning remain the best interventions available. Personal recommendations for pregnancy planning should be discussed with your health care provider

Pregnancy is a time of hope and excitement as well as increased concern for what the future will bring for your growing family.   Pregnancy during a pandemic can add to the fear that any parent-to-be may feel. The areas of concern are three-fold: What effects COVID-19 (SARS-CoV2) may have prenatally, how it will inform labor and delivery, and what effects it might have in the first years of life and beyond.  Expectant mom’s need guidance to help them navigate the changing landscape of pregnancy during pandemic. Arming yourself with knowledge and a plan of action can help you navigate this confusing time. What should you know and what can you do now to protect your baby?

We do not have a lot of information about pregnancy and birth outcomes related to COVID-19 as of yet.  Studies are based on small population size, and only exist from women in their third trimester. While we do not know what, if any effects, in utero or early exposure to COVID-19 may have on baby’s early and long-term development, new information is continually emerging, and we can use the currently available data to guide our choices. 

Prenatally, protection and prevention are absolutely the first line of defense. Follow standard recommendations for social distancing, frequent hand washing, thorough surface cleaning, and face covering. Discuss with your provider their policies regarding in person vs. telehealth prenatal visits. Basic health measures such as high-quality nutrition, physical activity, restful sleep and stress reduction become even more important, even while quarantine conditions add an additional layer of challenge to achieving these goals.  Consider pregnancy safe immune support such as vitamin C and D, zinc and echinacea as appropriate, but be careful with any supplements-herbs such as licorice and andrographis being touted as protection against SARS-CoV2, they are unsafe during pregnancy. Other compounds such as quercetin and melatonin, which may have anti-COVOD-19 activity, are lacking in safety data regarding pregnancy.

Once baby is ready to enter the world, the goal is to minimize risk to mom and newborn.  There is a higher risk of preterm delivery and low birth weight in babies born to infected mothers but thankfully, vertical transmission (from mom to baby in utero) of COVID-19 appears unlikely. In only rare cases has a baby been born with positive antibodies (a sign of prior exposure) to the disease. Horizontal transmission (from mom to baby after delivery) has occurred, likely due to exposure to respiratory droplets after birth, but in most cases, the infants have recovered well, and appear less seriously affected than adults. Because of the fear of both vertical and horizontal transmission, as well as respiratory concerns for mom, C-section deliveries and separation of mom any baby after birth were regularly initiated in early cases, but with more information these guidelines have changed.  For COVID-19 infected mothers, the World Health Organization (WHO) currently does not recommend routine C-section, unless deemed necessary for other reasons. The CDC does not support routinely isolating a newborn from its mother and WHO maintains the importance of room-sharing, skin to skin contact and breastfeeding to provide the baby with optimal immune support. There is no evidence that the virus can be transmitted via breast milk, however, COVID-19 positive mothers must use precautions such as wearing a mask while nursing, washing hands before and after touching the baby, and disinfecting all surfaces. In addition, if a mom is expressing her breast milk for any reason, including being too ill to nurse, all equipment must be carefully and thoroughly cleaned.

For the first year and beyond

Preterm delivery, C-section birth, antibiotic use, as well as maternal fever, infection and use of acetaminophen during pregnancy have been associated with an increased risk for autism spectrum disorders, ADHD, developmental delay and depression in children.  We suspect this is linked to disruption of the infant microbiome and alteration of innate immune function. Research is clear that healthy balanced gut flora exerts powerful effects on not only digestion, but immune and neurologic function as well. Alterations in these pathways are correlated with a variety of developmental and mental health challenges in children and adults. 

HOWEVER, remember that having a baby should be a time of joy and hope.  We cannot and should not live in fear of negative outcomes. What we can do is be aware, and proactive in supporting normal immune and gut health in our newborns, and be especially mindful of those who have been exposed to SARS-CoV2.  Being proactive includes breastfeeding for 6 months or longer whenever possible. Breast milk provides important immune modulating compounds as well as molecules called Human Milk Oligosaccharides (HMOs) that are used specifically by the gut flora to grow and thrive.   If appropriate, Vitamin C and D, probiotics, omega 3 fatty acids, and zinc can be used to enhance immune function.  While these nutrients are safe for both breastfeeding moms and babies, appropriate dosing is essential. Parents should watch carefully for signs of digestive and immune dysfunction such as colic, reflux, poor sleep, eczema and ear infections.   If you suspect your child is not achieving appropriate developmental milestones, then modify the familiar saying and “if you don’t see something, say something”. Work closely with a provider experienced in functional care who will take your physical and developmental concerns seriously, and intervene early.

This information is not designed to scare but to educate.  By knowing the facts, working closely with your healthcare provider to decide what is best in your individual situation, and making decisions with both short and long-term effects in mind, you can lay the foundation for a happy thriving child. 

 

Vicki Kobliner MS RDN, is a Registered Dietitian/Nutritionist. Vicki has a passion for helping parents-to-be navigate preconception, pregnancy and baby’s first year of life in the face of increasing chronic childhood illness.  She employs a functional nutrition approach to optimal health and healing. Vicki also works with infants through adults with chronic illnesses, digestive disorders, food allergies, ADHD and autism and provides fertility and mental health focused nutrition counseling.   Click here to book an appointment with Vicki.

Looking for more information on being pregnant during a pandemic?  Join Vicki for a live webinar on May 14th at 12 pm where she will explain what information we know so far, and how best to use that information for prevention and protection. Click here to register.
Submit questions forVicki in the comments section – she will address them during this live call! Sign up here.

 

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Coconut Quinoa & Broccoli Bowl with Ginger-Lemon Dressing

Here’s a wonderful recipe that will not only take the chill out of spring, but it also is good for your gut  … which makes it good for your immune system.

Check out all these gut-loving, immune-boosting ingredients: 

  • Broccoli and snow peas — green vegetables are the source of a chemical signal that is important to a fully functioning immune system. They do this by ensuring that immune cells in the gut and the skin known as intra-epithelial lymphocytes (IELs) function properly.
  • Coconut milk and flakes — Coconut contains lauric acid that is known for its antiseptic properties. It assists the body in fighting infections caused by bacteria, viruses, and fungi.
  • Quinoa is a complete protein and is critical for immune function.
  • Sesame seeds contain iron, zinc, vitamin B6, vitamin E, selenium and many more which support the functioning of the immune system.
  • Ginger has powerful anti-bacterial, anti-viral and anti-inflammatory compounds that keep rhinoviruses from binding to cells in the mucus membranes.

Enjoy this easy-to-make crowd-pleaser!

Ingredients:

For the quinoa and broccoli bowl:

  • 3/4 cup quinoa
  • 1 1/2 cups full-fat coconut milk
  • 1 pinch sea salt
  • 1/2 head broccoli florets
  • 1/2 cup snow peas, thinly sliced
  • 1 spring onion, thinly sliced
  • 1/4 cup large coconut flakes, toasted
  • 1 tablespoon black sesame seeds

For the dressing:

  • Zest of 1 lemon
  • one 2-inch knob fresh ginger, peeled and sliced
  • 1 teaspoon honey
  • 1 lime, juiced
  • 1/4 cup olive oil

 

Directions:

  1. Rinse the quinoa under cold water for about 30 seconds. In a medium pot, add the rinsed quinoa, coconut milk, and sea salt. Bring to a boil, then cover and simmer for 15 minutes, until quinoa has absorbed most of the liquid. Remove from heat, let sit with lid on for 5 minutes, and then fluff with fork.
  2. Lightly steam the broccoli until just tender and bright green, no more than 5 minutes once the water boils. Then, rinse broccoli under cold water to stop its cooking, and to retain its color and texture.
  3. Place the coconut quinoa in 4 bowls. Add the warm broccoli, and then top it with snow peas, spring onion, toasted coconut flakes, and sesame seeds.
  4. To make the dressing, place lemon zest, fresh ginger, honey, lime juice, and oil in a small blender and combine until smooth. A If needed, add a teaspoon or two of water to reach the right consistency.
  5. Drizzle the dressing over your  bowl.

 

Meet Melissa: Melissa Rapoport is the Manager of Health Coaching and Lifestyle Programming at Blum Center for Health in Rye Brook, NY. She combines her graduate work in Developmental Psychology with her education in nutrition, health and coaching to create highly individualized programs that result in lifetime change. A contributing author to three international bestselling books, Melissa’s greatest joy is her relationship with her two daughters. To learn more about Melissa’s coaching practice at Blum Center for Health, click here.