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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 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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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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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 Coachwrote 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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Tips for Boosting Your Immunity

My anti-viral approach is to help you build a strong immune foundation so that you boost your immunity and don’t get sick from any virus. A strong immune system is the basis for staying healthy in general and should be a year-round strategy…not just during flu season or when there is a threat of a novel previously unknown virus. This is, by far, the best prevention and protection!

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. If you are taking antacids or proton pump inhibitors -stop- because this alters your gut flora in a negative way.

Balanced stress hormones: Get a good night’s sleep to boost your immunity and don’t overwork yourself during flu season. Stress harms your ability to fight viruses.

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.

Take your vitamins! Here are some important ones you will need:

a. Vitamin D 2000 iu/day minimum. The dose is based on your blood levels, so if you havelow vitamin D you will need more.

b. Vitamin A retinyl palmitate 5000 iu/day. If you are pregnant or nursing, do not take morethan 5000 iu/day of this kind of Vitamin A (retinyl palmitate).

c. Zinc 30 mg/day.

d. Vitamin C 3-4000 mg/day as an immune booster. 1-2000 mg/day is good for general prevention.

Additional supplements to consider to boost your immunity:

a. N-Acetylcysteine (NAC):  One of my favorites for preventing cold and flu. NAC is widely used in the medical community for a number of conditions , and has terrific clinical data that shows it to be helpful for patients with chronic respiratory illnesses ( and so it is very useful for support treating respiratory viral illnesses). It also converts to Glutathione, the body’s most powerful antioxidant.  I usually recommend 900 milligram capsules or tablets – start with one twice daily and increase to two twice daily if needed. Pharmanac, a Canadian brand that comes in an effervescent form is easy to take as a fizzy drink – even for children!

b. Whey Protein Powder is high in immunoglobulins that boost your immune system. For a non-dairy alternative, try SBI Protect powder from Orthomolecular, packed with immunoglobulins

c. Herbs like Elderberry, Echinacea, Astragalus, and Beta Glucan (mushroom extracts). We love Immunoberry Liquid from Designs for Health, which is a potent and convenient blend of these. 1 dropper each day in your shake, or in a little water, is all you need for ongoing protection. We also love Immune Builder from Mushroom Science: 2 daily for prevention. Both of these supplement doses can be doubled or tripled if you are concerned that you had exposure or feel you have early symptoms of a viral illness.

Lastly, make sure to wash your hands multiple times a day — especially before you eat, and after exposure to public transportation like riding the subway.

 

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

The items listed are available for purchase from our office, or from our online store:

https://us.fullscript.com/welcome/blumcenter

 

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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Menopause Made Easy

Ok, let’s face it…every woman will transition through menopause, whether they like it or not. For some of us, it happens without any fanfare. One day your period is gone, and you’re done! (Yes, ladies, this does happen for some women). For others, it is a nightmare with hot flashes and sweats during the day and night, often ruining what used to be a good nights’ sleep. Other symptoms may include difficulty with memory, sometimes called ‘mental-pause’, low sex drive and painful intercourse when you do decide to make it happen.

So what is going on? One theory is that estrogen receptors in the brain become starved of estrogen, and this affects temperature regulation and memory. While this makes a lot of sense, there has to be more to it than that because all women have a loss of estrogen during menopause, but only some women suffer symptoms. To understand this, let’s look at the other influences on your hormones that could be the culprits.

First, you must look at your entire endocrine orchestra and make sure all of your hormones are working optimally. These include your thyroid hormones, your adrenal hormone cortisol, and also your blood sugar hormone insulin. If any of these are out of balance, your sex hormones will be too, and you are more prone to having menopause symptoms.

Second, you must look at your detox system and make sure your liver is doing a good job of processing both every day toxins and metabolizing your hormones properly. Even after menopause you should have some healthy estrogens in your body, and these need to be processed. Faulty estrogen metabolism can result in more symptoms.

What can you do? Here are 5 tips to help make menopause a non-event.

  1. Eat for hormone balance. This means eating protein (vegetarian or animal) and plants rich in fiber with all meals and cut out the processed sugar. This will keep your insulin in balance. 
  2. Have your thyroid checked, including the hormone T3. If you are already hypothyroid, make sure you aren’t taking too much or too little medication. 
  3. Do an adrenal saliva test to make sure your adrenals are healthy. An integrative practitioner can help you do this.  Live in our neighborhood? You can have a consultation with one of our practitioners at Blum Center for Health for testing.  
  4. Improve your estrogen metabolism by eating cruciferous vegetables, rosemary. Consider trying the supplements DIM (Di-indole methane), methylfolate and methylcobalamin. 
  5. Beware of alcohol and caffeine. They can make your temperature system go haywire during this time of transition. 
  6. Consider a safe and medically sound liver Detox program.  Renew your body by eliminating your toxic load and resetting your hormones. Try our 14-Day Whole Life Detox. 

Try one or more of these steps and evaluate how you feel.  Let me know how you are doing! 

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The Functional Medicine Approach to Breast Cancer Prevention

Breast cancer is a health issue that most women will think or worry about at some point in their lives. One of the reasons is because we hear so much about breast cancer these days: in the media; through fundraising organizations; and from family and friends facing the diagnosis. Another is because it has become much too common. Perhaps you, or someone close to you, are a breast cancer survivor.

October is Breast Cancer Awareness Month, and we want to honor and support all women by highlighting our Functional Medicine approach to the prevention of breast cancer, whether the focus is on primary prevention, or prevention of recurrence. 

Because research shows that how you metabolize estrogen can increase your risk, we focus on supporting estrogen detoxification, a process that happens primarily in the liver.

HOW MUCH ESTROGEN DO YOU HAVE?

Many women believe that after menopause they aren’t making estrogen anymore.

This is not true. 

Before menopause, estrogen is produced in several places in the body, including the ovaries, adrenal glands, and produced from testosterone by the enzyme aromatase in fat cells. After your ovaries have been removed or you have gone through menopause, estrogen is still being produced, in low but measurable amounts, by these other tissues. 

You might wonder: since we all have estrogen, why do some women, and not others, end up with breast cancer? 

Well, it turns out that all estrogens are not the same, and these differences are influenced by genetics and the environment.

When estrogen is processed for elimination, the hormones are sent to the liver where they are metabolized, a process also called detoxification. During the estrogen detox process, you can end up with “bad” estrogens or “good” estrogens. The bad ones are considered “toxic” because they are very strong stimulators of estrogen receptors (causing more cell proliferation), and they can damage DNA, as opposed to the “good” estrogen metabolites that are weaker estrogens and not harmful to cells. Of course, the “good” estrogens are preferable!

Although our genetics influence how easily we make the good and bad estrogens, it turns out (no big surprise!) that food and other lifestyle factors have an enormous effect on the kinds of metabolites the liver will make. Influencing your estrogen detox pathways in a good way is what we focus on for breast cancer prevention at Blum Center for Health.

IMPROVE YOUR RATIO OF GOOD:BAD ESTROGENS

Our first step to help you reduce your cancer risk is to increase your good estrogens, and decrease the bad. 

Top 4 Ways to Reduce Your Breast Cancer Risk 

  • Eat lots of food that supports estrogen elimination and detoxification pathways, including:
    1. Lots of antioxidants and cruciferous vegetables like kale, broccoli and cauliflower
    2. Fiber from fruits and vegetables helps you excrete estrogens via the gut.
    3. Soybean that is organic and non-gmo, and in its whole form, like edamame or tofu. Or, fermented soy like tempeh or miso. Soy has a very gentle and positive effect on estrogen receptors and is actually good for most women.
    4. Ground flax seeds:  can block the conversion of testosterone to estrogen, thus lowering your levels.
  1. Consider taking the supplement Di-indolylmethane, or DIM, or it’s more powerful cousin, Sulforaphane, which are basically the active component extracted from cruciferous vegetables. This can improve the good:bad estrogen ratio with the goal of decreasing your risk of breast cancer. We also recommend it to reduce symptoms of too much estrogen, such as fibrocystic breasts, uterine fibroids or heavy painful periods. This condition is called estrogen dominance.
  2.  If you want to know more about your personal risk, genetic testing can be done to evaluate your probability for making bad estrogens, and urine testing can be done to assess your current ratio of good:bad estrogens. With these test results, we can determine how to use food, supplements and mind-body practices to increase good estrogen levels and lower bad ones. These tests are available from our Functional Medicine nutritionist or practitioners.
  3. Lower your total toxin load.  In addition to targeted support for detoxing and eliminating estrogens, keeping your general toxin load and exposure low is very important because environmental toxins like herbicides and pesticides can push your estrogens down the “bad” pathways. We recommend cleaning up your exposures, and supporting your liver with a general detox program. How to do this?  Read on!   

HOW TO REDUCE YOUR ENVIRONMENTAL EXPOSURES AND LOWER TOXIN LOAD

We always recommend doing a simple Liver Support Detox program in the spring and fall to help keep these toxins from building up in the body and causing problems. Check out our do-it-yourself 14-Day Whole Life Detox to get startedAdd a bottle of Broccoprotect (sulforaphane) if you are concerned about your estrogens and you’re all set.  

And if you are confused about what to do?  Make an appointment with our health coach, Melissa Rapoport! She will help you form a plan to reduce your toxic load and bring balance back to your body. Either call 914-652-7800 to set up an in-person appointment, or go to CoachMe to set up a video or phone appointment. 

Want to learn more about detoxification? Check out these detox blog posts.

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The 5-Day Fasting Cycling Diet

How to adopt strategies from the new science of fasting so that you can decrease your risk of disease and optimize your weight.

Studies have shown that by following a very low-calorie food plan with very specific nutritional rules — a 5-Day Fasting Cycle — repeated every month for 3 months in a row, can help you achieve lasting weight loss, a boosted metabolism and improved blood markers of disease and aging.

Fasting is defined as an absence of food for a specific period of time that stimulates a regenerative state of health in one’s body without intentionally inflicting harm.  Our program tricks your body into responding as if it were fasting, providing all the great health benefits without actually starving yourself!

Research has shown substantial  benefits to following the principles of the Fasting Mimicking Diet:

  • Extended Lifespan and reduced cellular aging
  • Loss of abdominal fat without loss to muscle mass
  • Reduced desire to overeat or eat sugar
  • Improved insulin sensitivity
  • Drop in loss of bone mineral density
  • Improvement in cognitive state
  • Reduced risk of developing disease
  • Improved gut health
  • Enhances the body’s innate ability to function optimally to regenerate at the cellular level, detoxify environmental toxins, and metabolize nutrients.

It is well known that calorie restriction or changes in dietary composition can enhance healthy aging. The trick was for researchers to figure out HOW to help people implement calorie restriction in a way that is sustainable.  

Here are a few key studies demonstrating how and why these programs work.  They are all published by Valter Longo, PhD, the researcher who has led the way and created a fasting program that produces these medical benefits.  

  • “Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease”.  Published in 2017, this research triggered a huge buzz in the functional medicine and nutrition community because it was the first to show the results of a fasting-mimicking diet (FMD)—low in calories, sugars, and protein but high in unsaturated fats—on markers/risk factors associated with aging and age-related diseases. They compared subjects who followed 3 months of an unrestricted diet to subjects who consumed the FMD for 5 consecutive days per month for 3 months. They found that three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1).  (Wei et al., Sci. Transl. Med. 9, 8700 (2017))
  • “Dietary Restrictions and Nutrition in the Prevention and Treatment of Cardiovascular Disease”.  In this article, Dr Longo discusses how intermittent and periodic fasting interventions can help prevent and treat CVD. (Circ Res. 2019;124:952-965.
  • Fasting-Mimicking Diet Modulates Microbiota and Promotes Intestinal Regeneration to Reduce Inflammatory Bowel Disease Pathology. This study showed that cycles of a fasting-mimicking diet (FMD) reduced intestinal inflammation, increased intestinal regeneration, and stimulated the growth of protective gut microbial populations in a mouse model displaying symptoms and pathology associated with IBD. They also show that a similar FMD is safe, feasible, and effective in reducing systemic inflammation and the consequent high levels of immune cells in humans. (Rangan et al., 2019, Cell Reports 26, 2704–2719).
  • Cancer:  FMDs can reduce cancer incidence and aging-associated immunosuppression/ immunosenescence, a process aided by hematopoietic stem cell-based regeneration (Brandhorst et al., 2015; Cheng et al., 2014)
  • Multiple Sclerosis and Diabetes:  FMD cycles ameliorate or reverse disease progression in mouse models of multiple sclerosis (MS), and type I, and type II diabetes (Choi et al., 2016; Cheng et al., 2017).

PUTTING THE FASTING CYCLING DIET INTO PRACTICE

Whether you want to lose weight or need to treat a health issue, it is clear that this strategy helps everyone.  The definition of health isn’t simply the absence of disease; it is optimal functioning throughout your lifespan.  Using intermittent fasting as a strategy is a proven strategy and a practice that can be built into every day lifestyle goals.  

To do this, with the help of Keri Lynn MacElhinney (our Nutritionist at Blum Center for Health), we built our NEW, signature weight loss program around this central core concept and created the Blum Alternate Fasting Diet (AFD).

For our Blum AFD, we combine the principles of anti-inflammatory plant-forward eating with intermittent fasting and low calorie 5-Day Fasting Cycles, creating  a whole-foods, sustainable program that promotes healthy weight loss, and improves  metabolism and markers for disease — all while eating delicious food that supports the gut microbiome and the removal of environmental toxins that store in your fat cells preventing weight loss.

Our Blum Alternate Fasting Diet, features a 3-month guided weight loss program that includes one 5-Day Fasting Cycle per month.  

We provide all the information you need to follow this yourself, but to make it easy and convenient, we have teamed up with Organic Pharmer to create a fixed 5-day menu that follows the nutritional guidelines and provides a delicious and satisfying whole foods, ready-to-go option for the 5-Day Fasting Cycle part of the program. (LINK)   

There is also a supplement company that created packaged foods for you to eat during the 5-Day Fasting Cycle and you can read about them HERE.  

DO IT WITH US!

We will be offering our Blum Alternate Fasting Diet as a group program for the first time at Blum Center for Health, starting June 3.  I will be teaching the first class and would love to have you join us! LEARN MORE ABOUT THE PROGRAM HERE

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Should You Take Probiotics?

Probiotics are living bacteria normally found in the human digestive tract that are usually ingested to improve the quality and quantity of the gut’s beneficial bacteria. One of the goals of taking a probiotic is to shift the population of gut bacteria toward one that is more healing and low inflammatory. But most people don’t know that probiotics do a lot more than just influence the population of the microbes that live in your gut.

Many studies have shown that probiotics can repair a leaky gut, reduce intestinal permeability and help increase the production of butyrate (a short chain fatty acid made by good gut flora that is very good for us).  In their role as influencers on the gut microbiome, probiotics have been found to specifically reduce proinflammatory bacteria such as Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Streptococcus viridans, Bacteroides fragilis, Bacteroides uniformis, and Clostridium ramosum. When these and other potentially harmful bacteria are present in high amounts, they create a pro-inflammatory, leaky gut causing condition called dysbiosis. (1)  The term dysbiosis was introduced over a century ago by the Nobel Prize laureate Elie Metchnikoff, who used it to describe a disruption of the normal balance of the bacteria in the gut and then proposed using yogurt with active bacterial cultures to improve both the gut and human health.(2)

Probiotics have gotten bad press recently because many people believe that probiotics are like seeds that plant themselves in the gut and that they are supposed to grow there and flourish.  When studies recently showed that probiotics in fact pass through us in about 6 weeks, the buzz was that people shouldn’t bother taking them. This absolutely is not true, because probiotics exert their influence without needing to plant and grow.  They help improve the whole ecosystem of the gut and also have a huge role to play in helping treat inflammation like arthritis, and immune system imbalances like autoimmune disease.

For example, researchers have studied the use of probiotic supplements to treat the dysbiosis of inflammatory arthritis and found that probiotics improve symptoms in arthritis sufferers.  Generally speaking, when it comes to arthritis, probiotics are thought to improve all the functions of your good flora, including helping T regulator immune cells work better and live longer, turning off inflammation and repairing the gut lining and tight junctions.  Because probiotics help treat a leaky gut, and because of the gut-arthritis connection, it follows that they would also treat systemic inflammation and arthritis, and they do!  

The bottom line? The strains researched in arthritis with the most evidence for an anti-inflammatory effect are Lactobacilli:  casei, acidophilus, reuteri, rhamnosus GG and salivarius. There is also good evidence for Bifidobacterium bifidum.  Bifidobacterium infantis, E coli nissle, and Lactobacillus plantarum were found to improve tight junctions and heal leaky gut, even if they weren’t studied for their effects specifically on arthritis. This data tells me that a multi-strain formula that includes as many of these as possible, with a priority given to those that have been studied in arthritis patients, is best when using probiotics to reduce inflammation.

If you have arthritis or any inflammatory condition, taking a probiotic is a great place to start.  But to treat dysbiosis, functional medicine offers a more complete approach that includes an herbal program to clean the “weeds” out of the garden.  The HealMyGut program can be done by itself, or as part of the Arthritis Challenge.  

And finally, I leave you with a brief suggestion for choosing a probiotic.  This can be confusing! I prefer to use a multi strain formula that has as many anti-inflammatory strains as I can find.  I love Klaire Labs, because they have been around as long as I’ve been practicing Functional Medicine (almost 2 decades!) and I know they work since I have been using them all this time.  My favorite product is Therbiotic complete, because it includes all the above strains. That’s why I use this for my private label BCH! PURCHASE HERE

Klaire Labs Therbiotic Complete: 12 strains

  •      Lactobacillus rhamnosus
  •      Bifidobacterium bifidum
  •      Lactobacillus acidophilus
  •      Lactobacillus casei
  •      Lactobacillus plantarum
  •      Lactobacillus salivarius
  •      Bifidobacterium longum
  •      Streptococcus thermophilus
  •      Lactobacillus bulgaricus
  •      Lactobacillus paracasei
  •      Bifidobacterium lactis
  •      Bifidobacterium breve

 

[1]  Parian A, Limketkai B, Shah N, Mullin G. Nutraceutical Supplements for Inflammatory Bowel Disease. Nutrition in Clinical Practice. 2015. Vol 30, Number 4. 551-558.

[2] Zeng MY, Inohara N and Nunez G. Mechanism of inflammation-driven bacterial dysbiosis in the gut.  Mucosal Immunology. Online publication 24 August 2016. doi:10.1038/mi.2016.75

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How Stress Effects Your Heart and What You Can Do About it

For those of you who know me, either personally or professionally, you know that Mind-Body-Spirit self care strategies are at the core of what I practice and preach for preventing and treating chronic disease.  I meditate every morning and spend lots of time in nature. But more than this, I teach others about how stress affects your health and offer tools to do something about it.

For this month, I offer a guest blog on this topic from my friend and colleague, Dr Alon Gitig, a gifted cardiologist who I work with to help my patients get the best care, including prevention and treatment of various conditions.  Mind-Body Medicine for too long has been the step-sister to conventional medicine, but now you can see for yourself that it’s not any more!

Enjoy this perspective from a traditional cardiology practice!

Susan Blum, MD, MPH

 

Guest post by By Alon Gitig, MD, FACC

Health blogs talk a lot about “mindfulness” these days.  Many of us have read claims that controlling our emotions can improve our health, and are left wondering whether there’s evidence to support this.  Research into mind-body techniques is accumulating, as investigators look for ways to lower the risk of chronic diseases above and beyond the proven—yet incomplete–benefits offered by medications.  In the field of cardiology in particular, despite major gains in the past 50 years, there is still an unacceptably high burden of heart disease, even when people are well-treated with evidence-based therapy.  Let’s take a look at the evidence base behind whether stress management might help tackle this problem.

Psychological stress can have profound effects on our bodies.  

Studies suggest that up to 60-80% of all primary care visits are related to manifestations of stress.  A Mayo Clinic analysis identified stress as the most powerful predictor of cardiac events, while other studies indicate that mental stress predicts cardiac death more strongly than cigarette smoking.  Depression roughly doubles the risk of heart attack. Both anxiety and anger have been linked to a 6-fold increased risk of cardiac events, including arrhythmias and sudden death.

Stress activates the sympathetic nervous system, with potential effects on blood pressure and heart rate.  There is also evidence that elevation in cortisol levels, increased platelet clotting, and abnormal reactivity of artery walls might be triggered by psychological distress.  What’s more, the brain may also directly affect the heart via descending nerve pathways.  Amazingly, recent research reveals that subjects who intentionally generate positive emotions, such as gratitude, influence the heart’s beating into a pattern that is associated with healthy cardiovascular function and decreased risk of arrhythmic death.

These observations prompted studies attempting to improve health outcomes via stress-reduction techniques, such as meditation, yoga, and biofeedback.  Results have been mixed, confounded by practical, methodological limitations inherent in conducting such trials. Not surprisingly, all of these modalities have generally led to significant improvements in psychological well-being, both in healthy volunteers and specifically in cardiac patients.

Some studies have demonstrated improved control of cardiac risk factors as well.  Statistically significant reductions in blood pressure or resting heart rate have been achieved in patients with coronary disease, congestive heart failure, and atrial fibrillation.  Interestingly, the magnitude of blood pressure lowering in some studies (i.e. 10 mmHg) mimics that seen in certain trials of hypertension drugs.

The data suggest that clinical symptoms and physical functioning can benefit from relaxation techniques as well.  Patients with established coronary disease randomized to a 24-day intensive stress-management program experienced less angina episodes compared to baseline (versus no change in the control group).  These patients also exercised longer on follow-up treadmill tests, and demonstrated improvements in blinded measurements of cardiac function.

Of note, a strict vegan diet was part of the experimental regimen, hence the impact attributable directly to the relaxation intervention is uncertain.  Several studies of congestive heart failure patients treated with meditation or yoga demonstrated improvements in symptoms of breathlessness and fatigue, along with improved walking distance on standard 6-minute walk tests.  Here too, the magnitude of the increase in distance walked was comparable to benefits seen in trials of drugs for angina and pulmonary hypertension. Three months of yoga therapy in atrial fibrillation patients resulted in less symptoms and fewer detected arrhythmia episodes on wearable heart rhythm monitors.

But do these techniques prevent heart attacks or prolong life?  Believe it or not, there are two studies demonstrating reduced long-term risk of death following 3 months of meditation training.  Since the magnitude of benefit observed was far greater than would be expected from the brief exposure to meditation, these results are intriguing, but far from definitive.

So what’s the bottom line on stress?

First, it’s clear that psychological stress, anxiety, and other adverse emotional states often cause or exacerbate a variety of symptoms, and that relaxation practices can offer symptomatic relief.  Furthermore, evidence supports that emotional-regulation tools are very safe. For these reasons, two separate American Heart Association committees have endorsed their use as “reasonable to consider” in the care of cardiac patients.

For many people, the benefits of improved emotional equilibrium are motivation enough to try out these practices.  If you’re hoping that your yoga class will control your palpitations, improve your exercise tolerance, or cut your risk of heart attack, there’s no guarantee.  But if you are struggling with persistent symptoms despite your doctor treating you with the best available, evidence-based care, then there’s reason to be optimistic that mind-body practice may offer you the extra relief you’re looking for, with little to no downside to giving it a try.

By Alon Gitig, MD, FACC
Mount Sinai Riverside Medical Group
Yonkers, NY

Do you suffer with stress and arthritis? If you are interested in learning how to become resilient to life’s stressors, and what your gut has to do with arthritis symptoms, join Dr. Blum for a FREE Arthritis Masterclass on 1/22.  Save Your Spot