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Updated Supplement Recommendations for the Coronavirus Pandemic

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, there is new information that I want to share with you.  Based on what we have learned about the behavior of this novel coronavirus, and in consultation with my team at Blum Center for Health, I am updating our recommendations. 

Here is your update on supplements:

ACE receptors:  We have learned that this virus uses the ACE receptor on cells to gain entry.  We have read that one of the many actions of Vitamins A and D could be to increase the number of ACE receptors on the cells, and therefore, out of an abundance of caution, we are recommending to continue taking your usual doses of Vitamin A and D, but don’t increase your usual dose (something I had previously recommended as a response to virus infections, in general, and this virus in particular).

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. 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.  Many of you have been contacting us, asking for guidance on this.

  1. First, we must state that there are no studies that prove that any of the below supplements contribute to a cytokine storm.
  2. The Arizona University Department of Integrative medicine has made the recommendation, based on their understanding of how these supplements function, to stop the below vitamins and supplements if you develop symptoms of infection or a positive test because they could theoretically contribute to this cytokine storm.  
    • AU Integrative medicine recommends you stop taking these vitamins if you get sick. We share this with you because without knowing for sure, it is best to be cautious and follow these guidelines:  
      1. Elderberry
      2. Echinacea
      3. Larch Arabinogalactan
    • Everything else is considered safe to take, including:  
        1. Zinc 
        2. Vitamin C 
        3. Astragalus
        4. Andrographis
        5. NAC

 

  • Mushroom extracts

 

      1. We are having a debate about mushroom extracts because in general we recommend them for their support of the immune system and there really is no evidence that they would be harmful if you got the coronavirus.
      2. Therefore, we still recommend you take the mushroom supplements that your provider has given you.  Best to choose only those that have the name of the mushrooms themselves on the ingredient list.

PUTTING THIS TOGETHER

  • Supplements:  
    • Stick with Zinc (30 mg), Vitamin C (3 grams), and a probiotic, which you can continue even if you get sick.  There are reports from China about using high dose Vitamin C for treatment, and it seems reasonable to continue to recommend going up to 6 grams daily or more if you get sick (and can tolerate it; it can cause loose stools).
    • Stay on your usual dose of Vitamin A and D, but don’t add extra high doses.  
    • The jury is out on echinacea, elderberry and Larch arabinogalactans.  As of today (updated 3.23.20), probably best to avoid if you get sick until we have more clarity on these.  Stay tuned.
    • One more note:  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.  I will be having a weekly LIVE webinar every Friday at 11 am EST to answer questions. Sign up here.

 

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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.

 

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

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Viruses and Autoimmunity

If you are a human, living and breathing on this planet, then you have already discovered that viruses are everywhere.  

Sometimes you get sick from them and sometimes you don’t. Have you ever wondered why?  

Some people can clear these viruses out of the body easily after their cold or flu, while in other’s the virus can persist and run amok causing problems like autoimmune disease. How does that happen?  

This issue is important whether or not you have an autoimmune condition because persisting, active viruses can cause ongoing symptoms like fatigue, too.  

Let me explain.  

We are all exposed to viruses.  

A healthy immune system should be able to respond to the infection and take care of business, clearing out the virus after a self-limited short illness. I think of a robust and well functioning immune system as the product of good “soil” within your body.  

Another name for the inner soil that grows your immune system is your terrain, which is part of a larger ecosystem that determines the functioning of, well, every system in your body..  (note the gardening metaphors).

If you have good inner terrain, you will “grow” normal functioning immune cells that can clear out the viruses. If you don’t, then they can persist. We believe there is a genetic predisposition that allows viruses to persist and trigger autoimmunity.  

But that’s not all that’s going on. Twin studies have shown us that two people with the same genetics and the same triggering virus, can have two completely different responses, all because of their terrain.

By the way, you can repair your immune system terrain with me LIVE beginning Tuesday, October 16th → The Immune Recovery Challenge Begins!

How do Viruses Trigger Autoimmunity?

When viruses linger in the body (again, most often because of terrain issues), it is called “chronic persistence.” This leads to an ongoing antiviral immune response, which can trigger autoimmunity in a few ways.

First, the chronic antiviral immune response at some point moves from being focused on the virus to targeting your own tissue. This can be because the immune response becomes less specific and it spreads to other tissues.

Second, autoimmunity happens because the virus is inside your cells or damaging them and your immune system appropriately is attacking the cells to get at the virus.

And finally, as the virus continues to spread its “proteins” around your body, there is mistaken identity as these proteins can look like your own tissue. We call this molecular mimicry.  

But you can see, no matter the mechanism, to prevent and treat autoimmunity that has been triggered by viruses, you want to make sure your immune terrain is functioning well so that the viruses are cleared out and not allowed to become chronic persisters.

Here is how to improve your terrain to create a robust and healthy immune system to clear out viruses:

  1. Nutrition:  
    1. Anti-inflammatory diet: whole foods rich in antioxidants, low in sugar, animal and processed fats;  elimination of foods that trigger inflammation including gluten and gmo foods. Less animal, more vegetable.
  2. Balanced hormones:  
    1. Stress system and adrenals are balanced and resilient
    2. Sex hormones:  good estrogen metabolism; adequate androgens to balance estrogens
  3. Healthy Gut:  
    1. Intestinal ecosystem:  adequate beneficial bacteria, good barrier function
    2. Digestion:  stomach acid, bile acids, pancreatic enzymes
  4. Well functioning liver:
    1. Maintain a low toxic load
    2. Clean up environment and make sure biotransformation pathways through liver are working well
    3. Support Estrogen detox pathways

Remember, you can’t avoid viruses! They are everywhere. Instead we work on creating resilience in the immune system so that the viruses don’t become chronic. To do this, we focus on the terrain of the immune system, which leads to the 4-step Immune System Recovery Plan, the focus of my first book on autoimmunity.

How You Can Repair Your Immune System with Me

I am teaching the Immune Recovery Challenge online beginning next week. It is the step-by-step companion to my book, The Immune System Recovery Plan. During the course, you will follow the 4-Step Immune System Recovery Plan together with me LIVE, using video and live coaching. It is a wonderful opportunity, and I hope you’ll join me!  

>>Yes, I Want to Repair My Immune System LIVE With Dr. Blum<<

If you haven’t read The Immune System Recovery Plan, you can find it HERE. In print around the world, it has transformed the lives of tens of thousands of people including my patients in my private practice.

 

References:  

Vieira et al.  Diet, microbiotia, and autoimmune diseases.  Lupus 2014 23: 518

Getts, D, et al.  Virus, infection, antiviral immunity, and autoimmunity.  Immunol Rev. 2013 September; 224 (1): 197-209.

Vanderlugt, C, and Miller, S.  Epitope spreading in immune-mediated diseases: implications for immunotherapy. Nature Reviews Immunology 2, 85–95 (1 February 2002)

 

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Summer Green Smoothie Instead of Coffee? You Bet!

Like most of you, I really love my morning coffee (my morning fuel of choice is espresso).  The nespresso machine in my kitchen has been an attractive nuisance since I bought it, making it way too easy to have one or two shots as I am revving up to start my day.  As August rolled around, I decided to do an experiment to see if my espresso was affecting how I felt, good or bad. To do this, I decided to kick the habit, and substitute my espresso for black tea (which also has caffeine), followed by a green smoothie made from contents of my garden. Yummy live food that I whipped up in my Nutrabullet.  And here is what I discovered.

It took a few days to adjust, but by day 3, I noticed that I was sleeping deeper and longer.  Since I was having my espresso only very early in the mornings, it shocked me that it had such a dramatic effect on my sleep so many hours later. I always thought that because I wasn’t having caffeine or coffee after 10 am, it wouldn’t make a difference.  Boy was I wrong!

I found myself sleeping later in the mornings and remembering my dreams.  If you are having any sleep issues whatever, I strongly recommend quitting coffee and see what happens!  It has been about 4 weeks now, and I am still sleeping great, feeling more rested in the mornings.

What I Learned About Green Smoothies

I used to be more of a berries-in-the-smoothie girl, but I switched to a more tart, savory drink instead of sweet.  You will see my recipe below. After my live, green, smoothie breakfast, I am zipping to work and buzzing with a better energy than I used to get from espresso!  I decided to write this blog to inspire those of you that read this, to try this experiment. The good news is that you can get greens triple washed and ready to use, making this smoothie super easy to make each morning.  I usually go out to the garden and add fresh parsley, rosemary, basil, or mint, in addition to the kale and spinach. You can customize this to your taste.

Here are the nutrition facts:

Total calories:  265;

Fat: 12.9 grams; Carbs: 34.6 grams; Fiber: 7.2 grams: Sugar: 17 grams; Protein: 11.2 grams

Green Smoothie Recipe:

½ apple, skin on

½ banana

½ cup Baby Kale

½ cup Baby spinach

1 TBL fresh lemon juice

1 TBL fresh lime juice

2 TBL organic Hemp seeds

1 cup cold filtered water

Optional:  A twig of rosemary and a handful parsley from the garden, or other herbs of your choice like a few leaves of mint or basil.

Put all ingredients in the Nutrabullet and enjoy!

 

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Dr. Susan Blum Sits Down with Dr. Frank Lipman and Talks “How to Be Well”

A pioneer in functional and integrative medicine, Dr. Frank Lipman is the founder and director of Eleven Eleven Wellness Center and a New York Times best-selling author. In his four decades of clinical experience, Dr. Lipman has helped thousands of patients heal and change their lives with his unique blend of ‘good medicine,’ which combines the best of modern medicine with the best of alternative and complementary medicines, and integrates essential elements from Chinese and functional medicine as well as nutrition, acupuncture, meditation, yoga and more.

In his newest book, How To Be Well: The Six Keys to a Happy and Healthy Life, Dr. Lipman gives readers the ultimate cut-to-the-chase, at-your-own pace, total wellness toolkit with which to build a lifetime of vitality, resilience  and good health.

Recently, Dr. Blum sat down with Dr. Lipman to talk about the new book. Here’s what he had to say:

You talk about a Good Medicine Mandala in the book, Explain?

For the book, I created my “new map for a new era of medicine” around a unique organizing structure: The Good Medicine Mandala. A mandala is a symbol used in many wisdom traditions of the world. Almost always a circle, it represents wholeness, potential, and the infinite. It represents the unknowable and the eternal and suggests a cosmos or even a universe; it depicts continuity—one ending is another beginning—and captures the wheel-like turning of time, seasons, and of course, our own human life.

As such, it is used as a tool for establishing sacred practice, especially in Eastern traditions. They deploy it in practices of meditation as a focal point of contemplation to help you gain awareness of the totality of your Self—from the rudest physical aspect of your human body to the immeasurable and expansive nature of your spirit. At its most fundamental level, the mandala is a symbol that restores order.

The Good Medicine Mandala is a circular system in which you, not a doctor or any other authority figure, stands at the center. It is an antidote to old-school linear thinking (which often, just boxes you in). Six rings surround you, representing the six spheres of life that, as an integrative physician trained in modalities of East and West, I know to be the pillars of long-lasting health. When you restore and/or optimize all these spheres, you lead the pack in terms of your standard of health and enjoyment of life.

Each of the six rings contains the blueprints for an abundance of small actions you can take, beginning right now, to improve and strengthen your resilience and functioning. In an echo of a traditional mandala, the Six Rings of Good Medicine ripple outward from the most material aspect of health—the food we eat—to the most subtle one—our sense of connection to the world at large. The Six Rings are:

How to Eat Well – mastering the very building blocks of life: food

How to Sleep Well – re-prioritizing and restoring one of your most fundamental needs

How to Move Well – supporting the body to move in all the ways that nature intended

How to Protect Well – mitigating and preventing the invisible assaults of everyday toxins

How to Unwind Well – consciously switching off to allow for complete mental and physiological reprieve

How to Connect Well – awakening and enhancing a sense of belonging and meaning

Within each ring, you will find the instructions for the essential habits, routines, and tactics that boost resilience and improve functioning. These are universal by design. The way you use them however, is personalized. You can navigate through these rings in several ways, depending on your personality and your individual preference for changes—deep and focused, or gradual and gentle.

What do you want readers to take-away from How To Be Well?

My goal is to show people the extraordinary power of ordinary actions, both small and large, done on a daily basis. Even just one new habit can have a surprisingly wide reach when it comes to the interconnected system that is our human body. Once established, each new habit creates a ripple effect, making the next new habit easier to embrace and ingrain. I want readers to have the tools they need to develop the habits that will, over time, ensure life-long vitality – looking good, feeling good, dodging dysfunction – and enjoying life!

To pre-order your copy and receive some free gifts, visit HowToBeWell.com/preorder and begin your How to Be Well journey!