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Fall Update on Supplement Usage During the Coronavirus Pandemic

As of 10.1.2020

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

As the pandemic wears on and the seasons change, we find ourselves preparing for winter, a time when we will be back inside with less opportunity to see people, connect and socialize, as we might have been doing in warmer weather.  I can say that for me, I am not looking forward to this and am trying to stay focused on and appreciate this moment, when we have beautiful fall weather in the Northeast.  I encourage you all to spend as much time outdoors as possible while you still can!  Of course I am also making a commitment to myself to bundle up and still make myself go outside this winter…we will see!  

Since the pandemic began, I have been updating my recommendations for using supplements to support your immune system.  As time keeps marching on, and we prepare for month #8, and the likelihood of a surge in COVID during the winter months, I thought I would go back and update my supplement recommendations.  It’s really important that we step up our game and renew our vigilance for protecting ourselves from getting sick, and if we do get COVID, to have a mild course of illness and recover quickly.  From a Functional/Integrative medicine perspective, we continue to focus on nutrients and herbs that have been well studied, for their ability to support, modify or boost the immune system, or to fight viruses.  

**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 

These are generally safe for those with Autoimmune Conditions. For pregnancy check dosing with your doctor.  We recommend that you take Vitamins D and C now at a minimum, and add Vitamin A and NAC if you are exposed or get sick. 

  • Vitamin D: 5000 IU daily in absence of serum levels from blood test   
  • Vitamin C: 1-3 grams daily
  • N-Acetylcysteine (NAC): 600 – 900 mg twice/day (precursor for Glutathione (GSH), or can take GSH
  • Vitamin A: up to 10,000 – 25,000 IU/day (not safe for pregnancy)

We do not recommend the following supplements for those with Autoimmune Conditions or pregnancy.We recommend that you take 1 of the following at the recommended dose, or a blend that includes several of these, in which a lower dose of each are typically used:

  • Elderberry: 500 mg daily (of USP standard of 17% anthocyanosides)
  • Beta Glucans: 250 – 500 mg daily
  • Mushrooms: Shiitake, Lion’s mane, Maitake, Reishi. D Mushrooms: Shiitake, Lion’s mane, Maitake, Reishi. Dose depends on preparation
  • Astragalus: Dose depends on preparation
  • Echinacea: Dose depends on preparation
  • Andrographis: 200 mg/day

To make this easy for you, we added our favorite herbal blend to our store, called Immune Support. You can read more about it HERE.

Anti-Viral Supplements

These are generally safe for those with Autoimmune Conditions. For pregnancy, check dosing with your doctor.
We recommend that you take Zinc and add Quercetin if you are exposed or get sick:

  • Zinc: 30 – 60 mg daily in divided doses
  • Quercetin: 1 gram twice/day. Phytosome: 500 mg twice/day

At we offer our signature Antiviral Bundle, with all the supplements you need to keep your immune system strong, plus a Mediterranean Food Plan to follow! Check it out here.

Reduce Cytokine Storm

The illness caused by coronavirus, COVID-19, can cause a “runaway train” of inflammation in some people, causing terrible tissue and organ damage that can lead to the worst outcomes. This group of herbs and supplements appear effective in turning off this overactive immune response and helping bring the immune system back into balance. 

These are generally safe to use for those with Autoimmune Conditions. For pregnancy check dosing with your doctor.

We recommend that you choose a minimum of 1 of the following and add more if you get sick:

  • Curcumin: 500 – 1000 mg twice/day. Choose absorption enhanced.  
  • EGCG: 4 cups daily or 225 mg daily.
  • Resveratrol: 100 – 150 mg/day
  • Melatonin: 5-20 mg/day

Remember, you should also be focused on improving the functioning of your immune foundations.  Here are the things you should continue to 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 and join our 10-Day Spring HealMyGut Coaching Program
  • 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!

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It’s Flu Season – Is the Flu Shot Right for You

Every year, this is a common question I get asked from our patients and also submitted by the public on social media and online. This year it’s even more confusing and the answers aren’t easy for many with chronic illness or autoimmune conditions.  It doesn’t help that public health officials and the media are promoting the flu shot as a critical part of the fight against COVID-19.  The main concern is that people could get both illnesses at the same time, which would increase the risks of severe complications or death if this happened.  

However, let me just add a few words of calm into this storm.  First, if you are a high risk person and quarantining this winter, or at least being extremely cautious and wearing a mask and maintaining social distance guidelines when outside your home or your “quarantine bubble”, then you are unlikely to get either the flu or Covid.  The same measures you are doing not to get coronavirus will drastically reduce your likelihood of getting the flu.  

I think we need to continue to discuss the flu shot in the same context that I have talked about it for years.  In my opinion, all medical decisions should be based on comparing the risks vs. benefits of any medication or treatment for each individual person. This approach is called Personalized Medicine, and how we approach all treatment decisions through the lens of Functional Medicine at Blum Center for Health.  What is good for your friend might not be good for you.


In general I do recommend the flu shot, especially this year, for people who could likely become hospitalized or die from getting the flu: children, anyone over 65; those with pulmonary or respiratory diseases like asthma and emphysema; and people with any chronic illnesses like cancer or severe/life threatening illnesses.  And for those at high risk of becoming hospitalized or dying from COVID:  people with obesity, diabetes, high blood pressure, cardiovascular disease.  Also important to note, if you are a caretaker for the elderly or anyone at home who fits the criteria above, or if you are a parent to children living at home, these would be additional situations you need to keep in mind as accepted indications for receiving the influenza vaccination.  And this holds true for this winter, during the COVID pandemic.

However, on the flip side, some people with autoimmune conditions, or who take immune suppressing medications, should talk to their doctor before getting the shot.  The aluminum used as adjuvants, and the mercury used as preservatives, can cause side effects or flares for those with autoimmunity, and those on certain immune suppressing medication might not even become immune after getting the vaccine.  For you, it is a personalized decision and I cannot give you medical advice about that here.  But it might be that during this pandemic, your decision might be different than it usually is.

In either case, my approach is to help you build a strong immune foundation so that you 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. This is, by far, the best prevention and protection! 

Click here for more on supplement recommendations to strengthen your immune system.

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The Truth About Fiber

Fiber. It’s not a very…sexy topic. Just the word conjures up images of Metamucil commercials with the sandy-looking granules swirling in a glass and promises of being “regular.” But the benefits of a whole food, high fiber diet are many and certainly extend beyond the water closet.

Most Americans are fiber deficient—some experts in the functional medicine community claim that it’s the most clinically important dietary deficiency, a deficiency largely due to the Standard American Diet (SAD), which doesn’t favor whole, nutrient-dense foods like fruits and vegetables (complex carbs) and is chock full of sugar and processed carbohydrates in the form of “junk flour” (conventional bread, pasta, bagels, etc. (simple carbs)).

Unlike macronutrients (fat, protein, and carbohydrates) that our bodies break down and absorb, dietary fiber (also known as roughage or bulk) isn’t actually digested. It comes in two forms, soluble and insoluble; both are essential and can be obtained from a wide variety of delicious, high-fiber foods like true whole grains (vs. flour), fruits, vegetables, nuts, seeds, and legumes, which indeed, are mostly carbohydrates. (If you’re aghast at the suggestion to consider whole grains and/or legumes, you can read my prior post for Dr. Blum, In Defense of Grains and read my post[JG1] , In Defense of Legumes.)

Because of the common fiber-constipation association (you’re not allowed to laugh if you’ve never had it), many may not be aware of the many other benefits of adequate fiber intake:

  •       Promotes weight loss: What if I told you that fiber may be your best friend if you’re trying to lose weight? According to Monica Reinagle, licensed nutritionist, “Trying to lose weight on a low-fiber diet is like parallel parking without power steering.” Foods rich in fiber are filling, which means you eat less and stay fuller longer.
  •       Lowers risk of digestive conditions such as irritable bowel syndrome
  •       Lowers risk of heart disease by getting rid of digestive debris and environmental toxins and keeping bad cholesterol in check.
  •       Lowers risk of diabetes: Researchers are now finding that the fiber in grains specifically lowers the risk of diabetes. A September 2018 study from The Journal of Nutrition that followed 55,000 middle-aged women and men for 15 years discovered that those who consumed the most whole grains had the lowest risk of Type 2 diabetes.
  •       Lowers risk of stroke
  •       Provides fuel for the microbiome: You may be thinking…What?? I thought I was supposed to be low-carb to heal my gut and reverse my autoimmune condition. Read on!

Low Carb, Low Fiber?

We can’t discuss the important role of fiber and sidestep the carb conversation, given that so many gut-healing, immune modulatory diets eschew—or largely eschew—carbs and that fiber-rich foods are largely carbohydrates.

Fact: A low-carb diet, with its overreliance on fat and protein and under-reliance on complex carbs in the form of whole grains, legumes, and vegetables (including—and especially—starchy vegetables like sweet potatoes, yams, squash, carrots, etc.), tends to be low-fiber.

The importance of fiber in the diet is indisputable and has a profound impact on our digestive health and microbiome, our 100 trillion organism-strong “mini ecosystem” also known as “the forgotten organ.”

Justin Sonnenburg, PhD and Associate Professor of Microbiology and Immunology at Stanford, is the author of The Good Gut, co-authored by his wife, Erica Sonnenburg, PhD. The Sonnenburgs are considered some of today’s preeminent experts on digestive health and in the science of the fibers found in grains and their role in providing an important fuel source for the microbiome.

Justin says, “You have to ask the question of what it means when we’re consuming 15 grams of dietary fiber per day instead of 150—a 10-fold decrease in the foods that feed our gut microbe.”

In their book, The Good Gut, the Sonnenburgs state, “Increasing dietary fiber is essential to cultivating diversity in the microbiota. Microbes in the gut thrive on the complex carbohydrates that dietary fiber is primarily composed of. But rather than ‘dietary fiber,’ we prefer ‘microbiota accessible carbohydrates,’ or MACs. MACs are the components within dietary fiber that gut microbes feed on. Eating more MACs can provide more nourishment to the microbiota, help gut microbes thrive, and improve the diversity of this community. Our family eats what we jokingly refer to as a ‘Big MAC diet.’ This diet is rich in complex carbohydrates from fruit, vegetables, legumes, and unrefined whole grains, and is designed to create and maintain diversity within the gut microbiota.”

Dr. John Douillard states, “While fiber is linked to heart health, it is also critical for the protective health of the intestinal skin. If the intestinal skin breaks down, the beneficial gut microbes disappear.”

If you’re still unconvinced that grains and legumes can be part of a gut healing protocol, Dr. Susan Blum mentions quinoa, amaranth, millet, teff, buckwheat, various types of rice, and legumes in her book, The Immune System Recovery Plan, and incorporates these foods in several of her recipes. She calls them “foods to include” and states, “Fit lots of fiber onto your plate in the form of veggies, low sugar fruit like berries and apples, whole gluten-free grains, and legumes—to feed the good bacteria of the gut.”

It’s Easy to Get Enough

If you think you may be fiber deficient, slow and steady wins the race. Going overboard and increasing your intake with gusto can cause gut distress. And drink plenty of water.

Regardless of any deficiency, we all need regular fiber in our diet. At the end of the day, if you’re committed to a whole foods diet rich in color and variety, you’re likely getting the fiber that you need.

  •       Add nuts and seeds (especially flaxseeds and chia) to whole grain cereals, salads, soups, and smoothies
  •       Snack on raw veggies
  •       Legumes/beans play well with others; use them in soups, salads and many of your other favorite dishes
  •       Choose true whole grain foods vs. refined grains
  •       Eat fruit as a dessert or snack; the skin and/or seeds is where you’ll get the most fiber. Berries are a great choice, as they’re low on the glycemic index. Apples and pears are the best skin-on fruits.
  •       Incorporate all kinds of vegetables into every meal. In general, the darker the veggie, the higher the fiber. Get all that you can—it all counts!


Jill Grunewald, HNC, FMCHC, is the founder of Healthful Elements, an alopecia expert, and best selling author of The Essential Thyroid Cookbook.


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It’s Summer! Which cocktail is best for me?

Here’s a common question: It’s summer and I really want a cocktail, will having one ruin all my hard work?

Ahh, summertime … cocktail parties, bbq’s, dinner alfresco, family gatherings, rooftop parties … add a little heat, add the celebratory nature of being outside and you’ve got the perfect recipe for cocktail time.

Whether you’ve got a hankering for gin, vodka or tequila, there are a few things you should know.

The good news: If you’re in good health, and at low risk for cancer, then alcohol in moderation is likely okay. What is moderation? A few social drinks a week. There’s no need to drink every day, afterall, plan for them — wait for the rooftop get-together or the weekend summertime bash.

What you need to know about summer cocktails: 

Any amount of alcohol consumption of any kind, increases your risk for cancer. If you are concerned about cancer because you have a strong family history, or you have had cancer yourself, you should not drink. Period. Does this mean that an occasional glass of wine or cocktail will hurt you? Probably not. But chronic daily consumption, or drinking several days every week, is not a good idea.

Alcohol stresses your liver. Alcohol is viewed as a toxin by the body and needs to be processed in the liver just like mercury, pesticides, plastics and everything else you are exposed to in the environment. If you have known issues with your liver, other toxin exposure like mold or heavy metals or pesticides that are causing issues with your health, you shouldn’t drink, or only consume alcohol on occasion. If you have multiple chemical sensitivities, such as you can’t tolerate smells like perfume or cigarette smoke, this can be a sign that your liver is stressed with too many toxins.

TIP: Pad the lining of your stomach before drinking alcohol with healthy fats like nuts and seeds, avocado, or something made with olive oil or coconut oil.  This will slow the emptying time of the stomach so that alcohol will be absorbed slowly into the body, allowing you to excrete it more easily and then resulting in less accumulation of toxins.

Alcoholic beverages are high in sugar. If you have diabetes, insulin resistance, metabolic syndrome, or are trying to lose weight, keep In mind that when you drink a glass of wine or a cocktail mixed with juice, you are consuming a glass of sugar. This can trigger cravings for bread and dessert and other high starch foods, and cause you to make poor food choices that undermine your healthy eating goals. 

TIP: Be sure to skip the mixers and choose low sugar options, such as a cocktail with club soda or fresh lime juice.

All alcoholic drinks are dehydrating. Alcohol is a diuretic, meaning you might notice you’re running to the bathroom more often. Alcohol suppresses the hormone that regulates how much urine we produce. And, all the added trips to the bathroom strip water and electrolytes from the body. Even a small amount of alcohol can make you feel like you have a hangover.

TIP: Drink two glasses of water for every alcoholic drink you consume. Be sure to hydrate during the day as well. 

Better yet, give our delicious Blueberry Lime Margarita Mocktail a try. Put it in a beautiful glass with a spring of mint, and you won’t even miss the alcohol! Get the Recipe


Feeling like you’ve been having a little too much fun this summer — feeling bloated, heavy or out of control and need a quick, effective reset? Check out our HealMyGut Summer Reboot. Relief is on the way! Get Our Special Summer Reboot


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


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10 Steps To Refresh Your Body For Spring

Spring is here, a perfect time to refresh! This is the time when we give our body the nourishment it needs to support its innate ability to regenerate and thrive!

Feeling any of the following symptoms: sluggish, lack of clarity, chronic headaches, poor sleep, constipation, undesired weight gain?  If you do, your body is yelling out to you…it’s time to refresh!

On a day-to-day basis we encounter an overload from unhealthy exposures such as:

  • chemicals in the air
  • mercury in fish
  • medications and bacteria in the water supply
  • pesticides in food
  • even plastics from water bottles

Our liver and kidneys do a great job to filter these exposures but sometimes this load can cause strain on these organs.

What happens if our bodies become overburdened with toxins? Our immune systems become compromised because our liver is using up our glutathione supply, not to mention many other nutrients, to filter these toxins out. Glutathione is a powerful detoxifying antioxidant necessary to prevent damage to our cells.

When our immune system is not functioning optimally we get run down and become susceptible to infections and are at risk for developing disease. Plus, our fat cells do a great job of storing toxins resulting in excess weight. In fact, this is why we at Blum Center for Health detox every Spring. → Join Dr. Blum’s FREE Detox Masterclass

So how about you? It’s time to refresh, and give your body a boost!

First, 5 things to avoid when flushing your liver and kidneys:

Ø  AVOID prolonged detox programs that require severe calorie restrictions, < 500 calories a day, or 3 days or more. A starvation plan like this will deplete your nutrients instead of supporting your detox pathways. It will also put you at risk of dehydration, headaches and fatigue. Ultimately this puts the body in stress mode rather than reboot and go!

Ø  AVOID energy drinks with sugars and excessive caffeine, as well as “detox” drinks containing additives, color dyes and sugar sweeteners. We can’t refresh when we are adding more toxic substances.

Ø  AVOID diet plans that ask you to eat one food all day for many days such as the watermelon fast. I think the jury is out on this one! This type of diet promotes macronutrient deficiencies, calorie deficit, hormonal imbalance and more!

Ø  AVOID laxatives and colonics without adequate mineral and electrolyte replenishment or good flora to support your immune system. These types of procedures may be considered somewhat of an extreme way to detox and can be better achieved through a whole foods diet plan. Besides, colonics are not fun by any means and often result in nausea and abdominal pain.

Ø  AVOID any detox type diets for children and teenagers who are growing and require many calories and nutrients. Healthier ways of refreshing their bodies can be found in a simple elimination diets that only requires them to omit common allergens as well as sugars, additivities and color dyes.

Most  importantly,  you must know i how to cleanse and refresh your body, promote nourishment and gut healing.

10 Steps to Refresh Your Body for Spring:

1)Eat only whole foods, avoiding food that is highly processed, void of essential nutrients and generally full of unwanted additives and chemicals. The Spring is here! Look for fresh produce at local farmers markets where food was recently harvested containing more nutrients and taste delicious! See to find one near you!

2) Remove sugar from your diet. One of the most important things you can do for your health is to stop eating sugar. Sugar in all forms can be toxic for the body putting you at risk for fatty liver, heart disease, obesity and diabetes. Stick with natural sugars found in fresh fruits or other whole foods such as raw honey or pure maple syrup added in small quantities to a recipe.

3) Pay attention to your body and how it feels after eating certain foods. Consider a 3-week elimination diet from common allergens and/or inflammatory foods such as dairy, gluten, soy, sugar, alcohol. Each person responds differently to foods and not all foods that are consider “healthy” are right YOUR body. For some, an additional benefit can be seen from removing nuts, shellfish and nightshade vegetables that sometimes serve as inflammatory foods in the body. Reintroduce these foods one at a time every 2 to 3 days and take note to symptoms, if any after consuming the. Looking for a medically supervised elimination diet, come in for a nutrition consultation! We will take you every step of the way.

4) Eat an abundance of vegetables in your diet each day including a variety of sulfur-rich sources such as cruciferous vegetables. Best picks for the Spring include cabbage, broccoli, asparagus, collard greens, garlic, onions, and Swiss chard. My favorite is Bok Choy. Sulfur is an essential mineral that supports methylation and transsulfuration, optimizing the liver’s detoxification system.

If you cannot tolerate the sulfur in these vegetables, you’re not alone. Some people have genomic dispositions that affect these metabolic pathways. Add at least one serving day of sulfur-containing vegetables along with a vitamin known as molybdenum. Include a variety of vegetables and fibrous fruits such as berries to provide beneficial fiber, an important part of the elimination of excess waste in the body.

5) Hydrate! Drinking adequate water ensures good filtration of the kidneys, digestion, and bowel regularity. Eliminating waste in the body is vital to preventing toxic overload in the body. As a general rule, drink half your body weight (in pounds) as ounces. When exercising and in the warmer months, add more! Add fresh lemon and receive even more benefits for your liver. Consider a good water filtration system that uses a carbon filter.

6) Purge your home from harmful chemicals and environmental pollutants. Dump the harsh chemical cleaners and opt for a simple but effective solution of equal parts of water and vinegar. Be aware of harmful substances in your cosmetics and toiletries such as oxybenzone, parabens, and phthalates. Add an air purifier and/or a green plant.

7) Make time to unwind. Making time to rest in today’s fast pace world we often need to be reminded to do. Incorporate some kind of stress reduction modality each day whether it be a massage, a hot bath or reading a book of interest. Get closer to the earth with a walk-through nature or earthing (sinking your feet into the sand). Find THAT THING that relaxes you and plan to make it part of your day because it will be the best part by far!

8) Consider intermittent fasting. Intermittent fasting is generally considered a time period of caloric restriction such as 14-16 hours a day. When we “fast” it gives our body time to digest and ultimately deplete our glycogen stores (stored liver glucose). When this happens, our body looks for another source of energy to function in which it then uses our fat stores via a system known as B-oxidation. This energy source is known as ketones. This state results in the generation of new mitochondria, reduced insulin resistance and weight loss,2. As many positives as there may be with including some period of fasting in your diet, there can be some risks for some medical conditions. Talk with your Practitioner when considering fasting as well as what kind of fasting is the best fit for you.

9) Sleep! Sleep! Sleep! Studies will confirm that a lack of sleep correlates with a lack of concentration, weight gain, poor eating habits, as well as puts stress on your immune system. The best way to make sure you include adequate sleep each day is to plan it. Set a bedtime each day by shutting your electronics off at a certain hour while setting up a bedtime routine to help you unwind at the end of the day. Shoot for a minimum of 7-9 hours a night.

10) Be positive! Ever spend time around someone who’s energy is addictive? If you ask me, being pessimistic is nonproductive. Saying something nice to someone will not only make that person happy but in return reward you at the same time!

Other refreshing rituals that can be adapted include, meditation, dry brushing, infrared saunas and gentle movement such as restorative yoga, stretching and rebounding.                        

Look to refresh at least 2 times a year or more. Start each day with an alkaline green smoothie. Plan for a casual hike and a calming magnesium bath before bed. However you choose to set up this day, remember you deserve it and your body will thank you.


Keri Lynn MacElhinney, RD, CDN, CLT, IFNCP is a Functional Medicine Nutritionist at Blum Center for Health.  She has over 20 years of professional experience as a Registered Dietitian and holds a nutrition license in New York and the State of Connecticut. In her early years, her field experience covered a wide array of areas including acute care hospitals, community health centers, substance abuse.  Make an appointment with Keri Lynn at 914-652-7800.

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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 and begin your How to Be Well journey!


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Testing and Treatment for Traumatic Brain Injury (TBI) (Part 1)

In the United States, there are more than 3.5 million emergency department visits for TBI, which may be categorized as mild, moderate or severe. There are also many more individuals who may never seek medical attention. The majority of TBI cases are classified as mild TBI (mTBI). Approximately half of patients with TBI in the United States experience some form of short-term disability. However, brain injury after significant trauma has been associated with an increased risk of Alzheimer disease and seizures and repetitive TBIs is a risk factor for chronic traumatic encephalopathy(CTE) and Parkinson’s disease.

Very often, TBI after a concussive injury is not managed beyond an ER visit where a CT scan may or may not be performed. Acute hospitalization or Neurological follow up are usually only recommended if there is loss of consciousness or evidence of serious injury. Brain imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are often used but unfortunately can be interpreted as being “negative” or normal despite the fact that brain injury is present.

The good news is that there are now better options, including using biomarkers, newer brain imaging modalities and laboratory diagnostics, that can help make a diagnosis of TBI.  And these advances also make it possible to help identify the degree of brain injury after TBI and direct better treatment. Here we will focus on biomarkers and laboratory testing, and in my next blog we will focus on brain imaging.

Hormone Imbalances in TBI

Depending on the degree of brain injury, approximately 10-20% of patients with TBI can develop hormonal imbalances, including pituitary insufficiency. The pituitary gland is the factory for hormone production involving growth, reproduction, thyroid, etc.

  • Growth hormone deficiency (GHD) is one of the most frequent pituitary disturbances after TBI, followed by gonadotropin (sex hormones such as the precursors for testosterone), cortisol and thyroid-stimulating hormone insufficiency. Common symptoms after TBI, such as memory and concentration difficulties, anxiety, depression, social isolation, weight gain, bone loss, and exercise intolerance can be symptoms directly related to TBI or hormone imbalances.
  • We can measure subnormal Growth Hormone levels by measuring the levels of insulin-like growth factor-1 (IGF-1) which is used as a surrogate biomarker for Growth hormone. But results of IGF1 are often normal, and therefore reliance on IGF-1 as an assessment of GH function after TBI may be misleading.

Specific Hormone Assays to Evaluate TBI

Here are the tests you should ask your doctor to do, for a better evaluation of the severity of your TBI or head injury.  

  • After an overnight fast, serum levels of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), follicle stimulating hormone (FSH), luteinizing hormone (LH), total and free testosterone (males only), estradiol, cortisol (a.m.) and IGF-1 are measured at  baseline.  
  • Serum and urine sodium and osmolality and urine specific gravity are also collected to assess posterior pituitary function.
  • For Growth hormone (GH) deficiency, Glucagon, 1mg is administered intramuscularly, and blood (serum) is drawn at baseline, 90, 120, 150, and 180min to measure GH.

Integrative Treatment (non-pharmaceutical)

Here are some suggestions for repairing the hormone imbalance caused by TBI:


  • Vitamin D3/week has been shown to significantly raise IGF1 levels.
  • Angelica sinesis is a natural herbal treatment that contains polysaccharides such as  arabinose, rhamnose, and mannose which act to  stimulate IGF1/IGF1R gene expression.
  • Andrographolide is another herbal treatment has been shown to decrease levels of NSE, S-100β, and IL-6, inflammatory factors that are frequently elevated in TBI patients. . Andrographolides may help to  turns off the over-reactive inflammatory response related to alterations in blood brain barrier permeability, a frequent occurrence in TBI patients that may account for inflammation.
  • Resolvins are bioactive novel endogenous products which are metabolites of the polyunsaturated ω-3 fatty acids. They have potent anti-inflammatory and pro-resolution effects in the brain. I will discuss these in more detail in my upcoming blog on the use of biomarkers in TBI related to inflammation and neurodegeneration.
  • Nucelotides such as Inosine and Cytidine have been shown to activate repair mechanisms after brain injury and potentially promote remyelination.

Medical Options to Treat Hormone Imbalance from TBI

  • Growth hormone replacement if clinically indicated (GH of <3ng/mL is considered as being deficient and in need of GH treatment). GH replacement therapy 0.3 mg/day to 1 mg/day, showed significant improvement in cognitive functions. Ideally, these treatments are best given under the supervision of an Endocrinologist.
  • Cortisol replacement, such as low doses of hydrocortisone can be used if clinically warranted and if there are no contraindications.
  • In human studies, intranasal insulin has been shown to enhance memory. Clinical studies using 10 IU of insulin twice a day nasal drug delivery device designed to deliver drugs to the olfactory region are currently ongoing.
  • Cerebrolysin, a neuropeptide preparation of porcine origin, consists of neuropeptides and free amino acids and has been shown to enhance nerve growth and capable of stimulating the restorative capacity of the brain after injury. It is approved in Europe for recovery after brain injury but can only be administered in IV fashion.

In my next blog, I will review advances in brain imaging for TBI patients including SPECT, MRI, DTI and PET studies, as well as novel blood tests that assess tau protein, enolase and S100B. These can be utilized to help develop a unique treatment program for patients with TBI.

Meet Dr. Lombard: Dr. Jay Lombard is an Integrative Neurologist and co-founder of Genomind. He maintains a private practice at the Blum Center in Rye Brook, NY where he is known as the brain detective because of his ongoing research in patients with complex neuropsychiatric disorders.

Make an appointment:  If you live in our area, Dr. Lombard is available for in-person appointments at Blum Center for Health.  If you don’t live nearby and would like to work with Dr. Lombard, he is available for remote consultations via video or phone.  Please use this link to make an appointment.