Out of the Fog

Out of the Fog: Strategies to Prevent Brain Fog and Sharpen Cognitive Function

It’s easy to take your mental health for granted until one day you realize that you haven’t been feeling as mentally sharp as you once were. Maybe you’re having more frequent slips in memory or you feel like you’re walking around with your head in a cloud. When these moments occur, you may be quick to dismiss them, but brain fog, in a sense, is the body’s way of indicating that the brain is not working the way it’s supposed to be. So, what is brain fog and why does it happen?

Brain fog is not an actual clinical condition, but rather a term for a subjective set of symptoms that people experience. Some may be affected by poor concentration or a decrease in intellectual productivity, while others may experience memory problems (difficulty with recalling words, details, etc.). Other symptoms can include feelings of confusion, depression, and headaches. People of any age and gender can experience any one or all of these symptoms at any given time.

These changes in cognitive function are not only mentally exhausting, but they can also have a very real effect on a person’s emotional wellbeing. Operating in a reduced state of mental acuity can knock down a person’s self-confidence, cause workplace productivity to suffer, and may even be a reason to withdraw from social outings. But it’s important to understand that brain fog is not a normal part of the aging process.

There are many factors that can initiate symptoms of brain fog; some that you may not think are related. Unlike dementia, which can be permanent, and in some cases, progressive, brain fog symptoms are likely to improve when contributing factors are addressed.

Here are 6 common contributors with tips on what you can do to improve or even eliminate your symptoms altogether.


1. Poor nutrition.

The connection between the brain and the gut is also known as the “gut-brain axis.” It’s a bi-directional connection, which means that the gut and the brain essentially speak to each other. This means that when the integrity of one component is compromised, the other is directly affected. Therefore, poor nutritional choices will have a direct effect on brain function.

Highly processed meals and drinks that are loaded with simple sugars and other artificial ingredients can cause a disruption in the gut flora and lead to a condition called intestinal permeability, or leaky gut. When the gut lining is weakened unwanted substances are able to break through the protective filter between the intestines and our bloodstream. The are several issues that then become a problem. The first is that the body will start to make antibodies to foods, causing allergies to foods we would not have been sensitive to when the intestine was healthy. The other issue is that when the intestinal barrier is impaired, the barrier around the brain that helps protect our brains from immune substances floating in the blood now can enter the brain and incite an inflammatory reaction. This can show up as fatigue, sleep disturbances and alterations in mood, anxiety, and depression, and brain fog.

In addition, common food additives like aspartame, Monosodium Glutamate (MSG), and nitrates/nitrites promote widespread inflammation and oxidative stress by producing free radicals that cause damage to brain cells and DNA when they overwhelm antioxidant levels in the body.

Solution: We should never take our food choices for granted! There are things that can be done nutritionally to help clear brain fog, boost energy, and increase productivity. Start by cutting down on processed foods and eating whole, organic, and non-GMO foods whenever possible. Next, eat probiotic-rich foods to help balance your gut flora and get rid of harmful bacteria. Probiotic-rich foods include sauerkraut, kimchi, Kombucha (watch out for sugar content), and kefir. If you have trouble getting these foods onto your plate, another great way to get good bacteria into your diet is supplementing with a daily probiotic.

2. Biotoxicity and Neurotoxicity

Biotoxins and neurotoxins are environmental toxins that can poison our physical and mental health. As toxins penetrate the blood-brain barrier, they are free to circulate throughout the body – including the brain! Once there, the glial cells that work to defend the nerves and brain cells from damage are compromised and unable to do their job. Although the symptoms vary, a common complaint of someone diagnosed with some form of toxicity is brain fog.

Solution: Eliminating biotoxins and neurotoxins from your home is the first step in any detoxification process. This may mean professional removal of mold-infested areas, air purification, and a change to buying “green” products that do not contain harmful ingredients like pesticides and other toxic ingredients. You’ll also need to make changes to your diet to exclude food items that may contribute to leaky gut. A compromised gut lining will allow more toxic substances to circulate through your body instead of being eliminated. If you have symptoms of brain fog talk to your physician about whether getting tested for the presence of biotoxins or neurotoxins make sense for you.

3. Sleep Disorders

In the United States, as many as one-third of adults do not get the quality of sleep the body requires. It’s during sleep when the body is able to repair itself by calming inflammation and maintaining hormone production. When these two processes – both important elements in brain health – are compromised it can negatively impact your memory, decision-making, the capacity to focus one’s attention, and the ability to complete complex creative activities, among other things.

Solution: There are a lot of things you can do to improve your sleep pattern. Breathing techniques, meditation, dietary adjustments, starting an exercise routine (or adjusting your current one), and establishing a bedtime routine are just a few examples.
If you think you may have an actual sleep disorder, a first step in further evaluation is to answer the eight questions on the Epworth Sleepiness Scale. If your score is equal to, or higher, than 10 the results should be discussed with your doctor.

4. Celiac Disease

People with Celiac Disease (CD) are no strangers to brain fog. Just like poor nutritional choices can lead to leaky gut, so can an allergy or sensitivity to gluten. The difference is, with Celiac Disease your immune system mistakes gluten, a normally benign food ingredient for most, as a foreign and deadly invader. When it’s detected in the body, the immune system begins to attack and destroy the gut lining and causes leaky gut. Once the villi are damaged the body is unable to absorb the nutrients it needs to keep the brain and body healthy and allows harmful substances to enter. Brain fog is a common symptom of people who are ultimately diagnosed with Celiac Disease or gluten intolerance.

Solution: Patients who have been diagnosed with Celiac disease and/or gluten intolerance report a noticeable and significant improvement in cognitive impairment after eliminating gluten from their diet.

5. Estrogen

In women, the onset of menopause can trigger a myriad of symptoms including fatigue, weight gain, mood swings, hot flashes, joint pain, and brain fog. Research suggests that when it comes to changes in memory and other mild cognitive impairments that accompany menopause, the decline of estrogen levels may be partly to blame. We know that the brain is full of estrogen receptors that have neuroprotective and antioxidant benefits. The decline of estrogen during menopause compromises neuronal function and increases the risk of developing age-related neurodegenerative disorders.

Solution: Although there is no single solution that works for every woman, bioidentical hormone replacement therapy can relieve many of the unpleasant symptoms that most women experience during menopause, including brain fog. Talk to your doctor about a screening that will help identify hormonal imbalances so they can be effectively treated.

6. Side-Effects from Medication

Statistics show that over 20% of US adults report using 3 or more prescription drugs in the past 30 days and nearly 12% use 5 or more. Additionally, it’s not unusual that patients receive prescriptions from specialists in addition to their primary care physician, and supplement use is not always reported accurately. This leaves a lot of room for unwanted side effects, including brain fog.

Solution: Make sure to review your medications with your primary physician annually, and more often if necessary, particularly if you feel like you haven’t been yourself.

In sum, the good news about brain fog is that there are ways to help clear it up, boost your energy, and improve your productivity and memory. The key is keeping your brain well-fed, your body well-rested, and keeping your physician in the know about any changes in your mental acuity.

For individuals who would like to work directly with our providers, we offer comprehensive services that utilize the best alternative and conventional medicine solutions to keep your brain young, healthy, and vital. For more information, visit KaplanClinic.com/building-a-better-brain/. To make an appointment with one of our physicians please call 703-532-4892.


Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology. 2015;28(2):203-209.

Jedrychowski, Et al. Cognitive function of 6-year old children exposed to mold-contaminated homes in early postnatal period. Prospective birth cohort study in Poland. Physiology & Behavior. Volume 104, Issue 5, 24 October 2011.

Lichtwark , Et al. Cognitive impairment in coeliac disease improves on a gluten‐free diet and correlates with histological and serological indices of disease severity. Alimentary Pharmacology & Therapeutics. Volume 40, Issue 2, July 2014.

Yelland GW, Gluten-induced cognitive impairment (“brain fog”) in coeliac disease. Journal of Gastroenterology and Hepatology. 2017 Mar; 32 Suppl 1:90-93. doi: 10.1111/jgh.13706.

Zárate S, Stevnsner T, Gredilla R. Role of Estrogen and Other Sex Hormones in Brain Aging. Neuroprotection and DNA Repair. Frontiers in Aging Neuroscience. 2017;9:430. Published 2017 Dec 22. doi:10

Want to Take Your Workout to the Next Level? These Tips May Help

This is the time of year that many of us choose to upgrade work-out programs or maybe even start a new one. A successful fitness regimen requires thoughtful decision making and pre-workout preparation so you can get started, get the most out of your workouts, and ultimately meet your goals. Here are some tips from a functional medicine perspective on how to do just that and some insight on factors that may unknowingly hinder your progress.

Vitality and motivation are fundamental to feeling capable of healthy exercise and maintaining endurance.

If a lack of energy and motivation is keeping you from starting a new fitness program or taking an existing one to the next level, it may be a sign of a hormonal imbalance or another health issue coming to the surface.

Heart health, respiratory health, being free of allergies (especially, if working out outside), adrenal health, hormonal health, and thyroid health all affect your motivation levels and vitality.  If any of these areas of health are out of balance, working out can prove challenging or even leave you feeling more depleted and unwilling to work out again. Here are some examples:

  • low testosterone level for men or women may lead to low motivation, poor focus, lack of endurance, and poor workout recovery.
  • Adrenal Dysfunction leads to unbalanced stress hormones that may make you feel too tired to work out and leave you exhausted afterward.
  • Poor heart health could be exacerbated with a new work out if not diagnosed and dealt with by your physician.
  • Underlying lung disease may make your workouts difficult to get through. This is affected by inflammation, often in the gut.
  • Low thyroid function may make you too fatigued to make it to the gym.

Functional medicine physicians evaluate core systems in the body and apply targeted interventions to correct and optimize areas that are indicating a dysfunction. Once those areas are addressed, your body will be restored with the vitality and motivation needed to focus on your fitness goals.

Are you too inflamed to work out?

Sometimes people are riddled with inflammation in the joints, ligaments, sinuses, and other areas of the body, and feel physically incapable of working out. Inflammation can be diagnosed and decreased or eliminated to better support you with an appropriate and healthy exercise regimen.

There are a lot of ways to lower inflammation without taking medication, like dietary modifications (more on diet and inflammation below!) and other proven techniques like acupuncturemeditation to lower stressIV therapy and/or supplementation.

Are you eating a diet that energizes and supports you, or further depletes and inflames you?

Food should nourish and energize you. Many of us are unaware that we are eating foods that are inflaming us rather than supporting us. This leaves us feeling heavier and more fatigued and often less motivated to work out.

You may want to evaluate if you have food sensitivities or allergies that are creating more inflammation than providing nourishment. Sometimes we find that even the healthy foods people are eating are inflaming their bodies including joints, digestive tract, sinuses and more.

You may also want to determine if you have any key nutrient deficiencies that may be less than supportive of your exercise efforts, energy and vitality.

The key to leveraging the benefits of exercise is to know which workout best suits you based on your individual health picture.

There are many workouts out there so picking the right one for your unique health profile is crucial to staying motivated enough to continue and see results. For instance, if you have adrenal fatigue, HIIT (High-Intensity Interval Training) will likely leave you feeling worse than you do and may not help you hit your exercise goals. Running long distances may not help you lean-out based on your particular wellness picture. A functional medicine assessment will reveal some of these issues so you can make the correct choice from the get-go.

The bottom line is: you want to make sure your workout regimen is actually helping you to feel more vital and well, and not leaving you feeling depleted. 

If you are ready to upgrade or start an exercise regimen, a comprehensive Functional Medicine evaluation is a great place to start. You’ll be assessed for areas that can be optimized to best support your workout efforts, to determine the level of activity that may be most supportive of you and your goals, and to improve your overall health.

Be Well,
Dr. Nayo

Appts: 703-532-4892, Ext. 2.

Regular Aerobic Exercise Allows for Longer, Happier Lives

Two recent publications reinforce the benefits of aerobic exercise and provide even more motivation to get out and break a sweat on a daily basis.
The first study, published in JAMA Network Open last week, found that sedentary lifestyles are as harmful to one’s health as having a chronic illness. Over the span of 23 years 122,000 adult patients underwent periodic stress testing to determine the link between mortality and aerobic exercise. The study found that better cardiorespiratory fitness was directly associated with longer life spans and better overall health, with the inverse also being true.

A review and meta-analysis, published in the journal Depression & Anxiety, looked at the association between aerobic exercise and major depressive disorder (MDD). The results of 11 qualifying studies were examined and it was determined that aerobic exercise had a significant anti-depressant effect and can be considered an effective intervention for MDD and other mental health disorders. Click here to read the abstract.

Look, we all know about the benefits of exercising, but we don’t always stick with it. These studies really highlight the importance of daily movement in living longer and happier lives. Start off slow and find something you like and most importantly stick with it, as consistency is the key to reaping the long-term benefits and safeguarding your health.

Minimizing Breast Cancer Risk

According to the American Cancer Society, over 1.7 million people are expected to be newly diagnosed with some form of cancer this year alone. The causes of cancer are complex; genetics and our environment can play a large role. So while there is no sure way to prevent it, the tests, supplements, and lifestyle recommendations outlined below, along with the guidance of a trusted physician, can help minimize your risk.

Rick Assesment Tests

There are currently many tests available to assess the risk of breast cancer – for the purpose of this article I have chosen 2 to mention:

1) Estrogen-Metabolism Assessment: This valuable tool evaluates how your body metabolizes and processes estrogen. Certain types of estrogen metabolites may increase the risk and worsen the prognosis of breast cancer. Testing the levels of these metabolites in your blood or urine can help determine whether lifestyle changes, such as diet and exercise, are warranted in reducing the level of unhealthy estrogens in the body.

2) BRCA-Gene Testing for Women with a Strong Family History of Cancer. Certain gene mutations can indicate that some women have a higher risk of developing breast and ovarian cancers. Women who have inherited the harmful BRCA-gene mutation are about five times more likely to develop breast cancer in their lifetimes than women without it. Also, certain ethnic and geographic populations, such as Ashkenazi Jews, Norwegians, Dutch and Icelandic people have a higher prevalence of BRCA 1 and 2 mutations. Knowing whether or not you carry the mutation can help you understand your personal risk of developing breast or ovarian cancer.

Cancer-risk testing, although not yet perfect, is highly recommended, especially if you have a family history of the disease. Taking these tests can also help your doctor proactively tailor your care, depending on any medical predispositions.

The Importance of Lifestyle Choices in Minimizing Cancer Risk

Lifestyle can also play a very important role in minimizing your risk of cancer. I highly recommend the book, Keeping aBreast, by Dr. Khalid Mahmud, which offers the following suggestions for maintaining an optimal lifestyle (some of these also appear in well-regarded studies).

  • Nutrition: Good nutrition and targeted supplementation can help to reduce cancer risk. A low-glycemic diet that includes lean protein and more than 5 daily servings of vegetables is recommended. (See below for some of the best cancer-fighting foods and supplements.)
  • Exercise: Exercise programs emphasizing an increase in lean muscle mass offer benefits twofold by decreasing inflammation which in turn lowers cancer risk. On the other hand, an excess of fat in the body can increase levels of estrogen which increases the risk of breast cancer. One should aim for a BMI (body mass index) of 25.
  • Red Wine: Drinking red wine in moderation (less then 3 small glasses, 5 ounces each, per week) can reduce free radicals that damage DNA. Drinking in excess and smoking have the opposite effect of increasing free radicals, interfering with the body’s ability to repair potential cancer cells.
Consider Seeking an Integrative Medical Practitioner

A board-certified physician with experience in functional medicine can work with you to safely tailor a vitamin and supplement plan based on your personal test results and health concerns.

Eat More Cancer-Fighting Foods

Here are a few scientifically well regarded, cancer-fighting foods and supplements that a doctor may include in a personalized care plan:

Indole-3 Carbinol (I3C) – I3C enables the body to metabolize estrogen in a positive way; this is especially important if tests indicate high risk or a family history of breast cancer.[1] Good sources of I3C are cruciferous vegetables such as broccoli, cabbage, brussels sprouts, turnips, kale, and cauliflower. Those with a high-risk profile can take a supplement of I3C and should aim for 200-400 mg per day.
Omega-3 EPA-DHA Fatty Acids – Omega-3 has been shown to have a positive impact on preventing several forms of cancer, including breast and prostate cancer. You can increase your intake of Omega-3 fatty acids by eating fatty fish such as wild salmon. 1,500-3,000 mg of EPA-DHA Omega-3’s combined per day is considered optimal for most individuals.[2]
Vitamin-E Gamma-Tocopherol – “Whole” vitamin E is a potent anti-inflammatory vitamin and antioxidant. Most vitamin E is sold in the “alpha-tocopherol” form so make sure you are supplementing with whole vitamin E with “gamma-tocopherol.” Vitamin E is found in nuts, seeds, greens, and avocados. Suggested supplementation is 50-200 mg per day.[3]
Vitamin D – Your vitamin D levels should be checked regularly. Our practice regards an ideal vitamin D 25-hydroxy blood level to be between 40-80 ng/ml. Though Vitamin D can be obtained naturally from the sun, if you don’t spend enough time in the sun, or if your body has trouble absorbing it, you may need to supplement. The suggested dosage is 5,000 IU a day, with levels checked a few times a year by your doctor.[4]
Fiber – Research has linked a high-fiber diet to a reduced risk of colon cancer. 35 grams a day should be the goal. If dietary fiber levels are inadequate, supplementing with over-the-counter fiber is recommended.
Magnesium –Magnesium plays a role in enabling the body’s synthesis and repair of DNA, and research has linked low levels of magnesium to elevated cancer risk. Foods containing magnesium include leafy greens, nuts, fish, and avocados. 200-600 mg at the end of the day can also calm nerves and help with any sleep issues. Magnesium Glycinate is one form of magnesium supplement that absorbs particularly well to the body.[5]
Folic Acid – Folate, a B-complex vitamin, is helpful in building red blood cells and also can help regulate estrogen. Dietary folate is preferred, but supplementation may also be needed, especially for women who drink more than one alcoholic beverage per day. The ideal level of folic acid thought to be protective against breast cancer is 400 mcg per day. Folate is found in leafy greens, asparagus, beans and lentils, and avocado.[6]

If you are concerned about breast cancer, our doctors at the Kaplan Center for Integrative Medicine can work with you to tailor a scientifically-based program designed to lower the risk of cancer, while also helping you enjoy a healthy and active life.

[1] Brew, C.T., Aronchik, I., et al. 2009. “Indole-3-carbinol inhibits MDA-MB-231 breast cancer cell motility and induces stress fibers and focal adhesion formation by activation of Rho kinase activity.” International Journal of Cancer, May 15;124(10):2294-302.
[2] Simonpoulos, A.P. 2002. “The importance of the ratio of omega-6/omega-3 essential fatty acids.” Biomed Pharmacother, Oct; 56(8):365-79.
[3] Dietrich, M., Traber, M.G., et al. 2006. “Does gamma-tocopherol play a role in the primary prevention of heart disease and cancer? A review.” Journal of the American College of Nutrition, Aug;25(4):292-9.
[4] Garland, C.F., Gorham, E.D., et al. 2009. “Vitamin D for cancer prevention; global perspective.” Annals of Epidemiology, Jul;19(7):468-83
[5] Rosanoff, A., Weaver, C.M., et al. 2012. “Suboptimal magnesium status in the United States: Are the health consequences underestimated?” Nutrition Review, Mar; 70(3): 153-64.
[6] Chen, P., Li, C., Li, X., Li, J., Chu, R., and Wang, H. 2014. “Higher dietary folate reduces breast cancer risk.” British Journal of Cancer, 110(9):2327-38.

Posted: Oct 26, 2015. Updated: September 24, 2018.

exercise for bone health

7 Steps That Can Help You Prevent Painful Compression Fractures!

Research shows that one quarter of post-menopausal women eventually suffer from the compression or collapsing of some vertebrae, the bones that comprise the spinal column. Compression fractures can compromise one’s ability to function or cause disabling, chronic back pain.
Although these injuries are common, they usually can be prevented, delayed, or mitigated by adopting a healthy lifestyle that includes:

  1. Engage in resistance training, such as weight training and yoga, every other day, for 30-60 minutes per work-out ideally. There is good news for those who struggle to find those 30-60 minutes: a 10 year study that was completed in 2015 measured the bone mineral density (BMD) of 741 participants pre and post yoga regimen. Participants who routinely engaged in 12 yoga poses per day for just 12 minutes showed a reversal of osteoporotic bone loss.
  2. Do some weight bearing exercise like running, walking, or hiking, for at least 30 minutes per day. Weight bearing exercises work against gravity and stimulate bone cells to produce more bone.
  3. Get your Vitamin-D levels tested to ensure that they’re between 50-100 mg. If your levels are low, consider getting more sunshine (exposing some of your skin surface for about 15-30 minutes per day) and taking a supplement. Most people need between 3,000 to 5,000 iu of supplementation, but some may need up to 10,000 iu. If you take Vitamin-D supplementation, make sure to have your 25-hydroxy, Vitamin-D level checked two to four times per year.
  4. Check your calcium intake. Women should consume a total daily amount of calcium between 1200 and 1500 mg, with no more than 600 mg from supplemental calcium. Taking in more than this amount in supplemental form can lead to increased risk of heart disease and kidney stones. Good sources of dietary calcium are sardines, white beans, almonds, oranges, leafy greens, and dairy.
  5. Consider bioidentical hormone replacement therapyBefore prescribing medications, I explore the possibility of using bioidentical estrogens and progesterone or estrogen analogues like Evista to prevent bone loss.
  6. Talk with your doctor before using medications to treat bone loss. Because most of these medications work by decreasing bone breakdown, this can potentially cause more brittle, unhealthy bone and result in fractures of the femur and jaw necrosis. I would reserve medication treatment for those with severe osteoporosis or history of pathological fractures. Before considering bisphosphonates, like Fosomax, Actonel, Boniva, Reclast, or a newer injectable, Prolia,  it is recommended to complete any dental procedures before starting treatment for osteoporosis. Be sure to report any persistent jaw or thigh pain to your doctor immediately. Another treatment option is Miacalcin, a synthetic version of the hormone, calcitonin. It has been shown to build bone more so in the spine than in the hip, and it offers users some pain-relief. Two alternatives to the bisphosphonates and Miacalcin are Forteo and Tymlos, synthetic versions of a hormone called parathyroid hormone which also builds bone. Some of these drugs however, carry warnings about an increased risk of bone tumors called osteosarcoma.
  7. Ask your doctor about Bone-Density Imaging and “Urine osteomark.” It’s important to evaluate the effectiveness of any medications or hormone replacement therapies you may use because each individual inevitably has their own unique response to a given treatment. A urine test, called a “urine osteomark,” tracks bone breakdown, and therefore, is great way to measure the therapeutic benefits of treatment between bone-density-imaging studies.

In sum, there’s a lot you can do to keep your bones strong! So, do it!

Meal Kits: A Tool Towards Healthier Eating?

Many of our patients struggle when it comes to starting a new diet. In fact, the word diet alone can provoke feelings of anxiety, self-doubt, and even depression about one’s current state of health, hindering efforts to make real lifestyle changes. While most of us know what we should and shouldn’t be eating, impulsive decisions can cause major mental setbacks.
Meal kit services, like Hello Fresh and Blue Apron, debuted in the United States in 2012 and have steadily gained popularity. With over 150 companies delivering all the components of a home cooked meal tucked inside a box it is estimated that nearly one third of Americans have now tried one! While the most obvious reason for signing up may be convenience, from our perspective meal kits can be a wonderful way to kick-start and maintain a healthy eating routine.
If you’ve ever considered giving one a try but remain undecided, here are some pros and cons to help determine if it’s a good fit for you:

  1. Convenience. Let’s face it, meal planning night after night can be exhausting! Despite our best intentions, more people are dining out just to avoid the drudgery of grocery shopping. Meal kit services offer meal plans that send you up to 3 or 4 meals per week with no planning necessary whether you’re cooking for yourself or for a family. While many of the services are subscription based, there are some that are not, a perfect option for a trial run.
  2. Variation. “Eat this, not that! Make it colorful! Be creative!” This is all wonderful advice, but hard to adhere to day after day. A meal kit service can do a better job of introducing a variety of fresh and nutritious foods to your plate that you may otherwise never try.
  3. Portion control. It’s no secret that portion sizes in the United States are far larger than those in other countries, so it’s no wonder that our waist sizes are too. Meal kits come pre-portioned and ready to assemble and cook leaving no room for overindulgence. Over time, our bodies adjust to smaller, healthier meal sizes.
  4. Options galore! Fortunately, with so many online services available, it won’t take long to find one that caters to your food preferences. Whether you have no food restrictions or are following a vegan, vegetarian, gluten-free, or paleo diet, there is a service (and app!) for that. Some of the more well-known meal kit services include: Blue Apron, Hello Fresh, Sun Basket, Plated, and Green Chef.


  1. Cost. While some of services claim affordability, some can get downright expensive, especially if they offer irresistible add-ons and require minimum order amounts.
  2. Customization. While you are able to choose the type of meal plan you are on, many companies are designed to not allow substitutions. That means, you get what you get and you don’t get upset! However, with a little researching you’ll find that there are a few that do allow small changes for those who need to maintain a little more control over their selections.
  3. Not environmentally friendly. With some notable exceptions, most services have each of their ingredients wrapped individually in plastic or cardboard so make sure to have a plan for reusing or recycling those contents whenever possible.

At a time when we know so much about nutrition and how it can either facilitate illness or improve overall wellness, a meal kit service can be one more tool in the arsenal when it comes to better managing our health.
*The Kaplan Center for Integrative Medicine does not endorse any one service mentioned above. We encourage due diligence by our readers before making any purchase and, if necessary, a discussion with your physician or nutritionist about the options that may work best for you!

What the New High Blood Pressure Numbers Mean For You

When the American College of Cardiology (ACC) & American Heart Association (AHA) lowered the numbers that define high blood pressure (HBP) this past November, 46% of the adult population in the United States suddenly met the new criteria – that’s nearly half!

What was the motivation for making these changes that placed an unwelcomed label on so many people virtually overnight? It rests in the reality that despite the enormous amount of research, outreach, and medical advances, heart disease and stroke still remain 2 of the leading causes of death in men and women in the United States. Broadening the scope of high blood pressure numbers will generate more conversations between patients and health care providers about the associated risks that go with HBP, namely developing heart disease or having a future cardiac event. More importantly, it gives physicians the opportunity to introduce early non-pharmacological intervention methods to a wider population.

What is High Blood Pressure (HBP)?

When the blood pressure sleeve tightens around a patient’s arm it is taking two important measurements: the force of blood being pushed against artery walls when the heart pumps (systolic, or top number) and when the heart is at rest between beats (diastolic, or bottom number). These numbers are of particular interest to doctors as they can be an early warning sign of the patient’s risk for a future cardiac event or stroke; the higher the numbers, the higher the risk.

There are many factors that can elevate blood pressure, age being the most common, but lifestyle (think stress, activity levels, diet, etc…), weight, gender, race, medications, and certain medical conditions can also contribute. When a person is diagnosed as having high blood pressure (also called hypertension) it means very simply that there is too much force on a regular basis putting stress on the heart and blood vessels. Over time this constant, excessive pressure can cause damage to the walls of the arteries and blood vessels, causing them to narrow or leak, creating areas where plaque deposits can accumulate causing hardening and narrowing of the arteries, reducing elasticity, and all the while producing no obvious symptoms.

According to the American Heart Association, nearly half the population of patients with high blood pressure do not have it under control. This is an alarming statistic as so much is known about the correlation between high blood pressure and cardiovascular disease. But the good news is that high blood pressure is something that can be controlled with lifestyle modifications and, when necessary, medications.

Know Your Numbers!

The new guidelines stress the importance of proper blood pressure readings by both health care providers and patients. Blood pressure can be easily taken at home with the right device, and knowing your numbers is the first line in prevention!
High Blood Pressure Guidelines
Previously, blood pressure measured between 120 – 139 mm Hg was defined as pre-hypertensive, however, this terminology no longer exists. Now, patients diagnosed with having Elevated Blood Pressure are encouraged to look at a number of non-drug interventions as a first approach. These are lifestyle modifications that will not only help lower blood pressure but are positive changes for all aspects of health.

Non-pharmacological interventions recommended in the new guidelines include:

  • Weight loss
  • Eating a heart-healthy diet
  • Regular exercise
  • Reducing sodium intake
  • Potassium supplementation
  • Stopping or reducing alcohol consumption

In addition to the recommendations above, there are several mind-body therapies that have also proven effective in lowering blood pressure.

Patients now diagnosed with Stage 1 or Stage 2 Hypertension (HTN) would likely be prescribed anti-hypertensive medication in addition to the lifestyle recommendations above, with dosages and medications varying depending on each patient’s risk assessment and medical history.

The startling reality is that heart disease is responsible for 1 out of 4 deaths in the U.S. each year. The new guidelines introduce a number of wonderful non-drug therapies that can have an immediate effect on overall health and well-being. By knowing your numbers and taking proactive measures to get heart-healthy today, you can make a significant impact on your health in the future.

Seven Ways to Improve Your Health in the New Year

The new year is a blank slate and the perfect opportunity to contemplate and implement positive changes in your life. Because most resolutions require lifestyle changes, it’s smart to focus on just one at a time to increase the odds of achieving your goals.
In case you haven’t thought about your New Year’s resolutions yet, several of our medical providers have offered one recommendation, and below is our list. We hope it inspires you to make at least one health improvement in the new year!
Gary Kaplan, D.O.
1. Eat more chocolate! Dark chocolate is known as a “super food,” because it is chock-full of antioxidants that fight dangerous free radicals in your body. In addition, dark chocolate reduces blood pressure, increases the elasticity of the blood vessels, reduces inflammation, and reduces LDL (low-density lipoprotein) cholesterol – all of which can help to reduce your risk of developing cardiovascular disease. But only dark chocolate provides health benefits, so stay away from the milk and white varieties!
Video: Dr. Kaplan discusses the health benefits of dark chocolate.
Lisa Lilienfield, M.D.
2. Try yoga with a friend. If you haven’t tried yoga before, now is the time to start, and trying it out with a friend can provide the extra motivation you need to get started and establish a routine. Anyone can benefit from the many physical and mental improvements that yoga provides. In addition to increasing one’s flexibility, strength, and muscle tone, yoga promotes deeper breathing and in turn, relaxation. A review of clinical studies shows that it can also help alleviate chronic pain, improve sleep patterns, and improve one’s overall quality of life.
Audio: Dr. Lilienfield explains the Yoga Sutras: The Yamas & Niyamas of Yoga.
3. Take a daily probiotic supplement. An unhealthy gut can cause more than just bloating and discomfort. With 90% of the immune system located in your digestive system you can be sure that a well balanced and well nourished gut will support your overall health. A multi-strain probiotic with live cultures will help replenish and maintain the beneficial bacteria your gut needs.
Video: What’s Your Gut Feeling?
4. Don’t take your sleep for granted. Quality sleep can do a world of good for your health, including increasing your energy, lifting your mood, sharpening your concentration, reducing chronic pain, speeding your healing from an injury, and improving your hormone function. How can you can improve your sleep? Try to go to bed and wake up at the same time each day of the week, avoid caffeine intake after lunch, remove electronic devices (e.g. TV and computer) from the bedroom, exercise regularly, adopt a meditation practice to help quiet your mind, use soothing, white noise machines, and try drinking some chamomile herbal tea before bed.
Article: 8 Dietary Supplements to Aid Sleep
5. Think SUSTAINABILITY. Many of us have started in January with the resolve to increase our movement and exercise routine only to in March be fading from our new healthy activity. This year, let’s consider what would be a routine that will become our habit? We can consider: What is the best time of the day to exercise? How much time, days per week do I have to devote to my movement? Will I exercise alone or with a friend? My dog? Do I need a winter and a summer routine? Will it be free or with a trainer? How can I set up my routine to be successful? How to be sustainable? When to become a habit I do not question, just like brushing my teeth? Wishing you the belief that if long term rest has not allowed for you to heal, that you will embrace movement in 2017!
Jeanne Scheele, P.T.
6. Incorporate stretching into your routine. Stretching opens up your body tissues and muscles, and helps improve blood flow. Especially in the cold weather, your muscles can tighten. So, stay warm and flexible this winter by taking a few minutes each day to stretch! Your physical therapist or a personal trainer will be happy to talk with you about proper stretching techniques that you can incorporate into your daily routine.
Jodi Brayton, L.C.S.W., M.S.W.
7. Use exercise as a stress-control technique. Regular exercise not only provides physical benefits, such improving cholesterol, lowering blood pressure promoting healthy bones and boosting the immune system, it also provides important mental and emotional benefits. But what are your “stress relief” options when you’re still at work — for example, after a particularly stressful phone call or frustrating meeting?  I suggest getting up from your desk and running up or down a few flights of stairs or, if you have a private office, doing a few jumping jacks. Getting physically active helps to burn off muscle tension and stress hormones. In fact, any simple repetitive exercise can elicit a state of physiological relaxation. So get out and walk, jump, run, swim or row! You’ll not only boost your metabolism, you’ll also improve your mood!
Even making small changes in your diet, level of physical exercise, or quality of sleep can significantly improve your health. You can do it!  And if you need us, we’re here to help.
You have our very best wishes for a happy new year!

Conquer Unhealthy Eating Habits For Life

Do you know what you should, and want to, do with your diet and health, but lack the support, structure, encouragement, and feedback to make it happen? Have you tried a variety of diet plans, but not yet succeeded in making the lifestyle changes that will allow you to sustain a healthy weight and diet? Do you have a strong sense of where you want to be with regard to health and fitness?
Research confirming the link between the digestive system and the strength of the immune system has never been stronger. Good nutrition is critical in preventing disease and attaining optimal health so that we can act with vitality, think clearly, and feel great. And while our nutritional goals may be clear, the path to attaining them can sometimes be filled with obstacles. Whether you want to lose or gain weight, modify your diet due to an illness or condition, or simply eat smarter, a nutritionist can help you safely and confidently achieve those goals.
[frame_left src=”https://kaplanclinic.com/wp-content/uploads/2016/09/Vanessa_Berenstein-e1474377008701.jpg”]Vanessa Berenstein, M.A., R.D.[/frame_left]Last month Vanessa Berenstein, an Integrative and Functional Registered Dietitian, joined our team of healing experts. Vanessa specializes in digestive disorders, chronic pain, weight loss, diabetes, eating disorders, and natural detoxification protocols. Her passion is to help others experience powerful transformations through food and lifestyle choices by creating dynamic, interactive experiences to make it as simple, delicious, and fun as possible for her patients to turn healthy behaviors into sustainable habits.
If you live in the Northern Virginia area and would like to take that first step towards building healthier eating habits, please call our office or use our contact form to make your appointment with Vanessa today. No referrals are necessary.

yoga stretch

Yoga: More Than Just A Stretch

Q: How is yoga different from stretching or other kinds of fitness? Why does yoga pay particular attention to the spine?
LilienfieldDr. Lisa: Yoga is more than just movement. It is a complex philosophy that has been around for thousands of years, and involves breathing and meditation.

Yoga & Spinal Movement

One of yoga’s emphasis is on spinal movement. The spine has seven motions (flexion, extension, rotation, side bend to each side and axial extension which is lengthening). Any yoga posture therefore involves one or more of these motions. By the way, a recent study by Dr Loren Fishman, showed 12 yoga poses per day can reverse osteoporosis in the spine and hip.
Q: Is there a particular type of yoga that is best suited for beginners?
Dr. Lisa: What I would advise if going to a yoga studio is to speak with the teacher ahead of time to let them know that you are a beginner. There are many customizations that can be utilized in most any yoga class. If you have any injuries, I would recommend consulting with your doctor.


This Q&A was part of our Live chat with Dr. Lilienfield
on Facebook in January, 2016!

Dr. Lisa, here is a question that was sent in via email earlier this week about yoga: How is yoga different from stretching or other kinds of fitness? Why does yoga pay particular attention to the spine?
Posted by Kaplan Center for Integrative Medicine on Thursday, January 21, 2016