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Dr. Kaplan discusses what we now know about Long-Covid

LISTEN NOW: Long COVID: What we know now, with Gary Kaplan, DO

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What should patients know about recovering from Long-COVID? Dr. Kaplan discusses where we are now with research and what you need to know.



In this episode, Dr. Kaplan returns to the Less Stressed Life Podcast to talk to Christa Biegler, RD, about what the “treatment pie” is for recovering from Long COVID, why you may be experiencing long term symptoms, how you can be evaluated for treatment, request treatment or get more information.

Episode #328 – Long Covid: What we know now, with Gary Kaplan, D.O.

KEY TAKEAWAYS:

  • What are the symptoms of long COVID?
  • COVID can affect every system in the body
  • Why are we seeing an increase in cancer?
  • What helps with the loss of taste and smell?
  • Why do you lose taste and smell when you have COVID?
  • What is the treatment for a high fever?
  • Why do people struggle with detoxing and alcohol tolerance after having COVID?
  • What can you do to support the kidneys post COVID?
  • Solutions for Long COVID
  • How does metformin help Long COVID?
  • How do you diagnose Long COVID?
  • Benefits of methylene blue
  • What are cytokines?

If you are experiencing symptoms beyond six weeks of being diagnosed with COVID-19, our Long-COVID Recovery Services may help you regain your strength and vitality.

Most people recover from COVID-19 completely, but for reasons still unknown a percentage of patients, sometimes referred to as “long-haulers,” continue to suffer long-term effects of the virus. If you or a loved one are dealing with lingering symptoms of COVID-19, our Long-COVID Recovery Services can offer you a path to recovery.

With over 35 years of experience helping patients recover from chronic conditions. We understand the complexities of chronic conditions better than most other providers and we are well-prepared to offer long-COVID-19 recovery services.

Learn more about our services.
 

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Human_Optimization_Podcast

LISTEN NOW: Why You Are Still Sick

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Dr. Kaplan was a recent guest on the Human Optimization Podcast with host Lisa Pitel Killah, BCHHP, FDN-P, hTMAP.

In this podcast, Dr. Kaplan and Lisa discuss

  • How inflammation influences chronic pain and depression/anxiety symptoms
  • What are “microglia”, how they influence inflammation, and what sets them off
  • How stress and adverse events in childhood can impact your immune system
  • What it means to have a brain on fire
  • The importance of finding the root cause(s) of your symptoms to get to the bottom of why you are still sick
  • Supplements and medications that are effective in treating long COVID and other chronic illnesses
  • The importance of a healthy gut and good sleep hygiene, and so much more!

Listen now: Episode #77: Why You Are Still Sick

 

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Managing Fibromyalgia Pain with an Integrative Approach

Managing Fibromyalgia Pain

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Characterized by widespread pain, fatigue, and cognitive difficulties, fibromyalgia (FM) is a complex disorder of the central nervous system (CNS). It affects the brain’s messaging system causing those who have it to experience heightened sensitivity to pain. A fibromyalgia flare-up can last for months at a time and cause debilitating physical and emotional distress. Symptoms can vary from person to person and often suggest other conditions, making it a very difficult diagnosis. Despite all that has been learned about fibromyalgia over the last two decades, people with FM can go years without a proper diagnosis.

Fibromyalgia is associated with many other conditions like Chronic Fatigue Syndrome (also known as Myalgic Encephalomyelitis), sleep dysfunction, infections like Lyme disease or E-BV (Epstein-Barr Virus), digestive problems such as SIBO (Small Intestinal Bacterial Overgrowth), or Celiac Disease and other food allergies that can cause leaky gut. It can lead to autoimmune disorders like Hashimoto’s thyroiditis or autoimmune arthropathies. People suffering from FM may also exhibit reactions to environmental toxin exposure, like mold or heavy metals, which can be diagnosed through specialty labs looking at stool, urine, breath, and bloodwork.

A functional approach to treatment

Once you receive a fibromyalgia diagnosis, there are various treatment options and lifestyle habits to consider. As a functional medicine practitioner, my approach to treating fibromyalgia is multifaceted; I look at digestion and diet, sleep, hormone imbalances, injuries (psychological and physical), infections, environmental exposures, genetics, and more.

For example, I often find that fibromyalgia is related to a deficiency in delta-wave deep sleep; medications like Xywav, which promotes deep-wave sleep have been helpful in reducing chronic pain. If you don’t get enough deep delta wave sleep your body can’t recover, and chronic pain can be an issue. (We find that this is common in those with fibromyalgia.)

A common area of pain is the cervical spine. Treatments like physical therapy, acupuncture, or injection therapies like prolotherapy, perineural injection therapy (PIT), or PRP (platelet-rich plasma) therapy may be helpful. You may also consider having your jaw evaluated for TMJ by a dentist specializing in temporomandibular joint problems, which can often cause referred pain in the head, neck, and shoulders.

Another treatment to consider is Low-Dose Naltrexone (LDN). When chronic pain is a result of neuro-inflammation (brain inflammation), LDN can help by reducing the upregulation of the microglia that cause this inflammation.

If you have leaky gut from a food allergy, then inflammation of the intestinal tract leads to nutritional deficiencies and toxicity; I’ll want to look at dietary changes and supplementation. Supplements that may be helpful include D- ribose, fish oil, glutathione, and IV magnesium with B complex and Vitamin C (also known as Myers cocktail).

Because FM affects the CNS, it can influence your experience of pain and emotional sensations; therefore it’s very important to consider my patients’ emotional health which is often not addressed in chronic pain. There are many stress-reduction therapies that can be done from the comfort of your own home including yoga, mindfulness-based meditation, breathing exercises, and even a therapy called Emotional Freedom Technique which involves tapping acupressure points and utilizing positive affirmations. However, if you feel overwhelmed by symptoms, look for a psychotherapist who specializes in working with people with chronic pain. Dealing with chronic pain is emotionally exhausting; seeking help can be a vital lifeline for many.

As with other chronic illnesses, treating fibromyalgia is not a straightforward process; it requires a multifaceted treatment approach with close collaboration to help you recover or better manage your illness.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Additional Resources:

Consumer Guide: 18 Things You Should Know Before Choosing a Doctor to Treat Your Fibromyalgia

depression_pain

Is Depression Ever Just Depression?

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A modified model for understanding depression and anxiety ought to involve a whole person, integrative approach.

Public acts of violence seem to fill the news media streams these days and are typically followed by outcries for greater access to mental health care for those that need it most. And although almost all individuals with serious mental illness are not dangerous, many of the perpetrators of these heinous crimes later turn out to have a documented history of depression or mental illness, which often went untreated.

So, what can we do to stop the anguish? What is it that we are missing?

The Cost of Failure

Unfortunately, the number of Americans affected by serious depression and anxiety disorders is enormous, as are the costs to society due to failure to treat and/or treatment failure. Tens of millions of Americans suffer from depression, including chronic, low-grade depression (dysthymia) and anxiety. 21 million of those Americans have been diagnosed with major depressive disorder (MDD), the leading cause of disability for people ages 15 to 44.

The cost of failing to effectively treat these conditions is not just the individual’s inability to complete college, hold a job or cultivate positive relationships; it also includes the toll taken on an entire family and community when a despairing person takes their own life. And in other cases, the costs of acts of public violence – in terms of suffering, municipal expenses, personal medical and legal expenses, and lost human potential – are immeasurable.

Michael, a 17-year-old high school student, came to see me with a long history of hospitalizations after attempting to take his own life. Despite undergoing intensive psychiatric treatment, he remained depressed and suicidal. Like 40 percent of those who suffer from major depressive disorder, Michael was not responding to treatment.

When contemplating a situation like Michael’s, the question “What am I missing?” is never far from my mind. Statistics show that only about one-third of patients with MDD respond to antidepressant medication, with about the same number responding to psychotherapy alone. If we combine the two approaches the numbers improve slightly, but the fact remains that most people with MDD respond only partially to medical interventions, with almost half remaining entirely unresponsive.

A Central Nervous System in Turmoil

There is a mountain of scientific research demonstrating that neuropsychiatric conditions such as depression, anxiety disorders, and possibly bipolar disease are, in a very high percentage of cases, the result of inflammation occurring in the brain.

There is a great deal of research linking generalized inflammation to heart disease, chronic pain, and obesity. Inflammation in the body takes many forms: When we have an allergic response to pollen or food, our bodies’ inflammatory response includes the release of histamine, which makes our eyes itch and noses run; we see the inflammation associated with a skin wound when the white cells of our immune system respond to a bacterial infection. Inflammation in our brains, however, is unique in that it is mediated by tiny cells called microglia.

Microglia are the innate immune system of the central nervous system (CNS). Their job is to respond to trauma and damage to the brain. In response to brain injury, the microglia release a virtual symphony of chemical mediators that orchestrate the destruction of bacterial invaders, the elimination of damaged neuronal tissue, and the initiation of the repair process.

After responding to an assault on the brain, microglia typically return to a resting state. But ongoing and cumulative assaults to the brain will cause the microglia to remain chronically up-regulated, causing them to continuously spew out inflammatory, tissue-destroying chemicals. Examples of ongoing assaults include fever, physical assault, and emotional trauma. It can also be infections like Lyme disease or COVID-19.

Since the beginning of the COVID-19 pandemic, researchers have been studying how the SARS-CoV-2 virus affects the CNS as well as other body systems. What they are finding out is that it too heightens the activity of microglia leading to the release of inflammatory cytokines and a sequence of damaging events that can affect the brain and have other long-term effects on health.

Brain inflammation can produce a wide range of symptoms including depression, anxiety, chronic pain, difficulty focusing and concentrating, fatigue, and sleep disturbances.

Further compounding the issue is the fact that a solid understanding of the role of microglia in brain health is sadly lacking among most medical professionals, with the result that they continue to treat what are in fact “symptoms” as separate and unique “diseases.”

Looking Beyond the Symptoms

A better framework, where physicians look beyond the symptoms, involves giving priority to the discovery of the root causes of an individual’s depression or anxiety. This primarily requires an understanding of what caused the microglia to up-regulate.

Research has shown that anything that can damage neuronal tissue can be a trigger. So, an exploration of a patient’s depression may include asking them about possible traumatic head injuries, psychological traumas (acute events and chronic stress), infections (as mentioned above, tick-borne diseases, other bacteria, and viruses like Covid-19), and even biotoxins that may have entered the body from exposure to toxic molds, celiac disease, and hypoxia (usually related to sleep apnea). The list of triggers is long, and as such, the process of identifying the possible underlying causes of the disease requires putting together a thorough medical health timeline for each patient. By using this approach, treatment options expand due to the greater understanding of the origin of the illness, thereby increasing prospects for recovery.

As for Michael, my 17-year-old patient who was depressed and suicidal, it turned out that he has celiac disease. But how could a food allergy be related to his depression? Celiac disease is far more than an allergy to gluten – it is a very serious autoimmune disorder that’s triggered when even the smallest amount of gluten is ingested. As we know, with autoimmune disorders the immune system mistakenly attacks the body’s normal cells. In the case of celiac disease, when gluten is consumed the immune system goes into attack mode and causes damage to the healthy villi of the gut lining. Villi are responsible for absorbing nutrients and keeping food particles and toxins from entering the bloodstream. When the gut lining is compromised and toxins enter the bloodstream, widespread inflammation can occur, and this inflammatory response can affect more than the digestive system – it can cause inflammation in the brain. Research shows that people with celiac disease are at greater risk of neurological damage and mental health issues in addition to other serious chronic health conditions.

Michael, now gluten-free, is no longer depressed and he has re-engaged in life. He continued with antidepressant medications for a period of time, but slowly weaned himself from them under medical supervision (it takes time for the brain to heal after the assault is removed). His life has been changed, for the better, forever.

It is my hope that, with a modified model for understanding depression and anxiety, involving a “whole” person, integrative approach, more patients will be correctly diagnosed and treated, as Michael was. In his case, and I suspect in many more, we’re learning that all too often, depression is not just depression.

This article originally appeared in US News and World Reports, May 12, 2015. It was reviewed and updated in May 2023.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Additional references

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. 

Mohammadkhanizadeh A, Nikbakht F. Investigating the potential mechanisms of depression induced-by COVID-19 infection in patients. J Clin Neurosci. 2021 Sep;91:283-287. doi: 10.1016/j.jocn.2021.07.023. Epub 2021 Jul 20. PMID: 34373041; PMCID: PMC8289699.

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Are You Dying For A Good Night’s Sleep?

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It is estimated that over 70 million people suffer from a chronic sleep disorder in the United States, impacting not only the individual struggling to get a good night’s sleep but potentially all of us. It is conservatively estimated that more than 91,000 car accidents resulting in 800 deaths and 51,000 injuries each year are the result of driver fatigue.

And here’s another thought that might keep you up at night

One of the most common medical responses to helping you sleep may actually be putting your health at risk. About 4% of U.S. adults use a prescription sleeping aid in any given month. Yet taking as few as 18 sleeping pills a year increases your risk of dying 3.6 fold compared to people not using them. Those who take a prescription sleeping medication more than 132 nights a year have a 6.6-fold increase of death and a 35% increased risk of developing cancer.

A better response?

Individualized treatment to discern the underlying cause of sleep loss.

Sleep deprivation is the most common sleep disorder.

Newborns need as much as 18 hours a day, while teenagers — the most notoriously sleep-deprived group — require nine to 10 hours. Adults should have between seven and eight hours a night of restful sleep, yet a 2013 Gallup poll found that as many as 40% of Americans get only six hours or less of sleep a night.

Sleep deprivation can exhibit as insomnia, taking longer than 20 minutes to fall asleep, multiple awakenings during the night with difficulty returning to sleep, early wakening, and shortened sleep due to demands of work or school. Whatever the cause, its long-term consequences on your health and well-being are the same.

In the short term, your mental performance and reaction time when chronically sleep-deprived are the equivalent of being drunk. And like the inebriated, the chronically sleep-deprived do not recognize the extent of their impairment. Lack of sleep compromises the normal functioning of your immune system, and long-term sleep deprivation causes your body and brain to be in a chronic state of inflammation, potentially leading to an increase in heart disease, stroke, obesity, chronic pain, ADD, depression, and anxiety. The problem is also bidirectional; conditions such as chronic pain, depression, and heart disease can cause sleep disturbance, which then worsens the underlying condition.

Questions? Give Us a Call!

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So how sleepy are you?

If you think you may be suffering from sleep apnea or another type of sleep disorder, don’t put off seeking help. Being this tired is a potential danger to your own health as well as the health of others. One way to quickly assess your level of daytime sleepiness is the Epworth Sleepiness Scale. It takes about a minute to complete the test and should be part of any medical exam when someone is complaining of fatigue. A score of 10 or higher is suggestive of a significant sleep issue.  At the Kaplan Center, we also utilize WatchPAT ONE, a recyclable Home Sleep Apnea Test (HSAT) to help us detect sleep apnea as well as providing markers for quality of sleep.

Here are some steps you can take right now to improve the length and quality of your sleep:

  1. Go to your room! Try to tuck in and rise around the same time each day.
  2. Move it! Regular exercise improves sleep and regular sleep improves exercise performance. The regular practice of yoga, especially in older adults, has been shown to improve the duration and quality of sleep.
  3. Cut caffeine. If you have a sleep problem, minimize or eliminate your caffeine consumption. Caffeine in all forms — tea, chocolate, energy drink or pill — disrupts sleep.
  4. Eat more fish. Eating fatty fish, salmon, and tuna appears to not only lower your risk of heart disease but also betters your sleep.
  5. Eat at regular intervals. When and how much we eat, as well as the types of foods we eat, impact our internal clock, called our circadian rhythm. While we are just beginning to understand the relationship between food and internal clocks, it is clear that the two are related and the consequences of eating at irregular intervals are obesity and increased risk for disease, in addition to disruption of your sleep.
  6. Cooldown to sleep sound. People may have trouble falling asleep because they have trouble cooling down their core temperature, which reaches its maximum typically around 3 pm. A warm room will exacerbate the problem. Temperatures above 75 degrees and below 54 degrees Fahrenheit can disrupt sleep. So what is ideal for sleep? The consensus is that a room temperature between 65 and 68 degrees is probably ideal; this will vary among individuals.
  7. Go dark. Light is a major factor that regulates our sleep-wake cycle. Light exposure at night not only disrupts our sleep but also increases our risk for obesity, high blood pressure, and possibly breast cancer in women.
  8. Keep it quiet. Any amount of noise starting at 30 to 40 decibels, a level between a whisper and a quiet conversation, begins to impact sleep quality. That said, people generally find the sounds of their usual environment relaxing. Sound can also be used to help with sleep. One study looking at patients suffering from a generalized pain syndrome called fibromyalgia found that music embedded with a specific sound frequency called Delta wave that pulsated between .25 to 4 Hertz improved the quality of patients’ sleep and decreased their pain symptoms.
  9. Meditate. Numerous studies demonstrate that the regular practice of meditation can improve the quality of sleep, as well as help in the treatment of anxiety disorders, depression, and chronic pain.
  10. Sample supplements. Some supplements that might help in getting a good night’s sleep include 5-HTP and melatonin. The FDA does not regulate supplements, so be careful that the supplement you purchase actually contains the substance and the amount of the substance stated on the label. Also, supplements are drugs and can have side effects and interactions with other medications. If you are taking medications on a regular basis, please check with your physician before taking any supplements.

For more information on identifying & treating sleep disorders click here.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Note: This post was originally published in August 2014 and has been reviewed and updated for accuracy. 

Chronic Pain and Covid

Chronic Pain after COVID-19

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Since the initial outbreak of COVID-19 in December 2019, there have been more than 500 million cases of infection worldwide.

It has become apparent that infection with COVID-19 may be more complex than first thought. Recovery from the virus does not always mean an end to all symptoms. One unfortunate consequence is that patients may continue to experience long-term effects of the virus even after their original symptoms have resolved. Informally known as long-COVID or post-COVID syndrome, a large number of individuals who get infected with COVID-19 will go on to experience a wide range of symptoms such as tiredness, difficulty thinking, shortness of breath or chronic pain for weeks, months or years after they were first infected.

Chronic pain is described as pain that lasts for longer than 3 months and includes physical symptoms, such as muscle and joint pain, fatigue, as well as emotional symptoms, such as depression or anxiety. The pain may be “on” and “off” or continuous. It may also impact your ability to carry out basic functions or enjoy normal day-to-day activities. For many patients, finding ways to deal with chronic pain can be a challenge. Chronic pain following infection with COVID-19 is no different but there are some unique factors about this type of pain.

What makes chronic pain in COVID-19 special?

  • Although initially assumed to be a respiratory disease, it is now clear that COVID-19 does not just affect the lungs. It affects a variety of body systems including the heart, kidneys, blood circulation and the brain. This means that for some individuals, recovery from COVID-19 will look very different. It may involve seeking specialist help in these areas for long term follow-up.
  • Many patients infected by COVID-19 required critical hospital interventions like mechanical ventilation or a prolonged stay in ICU. For patients who experienced this, a condition known as post-intensive care syndrome (PICS) may be a factor in their recovery. Post-intensive care syndrome is a condition that affects the whole body including your cognitive, physical, and psychological well-being. These symptoms can have profound effects on your quality of life and chronic pain is often part of this.
  • The estimates of chronic pain following a prolonged stay in ICU vary from 14% to 77%. Studies suggest that it is likely that those surviving critical illness with COVID-19 will be at particular risk of developing chronic pain.
  • COVID-19 survivors that experienced prolonged periods of immobilization, sedation, and ventilation as part of their initial hospital treatment are at high risk of developing muscle weakness and chronic pain.
  • Lastly, research shows that COVID-19 infection is associated with an overproduction of cytokines, also referred to as a cytokine storm. This immune response results in an increase in inflammation which, when sustained, can lead to a number of pain symptoms such as muscle pain, joint pain, abdominal pain, headaches and chest pain. This is true even for those not admitted to critical care. Patients that experienced a relatively mild version of COVID-19 may still have these same problems.

Diagnosis

At The Kaplan Center, our goal is to treat long-COVID and its associated chronic pain by taking a holistic, whole-body approach. Our physicians will take time to explore the onset of your condition, the specific nature of your symptoms and the overall status of your health. We want to know when you last felt really healthy, what your experience with COVID-19 has been like and understand the difficulties that long-term COVID has had on your life.

In diagnosing a patient, we will also consider how the immune system may have previously been damaged in the past. This may involve exploring possible exposure to toxins or heavy metals. Additionally, we may ask questions about how well your gastrointestinal system is functioning. All of this information will give us a better understanding of your health before, during and after COVID-19.

Furthermore, we want to know about your relationship to other symptoms like anxiety, sleep disorders, fatigue and “brain fog”. It is possible that such symptoms are likely to be exacerbated or possibly caused by chronic pain.

Management

Our doctors have been treating chronic pain for decades and our specialty is treating those with long-term conditions. Management of chronic pain following COVID-19 may involve one or more of the following:

  • Nutrition – Dietary changes to improve your gut function
  • Replacement of minerals and vitamins
  • Psychotherapy, EMDR & Guided Meditation
  • Sleep Evaluation & Management
  • Acupuncture
  • Prescription drugs
  • Supplements

Our team is equipped to listen and work with our patients to come up with management plans that are tailored to their needs.

Additional References:

Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: implications for rehabilitation. Br J Anaesth. 2020;125(4):436-440. doi:10.1016/j.bja.2020.05.021

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Long-COVID Recovery Services

If you have been experiencing the persistent aftereffects of COVID-19 for longer than 6 weeks, we can help you regain your strength, energy, and vitality.

Learn About Our Services

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

hormonal_balance

Hormones, The Great Communicators

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A look at some of the causes of hormonal imbalance.

Somewhere in the middle of the brain is a control center called the limbic system, or the old mammalian brain. Here, amongst a host of structures, are two glands of the endocrine system: the hypothalamus and pituitary glands. These glands act as a hub for the body’s chemical messengers called hormones.

Hormones travel from one endocrine gland to the next to communicate messages from the brain that control a number of biological functions. For example:

  • The hypothalamus tells the pituitary to produce thyroid-stimulating hormone (TSH), which tells the thyroid to produce thyroid hormone, which feeds back to turn down the hypothalamus and pituitary. This is called a feedback loop.
  • The pituitary produces a hormone that travels down to the gonads (ovary and testes) to tell them to produce estrogen or testosterone.
  • The hypothalamus and pituitary tell the adrenals to produce cortisol, which is needed in times of an acute stressor, to increase blood pressure, glucose production, and suppress the immune system.

This whole structure is called the Hypothalamic Pituitary Adrenal Thyroid Gonadal Access, or HPATGA.

With age, both women and men undergo natural changes that interrupt this communication system and produce hormonal imbalances; but most of the time it’s external factors, like environment, diet, and lifestyle, that are to blame.

Symptoms that individuals experience vary greatly; among the more common symptoms are sleep disruptions, unexplained weight gain or loss, changes in mood, sex drive, and energy levels. When left unchecked these imbalances can contribute to more serious clinical conditions.

Questions? Give Us a Call!

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Causes of hormonal imbalances

Let’s start with the diet.

First and foremost, the gut and its entire bacterial flora are intricately connected to our immune system. We know that 1% of the U.S. population has Celiac disease, a condition where the gluten in wheat, barley, and rye causes inflammation in the gut and destroys the natural barrier in the small intestine to large proteins and toxins. This has been associated with autoimmune disorders like rheumatoid arthritis, lupus, multiple sclerosis, Type 1 diabetes, and autoimmune thyroid disease.

Similar issues are observed in people who are gluten intolerant, which by some estimates account for over 6% of the population.

There has also been identified a non-gluten protein in wheat called ATI (amylase trypsin inhibitor) that has been associated with autoimmune disorders[1].

For example, in autoimmune thyroiditis, the thyroid gland is attacked and becomes inflamed. As a result, it can produce too much thyroid hormone (Graves’ disease), or stop producing thyroid hormone leading to hypothyroidism (Hashimoto’s disease). A leaky, inflamed gut from gluten and other wheat proteins can be the cause or further aggregate these conditions.

What about lifestyle?

A busy, high-stressed lifestyle can cause the overproduction of cortisol from the adrenal gland which can results in an increased risk of diabetes, inflammatory diseases like heart disease and cancer, disruption of sleep, and an increase in anxiety and fatigue. Since cortisol suppresses the immune system, those who are chronically stressed get sick more easily. Cortisol also suppresses estrogen and testosterone, and interferes with the conversion of T4 thyroid hormone to the more active T3, resulting in fatigue, weight gain, irregular menses, chronic pain, and depression.

How does the environment affect hormones?

There are environmental toxins called endocrine disruptors that actually bind to hormone receptors and increase or decrease these hormones unnaturally. Examples of endocrine disruptors include pesticides like DDT, plastics that contain phthalate and bisphenol A (BPA), and industrial chemicals like PCBs. There are also glyphosate-based weed killers (like Roundup®) that are used in agriculture and end up in our food. These herbicides damage DNA and act as an antibiotic killing off our good digestive bacteria and disrupt the proper functioning of the immune system.

How to support hormonal balance

1. EVALUATE DIET AND MEDICATIONS. 

What we eat and the medicines we take make a difference. Food is code, meaning food turns genes on and off. If someone carries genes for Celiac disease, diabetes, or cancer, these genes can be turned on – or off – by specific types of food. Eat to minimize inflammation in the gut and promote the growth of highly diverse, good bacteria, which research shows is associated with good health.

There is evidence that over the past several decades, the newer wheat strains like dwarf wheat which are so loaded with gluten and other proteins, are causing more and more people to develop Celiac and non-Celiac gluten wheat intolerance, leading to leaky gut and autoimmune disorders[2]. Anyone with an autoimmune thyroid condition or other autoimmune disorder should eliminate gluten.

In addition, the overuse of antibiotics and other pharmaceuticals reduce the beneficial bacteria in the gut. Minimizing the use of medications, and eating fermented foods, probiotics, and dietary fiber that feeds our good bacteria promotes good gut health and decreases the likelihood of autoimmune disorders.

2. ASSESS STRESS LEVELS.

Stress can lead to chronically elevated cortisol. How can we lower cortisol levels and restore the natural cortisol pattern? We need to take the time to assess our stress levels. Are we working too many hours, sitting too long, staying up too late, worrying about yesterday and tomorrow, and coming up with excuses for not exercising and eating poorly? All of these practices increase cortisol which increases the risk of diabetes, hypertension, and heart disease, and affect our hormones. It is imperative that we slow down, prioritize, take time to move, eat well, sleep, seek help and support when needed, and get connected with the community and loved ones.

Yoga, Tai Chi, meditation, weight training, and aerobics help tremendously with stress and lower cortisol. Research is now showing that sitting too long can be as bad as smoking!

3. ELIMINATE TOXINS.

Environmental toxins are tougher to deal with, but minimizing the toxins we are exposed to, and eating foods that naturally detoxify like deeply colored and cruciferous vegetables, foods with omega 3 fatty acids (i.e. fish oil or other sources), and supplementing with magnesium, vitamins B and C, are just a few ways to support the liver’s detoxification process.

Every year since 2004 the Environmental Working Group assesses the sampling of pesticides in our food source from the U.S. Department of Agriculture and the Food & Drug Administration and makes a recommendation as to which fruits and vegetables should be consumed as organic and which are safe as non-organic (EWG Guide to Pesticides in Produce). As previously mentioned, herbicides like Roundup® are showing up in wheat, corn, soybeans, and a host of other foods. Shopping wisely for foods like grass-fed beef (not grain-fed), free-range chicken and eggs (organic may not be enough), wild-caught fish (rather than farm-raised), dairy products without hormones, and buying organic produce from the list put out by EWG, are ways to minimize your exposure to toxins.

Household cleaners, personal care products, and plastic bottles can also have endocrine-disrupting chemicals, so using glass instead of plastic, and minimizing exposures to these chemicals is recommended.

As we age, there is a natural decline of our gonadal hormones (estrogen, progesterone, and testosterone) and in some cases replacement hormones are beneficial. There are ways that we can minimize the risk associated with hormone replacement by using bio-identical hormones, which are closest to natural hormones, and by supporting the metabolic process with diet to reduce any harmful metabolites of hormones that could increase the risk of disease.

To support you in your journey to good hormonal health, I recommend hormonal testing, functional digestive testing when indicated (stool, urine, and breath tests), a dietary consultation to plan a healthy low-inflammation diet, meditation, yoga, a regular exercise plan, adequate sleep, and a look at any potential toxic exposures that could disrupt your hormones, the Great Communicators!

1 Consumption of wheat amylase trypsin inhibitors enhances autoimmune encephalitis in mice. Oral presentation, 16th International Celiac Disease Symposium, 2015, Zevallos

2 Akil Palanisamy, MD, The Paleovedic Diet

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Treating Low Testosterone with Testosterone Pellet Therapy

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In this video, Dr. Lisa Lilienfield explains Testosterone Pellet Therapy, a treatment option for low testosterone in men.

 

 

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

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7 Minutes a Day For Better Health

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Get moving and boost your immune system!

A N.Y. Times article cited a 2020 study out of Stanford where 36 subjects with various fitness levels exercised on a treadmill for 9-10 min and using the latest techniques showed almost 10,000 molecular changes during and after exercise.

With these new techniques, called “omics”, the researchers have isolated various molecules in our bloodstream that alter our biology. Metabolomics looks at molecules like appetite hormones and enzymes produced by the microbes in the gut; genomics looks at changes in gene expression; immunomics looks at the changes in the immune system; and, proteomics and lipidomics look at changes in proteins and fats. The list goes on. The author of the study quotes there is an “ orchestrated choreography of biologic processes” demonstrated to occur.

Why is this research important?

Recently we find that we are spending more time at home. We find ourselves sitting in front of the computer more than ever. Sitting too much weakens our immune system, increases the risk of diabetes, heart disease, depression and decreases bone density. We need to learn to be more creative about how we move our bodies.

We are all concerned about how robust our immune system is against potential illnesses.

One of the best immune boosters is exercise and this recent study out of Stanford, published in the journal Cell, showed even less than 10 min of exercise produces changes in thousands of molecules which affect inflammation, DNA and tissue repair, insulin resistance, oxidative stress, metabolism, immunity, and appetite.

Questions? Give Us a Call!

703-532-4892 x2

With less access to gyms, we need to be creative about making sure we incorporate exercise into our daily routine.

Hiking, biking, running, and many online classes including yoga are available. In addition, a total body workout is ideal to keep all of our muscles strong and stimulate bone density.

If time is short, one way is to do a 7-8 min workout using body weight and minimal props. Combining this with yoga improves bone density, strengthens our immune system, and stimulates proteins that reverse aging. So get out of your chair and move!

And there’s more to keep in mind…

  • Post-menopausal women have an increased risk of osteoporosis. Exercise is a key factor to improve bone density. Make sure you get a DEXA scan and review options for treating osteopenia and osteoporosis.
  • Evaluating gut health not only can boost your immune system but also can improve brain health. We have several tests to look at digestive health and a dietitian to help you navigate food choices.
  • Balancing your hormones (i.e. thyroid and sex hormones) can improve your metabolism. We have advanced testing to look at these hormones including cortisol to evaluate adrenal function.
  • NAD infusions can reduce DOMS (delayed onset muscle soreness), improve cognition and fatigue, reduce pain, and improve sleep.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Fatigue Symptoms

Fatigue: Causes, Diagnosis and Treatment Options

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Often hard to describe and even harder to treat, fatigue can be one of the most debilitating medical conditions that patients deal with. Defined as a feeling of lack of energy and motivation, fatigue can be physical, mental or both. Studies show that about 20% of Americans suffer from fatigue. Yet despite its common occurrence, the standard treatment options remain fairly limited.

What Causes Fatigue?

Fatigue does not necessarily have a single cause. In many cases, it might be a combination of one or more factors. Common causes of fatigue include:

Diagnosing Fatigue

During your visit our doctors will sit down with you and take a thorough history. We will ask you about the fatigue, about its effect on your day to day life, your past medical history and other core elements of your overall health.

Our approach to diagnostics is what makes us different – we will work with you to find the root causes of your symptoms. Using this information, we’ll then tailor a treatment plan that’s just for you.

How to Treat Fatigue

Whether it’s due to physical, emotional or psychological factors, the best treatment plan is one that looks at the whole individual. It considers every part of your wellbeing.

At Kaplan Center we take an integrative approach to medicine. Apart from the physical, we look at the emotional, mental and spiritual elements of health when considering treatment options. We pride ourselves on getting to know our patients and understanding what their concerns are.

Treatment Options for Fatigue

Treatment options will be based on the discussion you have with your doctor. It will also take into account possible test results and your own personal preferences. We may suggest treatments including:

Our goal is to work with you to create a personalized treatment plan. The plan may involve one or more of the elements listed above or include other treatment modalities. We spend time explaining all treatment options and work with you to design a plan that meets your needs.

Our team will guide you through the treatment process and make sure that you’re getting the best out of our integrative approach.

References

https://www.emedicinehealth.com/fatigue/article_em.htm
https://www.mayoclinic.org/symptoms/fatigue/basics/causes/sym-20050894