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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

How Much Fiber Do We Need

How Much Fiber Do We Need and Why It Matters

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Telling someone to eat more fiber is not very exciting. It may sound like a boring detail, one that could be forgotten quite quickly, but eating more fiber is one of the best things you can do for your health.

Researchers at Stanford University have discovered that bacteria in the gut (the good kind) like to feast on fiber. This keeps the good bacteria happy and by extension, they’re free to help make our gut healthier. Here are a few more things to know about fiber.

Why we need fiber

A high intake of fiber is associated with lower cholesterol and improved blood sugar control. Fiber can also lower your risk of:

  • Colorectal cancer
  • Gastrointestinal issues like diverticulitis, constipation, and hemorrhoids
  • Heart disease
  • High blood pressure
  • Type 2 diabetes

Because fiber also acts as a prebiotic, it serves as a food source for many strains of beneficial gut bacteria.

Additionally, research shows that in countries where people consume high amounts of fiber in their diets, the overall rates of chronic disease are low.

How much fiber do you need?

Nutrition experts say 25 grams of fiber a day is good for regulating digestion. Most Americans consume around 16 grams a day. This is a great start but it’s just short of where most people need to be.

The guideline of 25 grams is a general guide and does not take into account your medical history or history of any pre-existing digestive issues that you may have. For example, if you suffer from irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) that number may differ. In these cases, it’s important to speak to your health care provider or nutritionist about what amount of fiber they think is appropriate for you.

What foods are high in fiber?

Think about everyday foods that you can incorporate into your daily diet that already have a high amount of fiber. This will get you to your 25 grams much faster. High fiber foods include:

  • Fruits and Vegetables: Apples, avocados, bananas, berries
  • Carbohydrates: Potatoes, oats, and lentils
  • Legumes: Beans, peas, and lentils

For a more comprehensive list of high fiber foods, visit the Dietary Guidelines for Americans’ “Food Sources of Dietary Fiber”.

Taking fiber supplements

Although it is possible to take supplements that contain fiber, it’s always better to get your fiber directly from the source. Eating a well-balanced diet with some of the food items mentioned above is a much better way of getting your recommended fiber intake. Food is the best source of fiber.

Keep constipation away

If you frequently suffer from constipation or have hard stools, you might be low on fiber.  The consistency of your stools can be a good marker of short or long-term health. In the short term, hard stools might mean you’re dehydrated or probably not drinking enough water. In the long term, stools that are consistently difficult to pass might be a sign that you’re low in fiber. To help with regularity and stool consistency, try to reach that 25 grams of fiber daily.

Fiber and the microbiome

Eating a variety of high fiber foods is probably the best way of maintaining a healthy gut bacteria population. Research suggests that increased dietary fiber consumption can positively influence the diversity and population of the gut microbiome.

Fiber can help lower the risk of many common diseases and its role in the microbiome makes it a great food source to focus on. Where possible, try to increase your fiber intake. A little goes a long way in increasing your overall health.

References

spinach-anti-inflammatory-diet

11 Food Rules For The Ultimate Anti-Inflammatory Diet

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If you want to eat for long-term health, lowering inflammation is crucial.

Inflammation in the body causes or contributes to many debilitating, chronic illnesses – including osteoarthritis, rheumatoid arthritis, heart disease, Alzheimer’s disease, Parkinson’s disease, and even cancer. That’s why, as a doctor and founder of the Kaplan Center for Integrative Medicine, I recommend my patients eat a diet focused on anti-inflammatory principles.

Recent research finds that eating this way not only helps protect against certain diseases, but it also slows the aging process by stabilizing blood sugar and increasing metabolism. Plus, although the goal is to optimize health, many people find they also lose weight by following an anti-inflammatory eating pattern.

Here, I’m sharing the 11 principles I recommend everyone incorporate into their diet for optimal health:

1. Consume at least 25 grams of fiber every day.

A fiber-rich diet helps reduce inflammation by supplying naturally occurring anti-inflammatory phytonutrients found in fruits, vegetables, and other whole foods.

To get your fill of fiber, seek out whole grains, fruits, and vegetables. The best sources include whole grains such as barley and oatmeal; vegetables like okra, eggplant, and onions; and a variety of fruits like bananas (3 grams of fiber per banana) and blueberries (3.5 grams of fiber per cup).

2. Eat a minimum of nine servings of fruits and vegetables every day.

One “serving” is half a cup of a cooked fruit or vegetable or one cup of a raw leafy vegetable.

For an extra punch, add anti-inflammatory herbs and spices such as turmeric and ginger to your cooked fruits and vegetables to increase their antioxidant capacity.

3. Eat four servings of both alliums and crucifers every week.

Alliums include garlic, scallions, onions, and leeks, while crucifers refer to vegetables such as broccoli, cabbage, cauliflower, mustard greens, and Brussels sprouts.

Because of their powerful antioxidant properties, consuming a weekly average of four servings of each can help lower your risk of cancer.

If you like the taste, I recommend eating a clove of garlic a day!

Questions? Give Us a Call!

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4. Limit saturated fat to 10 percent of your daily calories.

By keeping saturated fat low (that’s about 20 grams per 2,000 calories), you’ll help reduce the risk of heart disease.

You should also limit red meat to once per week and marinate it with herbs, spices, and tart, unsweetened fruit juices to reduce the toxic compounds formed during cooking.

5. Consume foods rich in omega-3 fatty acids.

Research shows that omega-3 fatty acids reduce inflammation and may help lower the risk of chronic diseases and conditions that have a high inflammatory process at their root.

Aim to eat lots of foods high in omega-3 fatty acids like flax meal, walnuts, and beans such as navy, kidney, and soy. I also recommend taking a good-quality omega-3 supplement.

And of course, consume cold-water fish such as salmon, oysters, herring, mackerel, trout, sardines, and anchovies. Speaking of which:

6. Eat fish at least three times a week.

Choose both low-fat fish such as sole and flounder and cold-water fish that contain healthy fats, like the ones mentioned above.

7. Use oils that contain healthy fats.

The body requires fat but choose the fats that provide you with benefits.

Virgin and extra-virgin olive oil and expeller-pressed canola are the best bets for anti-inflammatory benefits. Other options include high-oleic, expeller-pressed versions of sunflower and safflower oil.

8. Eat healthy snacks twice a day.

If you’re a snacker, aim for fruit, plain or unsweetened Greek-style yogurt (it contains more protein per serving), celery sticks, carrots, or nuts like pistachios, almonds, and walnuts.

9. Avoid processed foods and refined sugars.

This includes any food that contains high-fructose corn syrup or is high in sodium, both of which contribute to inflammation throughout the body.

Avoid refined sugars whenever possible and artificial sweeteners altogether. The dangers of excess fructose have been widely cited and include increased insulin resistance (which can lead to type-2 diabetes), raised uric acid levels, raised blood pressure, increased risk of fatty liver disease, and more.

10. Cut out trans fats.

In 2006, the FDA required food manufacturers to identify trans fats on nutrition labels, and for good reason – studies show that people who eat foods high in trans fats have higher levels of C-reactive protein, a biomarker for inflammation in the body.

A good rule of thumb is to always read labels and steer clear of products that contain the words “hydrogenated” or “partially hydrogenated oils.” Vegetable shortenings, select kinds of margarine, crackers, and cookies are just a few examples of foods that might contain trans fats.

11. Sweeten meals with phytonutrient-rich fruits and flavor foods with spices.

Most fruits and vegetables are loaded with important phytonutrients. In order to naturally sweeten your meals, try adding apples, apricots, berries, and even carrots.

And for flavoring savory meals, go for spices that are known for their anti-inflammatory properties, including cloves, cinnamon, turmeric, rosemary, ginger, sage, and thyme.

Bon appétit!

 

First published on October 30, 2015; updated February 10, 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

 

digestive symptoms

Identifying the Root Cause of Digestive Symptoms

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Food is at the very center of everything that we do. The nourishment obtained from food is what keeps our body strong, fit, and healthy.

Digestion is an important part of our overall well-being. It’s intricately tied to a healthy immune system and the ability to fight disease. The gut microbiome, which is composed of hundreds of billions of bacteria and viruses residing in our intestines, is often referred to as our “second brain” because these friendly bugs produce and release brain chemicals such as serotonin that is directly linked to our mental health and improvement of depression and anxiety. That’s why unhealthy diets may worsen those symptoms.

At The Kaplan Center we don’t think of digestion as just the mechanics of eating. Digestion is a whole-body process. When looking for solutions to treat digestive problems, that’s exactly how we view it.

Imbalances in the digestive system

Digestive disorders in the United States are on the rise, and along with it the sales of over-the-counter (OTC) drugs and supplements. Self-medication and self-supplementation may also be a  contributing factor to the exacerbation of certain conditions and can sometimes cause more harm than good.  It is always encouraged to check with your healthcare provider prior to taking OTC drugs and supplements.

Symptoms related to the Gastrointestinal System (GI) issues can vary widely, sometimes unrelated to digestive discomfort.

Common signs and symptoms of digestive disturbances:

  • Gas
  • Bloating
  • Abdominal discomfort or pain
  • Constipation/Diarrhea
  • Skin conditions such as acne
  • Vitamin deficiencies that may be the result of improper nutrient absorption, leading to fatigue, sluggishness, or low energy

In some cases, these symptoms can be traced back to specific digestive disorders such as Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), Small Intestine Bacterial Overgrowth (SIBO) or Gastro-esophageal reflux syndrome (GERD). At other times, these symptoms appear as a secondary manifestation of an autoimmune or infectious disease.

Investigations

Issues with the digestive system can stem from a wide range of sources. Doctors will start by taking a full medical history to find out about your specific concerns. If needed, they may recommend routine lab work to rule out any autoimmune disease such as Celiac or Crohn’s Disease. They may also order functional testing of your gut bacteria (to check if you have any harmful bugs) and look for any inflammatory markers that may be contributing to your symptoms.

Treatment options

Treatment options for digestive disorders will vary and are patient-specific. Depending upon your symptoms, medical history, and lifestyle, our doctors will use that information alongside the results of any relevant tests. Our goal is to figure out the root cause(s) of your symptoms and how best to address them.

Treatment may include a combination of:

Good food and good digestion are essential for good health. Using an integrative approach, our goal is to take an in-depth look at the issues and use a variety of proven treatments to improve your digestive health.

References:

  1. https://www.sciencedirect.com/science/article/pii/S0149763418308613
  2. https://www.niddk.nih.gov/about-niddk/strategic-plans-reports/burden-of-digestive-diseases-in-united-states/burden-of-digestive-diseases-in-the-united-states-report
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717511/

New study shows that probiotics may improve bone health.

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A new study, published recently in the Journal of Internal Medicine, showed that probiotic supplementation may have a positive affect on bone health in humans. The double‐blind, placebo‐controlled study involved 90 women aged between 75 to 80 years old and had low bone mineral density (BMD). They were randomized to receive daily oral supplementation (1010 colony‐forming units of L. reuteri 6475) or placebo over a 12 month period. The results of the study showed that daily supplementation reduced bone loss in older women with low bone density. While more studies are necessary to back up these results, this study introduces new possibilities for those who are looking for non-pharmacological approaches to treating osteoporosis in the aging population.

To read the abstract, click here.

 

"What Gluten Does"  An Excerpt from Total Recovery

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The following is the third in a series of excerpts on gut health from Dr. Gary Kaplan’s book “Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression.”

“Leaky gut has been implicated in the growing number of food and environmental sensitivities affecting almost 25 percent of American adults. These are not food allergies, but delayed hypersensitivity reactions.1

As many as 40 percent of Americans are sensitive to gluten. One in 100 of those has a severe reaction in the form of an autoimmune disease, celiac disease.2

“Imagine gluten ingestion on a spectrum,” says Dr. Allesio Fasano, head of research at the University of Maryland Celiac Research Center. “At one end, you have people with celiac disease, who cannot tolerate one crumb of gluten in their diet. At the other end, you have the lucky people who can eat pizza, beer, pasta, and cookies – and have no ill effects whatsoever. In the middle, there is this murky area of gluten reactions, including gluten sensitivity or intolerance. This is where we are looking for answers.”3

Most doctors don’t know the difference. Some are unaware that gluten sensitivity can genuinely contribute to hundreds of diseases and that the symptoms may not manifest in the gut, but in other parts of the body.4

Years ago, we believed that celiac disease was a rare childhood syndrome. Today the average age of diagnosis is in individuals between ages 40 and 60. Celiac disease affects more than 2 million Americans – 1 in 133 people.5 Researchers have already confirmed that the dramatic rise in figures is not due to greater awareness. By testing old blood samples, they have shown that, in the last 50 years, the rate of celiac disease has increased fourfold.

Gluten intolerance is now estimated to affect 6 to 9 percent of the American population. Furthermore, people in their seventies, who have eaten gluten without problems their entire lives, are now experiencing gluten sensitivity.6

Unfortunately, gluten intolerance is sometimes viewed with skepticism. When the tests come back negative for celiac disease, many doctors dismiss their patients’ complaints rather than investigating further. Part of the problem is that, like allergy tests, gluten intolerance tests are not consistently reliable. While gluten intolerance is not an allergy to gluten, we have not yet found a definitive means of identifying it in the blood.

The only absolute way to determine gluten intolerance is to completely remove gluten from the diet for 6 weeks and see if the symptoms improve. It can be hard to tell. If there are other food intolerances and nutritional deficiencies at play, removing gluten may only eliminate some of the symptoms.

Peter Green, MD, director of the Celiac Disease Center, estimates that research into gluten intolerance is about 30 years behind celiac research.7 Without better research, patients are too often told it’s “all in their heads.” With a burgeoning series of product lines of gluten-free foods, estimated at $2.6 billion in sales last year alone, it is easy to assume that gluten intolerance is nothing more than a fad.8

It’s widely known that agricultural changes in wheat production over the past decades have altered wheat significantly and raised both its protein and gluten content.9 Some ascribe gluten sensitivity to the increase in our consumption of wheat. Gluten can now be found in everything from bread and canned goods to hand lotion and makeup.10 But the evidence is inconsistent. And the cause may lie in the bacteria in the gut itself. We’re beginning to suspect that gut bacteria determine whether the immune system treats gluten as food or as a deadly invader.11

In his studies of celiac disease, Dr. Fasano made an important discovery. He studied 47 newborns who were genetically at-risk for developing celiac disease. By the time they were 2 years old, these children had a fairly impoverished and unstable community of intestinal bacteria.12 As he continued to monitor their bacterial levels, the levels of lactobacilli declined in two children.

Both developed autoimmune diseases. One got celiac disease, and the other type 1 diabetes (which has a genetic proclivity similar to that of celiac disease).13

Dr. Fasano and his colleagues were excited. “Imagine what would be the unbelievable consequences of this finding,” he said. “Keep the lactobacilli high enough in the guts of these kids, and you prevent autoimmunity.”14

The questions is, was it the chicken or the egg? Which came first, the imbalance of bacteria or the autoimmune disease? Some studies show that intestinal inflammation accommodates bacteria that keep the inflammation going.15 As we’ve already observed, bacteria learn and fight hard to survive.

It’s a living system, where different choices can be made at any stage. Our genetics help determine our bacteria, but the bacteria can change us – turning genes off and on, adapting as they go. According to Bana Jabri, director of research at the University of Chicago Celiac Disease Center, even if the chicken comes first, the egg can contribute. “You have the same endpoint,” she says, “but how you get there may be variable.” Such complexity both confounds notions of one-way causality and suggests different paths to the same disease.16″

1 Lipski, Digestive Wellness
2 A. Fasano, “Zonulin and Its Regulation of Intestinal Barrier Function: The Biological Door to Inflammation, Autoimmunity, and Cancer,” Physiological Review 91, no. 1 (January 2011): 151–75, www.ncbi.nlm.nih.gov/pubmed/21248165.
3 Ibid.
4 Ibid.
5 A. Fasano et al., “Prevalence of Celiac Disease in At-Risk and Not-At-Risk Groups in the United States,” Archives of Internal Medicine 163, no. 3 (February 20, 2003): 286–92, www.ncbi.nlm.nih.gov/pubmed/12578508.
6 Melinda Beck, “Clues to Gluten Sensitivity,” Wall Street Journal, March 15, 2011, http://online.wsj.com/news/articles/SB10001424052748704893604576200393522456636.
7 Ibid.
8 Ibid.
9 Ibid.
10 Moises Velasquez-Manoff, “Who Has the Guts for Gluten?” New York Times, February 23, 2013, www.nytimes.com/2013/02/24/opinion/sunday/what-really-causesceliac-disease.html.
11 Ibid.
12 Ibid.
13 Ibid.
14 Ibid.
15 Ibid.
16 Ibid.

Reprinted from Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression by Gary Kaplan, D.O., with permission from Rodale Books. Copyright (c) 2014 by Gary Kaplan, D.O..

To read Part 1 of this series, “Gut Feelings,” click here.
To read Part 2 of this series, “Hidden Immune System,” click here.

gut microbiome

“Gut Feelings”: An Excerpt From Total Recovery

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The following is the first in a series of excerpts on gut health from Dr. Gary Kaplan’s book “Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression.”


“We now know that our intestinal tract has 100 million nerves – more than our spinal cords or peripheral nervous systems. With this radically new understanding, scientists have tentatively begun to refer to it as the body’s second brain.

As Michael Gershon, MD, explains in his book The Second Brain, the intestinal tract is far more independent than anyone had realized. It is even equipped with its own senses and reflexes.1

Surprisingly enough, our digestive systems manufacture just as many neurotransmitters as our brains. With the advent of “designer drugs” – such as selective serotonin reuptake inhibitors (SSRIs) – we have come to think of depression, anxiety, and insomnia in relation to the amount of serotonin circulating in the brain. Only recently has it become apparent that 95 percent of the body’s serotonin is manufactured not in the brain, but in the gut.2

Now it makes sense that the side effects of SSRIs often include intestinal problems.

In America more than two million people have irritable bowel syndrome (IBS), which may be caused, in part, from too much serotonin in the intestinal tract. As Adam Hadhazy points out in Scientific American, this means IBS – like other diseases caused by an imbalance of neurotransmitters in the gut – could almost be considered “mental illnesses” of the second brain.3

IBS may also signal an inflammatory process in the spinal cord or brain itself. An emergent theory on the cause of IBS is that it is a form of central sensitization. Inflammation in the spine increases sensitivity of the nerves controlling the muscles that line the intestinal tract and ensure the smooth flow of food throughout our digestive system. When the nerve signals from the spinal cord and brain to the intestines are disrupted, it can cause the intestinal muscles to spasm, resulting in pain and cramping. The muscles respond by becoming overactive (diarrhea) or underactive (constipation).4

As researchers have turned their attention to serotonin levels in the gut instead of in the brain, it has led to even more surprises. In a study of rodents at Columbia University Medical Center, scientists found that when they gave rodents with osteoporosis a drug that inhibited the release of serotonin in the gut, the disease disappeared. Gerard Karsenty, MD, lead author of the study and chair of the Department of Genetics and Development at Columbia, admitted, “It was totally unexpected that the gut would regulate bone mass to the extent that one could use this regulation to cure – at least in rodents – osteoporosis.”5

Dr. Gershon says, “We have never systematically looked at [the intestinal tract] in relating lesions in it to diseases like we have for the [central nervous system].”6 Once we have had time to investigate the implications of the second brain, important connections to diseases will be linked to the state of our gut.

We know that problems in the intestinal tract can go much further than heartburn and indigestion or constipation. Crohn’s disease, IBS, and ulcerative colitis also arise from imbalances in the gut.7 Early studies have suggested that imbalances in intestinal bacteria can cause “arthritis, diarrhea, autoimmune illness, B12 deficiency, chronic fatigue syndrome, cystic acne, colon and breast cancer, eczema, food allergy or sensitivity, inflammatory bowel disease, irritable bowel syndrome, psoriasis, and steatorrhea.” None of these conditions were previously recognized as being related to gut bacteria.8

Gradually, physicians reading the latest research are becoming aware that migraines are frequently triggered by food sensitivities that inflame the gut.9

Diseases like chronic fatigue syndrome, asthma, and fibromyalgia have a significant relationship to the intestinal tract. When balance is restored, the symptoms are often resolved. Any improvement in the health of our intestinal tract increases the effectiveness of our immune systems.

The question currently being investigated by researchers is: Can we analyze the stool to create a map of all the different types and amounts of bacteria in the gut and use it to predict illness? We’re hoping it can be done.”

1 Michael D. Gershon, MD, The Second Brain (New York, HarperCollins, 1998).
2 Lipski, Digestive Wellness.
3 Hadhazy, “Think Twice.”
4 Ibid.
5 Ibid.
6 Ibid.
7 Lipski, Digestive Wellness.
8 Ibid.
9 Ibid.

Reprinted from Total Recovery: A Revolutionary New Approach to Breaking the Cycle of Pain and Depression by Gary Kaplan, D.O., with permission from Rodale Books. Copyright (c) 2014 by Gary Kaplan, D.O.

To read Part 2 of this series, “Hidden Immune System,” click here.

Abdominal pain associated with SIBO

Is SIBO Causing Abdominal Pain And Weight Loss?

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Q: I am 70 years old, and have been fit and active all of my life. Now, I have “functional dyspepsia” resulting in early satiety, upper GI bloating, and belching, with unwanted 30-pound weight loss over 4 years. I’m also weak, exhausted, and sensitive to gluten and dairy. I would appreciate any suggestions. I especially need help in gaining weight. Thank you!

A: Dyspepsia is a common term that is used to characterize abdominal pain in the upper abdomen and chest. If you have been told you have functional dyspepsia, this indicates that there is no identifiable cause of your abdominal pain, a difficult and frustrating situation for a patient.

What you are describing may be a condition called SIBO, which stands for small intestinal bacterial overgrowth. Normally, the small intestine contains relatively few bacteria, as most intestinal bacteria are confined to the large intestine. Bacterial overgrowth in the small intestine can cause symptoms such as abdominal pain, gas, and bloating after eating due to the overproduction of methane and hydrogen gas. It also interferes with normal digestion and absorption of food and can cause inflammation to the lining of the small intestine.

Situations that promote the overgrowth of bacteria in the small intestine can be low pancreatic enzymes, low hydrochloride acid, or other conditions.

I would recommend getting tested for SIBO. The diagnostic test is a breath test. At the Kaplan Center, when called for, the breath test is ordered for our patients and results are normally ready in 3 weeks. If you test positive, treatment includes supplements specific to SIBO, dietary modifications, probiotics, and in many cases a specific antibiotic for SIBO.

I truly hope this is helpful.

– Dr. Lisa Lilienfield

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