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What I Know About Healing Chronic Pain From 37 Years Of Treating Patients

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There are over 50 million adults in the United States living with some form of chronic pain. The impact of chronic pain on people’s lives is enormous; unfortunately, despite modern medical advances we’re still not that great at treating it.

We may be unsuccessful in treating chronic pain because the way we’ve thought about where it comes from is all wrong. Research demonstrates that chronic pain is frequently a symptom of inflammation in the brain. Finding a cure requires that we identify and treat all the things that are causing the brain to remain in an inflamed state.

Here are seven things you need to do to effectively to deal with your chronic pain:

  1. Get a real diagnosis.

Chronic pain, in and of itself, is not a diagnosis. It’s a symptom of injury or illness, and even more specifically, it’s a symptom of inflammation. For example, over the course of 37 years of practicing family medicine and treating patients suffering from chronic pain, the worst case of acute shoulder pain I have ever seen was in a man who was having a heart attack.

I also have seen patients complain of chronic lower back pain, when their underlying problem was actually Crohn’s disease (an autoimmune disease that causes digestive problems).

Similarly, chronic migraine headaches may be a symptom of a food allergy. When this is the case, eliminating the offending foods can be a straightforward solution.

Today, we are seeing more and more people experiencing pain symptoms as a result of a previous COVID-19 infection. Long-COVID Syndrome symptoms often mimic the pain symptoms of fibromyalgia, ME/CFS and POTS.

Getting the right diagnosis requires a comprehensive history by a physician who can connect the dots. Frequently, what you think is the beginning of your pain problem is not its actually cause.

Bottom line: you must know what to treat if you have any hope of finding a cure.

  1. Get tested for sleep disorders and get enough rest.

If you’re getting seven or more hours of sleep per night, but you still feel exhausted all the time, you may have sleep apnea. Sleep apnea is a condition that means that while you’re sleeping you periodically stop breathing. During these intervals, your brain is deprived of oxygen, which causes inflammation of the neural tissue in the brain. Sleep apnea affects approximately 5% of Americans and it has been estimated that as many as 85% of people with this condition have not been diagnosed.

The inflammation caused by sleep apnea can cause or contribute to joint pain, migraine headaches, abdominal pain, and other chronic pain conditions. Ask your doctor about getting tested for sleep apnea or other sleep disorders. Sleep well and you’ll find you have more energy and less pain.

  1. Eat an anti-inflammatory diet.

To eliminate the dietary causes of chronic pain, I usually recommend that patients limit their food intake to rice, fish, chicken, and fresh fruits and vegetables for a period of six weeks. While this food plan doesn’t eliminate every possible allergen, it does eliminate the major offenders, such as gluten, milk and milk products, refined sugar, processed foods, nuts and eggs.

When you eat, notice if certain foods cause you to experience an adverse reaction such as a stuffy nose, fatigue, headache, bloating, or gas. By eliminating the foods that create inflammation in your brain and body, you’ll find that your pain decreases and your physical energy and mental clarity increase.

  1. Meditate.

Studies show that regular meditation improves brain function and can help the brain recover from inflammatory damage. Regular meditation also has been shown to improve our ability to tolerate and recover from stress. Meditate for 20 to 30 minutes a day and see if you notice a difference.

  1. Make time for manual therapy.

Hands-on therapies such as Osteopathic Manipulative Medicine (OMM), physical therapy, massage, and chiropractic therapy can help relieve, and in some cases, completely resolve chronic musculoskeletal pain.

Whatever the pain’s origin — whether its disease, traumatic injury or overuse, or emotional stress — bodywork can help stimulate healthy blood flow into damaged muscles, tendons, and connective tissue, thereby relieving musculoskeletal pain and tension and stimulating the body’s own ability to heal itself.

In fact, manual therapy is so effective in unlocking the emotional stress and trauma stored in our bodies that I often also recommend working with a psychotherapist who can help you process these issues.

  1. Take nutritional supplements that are right for you.

There are supplements on the market that can help address generalized inflammation and joint pain. Supplements are also a great way to strengthen your immune system and help keep you healthy. However, before you start taking any new product, make sure you are buying from a trusted supplier; the U.S. Food & Drug Administration does not regulate the manufacture and marketing of supplements as they do with prescription medication.

Talk with your doctor about the medications and other supplements you are already taking before starting a new supplement because some products can cause drug interactions. 

  1. Practice gratitude.

Although this is sometimes a lot to ask of people whose lives have been devastated by chronic pain, the cultivation of gratitude for family and friends and the other gifts in our lives helps make us more trusting, altruistic, resilient, and just plain happier. It also allows us to live each day more fully.

I recommend keeping a gratitude diary and listing five things for which you are grateful each day. Other gratitude exercises include visualizing and writing about your future, best possible self; putting your gratitude into action by writing a thank-you note or visiting a person to whom you owe a debt of gratitude. Spending time each day contemplating the things for which you are grateful is likely to help reduce not only your stress level but also your experience of physical pain.

Good luck on your healing journey!

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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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.

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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. 

Minimizing Exposure to Pesticides on Produce

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Several of our favorite fruits and vegetables made an unwanted appearance on Environmental Working Group’s (EWG) Dirty Dozen™ list yet again this year. Strawberries, spinach, apples, kale, and nectarines top the list, but you’ll find many more summertime favorites and lunchbox staples on it as well. If you’ve been trying to eat a rainbow of colors to improve your nutrition these fruits and veggies should be a welcome addition but finding them on EWG’s Dirty Dozen™ may have some of you saying, “no thanks”.

EWG’s Dirty Dozen™ is a shopper’s guide that ranks pesticide contamination of some of the most popular fruits and vegetables sold in the United States. According to EWG’s website, “the guide is based on test results by the Department of Agriculture and the Food and Drug Administration of around 45,000 samples of produce.” Their analysis finds that approximately 70% of non-organic produce carry pesticide residue even after they have been prepared to eat (i.e., peeling, scrubbing, rinsing).

Much like a produce PSA, the intent behind EWG’s list is simple: to provide you, the consumer, an educational tool that empowers you to make the most informed decisions for your health. EWG recommends that consumers choose to buy the organic versions of the Dirty Dozen™ whenever possible to the conventionally grown counterparts with the goal of lowering exposure to pesticides – and we agree.

Pesticides are toxins that over time can accumulate and have a poisonous effect on our physical and mental health. As toxins penetrate the blood-brain barrier they are free to circulate throughout the body, including the brain and other organs. Health risks from an accumulation of toxins are wide-ranging but can lead to very serious health issues, including brain fog, cognitive decline, cardiovascular disease, hormone disruption, and some forms of cancer.

We understand that for a variety of reasons, especially now as food prices are rising, buying organic is not always possible, but there are ways to limit your exposure. When weighing options, a diet of plentiful fruits and vegetables outweigh the risk of pesticide exposure.

Tips to limit pesticide exposure in produce:

  1. Buy organic products that do not use harmful pesticides whenever possible. Local farmers’ markets and CSAs (Community Supported Agriculture) are also a great source of organic produce. To lower the cost of a CSA consider splitting the membership with a friend. When fresh produce is not necessary (i.e., for cooking) frozen organic produce is a great and more affordable alternative
  2. Refer to EWG’s Clean Fifteen™ for an alternative selection of fruits and vegetables with the lowest concentration of pesticides (even when they are grown conventionally).
  3. Before eating, wash your produce with this two-step method that uses natural solutions to properly remove pesticides as well as wax and harmful microbes.
  4. Grow your own! If you have the time and space, pick a few of your favorites and start a container garden or raised bed. Not only will you reap the benefits of harvesting your own organic produce, but you may find it helps with managing stress and overall mental health.

 

Looking for a new recipe? Download and browse some of our staff’s favorites in our Recipe eBook: https://kaplanclinic.com/resources/recipe-ebook/

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3 Steps to Improve Brain Fog

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Doctors across the globe are seeing a noticeable uptick of patients concerned with memory problems, forgetfulness, and brain fog since the start of the coronavirus pandemic. If you are experiencing more frequent slips in memory, if you are more easily distracted, making more frequent mistakes at work, or feel like you are walking around with your head in a cloud, you’re certainly not alone.

For many people experiencing brain fog for the first time right now, the overload of pandemic-related stress and trauma from a very difficult year is more than likely to blame. Chronic stress and chronically disturbed sleep alone can cause inflammation in the brain which, over time, can damage neurons and affect cognitive functioning and memory.

But there is good news! Our brains are resilient, and when given the opportunity, the degenerative effects of chronic inflammation can be reduced – or even reversed – with certain lifestyle changes. There is light at the end of the tunnel, so, while we emerge from this pandemic let’s consider just a few basic strategies that will help improve your symptoms today.

3 ways to improve symptoms:

1) Get regular aerobic exercise:

Simply put, aerobic exercise increases blood flow to the brain, which helps your brain create new neurons and improve neural connections. A study by the University of Maryland School of Public Health, published in July 2013, showed that people who increased their heart rate with daily moderate exercise “improved their memory performance and showed enhanced neural efficiency while engaged in memory retrieval tasks.”

Regular exercise also down-regulates microglia in the brain. Try to incorporate just 30 minutes a day of moderate physical exercise – such as walking – for a significant impact on your brain health.

2) Eat smarter:

Not surprisingly, nutrition also plays an important role in brain health and there is an impressive amount of research confirming that essential fatty acids, like Omega-3’s, are very beneficial. If DHA levels are low (DHA is a form of Omega-3) the brain is more susceptible to degeneration. Omega-3 fatty acids also help scavenge free radicals (atoms, molecules, or ions with unpaired electrons) that attach inappropriately to tissue and damage it.

Since our bodies are unable to produce these fatty acids on their own, foods rich in Omega-3’s like salmon, shrimp, sardines, eggs, walnuts, and almonds, should make a regular appearance on our plates.

Fruits and vegetables, high in a type of antioxidant called flavonoid, also play a major role in brain health. Foods rich in flavonoids offer a number of neuroprotective properties, and can decrease rates of cognitive decline and potentially slow the progression of many neurodegenerative diseases, such as Alzheimer’s Disease. Foods rich in flavonoids include tea (black, green, oolong), bananas, blueberries, and other colorful berries, onions, apples, citrus, Ginkgo biloba, parsley, red wine, and chocolate!

3) Don’t take your sleep for granted

Sleep deprivation, sleeping less than the amount of time your body needs for growth and repair, is the most common sleep disorder. Adults should have between seven and eight hours a night of restful sleep, yet CDC statistics show that as many as 35% of American adults are not sleeping enough, and this figure is likely to have increased since then.

During sleep, the body repairs 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.

Breathing techniques, meditation, and establishing a bedtime routine are 3 great ways to help you settle down and improve the length and quality of your sleep.

Supplements May Be Helpful for COVID-19

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Those of us in the integrative medicine field have long seen the benefits of supplements and herbal medicine in healthcare.

COVID-19 is a novel virus, meaning it has never been seen before in nature. There is a lot that we don’t know about this virus, but there is a lot that we are learning as well. There have been studies done with supplements for other types of coronaviruses like SARS CoV. We also have research about the effects of supplements on the immune system suggesting that they may be helpful for upper respiratory infections in general.

Below is a list of several supplements along with a short discussion on research and clinical experience and references where you can read more on each topic. Please note: None of these have been proven as treatments for COVID-19, and none of the information should be taken as medical advice.

Dietary supplements are generally considered safe, but it’s important to review your medical history and current medications with a practitioner before starting. Please call (703) 532-4892 to make an appointment with your provider, nutritionist, or acupuncturist/herbalist. If you suspect you have any kind of infection, please make a telemedicine/ cloud appointment with your doctor.

Please remember that supplements are not regulated by the FDA and sometimes do not contain ingredients that they claim. At The Kaplan Center, we do extensive research to find the best companies with 3rd party testing to make sure you get the highest quality products. You can order your supplements directly through our online store at: https://store.kaplanclinic.com/

It is important to continue following guidelines from health departments and governments including frequently washing hands for 20 seconds, staying physically distant and socially innovative. When in public places like grocery stores, be sure to wear a mask.

ANTIOXIDANTS

Vitamin C

Vitamin C is long known for helping the immune system prevent colds and flu. It is important for the function of white blood cells to fight infections and the overall immune system.  High dose Vitamin C is being used by IV in several hospitals around the world including in New York. There is a small study that showed critically ill patients with COVID-19 who were given 1-6 g of Vitamin C either intravenous (IV) or oral decreased ventilation time by 25%.  There are other trials in progress to see if high dose Vitamin C can improve outcomes. Doses range in 12-24g administered by IV. At this time there is no evidence that taking Vitamin C orally will prevent or cure COVID-19. As a supplement, it is suggested to take 3g of Vitamin C per day. Talk to your doctor about if IVs would be right for you.

Glutathione/NAC

Glutathione is a powerful antioxidant in the body. It scavenges damaging free radicals and is involved in tissue repair and builds chemicals and proteins that are used for the immune system. N-Acetyl cysteine, or NAC, promotes the production of glutathione and is also used as a supplement. Studies in animal models of other viral infections have shown that NAC reduced the severity and duration of symptoms by increasing cellular defense and repair. NAC is taken in doses of 500-600mg. Glutathione can be taken orally 500mg or by IV 400-2400 mg with a doctor’s order.

Quercetin

Quercetin is a bioflavonoid found in a variety of fruits and vegetables. Laboratory and animal studies have shown that quercetin may inhibit a wide variety of viruses, including a coronavirus SARS CoV which is related to COVID-19. Quercetin supports antioxidant capacity and protects lung tissue. As a supplement is combined with Vitamin C, bromelain or sold as a single supplement. Recommendation is between 500mg-1000mg daily.

Food Sources: Leafy green vegetables, dill, peppers, apples, grapes, fennel leaf, red onion, oregano, chili pepper, green tea, and black tea.

ANTI-VIRAL PROPERTIES

Chinese Medicine

Computer analysis done in February of this year showed which drugs and natural compounds have the potential to inhibit COVID-19. Several Chinese herbs were shown to have the potential to interact with specific targets of SARS-CoV-2. These included Andrographis paniculate and Scutellaria baicalensis, two herbs that are commonly used in formulas for upper respiratory infections. This data is preliminary and does not meet the standards of evidence-based medicine.

Chinese herbal medicine is a complex system of medicine that is based on sequential diagnoses of signs and symptoms that change throughout the illness. It is personalized and a formula should be prescribed by an NCCAOM certified herbalist.

Monolaurin

Generally considered anti-viral, coconut oil contains lauric acid and the derivative monolaurin. It prevents the adherence of viruses to tissues by fluidizing the lipids and phospholipids in the envelope surrounding the virus that leads to the disintegration of viral particles and symptom improvement. Studies have not been conducted in humans on coronaviruses. Unrefined coconut oil contains the most lauric acid. Refined coconut oils and MCT oils contain very little. Supplementation of monolaurin is 1,200 -1,800 mg 2-3 times per day.

Biofilm Disruptors

Biofilm disruptors are enzymes that have the ability to weaken the virus by inactivating or fluidizing its outer layer, then exposing its viral content to the immune system. Biofilm disruptors are extensively studied for the treatment of bacterial infections, as most bacteria protect themselves within biofilms to hide away from antibacterial therapies. They slowly multiply until they form important colonies that then attack the body’s immune defense. An example of a biofilm disruptor is Lumbrokinase found in Buluoke, made from earthworms.

Probiotics

Are friendly bacteria that reside in the intestinal tract, they actively participate in the modulation of the immune system, synthesize vitamins, and aid digestion. Studies have shown that probiotic use can decrease the number of respiratory infections, particularly in children. Food sources include fermented foods like sauerkraut, kefir, yogurt, kombucha, kimchi, natto, and tempeh.  We can’t overstate the importance of gut health and nutrition on the immune system. For that reason, look for an entire article on this subject in a future newsletter.

IMMUNE BOOSTERS

Zinc/Copper

Zinc may improve the chance of avoiding respiratory tract infections in the elderly and those who are zinc deficient and is shown to have strong anti-viral properties.  It is found in beef, crab, lobster, and smaller amounts in chicken, cheese, kidney beans, garbanzo beans, cashews, and almonds. Supplementation can be taken in a pill or lozenge, daily recommendation is between 30-60mg.

Copper is a trace mineral that is needed in small amounts. It also has immune-boosting properties. The problem with supplementation of trace minerals is that they compete for absorption, so it’s necessary to take about 8 mg of copper along with Zinc. Typically a multivitamin supplement contains a small amount of copper for this reason. Be sure to eat food sources like two squares of 80% dark chocolate!

Food Sources of Immune-Boosting Nutrients

Food sources of immune boosting Nutrients

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Vitamin D

Vitamin D is created in the body in response to sunlight. While vitamin D has not been studied for coronavirus, low Vitamin D levels have been linked to a higher risk of upper respiratory infections in general. Most people do not have optimal levels of Vitamin D, especially in the winter. Since it is not found in foods at doses needed, supplementation is recommended at 2,000-5,000 IU per day.

Melatonin

Melatonin is used as a sleep aid that also has antioxidant and anti-inflammatory properties. Melatonin also has been shown to have an inhibitory effect on NLRP3 inflammasomes, which COVID-19 stimulates to create a cytokine storm in the late stage of the disease. This compelling research suggests the potential for melatonin as adjuvant treatment for COVID-19 but more research is needed. Dosage is typically 5-20 mg at bedtime.

 

Sources/ Additional reading:

Vitamin C:
https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-020-0432-y

NAC/Glutathione:
https://www.sciencedirect.com/science/article/pii/S0033062020300372?via%3Dihub

Quercetin:
https://www.tandfonline.com/doi/abs/10.1080/019021490927088?journalCode=ielu20&fbclid=IwAR1ZQN3xo9wHbqsp_53Fq57o4AEO19y0ChJWcph9QND9Fp8F8elkgysp11g&

Chinese herbs:
https://www.sciencedirect.com/science/article/pii/S2211383520302999

Monolaurin:
Seleem, D., Freitas-Blanco, V.S., Noguti, J., Zancope, B.R., Pardi, V., & Murata, R.M. (2018). In Vivo Antifungal Activity of Monolaurin against Candida albicans Biofilms. Biological & pharmaceutical bulletin., 41(8), 1299-1302. doi:10.1248/bpb.b18-00256
https://www.liebertpub.com/doi/abs/10.1089/act.2006.12.310?journalCode=act

Melatonin:
https://www.sciencedirect.com/science/article/pii/S0024320520303313?via%3Dihub
http://www.melatonin-research.net/index.php/MR/article/view/71

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

tonic herbs

Teas to Help You Sleep

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Herbal teas are a very gentle way to reduce stress and anxiety that also promotes sleep. They have been used across the globe for centuries, and are very accessible to all of us.

If you’re experiencing sleepless nights and looking for natural ways to get some z’s, here are a few to try:

  • Rose tea: loaded with antioxidants known as polyphenols that have anti-inflammatory properties, and one study showed that it also has antimicrobial properties. Roses are also a great immune booster as they are a source of vitamin C. In addition to its great taste, it is also effective for stress and anxiety and premenstrual symptoms.
  • Passionflower tea: used for insomnia, anxiety, adjustment disorder with anxious mood, in addition to menopausal symptoms, premenstrual symptoms, muscle cramps, and asthma.
  • Chamomile tea: in addition to its benefits for the gastrointestinal system in relieving colic, flatulence, and diarrhea, chamomile is also used for anxiety, restlessness, insomnia, and ADHD.
  • Peppermint tea: used for respiratory infections, including the common cold, pharyngitis, sinusitis, and others. Peppermint is also used to relieve IBS symptoms, SIBO, spasms, and flatulence. It could be a good preventative delicious herbal tea that can replace caffeinated beverages and keep you hydrated.
  • Lemon balm: Several studies have shown that lemon balm may be effective insomnia, relieving stress and anxiety. It also has immune-boosting properties.
  • Lavender tea: Lavender oil supplement has been studied and proven effective for the treatment of depression and anxiety. For its use as an herbal tea, it has calming and soothing properties. Spraying lavender mist on your pillow is a great sleep inducer and helps with insomnia.

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

large amounts of supplements

Supplements Offer Value, But Come With Caveats

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A recent article in the Washington Post rightly expressed outrage on the massive amount of money Americans are spending on dietary supplements each year. In this country alone, $35 billion dollars of our hard-earned money is being pumped into in an industry that has little oversight and is selling products that for the most part have no known benefits whatsoever.

I completely agree with the fact that the overwhelming number of supplements taken by Americans are pretty much worthless if not outright dangerous. The majority of the supplements sold and discussed in this study are for weight loss, muscle building, and sexual enhancement. Studies have repeatedly shown that these products are frequently not what they claim to be. Many are adulterated with medications that can potentially harm the people who are taking the supplement. Many have other potentially harmful contaminants. Most of them have little if any scientific support for efficacy.

Is there a time and place for supplements?

Absolutely. Caveats abound, however. The FDA does not regulate over-the-counter nutritional supplements. One study showed that many over-the-counter melatonin supplements did not contain the dose advertised on the label with ranges from 0% of the advertised supplement to over 200 x the dose. This can be an especially serious problem in taking a supplement like vitamin D where overdoses can have serious health consequences. So, the first caveat is that you need to know if you can trust the manufacturer.

The second caveat is – why are you taking the supplement? For people on a healthy diet, a general multivitamin is not necessary. Supplements should address specific issues and be monitored appropriately. Is there any research that the supplement is helpful? At what dose for which patients? The research is ongoing, conflicting, and ever-changing so you really need to be talking with someone who is knowledgeable about supplements if you are going to be serious about improving your health.

The third caveat is – are you on the right diet for you? The definition of a healthy diet is changing and as we get better with genetic and other testing methods, we are learning that one diet fits all is not true. It turns out that foods that might be excellent for one person, such as a paleo diet, may be a disaster for another, resulting in gout and heart disease. Also, the diet that is appropriate for you today might not be appropriate when you are sick or after a major illness. This gets complicated and you need a good coach who can help tailor a proper diet for YOU.

The supplement issue is complicated. If we are going to take supplements, we are going to need to be smart consumers and treat them as seriously as we would anything else that we put in our bodies.

Gary Kaplan, D.O., DABFM, DABPM, FAAMA
Medical Director Kaplan Center for Integrative Medicine

The Kaplan Medical Center Store offers a variety of supplements from trusted suppliers. Click here to visit the store. 

Out of the Fog

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

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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.

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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.

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

References:

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

Purslane: A Super "Weed" Worth Trying

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If you haven’t heard of purslane it’s not very surprising. What is surprising is that despite it being so darn good for you most mainstream grocers fail to keep it on the shelf.

It is estimated that human cultivation of the plant goes back 4000 years. It has long been used as a medicinal herb in Chinese medicine and is still a commonly used vegetable in Asia, Europe, Africa, and the Middle East. It grows abundantly across the globe and can be found in crop fields, gardens, orchards, and vineyards.

Here, purslane is often mistaken as a nuisance weed, but in truth, it is a nutritional powerhouse on par with many of the vegetables we find at the grocery store. Its vast nutritional benefits include:

  • Omega 3 fatty acids – We know that Omega 3 fatty acids offer protection against neurodegenerative diseases, cancers, cardiovascular disease, and other chronic illnesses. When tested, purslane was found to contain as much as 400 grams of alpha-linolenic acid, or ALA, a type of omega 3 fatty acid per serving (100 grams), making it one of the richest vegetable sources of ALA that you can find. Purslane is a great source of Omega 3s for vegans and vegetarians.
  • Glutathione – Glutathione is the most abundant of the endogenous anti-oxidants in the Central Nervous System, and perhaps the most important. Our bodies need glutathione to keep our bodies in balance. What does this mean? Without enough glutathione in our bodies, we become “unbalanced” in terms of inflammation and anti-inflammation, and in terms of destruction and repair. The depletion of this important antioxidant plays a role in the onset and progression of neurodegenerative and neuropsychiatric diseases. Unfortunately, glutathione levels naturally deplete as one ages, so maintaining adequate levels is important. Purslane contains approximately 8 mg of glutathione per 100 grams, which is more than spinach, broccoli, carrots, and many other more common store-bought vegetables.
  • Vitamins & minerals – Purslane contains the highest vitamin A content among the green leafy vegetables, which fulfills 44% of the daily needs. Research has shown that eating higher amounts of foods that contain vitamin A may help with vision and protect from certain types of cancer.[i] It’s also rich in vitamin C with 21mg/100g and other B-complex vitamins. Purslane also boasts high mineral content, with potassium (494mg/100g), magnesium (68/100g), calcium (65mg/100g), phosphorus (44mg/100g) and iron (1.99mg/100g) all well represented.[ii]

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Note: Like parsley, spinach and other leafy greens, purslane contains oxalic acid, a naturally occurring acid found in vegetables. Oxalic acid binds with calcium, reducing its absorption and also forms compounds called calcium oxalate and iron oxalate. These compounds can be naturally eliminated by the body by most people; however, for some, they can produce kidney stones and possibly other health issues. Therefore people who are prone to kidney stones should limit the consumption of foods that contain oxalic acid, particularly in its raw form. Cooking or steaming vegetables with oxalic acid can reduce the amount present.

In order to prevent oxalate from binding to calcium is to eat foods known to contain oxalic acid 2 hours apart from dietary calcium sources. Doing this will allow enough time for the body to absorb it.

How to use it

Grab a stem, take a bite and enjoy the tangy crunch! Fresh purslane’s texture and flavor make it a great addition to any salad. It also holds up well when sautéed and can be used in soups and stews. Or, try substituting purslane in your favorite pesto recipe! Many recipes call for removing the leaves from the stems, but there is no harm in keeping them in.

Farmers’ markets or farm stands are your best bet in finding purslane. It can also be found at some Whole Foods Markets.

References:
[i] Vitamin A Fact Sheet for Health Professionals, National Institutes of Health, Office of Dietary Supplements
[ii]National Nutrient Database for Standard Reference Legacy Release, United States Department of Agriculture Agricultural Research Service

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