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Yoga for osteoporosis

Preventing & Treating Osteoporosis with Yoga, Resistance Training, Diet, & Medications

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We often consider the frailty and disability associated with osteoporosis and osteopenia (bone loss that is not as severe as osteoporosis) as a normal part of aging. Medical research shows, however, that it’s not aging but inactivity that causes bones to weaken and easily break. Although medications may be necessary to treat severe osteoporotic conditions, the best preventative strategy is to engage in bone-strengthening exercises, like yoga and resistance training, and to make sure that you are getting the bone-healthy nutrition you need.

How Common Is Osteoporosis?

It is estimated that more than 53 million Americans either suffer from osteoporosis or are at high risk of developing the condition due to low bone density. In its early stages, the disease is likely to be painless or nearly painless, but as osteoporosis progresses and bones become brittle and break, the pain and disability can be severe. Many hip fractures occur when someone with osteoporosis falls. The complications associated with these fractures can require long-term nursing care or even lead to death.

In addition to osteoporosis, there are many other age-related health problems that increase one’s risk of falling, including poor balance and posture, poor vision, inner ear imbalances, a decline in proprioception (which helps us know where our body is in space), poor circulation and medications that can cause dizziness. Each of these problems, especially in combination with a decline in bone strength, increases the likelihood of fracturing a hip or vertebrae.

Additionally, research shows that bone mass is at its peak between 25-30 years old; once we hit that peak, bone rebuilding slows down and bone density can begin to decline. The earlier that you are proactive, the better, because the denser your bones are at their peak, the better the odds of postponing or even eliminating the onset of osteoporosis.

Risk Factors for Osteoporosis

The condition is usually seen in individuals over 50, but it can strike at any age, and there are factors that put you at higher risk, such as:

  • Being female
  • Low body weight
  • Lack of physical activity
  • A family history of osteoporosis
  • Early menopause without hormone replacement
  • Prior bone fractures
  • Chronic use of steroid medications
  • Smoking
  • Drinking alcohol excessively

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Prevention and Treatment

Yoga:

One of the safest preventative measures and treatments for osteoporosis and osteopenia is yoga. It’s something that anyone, any age, can do anywhere; the benefits are many and risks few if done correctly.

A pretty amazing study performed by Dr. Loren Fishman, Medical Director of Manhattan Physical Medicine and Rehabilitation in New York City, showed that when individuals practiced yoga for merely 10 minutes per day over a two-year period, their bone density increased! How is this possible? In the 19th century, a German anatomist and surgeon, Julius Wolff, theorized that bone will adapt to the load which is placed on it, i.e., it becomes stronger to resist the load. The inverse is also true; as the load decreases, bone becomes weaker. This phenomenon is perhaps best demonstrated by what happens to astronauts in space, who without the force of gravity working on their bones, are at great risk for developing osteoporosis.

In holding yoga poses, tensile (stretching) force and isometric, compressive (weight-bearing) force stimulate the osteocytes (cells found in mature bone) to produce proteins and lay down new bone. Yoga produces both the stress of dynamic loading when moving into a pose and static loading by holding a pose. In addition, yoga stimulates the production of synovial fluid, which not only lubricates and nourishes the joints but also activates chondrocytes (the cells found in healthy cartilage) to lay down new cartilage. By engaging our muscles to both pull and push on the bone, yoga surpasses the bone-strengthening benefits of gravity. The benefits occur when you hold a pose for anywhere between 12 and 72 seconds. I suggest holding each pose long enough to take five to seven deep breaths (about 30 seconds).

Is “the pain worth the gain”? In his book, Yoga and Osteoporosis, Dr. Fishman quotes an ancient guru, who said, “At first, medicine can feel like heaven, but it eventually resembles poison; whereas yoga may feel like poison at first, but eventually it resembles heaven.”

Even if you already have osteoporosis, practicing yoga can be beneficial in strengthening muscle tissue and bone; however, certain joint movements should be modified or avoided altogether. Consequently, for these individuals, I highly recommend beginning with a customized, one-on-one session with a therapeutic yoga instructor.

Resistance Training:

Resistance training is a very effective tool in both maintaining and improving bone density for those who have osteoporosis or those who are at risk. Like yoga, resistance training works by applying stress to bones, stimulating the formation of new bone tissue.

As explained in this 2018 study, Effects of Resistance Exercise on Bone Health, “To stimulate the osteogenic effects for bone mass accretion, bone tissues must be exposed to mechanical load exceeding those experienced during daily living activities.” This means doing weight bearing exercises like lunges, squats or stair climbing and/or free weights, machines, or resistance band exercises at least once per week, but ideally twice (depending on your fitness level).

While there are plenty of tools online to start resistance training at home, the safest way to start is to work with a trainer. A trainer can introduce you to the safest exercises for your fitness level and create a personalized routine for you.

In addition to increasing bone tissue, resistance training also helps by increasing muscle mass which supports and protects our bones by improving balance and reducing the risk of falls, as well as improving posture and overall mobility.

A Healthy Diet:

To keep our bones strong, it’s also essential that we get enough of the following nutrients.

Vitamins:

  • Vitamin C: red and green peppers, citrus fruits, broccoli, strawberries, Brussels sprouts, pineapple
  • Vitamin D: fatty fishes like salmon, mackerel, tuna and sardines
  • Vitamin B6: chickpeas, tuna, chicken, banana, avocados
  • Vitamin B9/folate: beef liver, asparagus, Brussels sprouts, dark leafy greens, nuts, beans
  • Vitamin B12: clams, oysters, beef liver, eggs, poultry
  • Vitamin K: prunes, dark leafy greens

Minerals:

  • Calcium: dairy products
  • Magnesium: spinach, okra, tomatoes, sweet potatoes, prunes, beet greens
  • Zinc: nuts, seeds, whole grains
  • Manganese: whole grains, clams, oysters, mussels, nuts, legumes, coffee, tea
  • Copper: cashew nuts, crab, dark chocolate, potatoes, mushrooms, oysters, beef liver
  • Boron: coffee, potatoes, milk, apples, cider, legumes
  • Silicon: oats, beets, barley, soy, grains
  • Omega-3 fatty acids: salmon, flaxseed oil, chia seeds, walnuts, sardines, mackerel, canola oil

Nutritional Supplements:

Generally speaking, a diet rich in fruits, vegetables, mono- and poly-unsaturated fats, complex carbohydrates and lean meat (in moderation) will provide the majority of the vitamins and minerals you need. As we age, however, our individual dietary needs and our body’s ability to absorb vital nutrients may change. For this reason, if a patient’s risk factors for developing osteoporosis are high, I often recommend measuring the vitamin and mineral concentrations within his or her body so we can supplement any nutritional deficiencies.

In addition to the nutrients listed above, Strontium has recently been identified as a promising agent in promoting healthy bone maintenance. It has been labeled as a “dual-action bone agent” because of its ability to both decrease osteoclast activity (bone-destroying cells) and increase osteoblast activity (bone-forming cells). In the US, it available in the form of Strontium Citrate, and it has been found to be effective in promoting healthy bone mineralization, supporting healthy vertebrae composition and promoting healthy hip bones. Research studies have demonstrated that the supplement is well tolerated by patients and can be used as an effective alternative to osteoporosis medications.

Medications:

Bisphosphonates, such as Fosamax, Actonel, Boniva, and Reclast, are the usual “go-to” medications for treating osteoporosis because of their effectiveness in reducing osteoclast activity. Unfortunately, however, some of the medications that are used to strengthen bone can produce poor quality bone by interfering with the osteoclastic activity that cleans up dead bone. In addition, patients who take these drugs can experience unpleasant side effects, such as acid reflux, nausea, irregular bowels, musculoskeletal pain, and in rare cases, osteonecrosis of the jaw and femoral fractures. For example, Boniva as an oral or once-monthly injection can increase blood pressure, and Reclast, an annual intravenous infusion, has been associated with atrial fibrillation exacerbation (heart rhythm disorder).

There are other classes of drugs that can be used to treat osteoporosis such as selective estrogen receptor modulators like Raloxifene; and hormones, such as Miacalcin, Forteo, and Estrogens. Prolia is a monoclonal antibody medication aimed at decreasing the osteoclast (bone destroying) activity that can suppress the immune system and, in some cases, lead to serious infections, including myocarditis (infection of the heart muscle). So although there are medications available that can help reduce bone loss, in some patients their side effects may be worse than the risks of living with osteoporosis! For additional information regarding these drugs, watch: Naturally Healthy Bones: How to Prevent & Treat Osteoporosis.

How Healthy Are Your Bones?

One indication of bone health is its density, but in terms of strength, the quality of bone is even more important. Its architecture, quality of collagen, the rate of bone turnover, and the size of mineral crystal, all contribute to good bone.

Ask your physician about the painless and brief procedure called a DexaScan that uses two different strength x-ray beams to measure the thickness of a person’s hip or spine. The test results are reported as a percentage from the mean density of a healthy 25-year old (T score). Any value below -2.5% is considered osteoporosis, and any value in the range of -1% to -2.5% is considered osteopenia, which can, but doesn’t always, lead to osteoporosis. There is also a supplemental test called “Ntx” that measures collagen breakdown in the urine associated with increased bone turnover.

These test results, used in combination with other measures of your health, can give you and your doctor a good indication of your bone health and the steps you need to take to prevent or counter osteoporosis. Osteoporosis can’t be cured, but yoga and good nutrition are the best things you can do to prevent the disease or forestall its progression.

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

This article was originally published in September 2020. It was reviewed and updated on October 14, 2024.

Additional References:

—Wolff, Julius. The Law of Bone Remodeling. Berlin: Springer-Verlag, 1986. 

—Rubin CT and Lanyon LE. Regulation of bone formation by applied dynamic loads. Journal of Bone and Joint Surgery. 1984. 66-A: 397-402.

—Fishman, Loren, and Ellen Saltonstall. Yoga for Osteoporosis: The Complete Guide. New York: W. W. Norton &, 2010. 

—Genuis SJ and Schwalfenberg GK. Picking a bone with contemporary osteoporosis management: nutrient strategies to enhance skeletal integrity. Clinical Nutrition. 2007. 26; 193-207.

—Jordan N, Barry M, Murphy E. Comparative effects of antiresorptive agents on bone mineral density and bone turnover in postmenopausal women. Clinical Interventions in Aging. 2006. 1(4): 377-87.

 

best_foods_for_brain-fog

Top 6 Food Types to Clear Your Brain Fog and Boost Your Cognitive Function

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Do you often experience brain fog? It’s that feeling of mental fatigue that drains your energy, causes poor concentration, and prevents you from gathering your thoughts. I’m sure that many of you can relate to that. Actually, brain fog is a common trend in our modern society. It may occur as a symptom of an underlying illness, side-effects from medication, hidden allergies (e.g. gluten), lack of sleep, dehydration, and even over-eating (i.e. eating too many calories).

However, brain fog is not a medical diagnosis, but a set of subjective symptoms that people experience and describe as:

  • Poor concentration
  • Mental Confusion
  • Eye fatigue
  • Headache
  • Poor sleep
  • A decrease in intellectual productivity

The good news is that there are small tweaks that can be done nutritionally to help clear brain fog, boost energy, and increase productivity. The key is keeping your brain well-fed, nourished, and oxygenated.

1. Drink Up! Water is the way to go.

Water is vital to the proper functioning of human cells and our body systems; it accounts for 60% to 70% of total body weight in lean adults, and 45% to 55% in obese adults. Water plays a major role in brain function; approximately 75% of the processes that take place in the brain occur in the presence of water!

Drinking adequate amounts of water will help increase mental clarity and concentration, help prevent headaches, and help in the removal of toxins and cellular waste that accumulate in the blood and travel to the brain.

How much should you drink? A simple way to calculate your daily water requirement is by dividing your body weight in half and replacing pounds with ounces. So if you weigh 140 lbs., your water requirement is 70 oz. There are two other factors to keep in mind, and the first is physical activity; athletes and active people need more water than sedentary people. The second factor is the weather; during the hot summer months, you need to boost up your water intake even more.

2. Brain Fuel: Omega 3’s

Omega-3 foods are good for the brain

Omega 3s are the most preferred “essential” nutrient to the brain and nervous system. They are called essential because our body does not make them, so we need to get them from our diet.
Among their infinite benefits, omega 3s lower inflammation, protect cell membranes, improve cognition and memory, and improve mood stability.

What to eat: The best sources of omega 3 are fatty fish (salmon, trout, cod liver, herring, mackerel, and sardines), shellfish (shrimp, oysters, clams, and scallops), or krill oil. You may also get omega 3s from plant-based foods, such as flaxseed, chia seeds, or walnuts, however, their conversion to the absorbable form, known as EPA and DHA, is very low – between 5% – 10%.

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3. Rainbow foods: Flavonoids

flavonoids are good for the brain

Flavonoids are plant-derived compounds that have antioxidant properties. They scavenge harmful toxic cellular wastes in the body called “free radicals.” Free radicals damage brain cells and DNA through a process called oxidation, which contributes to brain fog related symptoms.

Studies indicate that flavonoids found in certain fruits and veggies are able to improve memory and brain function, thereby helping to lower symptoms related to brain fog.

Fruits like grapes, pomegranates, strawberries, and blueberries have shown to improve many aspects of memory and learning, such as: rapid and slow memory acquisition, short-term working memory, long-term reference memory, and memory retention and retrieval.

What to eat: Lots of fruits and vegetables! Go for a rainbow of color.

4. Quercetin-rich foods

Quercetin is a flavonol (a subtype of flavonoids) found in plants and known for its antioxidant properties.
Unique to quercetin is its ability to block histamine release, the main trigger for allergies which can cause symptoms of brain fog.

What to eat: Foods that are rich in quercetin are: ancho peppers, red onions, dill weed, cranberries, and buckwheat.

5. Brain Treat: Dark Chocolate

Dark Chocolate for brain health

In addition to being delicious, DARK chocolate is a superfood, which means it’s a highly potent antioxidant and brain booster. Cocoa flavonols, which are the active compounds in the cocoa powder found in chocolate, have been shown to increase blood flow to the brain, providing it with an abundant supply of nutrients and oxygen.

Studies have shown cocoa flavonols improve cognitive function and blood pressure control in older adults, improve concentration, and can help stabilize mood.

What to eat: When buying a chocolate bar, the darker the chocolate, the better (look for 70% or more cacao* content). You can also buy good quality, dark chocolate cocoa powder, but you’ll notice it can be bitter, so a great way of getting it in your diet is by adding it to your smoothies.

* Cocoa powder comes from raw cacao that has been roasted at high temperatures.

6. Happy Brain = Happy gut: Probiotic-rich foods

probiotic foods for brain health and gut health

The human body carries over 100 trillion bacteria in the gut, outweighing the human body’s cells! These bacteria work synergistically with the body’s systems and contribute to the synthesis of vitamins and neurotransmitters (brain chemicals), and also help with food digestion.

The gut also hosts harmful bacteria, but in smaller amounts. These opportunistic species thrive on sugars, which can lead to overgrowth and create an imbalance in the microbiome. The connection between the brain and gut is bi-directional, which means if one consumes a high processed meal that is loaded with simple sugars, the brain will suffer from a lack of neurotransmitters and vital nutrients. This leads to brain fog symptoms and potentially other serious conditions. So basically, food choices and a clean diet are tremendous for brain health.

What to eat: Incorporating probiotic-rich food in your diet will help balance gut flora and get rid of harmful bacteria. These foods are Sauerkraut, kimchi, Kombucha (watch out for sugar content), and kefir. Supplementing with probiotics is another great way to get good bacteria into your 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

References:

Boots, A. W., Haenen, G. M., & Bast, A. (2008). Health effects of quercetin: from antioxidant to nutraceutical. European Journal Of Pharmacology, 585(2-3), 325-337. doi:10.1016/j.ejphar.2008.03.008
Anand David, A. V., Arulmoli, R., & Parasuraman, S. (2016). Overviews of Biological Importance of Quercetin: A Bioactive Flavonoid. Pharmacognosy Reviews, 10(20), 84-89. doi:10.4103/0973-7847.194044
Linus Pauling Institute | Oregon State University | Micronutrient Information Center | Essential Fatty Acids
Nehlig, A. (2013) The neuroprotective effects of cocoa flavanol and its influence on cognitive performance. Br J Clin Pharmacol. Mar; 75(3): 716–727.

This article was first seen in Dr. Kaplan’s column for MindBodyGreen on 4/17/2017. Reviewed on 9/19/24.

Paying attention to what you eat and drink may help prevent headache or migraine attacks.

What to Eat and What to Avoid If You Get Migraine Headaches

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Migraines are far more than just a bad headache. Experts believe migraine headaches are caused by abnormal brain activity, including dilation and constriction of the blood vessels within the brain. An attack can last from several hours to several days and affects a person’s ability to function at home and at work. A migraine can generate feelings of nausea, vomiting, sensitivity to light and sound, throbbing head pain, aura, and visual distortion, causing a person to want to withdraw and seek immediate relief. If you have never experienced a migraine headache, consider yourself lucky, but for those who do, finding a way to manage the pain and lessen the frequency is a top priority.

Knowing what triggers your migraine headaches is the best defense in avoiding them, especially since triggers can be cumulative. While there are a number of potential causes of a migraine – including hormones, stress, weather, medications, and environmental factors – for many, dietary triggers are a major contributor. Keeping a detailed journal for several weeks may sound tedious, but the effort you put in will be well worth it. With some careful recording, a pattern should be detected. Doing this, along with a thorough physical exam to look for possible nutritional deficiencies (migraine sufferers tend to be deficient in magnesium, vitamin B (riboflavin), vitamin D, and CoQ10), and a detailed discussion with your physician or migraine specialist will put you well on your way to regaining the quality of life you have lost.

When considering how you can reshape your diet to improve migraine symptoms, the bottom line is to eat fresh, not processed, food. The more work that goes into preparing foods for the consumer, the more likely it is that it will have an additive that may be a trigger for you. In general, the following food guidelines will benefit most migraine sufferers.

Questions? Give Us a Call!

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What to Eat

Halibut, mackerel, and salmon

Opt for the fattier fishes at the grocery store to make sure you are getting enough omega-3 fatty acids. Diets high in omega-3s and low in omega-6s have been found to lessen the frequency and occurrence of migraine headaches,

Cashews, almonds, and pumpkin seeds

Because of their high magnesium content, cashews, almonds, and pumpkin seeds are the nuts to turn to if you suffer from migraines. Aim for 1 ounce per day.

Steel-cut oatmeal

Drops in blood sugar can be a trigger for many migraine sufferers. To maintain steady blood-sugar levels, eat foods with a low-glycemic index, like steel-cut oatmeal and oat bran.

Spinach

Popeye ate it for energy and iron, but migraine sufferers will appreciate spinach for its high folic acid (B9) content. A 2024 study folate’s relationship with the frequency of migraine found that participants who increased their intake of folic acid experienced an improvement in their migraine symptoms. A review of 11 studies regarding the role of vitamin-B supplementation to treat migraines found it to be an effective treatment for adults, with few side effects. Other dietary sources of vitamin B include mushrooms, asparagus, and eggs.

Incidentally, spinach is also high in magnesium, doubling its migraine-fighting properties. Whether it’s steamed, fresh, or sautéed, try adding a spinach dish to the menu once a week!

Water

Staying hydrated is one of the most important things you can do for your body in general, and you’ll see that it will help with migraines too. Eight glasses of water each day is recommended, but if you consistently miss that mark make sure to snack on foods with high water content, like cucumbers, apples, and pears!

What to Avoid

Alcoholic beverages

Red wine, beer, and whiskey, in particular, have been cited in numerous studies to be triggers for migraines. Alcohol is the most frequently reported trigger by those suffering from migraines, with most studies finding a prevalence rate between 29 and 36 percent.

Baked goods

Wheat flour, found in most traditional baked goods, contains the protein gluten. If you are sensitive to gluten (approximately 6 percent of the population is) or if you have the autoimmune disorder celiac disease (it is suspected that there are more people with undiagnosed celiac disease than diagnosed), even small amounts of gluten can set off an inflammatory response in your body. While celiac disease can be diagnosed through specialized testing by your physician, there are no specific tests for gluten intolerance. Eliminating all gluten from your diet for at least two weeks and monitoring your symptoms is the only reliable way to make the diagnosis of gluten-sensitivity at this time. Along with intestinal problems, neurological presentations—including migraines—are common to both diseases. If you think gluten may be the cause of your migraine, talk to your physician before you adopt a gluten-free diet for a better understanding of how it will affect your overall health.

Processed meats

In order to maximize the shelf life and flavor of processed meats and fish, such as hot dogs, sausages, bacon, deli meats, and smoked fish, manufacturers add the food preservatives sodium nitrate and sodium nitrite. When we consume foods with nitrates and nitrites the result is an increase in nitric oxide, which has been linked to an increase in the occurrence of migraine headaches. Furthermore, a very interesting study found that people whose intestinal microbiome contained a higher level of particular bacteria that facilitates the breakdown of nitrates were more likely to suffer a migraine attack after eating food that contained them.

Aged cheeses

Cheese lovers, beware! Certain aged cheeses, such as blue, Brie, cheddar, provolone, Gorgonzola, and Parmesan all contain tyramine, a naturally occurring substance found in aged and fermented foods that have long been linked to an increase in migraine headaches.

Questions? Give Us a Call!

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MSG

It’s not just in your Chinese food! Monosodium glutamate, which has a long, proven history of causing headaches and migraines, is a flavor enhancer that can be found in food items from marinades and salad dressings to chips, seasonings, even canned tuna! It has so many aliases – natural flavoring, hydrolyzed plant protein, komu extract – that unless you are an expert in food labels, it’s hard to know if you’re eating it or not. The bottom line—if you eat a lot of processed, packaged, or restaurant foods, you’re likely eating a good amount of MSG.

Artificial sweeteners

They are found in beverages, baked goods, candies, and scores of other processed foods, and for many, artificial sweeteners such as aspartame are a migraine trigger.

Citrus fruits

It may surprise you to see citrus fruits on this list, but octopamine, a chemical compound found in certain citrus fruits, can cause migraines with aura for those who are sensitive.

Bottom line

The only way to improve the frequency of migraines is to understand what is causing them. Our providers have years of experience treating patients with chronic migraines and we can help you uncover the root cause of your pain. To speak to an experienced nurse today, please give us a call at 703-532-4892.

Watch now: Dr. Lisa Lilienfield on “The Mystery of Migraines”

Praise for Dr. Kaplan’s book – Why You Are Still Sick: How Infections Can Break Your Immune System & How You Can Recover

“Gary Kaplan is not only a pioneer in his field, he’s a badass who is changing the face of medicine. This book holds everything I wish I knew twenty years ago about autoimmunity. It’s an incredible resource for anyone with chronic pain and illness. It will bring hope and health to so many people.”

– Dave Asprey, founder, Bulletproof 360

References

Finocchi C, Sivori G. Food as trigger and aggravating factor of migraine. Neurol Sci. 2012 May;33 Suppl 1:S77-80. doi: 10.1007/s10072-012-1046-5. PMID: 22644176.

Sun-Edelstein C, Mauskop A. Foods and supplements in the management of migraine headaches. Clin J Pain. 2009 Jun;25(5):446-52. doi: 10.1097/AJP.0b013e31819a6f65. PMID: 19454881.

Haghdoost F, Togha M. Migraine management: Non-pharmacological points for patients and health care professionals. Open Med (Wars). 2022 Nov 23;17(1):1869-1882. doi: 10.1515/med-2022-0598. PMID: 36475060; PMCID: PMC9691984.

Saedisomeolia A, Ashoori M. Riboflavin in Human Health: A Review of Current Evidences. Adv Food Nutr Res. 2018;83:57-81. doi: 10.1016/bs.afnr.2017.11.002. Epub 2018 Feb 2. PMID: 29477226.

Razeghi Jahromi S, Ghorbani Z, Martelletti P, Lampl C, Togha M; School of Advanced Studies of the European Headache Federation (EHF-SAS). Association of diet and headache. J Headache Pain. 2019 Nov 14;20(1):106. doi: 10.1186/s10194-019-1057-1. PMID: 31726975; PMCID: PMC6854770.

Chen YS, Lee HF, Tsai CH, Hsu YY, Fang CJ, Chen CJ, Hung YH, Hu FW. Effect of Vitamin B2 supplementation on migraine prophylaxis: a systematic review and meta-analysis. Nutr Neurosci. 2022 Sep;25(9):1801-1812. doi: 10.1080/1028415X.2021.1904542. Epub 2021 Mar 29. PMID: 33779525.

Tian S, Yu X, Wu L, Zheng H, Zhong X, Xie Y, Wu W. Vitamin B6 and folate intake are associated with lower risk of severe headache or migraine in adults: An analysis based on NHANES 1999-2004. Nutr Res. 2024 Jan;121:51-60. doi: 10.1016/j.nutres.2023.11.008. Epub 2023 Nov 15. PMID: 38042023.

Zaeem, Z., Zhou, L. & Dilli, E. Headaches: a Review of the Role of Dietary Factors. Curr Neurol Neurosci Rep 16, 101 (2016). https://doi.org/10.1007/s11910-016-0702-1

Bagdy G, Riba P, Kecskeméti V, Chase D, Juhász G. Headache-type adverse effects of NO donors: vasodilation and beyond. Br J Pharmacol. 2010 May;160(1):20-35. doi: 10.1111/j.1476-5381.2010.00643.x. Epub 2010 Mar 19. PMID: 20331608; PMCID: PMC2860203.

D’Andrea G, Gucciardi A, Leon A. Elusive amines: migraine depends on biochemical abnormalities. Neurol Sci. 2022 Nov;43(11):6299-6304. doi: 10.1007/s10072-022-06241-2. Epub 2022 Jul 16. PMID: 35840874.

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

This article was originally published in March, 2017. It was reviewed and updated in Jan 2024.

Healthy omega 3 fats

Build a Healthier Brain With Fat!

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We don’t usually associate increasing the amount of fat in our diets as a way to improve health, but when it comes to a particular type of fat, that’s exactly what the doctor ordered!

Omega-3 fatty acids are polyunsaturated fatty acids (PUFAs), a type of essential fat involved in several metabolic processes, and they are a crucial component of good health.

Research shows omega-3 fatty acids reduce inflammation and may reduce the risk of chronic diseases such as heart disease, cancer, and arthritis – conditions that often have a high inflammatory process at their root. But most impressive is the research that confirms Omega-3’s benefits on the brain.

There are 11 different types of omega-3s, but the most well-known for their beneficial properties are Alpha-linoleic acid (ALA), Docosahexaenoic acid (DHA) and Eicosapentaenoic acid (EPA).

Dietary sources of ALA, DHA, and EPA

The modern American diet is typically low in Omega-3 and high in Omega-6 fatty acids, another form of polyunsaturated fatty acid found in some vegetable oils (like corn, soybean, and cottonseed oils), nuts and seeds. Too much Omega-6 causes inflammation; therefore, avoiding processed foods that contain them is important. Interestingly, too much Omega-3 can also be bad; it’s all about keeping the ratio of Omega-3 to Omega-6 in check.

A well-balanced diet with natural sources of ALA, DHA, and EPA is fundamental to maintaining a healthy ratio that prevents inflammation and promotes long-term health.

DHA and EPA are found in fatty, cold-water fish, such as salmon, trout, cod liver, herring, mackerel, and sardines, as well as shellfish such as shrimp, oysters, clams, and scallops. Fish is the best source of Omega-3s as DHA and EPA are more bioavailable, meaning it is easier for the body to absorb it over ALA. Whenever possible, purchase wild-caught fish and check out SeafoodWatch.org to see which fish are lowest in mercury and other environmental toxins.

ALA comes from plants and is the most largely consumed form of Omega-3 in the typical American diet. It serves as an energy source for our cells and a small percent is converted into DHA and EPA. Dietary sources of ALA include flax seeds and flax oil, walnuts and walnut oil, chia seeds, pumpkin seeds, hemp seeds, and hemp oil, mustard oil, most leafy green vegetables, and tofu.

Some research is being done on algal oil, as it contains both DHA and EPA making it more bioavailable than other plant sources of Omega-3s. For vegans and vegetarians, this may be a promising alternative to fish oils. Some supplement brands have already started creating vegetarian EPA/DHA supplements from algal oil for those who prefer not to take fish oils.

Supplementation

When diets don’t meet the mark, supplementation may be recommended, but should always be done under the supervision of a doctor and dietitian for these reasons:

1) A doctor and/or a dietitian-nutritionist can monitor the ratio of Omega 3:6. Certain health conditions may benefit from additional Omega-3; in this case, proper dosage should be determined by a doctor.

2) When a diet is already rich in Omega-3, supplementation may throw a proper Omega 3:6 ratio off-balance and unintentionally cause inflammation.

3) There are some supplements of omega-3 that are actually inflammatory. Many retail brands of Omega-3 or fish oils come from sources of fish that are fed an atypical diet of corn and soy, which alters the composition of fatty acids in the fish oil. This can cause inflammation. As supplements do not require FDA approval, a dietitian or doctor can recommend a trusted brand.

Effects of Omega-3 Fatty Acids on the Brain

– Neuropsychiatric conditions: Research shows that Omega-3 fatty acids can be effective in treating depressive conditions, such as Major Depressive Disorder and bipolar disorder.

– Post-stroke & post-concussion: A study published in the Journal of American College of Nutrition found that giving DHA post-concussion helps in the repair and recovery from injury.

A 2015 study published in the Journal of Neuroimmunology found evidence that supported the clinical use of Omega-3 in treating “stroke and other acute neurological diseases” due, in part, to its anti-inflammatory and anti-apoptotic (prevention of cell death) properties.

– Neuropathic pain: Neuropathic pain, or pain due to damage of the peripheral or central nervous system, can cause debilitating pain for those affected.

A 2018 study found that patients with neuralgic pain who were treated with omega-3 fatty acids in conjunction with conventional medicine, reported more improvement in pain intensity and quality of life than those who received conventional medicine alone.

In 2010, a review of case studies found that patients with neuropathic pain who were treated with high doses of Omega-3 fish oil had “clinically significant pain reduction” and improved function.

– Migraines: Diets high in Omega-3 fatty acids have been found to lessen the frequency and occurrence of migraine headaches.

– Neurodegenerative disease: DHA is extremely important for brain development and function. Studies show that when DHA levels are low, the brain is more susceptible to degeneration.

Omega-3 fatty acids help scavenge free radicals (atoms, molecules, or ions with unpaired electrons) that attach inappropriately to tissue and damage it.

A study published in The FASEB Journal found that “omega-3 polyunsaturated fatty acids, which are found in fish oil, could improve the function of the glymphatic system, which facilitate the clearance of waste from the brain, and promote the clearance of metabolites including amyloid-β peptides, a primary culprit in Alzheimer’s disease.”

Studies also show that DHA supplementation can improve cognitive performance.

How much is enough?

Eating a Mediterranean diet with plenty of fruits, vegetables, whole grains, nuts, lean meat, and cold-water fish will help a person consume more Omega-3’s on a regular basis. Current literature advises that at least 2, 3.5 oz. portions of oily fish should be eaten weekly, but does this amount support long-term health?

Determining the correct intake of Omega-3 fatty acids depends on an individual’s age, the overall state of physical and mental health, and whether there is a history of trauma that suggests heightened inflammation. To find out the amount that is best for your unique condition, make sure to consult with your health care provider or schedule an appointment at the Kaplan Center.

 

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

This article was originally published on December 2016. It was reviewed and updated in June 2023.

Additional research:

Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids.
Targeted alteration of dietary n-3 and n-6 fatty acids for the treatment of chronic headaches: a randomized trial.
Association between serum long-chain omega-3 polyunsaturated fatty acids and cognitive performance in elderly men and women: The Kuopio Ischaemic Heart Disease Risk Factor Study
Omega-3 fatty acids and brain resistance to aging and stress: body of evidence and possible mechanisms.
Therapeutic use of omega-3 fatty acids in severe head trauma.

 

Dealing with Anxiety

8 Commonly Overlooked Causes Of Anxiety and Depression

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With the right treatment, people seeking relief from depression or anxiety can live happy, productive lives. But if you’re one of the many Americans seeking relief from depression or anxiety, you’re no doubt aware of just how elusive successful treatment can be. It is estimated that as many as 30% of depressed patients do not respond to treatment, raising an important question: could it be that we’re thinking about — and therefore treating — these conditions in the wrong way?

A growing body of research suggests that depression and anxiety might not be mental disorders in and of themselves, but rather symptoms of a physical inflammation stemming from increased microglial activity in the brain. Microglia are the immune cells of the Central Nervous System (CNS) and are responsible for producing inflammatory chemicals in response to infection or other CNS damage.

This gives the medical community and those living with these debilitating conditions new hope. In thinking about depression and anxiety as symptoms, we’re afforded new insights into potential root causes, as well as alternative methods of treatment.

Here are eight often-overlooked causes of depression and anxiety that you should consider:

1. Celiac disease or gluten intolerance.

About 1% of Americans have celiac disease, an autoimmune disorder caused by the body’s negative reaction to gluten, the protein found in wheat, barley and rye. And gluten intolerance — also called non-celiac gluten sensitivity — is estimated to impact six times as many Americans.

While we don’t yet understand the mechanism of gluten intolerance in the body, the impact can be very similar to that seen with celiac disease. While intestinal complaints are most common, research is showing that some people with these conditions may, in fact, present with anxiety and depression as the only symptoms.

You can test for celiac disease with a simple blood test. The only way to test for gluten intolerance is to go gluten-free for six weeks and watch for any improvement. (Before making any major dietary changes, make sure to consult your provider or a registered dietitian.)

2. Sleep apnea.

There are two types of sleep apnea. Obstructive sleep apnea is the more common form and occurs when the soft tissue in the back of the throat collapses, thereby blocking the airway during sleep. Central sleep apnea, although not as common, is a result of the brain forgetting to tell the body to breathe. Studies confirm the relationship between sleep apnea and depression.

If you get plenty of sleep but never feel quite rested, or you find yourself often nodding off, a first step you can take is to answer the 8 questions on the Epworth Sleepiness Scale. If your score is equal to or higher than 10, the results should be discussed with your provider.

3. Lyme disease.

Lyme and other tick-borne diseases are becoming increasingly prevalent. While the most common symptom is joint pain, these diseases can also be associated with depression and anxiety disorders (affective disorders).

This link between Lyme disease and neuropsychiatric disease was first documented in 1994 in the American Journal of Psychiatry and has been widely documented since, but the potential connection is frequently overlooked when diagnosing those with psychiatric illness. If you are suffering from chronic pain and a mental disorder, this diagnosis should be considered.

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4. Unhealthy diet.

A study published in PNAS (Proceedings of the National Academy of Sciences of the United States of America) confirmed that “…frequent fried food consumption is strongly associated with a higher risk of anxiety and depression.”

On the other hand, eating a diet high in omega-3 fatty acids (fish oils, walnuts, and flaxseed) and antioxidants (colorful fruits, berries, and greens including spinach, broccoli, and collards) can help provide the brain with the nutrients it needs to repair free radical damage and optimize function.

5. Thyroid disease.

Both an under-functioning thyroid (hypothyroidism) and an over-functioning thyroid (hyperthyroidism) can present as depression or anxiety — not to mention other symptoms like weight changes and exhaustion. If you suffer from depression or anxiety, you may wish to have your thyroid hormone levels checked to rule out any disorder.

6. Medications.

It’s also possible that regular medications may be causing or worsening your depression or anxiety. Beta-blockers used to treat high blood pressure are known to cause depression, and acne-fighting Accutane, birth control pills, and even statins all list depression as a possible side effect.

If you take medication regularly, I recommend talking with your provider about the chances that your medication is bringing you down or making you anxious.

7. Toxic mold exposure.

Exposure to certain indoor molds can result in a wide range of symptoms, including depression, ADHD, difficulty concentrating, fatigue, chronic sinus infections, and various pulmonary and neurologic issues. If you fear that you’ve been exposed to indoor molds, it’s critical that you speak with a physician who is familiar with mold toxicity disorder.

8. Coffee.

Several studies have demonstrated a link between coffee consumption and heightened anxiety. While most people can tolerate one to two cups of coffee per day without issue, if you are prone to anxiety, you may want to rethink your morning pick-me-up. Try cutting out coffee altogether for at least two months and observe whether or not your mental state changes as a result.

This article first appeared in Dr. Kaplan’s column on MindBodyGreen.com in September 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 Resources

Harding CF, Pytte CL, Page KG, Ryberg KJ, Normand E, Remigio GJ, DeStefano RA, Morris DB, Voronina J, Lopez A, Stalbow LA, Williams EP, Abreu N. Mold inhalation causes innate immune activation, neural, cognitive and emotional dysfunction. Brain Behav Immun. 2020 Jul;87:218-228. doi: 10.1016/j.bbi.2019.11.006. Epub 2019 Nov 18. PMID: 31751617; PMCID: PMC7231651.

Temple JL, Bernard C, Lipshultz SE, Czachor JD, Westphal JA, Mestre MA. The Safety of Ingested Caffeine: A Comprehensive Review. Front Psychiatry. 2017 May 26;8:80. doi: 10.3389/fpsyt.2017.00080. PMID: 28603504; PMCID: PMC5445139.

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!

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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

 

woman talking to physician about prediabetes

Pre-diabetes: Are You at Risk?

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Approximately 37 million people in the United States have diabetes. Over the last decade, statistics show that the diabetes incidence rate (new cases diagnosed) has trended downward. In 2009, approximately nine out of 1,000 adults were diagnosed; in 2019 that rate declined to just under six. Statistics also show that there are more adults living with diabetes (diabetes prevalence) than a decade ago. This may be due to better detection and management of the condition.

These statistics are encouraging, but as the eighth leading cause of death in the United States, we must continue to be vigilant in identifying the risk factors.

Pre-diabetes is a condition where blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. It affects over 96 million adults in the U.S. – that’s 38% of the U.S. adult population! Caused by a condition known as insulin resistance, an abnormal response to glucose regulation, pre-diabetes increases your risk of developing type 2 diabetes, as well as other conditions such as heart disease and stroke.

While the incidence rate of pre-diabetes has remained relatively steady since 2005, there has been a significant increase in the percentage of adults aware that they had the condition. This is good news in that in many cases pre-diabetes CAN be prevented or even reversed, and knowing you have it is key. Dietary modifications and lifestyle changes are the most effective ways to return blood glucose levels to a normal range.

What are some of the contributing factors?

Sugar:

The average American consumes 152 pounds of sugar and 146 pounds of flour per year. Could this have a correlation with diabetes? Yes! Waistlines are increasing because the sugars and refined grains that we consume increase insulin levels causing belly fat (or visceral fat) to accumulate around the organs. Insulin resistance then causes the elevation of blood sugar which increases that person’s risk of developing other serious health conditions, such as heart disease, stroke, cancer, diabetic eye disease, neuropathy, and kidney disease.

There are several ways to diagnose obesity and determine if one has visceral fat accumulation. A person’s BMI, or body mass index, is one measurement to take into consideration. BMI is a measure of body fat based on height and weight, and while it does not consider lean muscle mass, the measurement is still useful, with a recommended BMI of 25 or less. Waist circumference is another important indicator. Men should aim to keep their waistline circumference under 40 inches, and women should aim for 35 inches or less, with a waist-to-hip ratio (waist circumference divided by hip circumference) of less than 0.8. This reading in particular can be helpful in detecting those we call “skinny fat” – these people look thin but have a potbelly. All of these measurements taken together are good indicators of insulin resistance. The ultimate testing however includes glucose tolerance testing (fasting blood sugar and insulin levels) and/or hemoglobin A1C, which is a blood test that provides information about a person’s average levels of blood glucose over the past 3 months.

Something else to keep in mind is that all calories are not the same. A soda which has approximately 45 grams of sugar and 150 calories, causes a spike in insulin, whereas an apple and handful of almonds with the same amount of calories, does not. A 2007 study reported in the American Journal of Clinical Nutrition, demonstrated that certain types of carbohydrates, such as wheat and potatoes, up-regulated the genes for diabetes and inflammation in the abdominal subcutaneous fat, as compared to other carbohydrates like rye and corn, even though the caloric value was the same.

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Sleep:

Sleep deprivation also increases insulin resistance. One study showed that adolescents who slept less than 8 hours per night had an increase in central fat and insulin resistance. Another study recently reported that for every 30 minutes of weekday sleep “debt” the risk of obesity and insulin resistance increased by 18% and 41 % respectively over a year.

Exercise:

Besides lowering the consumption of sugar and flour and improving sleep, what else can we do to improve glucose control? Research is strongly supporting all types of exercise like walking, running, biking, and swimming for the regulation of blood sugar. Weight-training in particular increases lean muscle mass and metabolism long-term and increases a specific type of muscle (white muscle) that has been shown to lower blood sugar.

Digestive health:

Newer studies show that there is a link between the microorganisms living in your digestive system, central obesity, visceral fat, and insulin resistance. Taking a prebiotic (dietary fiber that feeds the good bacteria) and consuming foods like kefir, yogurt, sauerkraut, and supplements with probiotics, may help reduce insulin resistance.

Here is a summary of some of my recommendations:

  1. Reduce sugars and processed foods, and lower or eliminate wheat products. Avoid at all costs high-fructose corn syrup which has a strong link to insulin resistance. Eat more of a plant-based diet, grass-fed meats, and fish that are high in Omega 3’s, like wild-caught salmon. Be aware if you have a food sensitivity to gluten or dairy as these are highly inflammatory and can add to visceral fat.
  2. Get an activity monitor and aim for 10,000 steps per day. This is a goal, but any amount of extra steps that you can take each day towards this goal can make a difference. Consider getting a personal trainer to help you with a weight-training program, or take a yoga class at least once to twice a week or practice at home.
  3. Create a comfortable sleep routine and climate, and make good sleep a priority. If sleep is poor, then ask your doctor for a sleep study to rule out sleep apnea.
  4. Take a daily probiotic and switch them around every few months. Consider a prebiotic as well, but know that a good plant-based diet feeds your good bacteria too.
  5. Take a few moments to practice deep breathing and meditation. Start a gratitude journal and write down something every day. This lowers stress hormones like cortisol, and thus lowers insulin resistance.
  6. Get your vitamin-D checked and supplement as needed. Take 2 grams of Omega 3’s per day if you don’t consume fish regularly. Other supplements that help reduce insulin resistance include chromium and alpha-lipoic acid and magnesium.

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

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!

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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.

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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

Breast Cancer Awareness

Minimizing Breast Cancer Risk

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According to the American Cancer Society, about 276,480 new cases of invasive breast cancer will be diagnosed in women in 2020. A further 2,620 new cases of invasive breast cancer are expected to be diagnosed in men.

The causes of cancer are complex; genetics and our environment can play a large role. So while there is no sure way to prevent it, the tests, supplements, and lifestyle recommendations outlined below, along with the guidance of a trusted physician, can help minimize your risk.

Lifestyle Choices in Minimizing Cancer Risk

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

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

Risk Assessment Tests

There are currently many tests available to assess the risk of breast cancer – for the purpose of this article I have chosen 3 to mention:

    1. Estrogen-Metabolism Assessment: This valuable tool evaluates how your body metabolizes and processes estrogen. Certain types of estrogen metabolites may increase the risk and worsen the prognosis of breast cancer. Testing the levels of these metabolites in your blood or urine can help determine whether lifestyle changes, such as diet and exercise, are warranted in reducing the level of unhealthy estrogens in the body.
    2. BRCA Gene Testing for Women and Men with a Strong Family History of Cancer: Certain gene mutations can indicate that some women and men have a higher risk of developing breast and ovarian cancers. Those who have inherited the harmful BRCA gene mutation are about five times more likely to develop breast cancer in their lifetimes than if they were without it. Also, certain ethnic and geographic populations, such as Ashkenazi Jews, Norwegians, Dutch and Icelandic people have a higher prevalence of BRCA 1 and 2 mutations. Knowing whether or not you carry the mutation can help you understand your personal risk of developing breast or ovarian cancer as well as passing it on to children.
      While the BRCA gene mutation is the most common mutation associated with breast cancer, over the past few years other gene mutations have been identified. If there is a strong family history of cancers, genetic counseling would be advised.  
    3. DUTCH (Dried Urine Test for Comprehensive Hormones) test: The DUTCH test is an advanced hormone test that can help identify symptoms of hormonal imbalances. DUTCH testing can help patients manage risk, based on their unique hormonal profile.

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

Eat More Cancer-Fighting Foods

Click Here to Download the Infographic: Cancer Fighting Foods & Supplements PDF

Consider Seeking an Integrative Medical Practitioner

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

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

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:

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

Updated: September 24, 2018.